115ml to 30ml detox,then transfer to subutex???

[Fluoro]

Im currently on a daily dose of 115ml methadone 1mg/1ml. I have been stable and fairly happy on this dose for 2 1/2 years. Prior to this, I was on 60ml, but was less stable. I have recently moved area and as a result, moved drug service. Pretty much from the introduction to my new key worker, she has constantly raised the issue of Methadone reduction. I am keen to do an inpatient detox, but feel it has to be on my terms, which is that if it doesnt work out, I can be put back on my current dose, obviousely in safe, NHS dose increments.

I agreed to do it, on condition of the above and have recently attended a pre-admission interview. We agreed that I will go in some time after christmas. The plan is that I will be admitted dependent on 115ml, then I will reduce 5ml every day, until I am down to 30ml (the supposed required amount for a guaranteed "easy" transfer to Subutex), then I will go without any Methadone until I am starting to withdraw, at which point I will recieve my first dose of Subutex.

This all sounds straight forward enough in a text book, but having had a bad time with withdrawals in the past, I am very worried it wont go as planned.

I am 27 and dont want to spend the rest of my life chained to the chemist, but at the same time I don't want any unnecessery pain

I appreciate any advice anyone can give. Thanks

     

[Jim]

The transfer to Subutex is as per recommended guidelines.  Many people find it easier than going the whole way down on meth.  I'm sure it won't be easy but they are going by the book.  Make sure you're really up for this though.

[bp]

then I will go without any Methadone until I am starting to withdraw, at which point I will recieve my first dose of Subutex.
     

You will be withdrawing a long time before you get down to 30 mls, at a reduction of 5 mls pd you will get down to 30 mls in about a fornnight but I predict you will start feeling the withdrawals long before that; withdrawing 5 mls pd is pretty speedy. I wish you all the best but I feel you're being set up to fail, it seems to me this is what your keyworker wants for you; what do you want? I would advise you to reduce your methadone by about 5 mls per fortnight until you're down to approx 60mls-70mls and then start your inpatient de-tox., as Jim says "make sure you're ready for this".

Best Wishes

Beryl

[Fluoro]

Thanks Beryl & Jim, I appreciate your advice. I thought 5ml per day sounded a lot...

I think what I'll do is start reducing myself now, I'll reduce starting tomorrow straight to 80ml from 115ml, staying on 80ml for a month, then reduce 5ml every 2 weeks until I am down to 60-65ml, then go in for my detox. This has to be better than what has been offered to me?

Once again, thanks...

[Jim]

Sounds a good plan.  Beryl, 5mg a day is a very rapid detox for a community detox, but pretty standard for inpatient which is why I felt they are going by the book.  As an inpatient you have much redier access to care and symptomatic medication.  Also they can't afford to go much slower.