Adjunct medications and supplements.

  1. alfa
    a) Benzodiazepines.
    These are very often used to assist with the anxiety and sleeplessness of withdrawal. I have not seen conclusive evidence to sway me either way as to their efficacy. They will not help you sleep in serious withdrawal, at least not in "sensible" or even moderately stupid doses. They do seem to help somewhat with anxiety but the effect of benzodiazepines is still very "wrong"; they don't really help that much. On the down side, they will interfere with re-establishment of sleep-patterns, and some would contend the rebound insomnia/anxiety is not a good thing (I tend to think that such a rebound if it happens after w.d. is over is not a major problem), and lower inhibitions. I should caution against anyone who is not entirely confident of success taking benzodiazepines if there is any chance of them getting in a car to drive to score opiates. Driving while under the influence of benzodiazepines is totally dangerous especially if you are new to them, and I mean a totally different order of dangerous than driving after a few beers. My recommendations would be to take at most 20mg diazepam or 40mg temazepam at night, and if you are still anxious (which is unlikely) 10mg diazepam in the morning, or equivalent. I'd not recommend midazolam, alprazolam (Xanax) as they are short acting, and might have higher short-term addictive liability. Note that although these are low doses in some sense, 20mg diazepam (or 40mg temazepam) is a high dose, and will quite probably leave you with ataxia (difficulty walking). If this is a problem, (i.e. you are on your own) halve the dose I've given. If you are not affected (and be aware you might not be the best judge of that) take more. Do not take benzodiazepines if you do not feel anxious, or they are not helping you sleep.


    b) Z-drugs
    As an alternative to benzodiazepines, you could try Z-drugs. MY cat found zolpidem (Ambien) mildly useful in late withdrawal one time, but hated the metallic taste given from zopiclone (his taste and smell is always unduly heightened), even though he obtained some sleep from using it. Again be sensible; use low doses if you plan to use these things.

    As a general guideline, chances are you simply won't sleep for a few days/weeks, or rather you may have a few totally sleepless nights and then a few with a laughably small amount of sleep. Sleep medication is unlikely to help much, and even if it does, the quality of sleep will probably be dire, and you'll wake feeling as bad as if you hadn't slept.

    Obviously, if you choose to use either of the above, I strongly suggest you use either benzodiazepines or Z-drugs, not both.


    c) Sedating anti-histamines.
    I do not get on well with these, but using the sedating first-generation antihistamines can help with sleep and anxiety. One recommendation is hydroxyzine (Vistaril) 50mg-100mg three times daily. It apparently loses it's effectiveness after 10 days, so use only at the critical juncture.


    d) Imodium (loperamide)
    This works well for diarrhoea. It is an opiate, but does not cross the blood-brain barrier.


    e) Non-Steroidal Anti-Inflammatory Drugs [NSAIs]
    I have used diclofenac and ibuprofen with some limited success for general aches and pains associated with withdrawal.


    I have decided to add (almost) in it's entirety the following list of supplements from this thread. This is very good information on detoxing, and I suggest you read it. I've edited out the mention of i.v. nutritional therapy that might be good in an inpatient setting, but will be impractical for a home detox. I've left in the general guide to nutrition.
    • 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 xxxxxxxxx or xxxxxxxxxx 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.

    To this I'd add chamomile tea as a perfectly safe and mildly effective sleep-aid.

    And finally (except for the appendix)!
    I hope this guide has been useful. It is far from complete, in that just about anything and everything has been tried at some time as an aid to quitting. The main thing to remember is that quitting is not about quitting using some perfect “method”, it is about quitting any which way but use. I commend a terminator-like focus, a black sense of humour, and a smile. Also don't fear any “surrender moment” where you really feel you can't cope or go on any more. This can be empowering if you don't use and get through it.

    Best of luck, and talk about what you're going through. You're not alone!

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