Should I Come Off Methadone?

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Feeling sick is an unpleasant symptom of methadone withdrawal. Westend61/Getty

A typical question I receive about methadone: "I have been on methadone for a couple of years now, and I'm thinking of coming off. I've only slipped a couple of times, and my doctor has given me heck when my urine screen came back positive. I've had enough of the way they treat me at the methadone clinic and I never wanted to be addicted for life. Now I want to just quit, but I'm worried that withdrawing from methadone might be as bad as coming off heroin cold turkey. Should I come off methadone?"


You are not alone in your feelings about methadone.

In fact, the majority of people on methadone maintenance treatment (MMT) don't plan to take the drug for the rest of their lives. But MMT service providers often have the opposite goal -- they want to keep you on methadone, because research consistently shows that it is less likely that you will relapse to heroin addiction, and that you will spread diseases such as HIV and Hepatitis C, if your progress is maintained on methadone long term.

Methadone maintenance programs vary a great deal, as do methadone prescribing doctors. Some are extremely supportive and follow best practices for wrap-around services in addition to prescribing the drug, such as drug counseling, psychotherapy, help with housing so you aren't living in a situation that might increase your risk of relapse, help with financial issues and welfare if you need it, and healthcare services. Others do little more than check your urine does not contain illicit drugs and repeat your prescription.

So if your main reason for wanting to come off methadone is because of the attitude of your doctor or the staff at your methadone clinic, you should look into finding another methadone service provider. It may even be worth moving to a different area to be able to access a really good service that meets your needs.

As far as coming off methadone cold turkey is concerned, this is very risky. While it is not as dangerous as coming off alcohol or benzodiazepines, it is typically very unpleasant and depending on your dose, you may feel very ill. The withdrawal from methadone is similar to heroin withdrawal.

Tapering Off Methadone

On the other hand, it is possible to withdraw from methadone more gradually. There are several ways of doing this, including tapering off methadone and using another drug, such as suboxone, to assist the process over the course of several weeks. If a taper is done properly, it will be slow and gradual enough for your body to adjust to lower and lower amounts of methadone without you having to experience withdrawal symptoms. Your doctor's goal will be to go slowly enough that you won't be uncomfortable and experience cravings and have a relapse, whereas your own goal may be to get the drug out of your system as quickly as possible. Research shows that slow and steady is much more likely to work than tapering too quickly, so it is important to be patient.

The research on the success of people tapering off MMT is very mixed, generally ranging from about 10% to nearly 90% success rates, with the most common success rates being from 25-50% of people successfully tapering off methadone remaining abstinent from opiates. Obviously, this wide variation of success proves that coming off methadone is not a straightforward physical process, and involves many other factors. Of course, it only makes sense that your doctor will be preparing for a relapse, simply because this is a very common occurrence.

If you are sure you are ready to come off methadone, tell your doctor, and consider a slow taper. Also, plan for how to handle a relapse -- which can be much more life-threatening if you reduce your dose -- and plan for how to re-initiate methadone if it turns out you aren't ready to manage without it right now.

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