How To Come Off Methadone Without Really Trying

Over a year ago - I think it was in August - I finally came off methadone, which drug I'd been taking since  the late 1980s, including every day, barring accidents, since 1990. I started reducing gradually from 120mg  in 2004, after I started taking antioxidants (see the recent post on Viral Manipulation of Host Behaviour).  There are two rules about this kind of slow reduction:

 The first: whatever happens, NEVER ask for the dose to be put back up. There's always something else you could be doing instead.

 The second rule is related to the first: use the discomfort from reductions to experiment, to sort out the changes in diet and lifestyle and the supplements that will actually help you once drug-free. At this stage there will always be another dose tomorrow, so mistakes are less important.

 By the end I had a pretty perfect protocol worked out. Diet really helped. Gluten, dairy, carbs, even too much fruit or vege made things much harder. This is the letter I wrote to my case manager when I quit. I was on about 7.5 mg/day and could have drawn it out longer. Some people say the last drop is the hardest, but this wasn't the case with me. Every drop got easier and easier. The less methadone I took, the better I felt. I still have my last doses of methadone in the house. In the past year I've never considered I've had any use for it, nor have I felt any kind of desire for it. Feelin' fine...

15 August 2011

Hi Mark,
I won't require another pickup, I'm due for one tomorrow, but don't need it, having had no dose since Friday. Saturday I was weak and slept very badly, Sunday I was weaker but slept well, today I feel virtually normal if a bit convalescent. Unless my body has found and released a stored well of methadone, I think I'm over the worst.

 As I have got lower adjustement has tended to get faster.

 My tips for withdrawal; 

1) low carb diet. Cravings for unhealthy (sweet or high-carb) food and cravings for drugs are related, so a diet that reduces cravings of all sorts is best. Plus, I think it easier and more reliable to burn fat than carbohydrate during withdrawal. And extra protein is required - make room for it.

2) hormonal regulation - supplement vitamin D, use DLPA pre-treatment to elevate endorphins during withdrawal, tribulus increases hardihood and resistance to pain and stress.

3) l-carnitine or acetylcarnitine is clinically proven to significantly reduce methadone withdrawal; 500mg 3-4x daily improves energy and mental focus by promoting burning of fats and GABA sensitivity.
http://www.ncbi.nlm.nih.gov/pubmed/18978503 

4) niacin (as niacin 100-200mg PRN or no-flush niacin 500mg 3-4xdaily) supresses craving and physical discomfort, especially combined with vitamin C.

5) magnesium chelate in high doses, plus salt, prevents cramps

6) high-dose probiotic prevents diarrhoea

7) multivitamin/mineral because metabolism is sped up, diuresis etc. will deplete some other nutrients. Not so much on a nutrient-dense low-carb diet though.

I was following this regime through the lower stages, below 10mg.
And there you have it. Feelin' fine, and no struggle over willpower (whatever that is) was ever required, methadone (and other drugs) held no appeal, but an inspiring dream on Friday night definitely helped.

In my dream I was looking at pictures of cities;
 one was: Dunedin: the Edinburgh of the Antarctic. the other: Edinburgh: the Edinburgh of the World. 

Then I was on a skyscraper over Edinburgh (the city where I was born) looking down on huge cathedrals and mausoleums, around to skyscrapers, then up and around to structures built by Gods or Giants, in a kind of Art Deco style, topped by square white pillars with a rounded edge at the front topped by statues of winged Egyptian animal-headed Gods which I could see all around the skyline, all visible in a bright, pastel light like the light of sunrise, or a Maxfield Parrish sky. Then I realised how high up I was, how dangerous it was to get back inside, and woke up. The awe-struck emotion from the dream and the imagery remained with me vividly all day. An experience of grandeur as an intense emotion. What it meant I can't say but it sure was a good thing.

Footnote: at a time of stress you need lots of energy, but you also don't want too much food that needs digesting sitting your stomach. A diet that helps you burn any stored fat (i.e. a diet that doesn't raise insulin) and that also supplies concentrated energy - i.e. is "energy dense" in the language of the Food Police - is one that adds less stress to an already stressful situation.

See this very different yet weirdly analogous story about running an ultra marathon on a low-carb diet:

http://www.meandmydiabetes.com/2012/08/11/western-states-100-low-carber-wins-ultramarathon-steve-phinney-and-jeff-volek-study/

You  can learn a lot about low-carb vs. high carb from a careful perusal of this story, even if you're not interested in athletics. For example, it becomes obvious why people who are dieting tend to eat fewer calories on high-fat diets. It has nothing to do with flavour.

He’s got very little body fat, but if let’s say he’s 7% by weight body fat that means he still has at least 30,000 calories of fat in his body when he starts the race.

A 30,000 calorie tank of fuel?  On his body?
STEVE PHINNEY:  When the starting gun goes off, 30,000 calories of body fat.  Now, if you run this race typically your body will burn 10,000 calories over the 100-mile course, so he’s got enough to run the race three times over before runs out of fat fuel.  But that’s because he’s a fat-burner.  For the carb loaded runners, who are less adapted to burning fat, at the same starting line, even if they’d done their carb loading to the maximum, the most carb calories they’d have in their bodies is 2,000.  Now, if you’re running on a carb fuel strategy, and you’ll need 10,000 calories to complete the 100-mile race, that 2,000 calories of carb stored in your body at the start of the race is only 1/5 of the fuel that you need to complete the race.

High-carbers have to fuel up more often?

STEVE PHINNEY:  That’s correct.  In contrast, if you’re running on a fat fuel strategy, you’ve got three times as much fuel in the tank as you need to complete the race and that’s the beauty, literally the metabolic beauty of the low-carb adapted athlete in an ultra-performance event.

That leads to another important distinction between the high carb diet high-fat diet and that is for many runners when they use the high carbohydrate fuel strategy many runners found that by mile 50 and certainly by mile 75 that they started having major gastrointestinal upset.  The upset would get to the point that not only could they not hold food  down, but they had a hard time holding liquids down.

Some high-carb runners had trouble with digestion?  But not on low-carb/high fat?

STEVE PHINNEY: Yes, and that’s disastrous in a race where the sweat losses and the evaporative losses are so great that if you can’t keep fluids coming in, you’re out of the race.  Many of the high-carbohydrate runners experienced frequent and severe gastrointestinal problems.  In fact, what has induced many of them to do this bold thing and switch to get being low-carb is that they’ve heard from other people who do this race that when they went from high carb to a low-carb, high-fat diet those gastrointestinal problems went away.

Now, if you were just detoxing off opiates, instead of running an ultra-marathon, that would still be a highly desirable advantage, wouldn't it?