Opioid Road to Success: Tapering Off Methadone

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Opioid Road to Success: Tapering Off Methadone

By Laura C. Meyer 06/22/17

“I’ll never forget the day I walked into your office and you told me that I can get off the medicine if I wanted,” Walter said.

Image: 
A man with his arms up, the sun behind him.

Walter would have been a successful country singer. He arrived at my office (at the methadone clinic) after losing his wife, home, job, car, and family, in addition to internal losses.

Walter was a transfer patient from a methadone clinic in another state. Upon meeting him, I quickly discovered that his previous clinic failed to help him rebuild his life, nor did they offer a taper plan so he could one day get off the medicine.

When I first started working with methadone patients, I was confused when patients told me they’d been on the medicine 10 years (for some), and weren't consulted or given support for a taper if they wanted.

Choice is important. As a mental health therapist, we are trained in "person-centered" treatment, which means ultimately clients get first choice in the details of how they want to live. As addiction professionals, we sometimes take the general idea that people with addiction issues can't choose or think for themselves.

I love the idea of offering a taper because the client gets to start making conscious choices for themselves. Even if the answer is no, they have chosen for themselves. We have been offering choices and alternatives for years in the mental health field when it comes to medication, and I'd like to see more choices and support in medication-assisted treatment.

I had many clients who wanted to taper, but at the time, I had little to offer them in way of a structured, research supported plan. I offered a lot of hope, and that was the best I could do until I met Walter. Walter was the first client who stuck with my "trial and error" approach, and this became the foundation from which I began my mission to research and educate clients who wanted a successful taper.

Walter's start with opioids was for a physical injury in 1995. Like many people introduced to opioids for injuries, unaddressed emotional pain would eventually take control and demand more painkillers.

Five years later, he realized he had a problem. His opioid use continued, leading to the decline of his life, various “ins and outs” at his local methadone clinic, and even living in his car. Until he lost the car.  

With that said, in just under two years Walter created a new life for himself, and on December 8th, 2011, he finished his taper from methadone. He continues a meaningful life as a man and a father, and, this is especially important for him, he is free from any addiction or dependence issues.

I continue to meet with Walter periodically. He keeps me up to date with the events of his life such as: buying his first car, the healed relationship with his daughter (which was incredibly challenging but he never gave up), attending his son’s wedding, moving from renting to buying a home, and most recently his upcoming grandchild. When I last met with Walter, I asked him for his best advice to support patients who want to taper from methadone.

You need someone to tell you that you can. “I’ll never forget the day I walked into your office and you told me that I can get off the medicine if I wanted,” Walter said. “I didn’t and wouldn’t have gotten that at the other clinic.”

Do the life part. “Looking back, getting off the methadone was the easy part- getting my life back together was harder,” Walter told me.

Walter was at the clinic with me for almost two years. The first year was focused on getting the basics: a job, car, a place to live, resolving marriage issues, and his health. My job was primarily to help him not give up. We also worked on what I think are the most important basics: reclaiming integrity and looking at emotional pain; emotional pain such as all the loss, and the pain of his children not talking to him--which for Walter was the greatest pain of all.

Coming up to the second year is when we started the taper. At 90mg of methadone, we began to taper 4mg every 2 weeks. We increased lifestyle changes to include working on physical health by joining a gym and making better food choices. We looked closer into family relationships because some members were hurting him more than supporting his healthy choices. He came to terms with his marriage ending, but never gave up on his children. The spiritual support of his own choosing became prayer, and he was willing to continue addressing any emotional pain.

Prepare for the final jump. The “step off” as Walter calls it.

We had some challenges in the final days of his taper. Eight years ago--still learning by trial and error due to the sheer fact that it was hard to find any research or support for a methadone taper--our biggest challenge was that after six days, Walter still had not slept.

I used to inform my clients to have a regular physician to support any final withdrawals. I teach my clients to be in the mindset of a “normal” person regarding any final symptoms. I say, “If a normal person can’t sleep, gets cramps, nausea, etc., they go to their regular physician for help, not a methadone clinic.” If you feel you need to go to a methadone clinic to resolve your withdrawal symptoms, you may not be ready to taper.

When Walter called me after not sleeping, I knew he was at high risk for relapse. Even though he had a physician, the sleeping medication was not working. I sent Walter to an acupuncturist for sleep, and he slept for six hours that night. Sleep then became a matter of time. After that, I informed all my clients to be prepared for acupuncture if needed.

“After one month, the challenge with sleep and low energy was over. After three months, I felt fully normal,” Walter said.

Final thoughts from Walter. At age 58, Walter will tell you that he feels better, and has more energy than he can remember. His current maintenance plan is regular exercise, healthy food, prayer, time with his children, and fishing. He even has an upcoming trip planned in 2019 to climb Mount Kilimanjaro with his daughter. His desire at this point: “To work with and help people do what I did.”

Final thoughts from me. I no longer work with methadone patients, and currently work in a private practice supporting patients in their buprenorphine/naloxone taper. I educate my clients on how the body and brain can heal, and how to get natural chemicals flowing. I have found that the education process is a huge step in relieving fears of a taper.

Helping people taper has become one of my favorite things to do. The doctor and I work together with patients, and we have had incredible success in our four years in private practice together. My hope is to increase and share people’s stories of success to help anyone who finds themselves on the opioid road... and wants to get off.

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