What Comes After Methadone?

[Bannia]

I was on methadone for around 7 months for my RLS. My doctor said it was pretty much the last option, as I augmented on all DAs and Horizant didn’t work for me. I even tried a couple of other things, but can’t remember the names of the meds.

I stopped methadone 10 days ago, because the side effects were too much, and am still in the rough withdrawal stage. The almost complete lack of sleep and unbelievable restlessness are the worst. I know it will improve somewhat at some point, but I am afraid that I will never sleep again.

Has anyone else stopped methadone and found something else that works?

EDIT—2nd question: How did you deal with RLS and lack of sleep during withdrawal, if you went through it?

[Rustsmith]

I have been through methadone withdrawal twice, and it lasted less than half a day each time. It is very possible that what you are experiencing is untreated RLS.

As for what comes after methadone, if you iron level are acceptable (for RLS), then the only options are a different opioid. Since your issue with methadone was side effects and not effectiveness, this makes a lot of sense. There are a number of other opioids that are used to treat RLS. Several of the experts have started using Suboxone, which is a combination of buprenorphine (an opioid) and naloxone (what they give for overdoses). One advantage of this combination appears to be less constipation thanks to the naloxone. Buprenorphine without the naloxone is used as are tramadol and the oxy meds. Suboxone, buprenorphine and Tramadol ER are also a one/day meds, but are also more expensive. Tramadol is also the only non-dopamine med that can cause augmentation, although this is rare.

Finally, buprenorphine and tramadol also have anti-depressant properties, which is something that most doctors do not know. This is important because anti-depressant withdrawal is far worse than opioid withdrawal, so a proper taper if you switch (even to a different opioid) is VERY important. I suffered for many months with a form of PTSD because my idiot doctor abruptly cut of my access to tramadol. But I have safely transitioned off it it twice since then using a taper that lasted several weeks.

As for your last question about sleep, if you have access to gabapentin, Lyrica or marijuana, these can help. Soaking in a hot bath immediately before bedtime can also allow enough time to fall asleep, at least for a while. So it becomes, soak, sleep, repeat throughout the night.

[Bannia]

Thanks for the reply. Unfortunately, everything you mentioned, other than the oxys, I have used. Tramadol was fantastic for a long time, but I did ultimately augment. That lead to Suboxone, which was much worse for me than methadone. I just couldn’t find stability at a dose for very long, so I felt terribly half the time. Plus, like methadone, it caused significant personality changes, including elimination of libido. I just seen to have an issue with the long acting opioids. Maybe I metabolize them too slowly, but I really tried to stick it out with methadone. It took care of RLS very well.

I know the oxys work on RLS pretty well, but there are obvious tolerance issues there. Are you aware of anyone who has tried something like only using them every other night in order to reduce that likelihood? Just a thought I had. Not sure if it would work, but I think short acting meds have always been my preference.

I’m most definitely still in withdrawal. Went through it with Suboxone. Felt better yesterday, and then it hit me hard today again. Severe chills and leg pain, diarrhea, etc, but those are easier to deal with when you can get a few hours of sleep. The restlessness in my arms is what is really problematic. I have spent a fair amount of time in showers and baths. The tub is awesome, but hot water on my legs often triggers my RLS.

How in the world could you have 1/2 day of withdrawal from methadone? I have never heard of that before. The half life of methadone for most people is at least 2 days, so it doesn’t clear your body for at least 10 days. I am really envious of you! Did you do something special? How long were you on it?

I am going to ask my doctor about iron infusions, as he has never mentioned it to me. I have read some promising things about that.

Thanks again!

[Polar Bear]

Just a quickie to say have you ever tried icy cold water on your legs. This worked for me. I got a bucket and used water as cold as I could make it. Feet in...... This feels quite painful but it only takes a minute to acclimatize. Use hands or a cup and splash the water up as far as the knees. It takes about 15 minutes to work for me but eventually I feel the symptoms start to ease and it gives me a window to try to sleep.

[Bannia]

I have not tried cold water. I will definitely give that a try. Thanks for the tip!

[Rustsmith]

Bannia, you might ask your GP to check your hormone levels. For a while, I was switching between methadone and tramadol ER because methadone caused me to have severe depression after about six months and tramadol would kill both my libido and emotions. I understood the issue with tramadol's anti-depressant side effects, but my doctor never mentioned anything about methadone depression testosterone production. My GP had checked my testosterone levels, but when I cross referenced the dates, it was during a tramadol period. So, I sent myself to a men's health clinic and found that my testosterone level was well below normal. Two days after my first injection, the depression was gone and has not returned. My female neighbor was fighting similar emotional issues (not caused by methadone) and just found that her hormone levels were all out of whack. A day or two on supplements and she felt great. Doctors either don't bother to tell us about side effects that are not directly life threatening or else they don't know. So we are left to figure these things out ourselves, which is difficult when they control access to the information that we need to do so.

[Bannia]

Thanks for the suggestion. It went beyond the apathy and lack of emotion. I had a weird problem develop where I felt like complete garbage every single morning. It started around 2 months in and got progressively worse. From around 20 minutes after waking until around noon, my head felt disoriented and sometimes my legs hurt. Thought it might be minor withdrawal, so I increased my dose, which only made it worse. Tried cutting my dose and it didn’t get better. Changed the timing of my dose, and tried splitting my dose, both to no effect. We went to Maui in July, which is 6 hours behind us, which naturally pushed my dose time to first thing in the morning. First day, I felt ok. 2nd and third days, I started feeling bad. It was the weirdest thing. My doctor ran every single blood test on me, thinking I might have an adrenal problem or something else, and everything came up normal. After all that, I had to make a lose-lose decision, and this was the choice I made. I can’t be out of it for half my workday.
I took Suboxone previously and I had major issues with that, as well. It just seems like long acting opioids and me don’t agree. Very disappointing, because methadone really did a good job on my RLS.
I appreciate all your input. I am meeting with my doc on Monday, and we’ll see what he says.

[Macadwel]

Hey Bannia,
Did you ever find a solution to what happens after Methadone? I am kind of where you are, been on all of the above and now they are putt= me on a very low dose of hydrocodone 5mg that is not even coming close to shutting down my RLS. Would love to know if you found an option.

[debbluebird]

My side effects usually only last a month or so, sometimes less. I took methadone and now take buprenorphine because I can't get methadone in NM.
Good luck

[frickets]

I'm currently taking methadone. It helped me get past a bad augmentation experience from Pramipexole, and has worked fairly well the past couple of years. Now I'm facing a move from Virginia to Arizona in a couple months and, looking ahead, I'm finding it impossible to find an AZ doctor interested in prescribing Methadone. Got me thinking that the problem I should be trying to solve is getting off of Methadone and on to something more doctors will be amenable to. So, what is after methadone? How do I get unstuck?

[Rustsmith]

There are two opioid meds that are not Schedule 2, they are tramadol and buprenorphine. Tramadol is Sch 4 and buprenorphine is Sch 3. You may still have issues with doctors and buprenorphine because it is relatively new and had extra federal restrictions up until a few years ago, so most doctors are not that familiar with it. Tramadol is a mild opioid, so the dose you will require is higher and it is much more expensive than methadone. It is also an anti-depressant (most doctors don't realize this). The AD part doesn't mess with RLS, but it does carry a few extra side effects, such as the potential for causing sexual dysfunction (especially in men since it is used off label to treat premature ejaculation) and stopping it requires an longer taper to avoid triggering Anti-depressant Withdrawal Syndrome, which is a horrible thing to deal with. As an AD, you may also find that your emotions are blunted by it.

[debbluebird]

I'm currently taking methadone. It helped me get past a bad augmentation experience from Pramipexole, and has worked fairly well the past couple of years. Now I'm facing a move from Virginia to Arizona in a couple months and, looking ahead, I'm finding it impossible to find an AZ doctor interested in prescribing Methadone. Got me thinking that the problem I should be trying to solve is getting off of Methadone and on to something more doctors will be amenable to. So, what is after methadone? How do I get unstuck?

My buprenorphine is working great after methadone.

[EdSoFlo]

I had the same issue with methadone (after about a decade of highly effective use of oxycodone, it's efficacy diminished quickly, and subsequently went to methadone.) Knocked out my severe RLS, but I felt absolutely awful...sluggish, nauseous, cranky and mildly depressed 24/7. Went to buprenorphine after that, and for the past three years it's been a fantastic medication for me. Reduces RLS to virtually imperceptible level, and close to zero side effects. it also has the advantage of being a CIII controlled substance, so can have scripts called in, refills, etc. Absolutely worth asking about. Unfortunately can be oddly difficult to obtain as sublingual tablets are only officially approved for opioid abuse disorder, but it can be prescribed off-label for pain quite easily if dealing with sane and reasonable Drs. and pharmacies (hardly a given in 2023.)

Best of luck!

[EdSoFlo]

I had the same issue with methadone (after about a decade of highly effective use of oxycodone, it's efficacy diminished quickly, and subsequently went to methadone.) Knocked out my severe RLS, but I felt absolutely awful...sluggish, nauseous, cranky and mildly depressed 24/7. Went to buprenorphine after that, and for the past three years it's been a fantastic medication for me. Reduces RLS to virtually imperceptible level, and close to zero side effects. it also has the advantage of being a CIII controlled substance, so can have scripts called in, refills, etc. Absolutely worth asking about. Unfortunately can be oddly difficult to obtain as sublingual tablets are only officially approved for opioid abuse disorder, but it can be prescribed off-label for pain quite easily if dealing with sane and reasonable Drs. and pharmacies (hardly a given in 2023.)

Best of luck!

Oops sorry, just read earlier replies on thread....I guess I should do that prior to writing my own!

[debbluebird]

I get the films for buprenorphine. I didn't have any troubles getting it. That way I can cut it easily.