AboutJacqui Expertise I am committed to Harm reduction (is it a dirty word in America??), a philosophy which acknowledges that people are going to continue to use drugs despite all of the effort put into stopping it (case in point - US government drug war ... trillions of dollars, people still using ... hello??) Anyway, I advocate to support people who use drugs by reducing the harms associated with their use through needle and syringe programs, advocating for drug law reform (alcohol legal, marijuana not ... go figure?). I currently manage a service that provides primary health care, health education and needle and syringe program to people who inject. I have also worked as an "on the ground" worker for many years and am currently studying a Masters in Clinical Psychology. Happy to answer questions about blood borne viruses such as HIV and hepatitis C, questions about dependency on opiates and other substances. Questions about treatment (particulary methadone and buprenorphine). Questions about harm reduction and why we bother with it. I can try to answer questions about drug tests. As an alternative to my fellow experts, I won't be judging anyone. If anyone has taken a sip of a coffee, or drunk a beer, then ... well we are all drug users, and I don't think we are going to see an end to it! Deal with the real, I say.
Experience Manage a primary health service for people who inject drugs, and have worked at that centre for 7 years
Organizations Registered as a provisional psychologist with the Victorian Psychologists registration board (this is for psychologists working under supervision or currently studying a masters). Much of my experience is related to my work rather than to my studies
Education/Credentials Bachelor of Arts (Humanities), Bachelor of Psychology with Honours,
currently studying a masters of clinical psychology, completed one half of a graduate certificate in Addiction studies (transferred to psychology as it had better career prospects) - lots and lots of short training courses.
Awards and Honors Presented at international conferences (Harm Reduction Conference in Thailand and Melbourne)
Question Hello Jacqui,I have some Q's regarding my imminent Methadone Detox and would appreciate any advice you can give me around this delicate area. I have been on Methadone for around 5 years (this time around) I am clean 2 yrs of Heroin. I am on 65ml Methadone. I want to ask you about an inpatient 2 week Detox (thats the length of time my Drug service offers).I am really worried about how I will FEEL once the withdrawals are over. How will it change me as a person? Is it beneficial to go into Detox? There are beds available this week and my animals will be put into kennel and cattery which my Drug team will kindly pay for but I am SCARED. Also I am a very independent person and worry how I will cope being locked up for 2 weeks. Are there any plus reasons you can tell me with going in because I now realize that at the moment I am looking at all the negatives? I feel trapped by being on Methadone and would love the freedom of being off it once and for all but I am worried as I don't want to 'lose' myself meaning my personality. Half of me right now wants to change my mind with my therapist who I saw last week and turned down Detox but I am having a change of heart and thinking it will be a better idea to go in in the long run. I have a meeting with my doctor next week to discuss this and I know he will tell me the ins and outs but I wanted some knowledge before hand so if you can offer anything at all it will be most appreciated. Thanks, Sarah
Answer Hi Sarah,
Its great to hear from you and sounds like things are going pretty well.
I am a bit concerned that the amount of time you have been on methadone ("this time" which is like most people who have a bit of time on then a break then on again), and the amount that you are on, in that you might not be fully over the withdrawals in two weeks. Is there any reason why you can't go down in very small increments? Ideally, methadone works the best best it is reduced very slowly, and from my experience, when people are down below ten, this might be as little as one milligram a week!
Sixty five isn't a massive dose (I have worked with people on much higher) but it isn't low either. There is another option that you could consider if you would like to speed it up, and that is to go into the detox (which has all of the supports, you don't have to worry about your usual day to day responsibilities, people cook for you, etc) and just reduce a large amount. For example, go from 65 to 35, then sit on that for a while, or reduce two or three milligrams a week, then either keep reducing until you get to nothing, or go in again and drop down to ten, then reduce a bit more, then go in when you hit zero.
One thing I would like to ask you is "how likely is it that you would use heroin again if you were suffering withdrawals? If the answer is definately no, you may be fine with the detox. If the answer is "I don't know" it is something you will want to consider very carefully. After a fortnight of no methadone you should have the worst of it out of the way, but lack of sleep is sometimes a problem that can last for ages (and it is much better to avoid benzos unless absolutely necessary as they have their own issues), and sometimes people find that they have muscle pain that they didn't know about. Also, methadone can dull emotions a bit, so when people come off it, they often experience what feels like extremes of emotion (in my experience, good and bad). Finally, if you have a history of mental health problems (i.e.: depression or an anxiety disorder) you may want to be prepared for this and arrange for some kind of 'preventative' treatment. I think that relaxation strategies are great, and if you feel up to doing something like yogo or tai chi this would be really helpful.
The pros of going into the detox are what I mentioned before, i.e.: support on tap! But, remember that it only lasts 14 days, and you will need some kind of support afterwards as well.
One other little thing to consider - which probably isn't raised very often, is that withdrawal from opiates can make people feel really cold. So it is probably good that you are thinking about doing this in summer!
So finally, I can't give you a definitive "yes" or "no", although I do suggest you think about getting down to a bit of a lower dose before the withdrawal.
And finally again! I wouldn't be a proper harm reductionist if I didn't say ... be careful! If you do go through the withdrawal and have a small relapse (I am definately not saying that this will happen, but it isn't impossible), then you need to consider that your tolerance will be much lower. If you do relapse, don't hate yourself, just consider it in the context and keep trying.
Best of luck and stay safe. Let me know if you would like any more information.
