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Monday, 10 September 2012

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. 

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:
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?


snakeoil said...

very inspiring stuff Mr Henderson. I will use your system if anyone ever comes to me wanting help to do offence, but if you can do it, it can be done. Love from Lynda Llama

Puddleg said...

lol, as they say! - and hi.

Unknown said...

Very interesting post. My cousin has been on Methadone for a while. Now she is experiencing the methadone withdrawal that comes with it.

Puddleg said...

It's not good stuff. She should try the acetyl-l-carnitine if she can afford it, and take probiotics to settle the digestion.

Unknown said...

Onya George...

cannabreeder said...

hi george, i quit the clinic after 6 years.For me it was a seemless transition over 18 months from 160mg to 10mg. the last dosages below 10 is where my w/d kicked in. So at 4mg i discontinued use to get the w/d over.Prior to mdone discontinuation i never felt my liver inflamation, but since quiting i notice i daily inflamation. i really notice it i use cannabis. Do you think methadone is a viable option for treating imflamation discomfort and also treating the side effects of hep c treatment. Also i never got sick while on methadone. Since quiting i have gotten sick 3 times in 8 months with the cold.

Puddleg said...

In my experience methadone caused a lot of problems that added to inflammation, especially related to malabsorption of nutrients. I think it's a very poor medicine for anything but pain and cough.
Both opiates and withdrawal can speed up hcv replication, but at least withdrawal goes away.
The best treatment for liver inflammation is removal of added sugars and vegetable oils from the diet and reduction of carbohydrate. Ideally you'd eat red meat, fish, eggs, greens and root veges, cooked in animal fats (dripping) and olive oil only, and a little fresh fruit. No grains, no deep fried food. Antioxidants from tea, coffee, hibiscus tea, spices etc. but no soft drinks/energy drinks.
If you get carbs down low in a paleo-type diet it will tend to lower the virus and heal the liver.
What helped me most was eating dense food like liver, lamb chops, eggs, sardines, bone broth (e.g. ox tail), and cooked leafy greens (not just salads).

This post covers fixing fatty liver:

For immunity I suggest a probiotic (rhamnosus and reuteri) and vitamin D. Take 10,000iu a day for a while then 5,000iu, unless it is summer, where you are, then get lots of sun. This fixed my frequent colds and flus, I've had about 1 very short, mild cold a year since and no flu.

It takes a long time to adjust to being without methadone, maybe a year, or more, but it does happen.

Puddleg said...

I should have specified that the flush from niacin prevents the hot-and-cold flashes of withdrawal. It also quickly suppresses nagging thoughts about missing medication, or not feeling safe without it.
Probably necessary to have taken niacin a few times before so the effects are not too extreme or unexpected.

s_helly76 said...

I know this is an old thread.... but I’m hoping for a response- Thank you so much for bringing hope back- this is the first positive post with real info that may help. I’m currently stuck at 26mg, down from 120. 12 years on the stuff. I recently went low carb/keto, and my dose isn’t holding anymore. I don’t want to go up in dose, but the lack of sleep is affecting my work performance- any thoughts?

Puddleg said...

Firstly, add something alkalising to the urine like baking soda, 1/2 tsp 2x day, this will increase methadone half-life which is probably your problem. Try niacinamide or 5-HTP with magnesium at night, this helped me sleep. Some herbals are effective - skullcap, passionflower, chamomile blends, but be careful as all but passionflower leaf have given me residual grogginess.

Khaya said...

What does that mean to add the baking soda to the urine?

Puddleg said...

Hi Khaya, sorry I should have been clearer. If you take a urinary alkaliser - baking soda in water is a cheap one - when it reaches the urine it will make your urine alkaline.
When your urine is alkaline, any methadone in it is easier for the kidney to reabsorb, meaning that methadone stays in the body longer. If you take a urinary acidifier, such as unbuffered ascorbic acid, the opposite will happen - methadone will be excreted quickly and have a short half-life.
Just be careful if you are using other drugs affected by the urinary pH - amphetamine is one, benzos and fat-soluble drugs aren't.

Unknown said...

Hey did you try adding the baking soda? I'm having the problem my donze doesnt last more than 12 to 14 hours n had to take today off bc so weak sneezing cramps n ridiculous restless leg syndrome

Jessmac said...

Hi! I started a ketogenic lifestyle in March, solely for the weight loss benefits. At the time, I was also tapering off of methadone and was at around 10mgs daily. In June, I walked off the clinic at 3mgs (the lowest dose my clinic allows for takehomes). I’ve never felt any withdrawal. I did feel dirty for the first week or so and had an awful taste in my mouth. But no serious withdrawls. Not even sleep issues. It is now December and I am a healthy size 6, from an 18, AND substance free! I randomly googled methadone and Keto and came across your article. I wasn’t aware of the correlation between the two before I completed my methadone treatment but it really does make sense now why I didn’t struggle with withdrawal. I wonder why the medical community hasn’t done any studies on this? It seems this is a much easier and painless way for anyone to get off of methadone. Thanks for sharing!

Puddleg said...

Wow Jess, that's a very cool testimonial. I didn't really try full keto till after I stopped methadone, but it all adds up. Thanks for your comment, all the best, George

Unknown said...

I am on 37mg and have been tapering down for several months now. I tried keto for a couple weeks and could feel a difference at night like my body was going into withdrawal. I really want to try keto again but I don't want the withdrawal symptoms. Please help me with any advice.

Unknown said...

Not sure if you will get this since it's been so long but I am having the same issue. Did you find a way to eat the keto way and have your daily dose last it's full time. My dose is running out at night around 7 and making it hard to sleep or anything really. Thanks for listening

Puddleg said...

Hi Unknown,

I recommend using baking soda in water twice during the day to keep urine alkaline, or a urinary alkalizing product like Ural. This maximises the half-life of methadone as methadone is only soluble in acidic urine and will be re-absorbed by the kidney if the urine is alkaline.
The keto diet may well speed up metabolism - this is an intended use (increased REE, Resting Energy Expenditure helps with appetite control) which could translate to improved, faster detox - however when I was supplementing detox nutrients like NAC and selenium ACE this didn't cause me to withdraw but helped me feel more satisfied - even though my urine screens started coming back so low that I was accused of diverting my dose - as if!

Unknown said...

Thank you for getting back with me. I will try anything. I was wondering if you have any advice about tapering. I am on 37mg now and have been going down for a while. I know slow is better but how much should I be going down at a time and how often. I know everyone is different. I just want to continue to taper off without any withdrawals if possible. Thank you again for your help.

Puddleg said...

I would try for 2mg a week, 1mg if that proves too rough. That sort of drop should be lower than the variation between your body's response to the same dose at different times.

Unknown said...

This is an incredible post full of useful info. As someone who's been on methadone for years, and has used keto type diets for bodybuilding purposes, the info about the baking soda- Henderson, you're a regular ole Einstein. Cheers!

Puddleg said...

Thanks - you might like this theory too, which sort of fits.

I found injecting vit C helped with acute opiate withdrawal, but when I tried using it orally when I was on methadone the acidifying effect made things much worse - later worked out I should have used a buffered version!
But with low carb vit C metabolism is very much enhanced - a carnivore diet, with extra C only if needed, might be the ideal version of that protocol today.

K Logic said...

Been on methadone for over 5 years now and recently went onto a high fat high protein low carb diet as a means to fight the almost constant fatigue and crazing for sleep and sweets. I’m on day 5 now of less than 20 carbs per day and the last 3 days ( day 3 day 4 and today) I’ve experienced what is commonly known as the Keto flu (as you probably know the body learning to use fat instead of carbs -a different type of withdrawal) but I’ve also experienced some methadone withdrawal symptoms which struck me as extremely odd as it seems that the body burning fat stores would release more methadone into my system than normal but I’ve found my cravings up in response to hot flashes I always experience in the first few hours of methadone withdrawal along with the accompanying irritability. I haven’t attempted to lower my dose. Did you have any similar experience when first started your high fat diet or any thoughts to share?

K Logic said...


K Logic said...

A new little symptom this morning woke up covered in sweat 😓

Puddleg said...

Hi K, I would say that this effect is almost certainly due to the diet acififying your urine - take a small spoon of baking soda or a sachet of Ural twice a day and you should be okay.
Methadone is soluble in acidic solution, is resorbed from an alkaline solution, so anything that increases acid in the urine (as ketosis does, or ascorbic acid) can greatly shorten the half-life of methadone. A little bicarbonate reverses this.