If so, and they want to taper, then they should begin a slow taper at a rate of no more than 10% of their dose every 2-4 weeks and taper all the way down to 1mg. Doing a taper the proper way will not result in horrible withdrawal symptoms–in fact, most people tolerate this very well indeed. It is when people become impatient with the process and try to rush through it that it becomes unpleasant and relapse rates rise accordingly. Most inpatient rehabs cannot keep a patient long enough to do a taper at this rate from a dose of more than 20mg or so, and many will not even take methadone patients until they are on a very low dose or off completely.

Being in methadone treatment is NOT the same thing as being in active addiction, and there is no reason to believe tat everyone coming off methadone treatment is in need of “drug rehab”, any more than everyone completing a treatment for smoking cessation by finishing the use of a nicotine patch needs treatment for smoking. Not all addiction patients in this day and age have the social problems that many did decades ago. Assuming that everyone is homeless, jobless, unkempt, poorly educated and in need of extensive social rehabilitation efforts, or that they all have harmful family dynamics or childhood abuse issues that need to be uncovered through extensive counseling, or that they all have a “spiritual malady” that can only be repaired by a belief in God, prayer and group meetings is wrong. Some people MAY have these issues and they should be offered appropriate care and referrals–but not all people need this. I have personally been to rehabs where they sat us all down and instructed us in personal hygeine, how to dress for a job interview and how to avoid being late for one and rude to the interviewer, how to avoid beating your spouse and kids if they angered you, or slugging your co-worker on the job, how to stop promiscuous sexual behavior, stop smoking, and so on–all things that I and many others there had no issues with and did not need. Treatment is usually one size fits all, despite claims of individualized treatment plans. There are many patients who simply need assitance in breaking the physical bonds of addiction and that’s it.

There are others who, even after years of being clean and sober and of doing everything suggested to them (going to meetings, working steps, calling sponsors, proper diet and exercise, etc etc) find that their natural endorphins never return to a normal functioning state–the damage done has been, sadly enough, permanent–as illustrated by CT scans of the addicted brain, psychological testing and behavioral observation, and lack of response to other therapies for the ongoing depression, malaise and cravings they feel. In these cases, long term MMT may be necessary to stabilize the brain chemistry and allow the person to live a more functional, happy life. There is no need to demonize a medication simply because it is an opiate, or causes physical dependence. Opiates are naturally occuring substances in our bodies and we all have them–that is why we have opiate receptors. Not having enough of these enorphins cases acute distress, inability to feel pleasure, etc.

It is important to give any attempt at abstinence a fair trial of at least a year or so, to see if the endorphins will begin to come back. They may not make a full return by that time and patientce must be utilized, but some improvements should be noted. If there is no improvement at all, there is no need to go through the rest of your life in misery, relapsing and going to rehab after rehab after rehab–as I did, 13 times–because someone tells you it is wrong to take medication appropriately prescribed and to feel better because of it.