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 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.
Jacqui
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QUESTION: Hi Jacqui and thank you for your reply.I will be going into a Detox facility for 2 wks and I have a great amount of outside support from health care workers so thats not a problem but I guess I have to be prepared for the rollercoaster of emotions that will come flooding in.I have decided I am going to do the in-patient route as I am sick of being on Methadone and want off it now.There is no way on this earth will I go back to Heroin and after several blunders from the new Dr who is writing my scripts the last straw came last week on a major mess-up and I decided enoughs enough and I can't take anymore so for me this is the best way forward.I did it before so I hope I can do it again and I believe the majority of the Detox will happen in the unit and on leaving I believe I will have a low dose of Subutex which the withdrawal will be continued with the Drug service.I am seeing the Head Dr on Friday so I'll know more but until then I have had enough now and want off it. I am concerned about the emotions that will surface and I have a feeling I will be doing a whole heap of crying! I'm preparing for the sleep issue by listening to relaxation CD's at bed time which I do now anyway so I will take that into the unit with me. I am scared,I don't know what I will feel like afterwards and that scares me-I don't want to change;I like me and don't want to lose myself so what I want to ask you will there be a shift in my personality?? (I've been on it so long and don't know life without it) So will you give me some assurances/facts/ideas about what will happen to 'ME' as a person and as I said my personality?? Sarah
Answer Hi Sarah,
The Suboxone is a great idea ... not sure why I didn't think of it! It will definately take the edge of the withdrawals. You will have to reduce of that as well, unless you only take it for a few days. But, it will definately make life easier.
I really want to assure you that your personality won't change. As someone studying a masters in clinical psych, we are taught that personality is generally consistent throughout life. We can't really change it, but we can learn to deal with some of the issues it may present.
It is great that you like who you are. It is so refreshing to hear this as there are so many people who have used drugs who, because of the stigma associated with illicit drug use, don't like themselves - and this is often reinforced by mass media, family and even the drug treatment sector. Your drug use, whilst there were negative aspects, was meeting a need at the time. I doesn't mean that there was anything wrong with you, it just means that you felt that you needed it for some reason or another and now you don't. This means that you have found some other way of meeting your needs.
You sound like a very together person and it is great that you have put things in place like the relaxation tapes. I am really impressed by this. As far as "changes" to emotions, this is not uncommon after going through opiate withdrawal, but it does not mean that your personality or who you are changes. Opiates can act as a type of anti-depressant and increase endorphin in your brain. When this is removed, the brain has to start generating its own endorphin again. From what you are doing, it sounds like you will get to this (i.e.: the relaxation tapes, support). In the short term, what MAY happen (or it may not) is that you may feel less "numb". I have heard people describe this when coming off opiates, that they might be watching television and see a really sad movie, or alternatively see something really uplifting and happy and end up in tears. It just means that you are going to be more in touch with these emotions and that can be really empowering. It is just important that you are aware that this might happen, and try to avoid putting yourself in situations that are going to be high stress or upsetting. Of course this isn't always possible, but you can try to minimise this. Just be kind to yourself. Don't undertake any new project, don't see people who drive you nuts.
I remember from your first post that you have a therapist who you see. I would suggest speaking with her or him and asking for some strategies for coping with challenges over the next few weeks. One strategy that I quite like is Mindfulness. Mindfulness comes from Eastern philosphy and has been ingrained into western psychology. It encourages people to accept their thoughts and feelings and "be mindful" of them. When you feel bad, don't fight it. By fighting it you are giving it power. Acknowledge to yourself "I am noticing I am feeling unhappy right now" and accept it. Of course if it doesn't go away after a while, speak to your therapist. But there are also other tactics to use. Mindful walking is a really nice idea (and it gets you doing exercise which helps with the endorphins). Take a walk by yourself. As you walk, start by listening. Listen to things that are close to you, listen to things in the mid range, then listen to things a long way away. Acknowledge what you hear. Notice the birds singing, notice cars driving a distance away. Notice voices. Then after a while, switch to looking. Look at your immediate area, then further afield. Then smell - which I often think is the most powerful sense. Do the same. Being mindful allows us to accept the world without trying to change things. This, combined with some cognitive therapy techniques (perhaps your therapist has discussed this), social support and medical interventions will help you a lot. Use the things that have got you through your experiences ... as I am sure that you have a lot of strength.
If you do find that you are feeling a little less secure than before, or a little more anxious, then of course therapy is helpful. But, remember this is not your personality changing. This is you adjusting to not having opiates in your system and it won't last forever. You will get through it.
I don't know if this has been much help, but if there is anything else I can offer, please let me know. I would love to hear how you go with the detox.
