Last updated 3/21/05
I believe in the search for
truth…the following monograph is what I know to be true about the use and
withdrawal from methadone. I also understand that in life, the truth is
constantly evolving. My 18 years on the road to recovery probably taints
my judgment somewhat…but friends—I know recovery from the bottom rung.
I’ve written countless e-mail replies to those of you who wish to
discontinue methadone. In order to save myself time I’ve decided to write
as much as I can on one, or two, pages…the truth as I see it…to assist you
in your endeavor. I will be adding and subtracting as more information is
made available. Certainly, you may perceive your truth to be different. If
you think that going to the methadone clinic every morning to get your
dose for the rest of your life…gives you quality of life…then read no
further and God bless you. I assure you, the standard medical
establishment does not have an answer for withdrawal. In fact, the new way
of thinking is that many of you will have to be on methadone for the rest
of your lives. Nothing could be farther from the truth. They will try and
convince you that sudden withdrawal will cause your untimely demise.
Another falsehood, although the truth is you may feel like you’re dying. I
consistently work with people stopping cold turkey and have better luck
than lowering the dose over time., I’ve NEVER had an in-house methadone
withdrawal case leave the program early…all have gone cold turkey from
60-150 mg per day…Many do this without the aid of other mind-altering
prescriptive drugs…even though I’m licensed to prescribe these drugs.
There are exceptions, for those that I detox out-patient, and for those
that are on other medications when they come in for treatment…I’ll cover
those medications in the following paragraphs. Personally, I urge all to
consider in-house Detox for methadone…especially if going cold turkey.
Although in my personal experience I’ve never seen any advantage in
lowering the dose over time. Especially, if one is at 45 mg or less per
day. Methadone Detox can normally be accomplished in 3-5 weeks. For
information on natural methadone detox, in-patient, please visit http://www.theriversource.org
The most important issue in
treatment for withdrawal is not so much treating the disease state but
treating the individual. One specific protocol designed to treat a disease
is standard medicine’s answer to all disease states. This is mechanistic
medicine. It does not take into account our genetic variability…we respond
to treatment in different ways…not just through biochemistry, but also on
the emotional and spiritual levels. For the last 4 years I’ve been using
nutrition—Intravenous and oral—to rebuild and repair the biochemistry
pathways in the body and mind. Over four years experience —this includes
heroin, and all other street drugs, alcohol, and prescription
medications--has taught me that natural detox works 100 times better than
detox formulated and predicated by the use of other mind altering
chemicals. It is also important to recognize that there are many of you
that were prescribed methadone for chronic pain. Yet one must recognize
that the end result is the same—and therefore the remedies for withdrawal
are the same.
One more important point is that
emotional and spiritual supports are necessary in this journey back to
health. It would be rare that a person is not stretched to the absolute
limit—body, mind, and spirit--in the process of withdrawing from
methadone. Those who chose to do this alone, rarely succeed. The support
of family, friends, or even the 12-step programs are important adjuncts to
this journey.
One final point needs to made about
the use of methadone. There are those that were put on methadone for pain
management. This occurs because opiates in general—while good acute
therapy—are not good choices for chronic long-term pain. The body adjusts
to opiate therapy by down regulating opiate receptors and the patient will
eventually build a tolerance to the standard opiates like vicodin,
percocet, or oxycontin just to name a few. Methadone is the last ditch
effort to control pain…unfortunately, the use of methadone usually creates
more long-term health problems. The other unfortunate aspect of taking
someone off methadone—those that have been using it to treat chronic
pain—is what will be used to control pain in the future. There has been
some movement in treating pain with anti-depressants with poor results.
Furthermore, long term opiate use eventually create what is termed the
opiate pain syndrome…which simply is the fact that the receptors are so
down regulated that the opiate have nothing to act on…and that’s why
opiate therapy doesn’t work over the long term…For many of those with
chronic pain, choices have to be made…and the withdrawal from methadone
will be especially trying…but it can be done following the protocols
listed below…as your body heals and the receptors are synthesized in the
body your own enkephlins and endorphins (natural body opiates) will start
to be interactive in pain management…this may not be enough…yet many cases
of chronic pain will subside if serotonin levels in the brain can be
increased—the reason for doing amino acid therapy is to increase these
levels. Anti-depressants don’t increase the production of anything over
the long term…in fact it is well known that in the long term they decrease
levels of neurotransmitters such as serotonin. Amino acids therapies work
well on most cases of fibromyalgia even though many of these patients will
fall victim to the use of methadone which just creates more problems. The
good news is that if a fibromyalgia patient will start the following
protocols to get off methadone…these are the same basic protocols for
treating Fibromyalgia…
1)
Most Methadone clinics are for profit, private
enterprises, do you really think they want you off the methadone. The
cost of a dose of methadone is about $1.00…what are they charging you?
2)
Since all associated therapists and counselors that
work the methadone clinics are trained and get their information from the
standard medical establishment…do you really think they know the truth…no
one is saying that they are not caring individuals--but they don’t know
the truth anymore than the people who prescribe the medication to you.
If fact most of them think we’re idiots because we doubt and ask
questions. The fact is that we do not know the long range effects of
methadone on the human body and mind…many are now thinking that the longer
you are on the methadone the more profound, and possibly irreversible
these changes may be…In fact we don’t know the exact mechanism of action
of many psychotropic drugs—just review the Physicians Desk Reference on
Prozac…along with the countless other caustic chemicals we insist on
putting in the human body.
3)
Methadone is one of the most physically dependent
medications invented in the 20th century. The reason for
this is a) its long half-life (24-36 hours)…b) it is a synthetic morphine,
c) the diabolic symptomology associated with withdrawal and the length of
the withdrawal symptoms. Methadone, like all opioids creates profound
changes to gastrointestinal function… In layman’s terms this means that
regardless of the food you eat--absorption of the vital nutrients is
impaired. If nutrients cannot be absorbed in sufficient quantities and
associated quality…all biochemical pathways in the body are affected
negatively. Chronic fatigue, sleeplessness, aches and pains, depression,
anxiety, are all signs and symptoms of these deficiencies. Methadone also
has profound effects on brain neurotransmitter production and function. It
is also known that it creates havoc in what is called the
hypothalamic-pituitary-adrenal axis…which accounts for the chronic
fatigue. And like all opiates, methadone down-regulates opiate receptors
in the human body thus the long lasting aches and pains associated with
withdrawal. Methadone withdrawal is particularly insidious because, left
untreated; these symptoms can last literally for months. Also the longer
you are on methadone the more profound these changes in body and mind
function.
4)
Regardless of the level you decrease the dose before
quitting…you will suffer some level of withdrawal…Frankly, I’ve never been
able to discern much difference in the withdrawal intensity between 1 mg
or 80 mg…it’s always difficult. The withdrawal is unique to each
individual…I’ve had some come off 65 mg or more, and while uncomfortable,
hardly seem to break a sweat. Others coming off low doses and be in pure
agony. One must treat the individual, not the disease.
Nutritional treatment is essential
in the recovery and withdrawal phase of any type of drug or alcohol
dependency. To clarify nutritional treatment, consider the following
statement:
The body on methadone, or any other
mind altering drug or alcohol, is like the house that has been damaged in
a storm. If you were repairing the house what building materials would you
need? You would need lumber, sheet rock, shingles, and etc for the major
supplies…these are the equivalent of the bodies need for protein,
carbohydrates, and fats. How would you hold everything together?…nuts and
bolts, nails, and screws—these are the equivalent of the bodies need for
vitamins and minerals. To make the repairs we need the proper tools to
cut the lumber and fit it into place…one would need the saws, the
equivalent of the bodies production of enzymes…these are made from the
proteins we eat…one can draw analogy after analogy to explain the
necessity for nutritional treatment to facilitate one back to health…only
one thing needs to be clearly understood…you put back into the body the
things it needs to come back to health.
Any nutritional therapy should be
adhered to for at least 90 to 180 days regardless of how you feel. Just
like it takes time to alter profoundly the body’s biochemistry with
drugs…it takes time to repair with proper nutrition. Oral nutrition is
best but often is difficult for those in their first week of detox and
recovery. Proteins, complex carbs, and essential fatty acids are necessary
building blocks for repair and return of proper function of organ systems
and brain neurochemistry. Vitamins and minerals are “co-factors and
co-enzymes” which work on the building blocks to do repair and
rebuilding. Additionally, it is always counter-productive to move from the
complex to the simple…my philosophy is to start simple and move to the
level of complexity that works for you…remember all patients are unique in
the way they process nutrients and in their ability to maximize therapy.
For more information on these necessary supplements go to
www.happydestinysupplements.com
The following I suggest for those
who wish to detox out-patient:
1)
Pharmaceuticals: Clonidine 0.1, or 0.2 mg,
twice to three times per day. Clonidine is an anti-hypertensive
medication that is commonly utilized in opiate withdrawal syndromes. You
must come off this medicine slowly—rebound hypertension may
occur…especially if you already have high blood pressure…this medication
is non-addicting; Vistaril 50-100mg…three times daily…this is a
sedating antihistamine which helps with anxiety and sleep…down side is
that after 10 days or so it loses its therapeutic efficacy; phenergan
25 mg tab…one every 6 hours for nausea and cramps. I may use these
medications on my out/in-patient clients depending on the severity of
symptoms. Imodium A/D works well for diarrhea.
2)
Intra-Venous Nutritional therapy: In patient
or out-patient…typically every day for the first 5-6 days, than every
other day until the symptomology has subsided. These nutrient bags can
contain proteins, vitamins, electrolytes, and other elements necessary for
the body-mind to heal. The advantage of IV therapy is that all essential
cofactors bypass compromised gut function. Only when the healing occurs
will the symptoms of withdrawal disappear totally. Diarrhea is uncommon in
those that receive IV nutrient therapy…but for those not so fortunate,
Imodium A-D seems to work well in most. If your are a medical professional
and wish I.V. treatment protocols contact me at
thesourcenmc@msn.com
3)
Oral nutrition: Increase the right
proteins!!!! Proteins are the building blocks for
neurotransmitters and neurotransmitter receptors…as well as the building
blocks for your natural opiate receptors
·
For 3 weeks you must
remove all red meats from your diet. Red meat has chemical components that
increase inflammation and pain. Fish, chicken, eggs are good sources of
protein. If you are having a hard time taking in solid foods go to a
health food store and buy protein powders that can be made into smoothies
or drinks. You absolutely must have increased protein intake…proteins are
the building blocks for all enzymes, neurotransmitters, and enzyme
receptors in the body. No chemical works in the body without receptors.
Just like opioids have to have opioid receptors—which are down regulated
during methadone use—this is the reason people have long-lasting pain and
aggravation coming off methadone…this isn’t much of a problem with heroin
use because of it’s short half-life…proteins are essential for the repair
work in recovery…I now use a formulation made by Neuroresearch…their
Neuroreplete/D-5 protein formulas works well for those
coming off of methadone, methamphetamines and benzodiazepines or any drug
for that matter…for more information on this product go to
www.neuroresearch.com
or
www.neuroreplete.com
and try to find a doctor close to you that will help you get his
product…in fact I treat all my methadone withdrawal patients with this
formula
·
L-Methionine—a
sulfur bearing amino acid…necessary for the production of S-Adenosyl-methionine
(SAM-e)…SAM-e is a necessary cofactor in the production of the master
neurotransmitters—serotonin, dopamine, adrenalin, and nor-adrenalin…this
must be added to any amino acid therapy directed at rebuilding
neurotransmitter production and function…500 mg—two twice per day
·
Increase your intake
of raw fruits and vegetables…you get little or nothing from canned
foods…fresh fruits and veges are loaded with fiber which help bind and
remove toxins from your body…they also normalize gut function
·
Stay off candy, and
other sugar heavy foods
·
Drink lots of good
water, green teas are good for the antioxidants and anti-inflammatory
properties…no cokes or soda waters for three weeks
·
When capable you
must start exercising…swimming is best because it is low impact
exercise…yoga…tai chi…walking daily…detoxing or otherwise…exercise is a
normal component of good health.
Supplements: Some need
less and some more…remember the efficacy of all nutrition and supplement
use is ultimately guided by your genetics…and we are all different to some
degree…This is the value of seeing a good Naturopathic physician in the
state you are in…The fact is that very few Medical Doctors know anything
about nutrition…70%-75% of the standard medical schools in this country
have absolutely no nutritional classes what-so-ever…in the other 25
%--nutrition is often a 14-20 hour block of education and this is commonly
an elective…Naturopathic physicians that are educated in a medical school
environment are taught nutrition extensively with the associated
biochemistry. I use the following
with all types of drug and alcohol recovery:
-
Multivitamin
with a strong mineral component: in gel caps only…an excellent quality
multivitamin is absolutely necessary…remember that vitamins and minerals
are cofactors/coenzymes for repair, healing, and normal function of the
body…most times I have patients double up on multivitamins for the first
3-4 weeks
-
Mineral complex:
see above
-
Fish oils, or flax
seed oil.: necessary for repair and proper function of cellular
membranes…anti-inflammatory…these need to be mixed omega 3, omega 6, omega
9 oils—4000 to 6000 mg per day in split doses…although some can be
purchased as liguids and mixed with your smoothies.
If you don’t do the
drinks…get proteins as free amino acids…double up
-
L-Glutamine 500mg
caps…at least 2000-3000 mg per day…split the dose so that your doing
it at least twice per day…helps heal the gut and the building block for
GABA…the primary inhibitory neurotransmitter…helps slow things down…Do not
take GABA as a supplement…GABA is make in the brain…when out side the
brain the molecule is to large to cross the blood brain barrier…the
building block for GABA is L-Glutamine or Glutamic acid…these building
blocks readily cross the blood brain barrier.
-
Valarian Root 450
mg: Botanical that reduces anxiety and helps one to sleep…Kava,
Jamaican Dog Wood, Lemon Balm, Avena are all nervine botanicals which can
be used together or by self…I find the doses for each individual varies
but typically 1000 to 1500 mg every 4 hours.
-
Melatonin…dosages
vary…this is a hormone released from the pinal gland in the human body at
night time for sleep…this is essential for those coming off opioids…in my
experience as little as 1 mg to 30 mg has been effective…do what you have
to do…I’ve had addicts coming off $100.00 a day habits sleep 4 hours the
first night…start low and add 3-5 mg every half-hour till sleep…research
on healthy volunteers using up to 100 mg of melatonin in a single dose
shows little side effects…Melatonin is also known as a very strong
antioxidant with 1000 times the potency as Vit E…Take only at night
when you would be going to bed at the regular time…the room must be
dark…that’s the way this hormone is released in the natural state…
-
Full Spectrum
antioxidants: relieves inflammation and helps normalize inflammatory
pathways and reduces damaging molecules (free radicals) present in the
system while detoxing
-
Vitamin C:
2000-3000 mg per day divided doses…
-
Reduced
L-Glutathione 300mg per day: Helps liver detox metabolites of
methadone…Detoxing agents can be found in many products…most in
combinations…
-
Adrenal Support:
Research has shown that methadone, and drug use in general, has
profound effects on the adrenal glands. In fact, research shows that there
is a profound negative effect by methadone on the
hypothalamic-pituitary-adrenal axis. This is why those that withdraw from
methadone have protracted fatigue and problems with anxiety and insomnia.
I often use freeze dried adrenal extracts in treatment with fairly good
results. You’ll find these products listed under names such as Adrenal
Plus, or Adrenplus…the starting dose is around 1000 mg per day in split
doses.
-
Milk Thistle with
alpha-Lipoic Acid is one combination that I use extensively---for
liver repair and detoxification…1200 to 1500 mg of milk thistle and 400 mg
of lipoic acid per day in split doses
This is the basics. There is
absolutely no way to eliminate all the problems associated with withdrawal
from methadone...one must have a supportive environment and often with
daily visits from a compassionate health care provider…This will not kill
you…it will be a miserable event…what kills most is the movement back to
street drugs to ward off the side effects of withdrawal. If fact, cold
turkey deaths coming off opioids and methadone are rare and usually
associated with other health problems, or overdosing on prescription
medications…withdrawal from methadone is much less of a risk than total
withdrawal from alcohol. I wish you all luck on this endeavor…My
compassion and empathy goes out to you…Ultimately, I know that you can do
this…after all…it has to be done.
CURRICULUM VITAE
David Arneson was born
on September 22, 1949 in Sidney, Montana. He graduated from Philomath High
School in Philomath, Oregon in 1967. He entered the U. S. Army in 1968 and
was honorably discharged in 1970. After his Army service, he went to
Oregon State University for one year where he majored in Liberal Studies.
In 1971 he moved to El Paso and worked for several years in the customer
service industry. In 1976 he started his own contracting business to which
he sold majority interest in 1992 and the remaining limited interest in
1996. In 1988 he took the opportunity to return to school and entered the
University of Texas at El Paso where he received his Bachelor of Science
degree in 1992 with a double major in Biology and Psychology, graduating
with Honors. From 1994 to 1996, he continued his education at the
University of Texas at El Paso and the El Paso Community College. In 1994
he received the necessary training to be certified by the American Board
of Hypnotherapy in clinical and regression hypnotherapy. In 1996 he
entered into his medical training at the Southwest College of Naturopathic
Medicine where he received his Doctorate in Naturopathic Medicine in
August 2000. From 1988, he has worked in both the volunteer and employee
capacity in the field of addiction, as well as with the seriously mentally
ill, working extensively with both adult and adolescent populations. Since
October of 2000, to July 2002, he served in the capacity of
Clinical/Medical Director at the Naturopathic Detox Program, a non-profit
14-28 day residential naturopathic drug and alcohol detoxification
facility. Presently, he is Medical Director of The River Source
Naturopathic Detox and Treatment Program in Mesa, Arizona. He is currently
a part time Clinical Instructor of Naturopathic Medicine at the Southwest
College of Naturopathic Medicine and Health Sciences where he supervises
and trains student doctors in clinical settings. He also maintains a
private practice, focusing on treatment of alcoholism, drug dependency,
and chronic disease.