Bill, a long-time addict and alcoholic, has cleansed himself of all chemical dependencies, except methadone, which he cannot quit below a certain level. Apparently driven to try, he asks for advice and help. Two contrasting responses are provided by me and Robert Newman, a long-time methadone maintenance advocate.
Can I ever get off methadone?
Hello stanton, I seem to have a problem. I have been a severe alcoholic and drug addict (mostly heroin and pain killers but there were years of crack, smoking coke, and everything else). When I reached 40 years old I was about to dye from drinking , I was diagnosed with hepatitis C and my life was so unbearable because of severe stomach pains all day, every day.
I decided to try to quit everything , but the pains were constant and severe in my stomach for years, so I kept up a little bit of pain killers to function. After awhile they didn't work of course and I got on a access medical program to find out why my stomach was so painful, after every test I can think of and cameras up my rear they could not find any actual reason and settled on the fact I was an addict and there was my reason for anything else that could possible happen, and the tests stopped, and it did seem they tried at first to find a reason.
Well I started buying methadone on the street to kill the pain, and it worked, so I bought it on the streets for about a year and finally got on a methadone program. On the streets I was taking 100 to 140 a day or sometimes every other day depending on my pains. Eventually the pain went away, I settled down and dropped to 85 mgs and my life got excellent, I was happy again, no pains, worked all day (started my own business which is successful for all purposes, which took hard work 10+ hours a day with very few days off ever ,and my life was good for the first time since I was eleven (when my addictions started).
Well it has been 6 years on methadone now, and after about 3 good years I decided I was fine and and could start the withdrawal process. By the way I had stopped all drugs and drinking and was clean completely since almost the very start of methadone! So the first time I tried to stop methadone I dropped in groups of 5 mgs or sometimes 10 mgs a month till I was down to 28 mgs. Well all of a sudden severe depression set in I started having stomach problems and after months of that I went back up to 35, even though I wanted more. It did help and I was ok mostly again, so from there I dropped slower down to 10 mgs, well that was a struggle and at 10mgs I tried to stop completely.
Well after 4 weeks off completely, I was so sick and life seemed worthless again I raised my dose back to 28 mgs and it went ok again. I decided that next time I would drop slower like I should've and try that. I desperately wanted and still want to be drug free, but normal feeling. Well I dropped 2 mgs, a month which took forever it seems, and I am at 8 mgs. The problem is I am very sick almost always, I feel like I have severe arthritis and my stomach is going off the roof, just like 7 years ago when I started for that reason, although it isn't quite as bad as it used to be.
I am confused, I am doing this just like they said to and I can barley take it, shouldn't my withdrawing be much less painful as I am going slow? I keep thinking I am very sick and need to get to a doctor but then I start thinking it is just the dropping and that's what happens. Like so many I have had bad problems with doctors after they find out I was an alcoholic and drug addict, on methadone, then that's always the reason for everything and they don't do much to find out or seek an alternative reason for me being sick.
It seems like when I try to get off the methadone everything from years ago starts coming back, even though I been clean for 7 years. I am confused and am wondering how long does this withdrawal take approx. And should I be sick at this small drop for so long? I been dropping for almost 2 years now, and if and when I reach 0 mgs will I eventually get back to feeling better after a period of time, or am I just what I am and maybe I will never be well again, or just to wake up without being very sick, because as much as I want so bad to be finally off everything, could it be I cant function without it? I realize this was a long question but it is an important one to me, and I find myself confused and unsure of my future, when it was so good for so long. Does it happen sometimes people need to stay on this methadone forever, or am I at just the worst part of a very long battle?
Thanks,
Bill
Dear Bill:
You are interesting person. And I admire you. You have been addicted all your life, and you want to change that. I admire people like that.
Some methadone maintenance advocates say that you always need to be on methadone. But you don’t buy that and want to fight it. I can’t speak about your individual situation, because I am not your therapist. But I like to believe it is possible.
Obviously, others will look at your efforts and say, “When Randy gets below a certain level of opiates, he can’t function. He becomes depressed, his body fails him, and so on.” This seems to be what doctors are telling you.
But one thing you are set on doing is improving your life, and there are many ways to keep doing that – methadone or not -- things you don’t talk much about, like exercise, family, friends, work, helping others.
I am copying this e-mail to a couple of people who advocate methadone maintenance, and have much experience with it, to see if they have additional advice or referrals for you.
Stanton
Dear Bill,
A somewhat different perspective than Dr. Peele's. My view is that when someone has had a problem of life-and-death significance (as you had with opiates), which has made it essentially impossible to function normally (as in your case), and precluded great personal and professional success (as it did in your case), and then that person has the enormous good fortune of finding a medication that has essentially no side effects and that reverses all of the terrible consequences of the condition (as has been your experience with methadone), and then finds that as this safe and effective medication is withdrawn the pain and fears associated with the underlying problem return - then the question for me is why in the world would you want to risk everything by persistent effort to stop the medication?
Yes, there are dumb people - including without question a great many healthcare providers - who view methadone as an evil substance and those who receive it as stupid or weak of bad people. But hell, life is full of dumb people, but why seek to gain their approval by putting one's very life on the line?
No one "likes" to take medicine. Who "likes" taking insulin, or antidepression meds, or cardiac arrhythmia or hypertension meds, or even vitamins for that matter? And almost everyone on those meds knows that there are folks with the same problem(s) who manage to overcome the need for the meds (e.g., diabetics can overcome their insulin dependency by exercise, diet, stress-reduction, etc etc etc). But while it's nice to do what one can to be free of the medication, is it worth risking one's personal and professional success, happiness, health and very life? I don't think so.
Obviously, if a patient - any patient - wants to overcome the need for a medication - any medication - physicians should do all they can to assist. But at the same time, it would be unethical not to ensure the patient has thought through the potential benefits and the potential risks of such a course.
My own views reflect the fact that I draw absolutely no moral or medical judgments based on whether a former heroin user is living a healthy, self-fulfilling, personally gratifying life with or without methadone or other medication, any more than I consider a recovering alcoholic a better or healthier person if s/he does or doesn't attend AA meetings, take antabuse, rely on yoga, or whatever. If someone who was largely unable to function with heroin and whose life was at risk several times a day with each and every shot of the drug is today leading a good life, I could care less as a physician, friend, employer, father or whatever whether that person is a graduate of a residential treatment facility, was or is taking methadone, found the way to abstinence through Christ (or through Islam), or just plain stopped without any support at all.
Whatever you do, I wish you the best.
Bob Newman
Director, Chemical Dependency Institute
Beth Israel Medical Center
Bob:
Thanks for taking the time to give your inputs. Bob, you don't think I'm one of those dumb people, do you? The only thing I think you miss in your heartfelt answer is Randy's own repeated drive to get free of drugs.
Stanton
Stanton,
Never (hell, it would cheapen greatly the meaning of the Lindesmith Award which you and I both received - the dumb people are those Bill refers top in his message - the doctors and others who blame whatever difficulties a person has on the methadone. You can use my response in any way in any forum you wish - it'll be an honor.
Bob
