Methadone Detox: “Center Stage”

Lots of people know a little bit about Methadone.  This medication has been a strange feature of American culture for decades, often taking center stage in the controversial world of addiction treatment.

In a Rolling Stone interview, songwriter James Taylor famously described his usage of Methadone:

When I got to Chicago I got in touch with a doctor who was a friend of mine. He got me off smack and onto methadone. I’ve been on methadone maintenance for the past year. After I got out of Austin Riggs, I was clean for almost a year and a half. But by the summer of ’71 I was getting high again.

Taylor further spotlighted Methadone therapy by mentioning it in two of his original songs:  ”Little More Time with You” and “A Junkie’s Lament.”

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Here are two of the most mysterious and misunderstood features of Methadone maintenance therapy:

1. Why do people start using Methadone?  Isn’t it just replacing one drug with another drug?
2. How do people get off of Methadone if they don’t want to use it any more?

For starters, let’s answer a basic question:  ”What is Methadone?”  Methadone (pronounced “meth-a-doan” or “meth-a-don”) is a very powerful opiate and has been used for many decades in the treatment of chronic pain and opiate addiction.  In some ways, Methadone is the ideal substance to treat opiate addiction.  It is very long acting with the ability to dose it just once a day.  Blood levels can be measured and, therefore, compliance can be tracked.  Lastly, it is cheap.  (The cost of treatment varies, but an average of $500 per month is not unusual. )

Unfortunately, Methadone also has its drawbacks:

1. It is very addictive and can be readily abused.
2. It can also be very deadly with little difference between a therapeutic dose and a fatal overdose.
3. Because of points 2 and 3, Methadone treatment must occur in licensed Methadone clinics that require daily visits to receive a dose.

Getting started on Methadone is relatively easy.  Coming off is another matter.  As we said, Methadone is very powerful and very addictive.  It is great for controlling cravings, but stopping Methadone can cause severe withdrawal symptoms.  Without treatment, the withdrawal symptoms associated with Methadone Detox can last anywhere from a few days to a few weeks.  Tapering Methadone usually requires 3-6 months at best.

So, can someone be taken off Methadone any faster?  Based on a typical Methadone maintenance dose of 120mg daily, discontinuation by gradual tapering would take at least 90 days.  It is possible to switch over to another substance, Suboxone, but current guidelines suggest that a person should be tapered to 40mg before transitioning to Suboxone.

In our experience, we have had great success in transitioning from Methadone to Suboxone in a residential treatment setting regardless of current dose.  It does require monitoring in a residential center because timing of the first Suboxone dose is very important.  If it is given too early then a severe withdrawal episode will occur – an episode that is not easily treated.  Unfortunately, it is impossible to predict when a particular person will be ready for Suboxone.  Determining the right time can only be done through very precise withdrawal symptom assessments.

To conclude, Methadone is a very powerful opiate that has improved the lives of many addicts through its use in a maintenance program.  Coming off Methadone can be difficult — but with a tapering plan — it can be done.  Also, new techniques have dramatically decreased the time necessary to do it.  So, what exactly is Suboxone?  We’ll leave that to the next post.