1 reply to this topic

[Uncas_669]

Hello,

 

I was physically dependent on opiates/opiods on and off for a period of 4 years. I went through many periods of using, then withdrawal, and then phases of sobriety where I never really fully recovered and always relapsed. I got on methadone and commenced a slow taper down to where I am now (0.5mg a day) and am preparing to continue lowering and jump off.

 

I began naltrexone while still using short-acting opiates like oxycontin, dilaudid, heroin, at a dose of 2mcg, and as I continued and got on methadone and lowered the opiate dose, I raised the naltrexone dose to where I am now, 2.25mg. I am following a protocol pushed by a local retired physician where you titrate up the naltrexone and down the opioid in order to lessen withdrawal syndrome. It does seem to work but theres no free lunch. Along the way I've relapsed on opiates numerous times, setting back my taper again and again. But I get back on track and one step closer to wanting to be done with the vicious cycle.

 

Anyways, I find that when I dose the LDN at about 10pm-midnight, I will sleep ok using herbal sleep-aids and melatonin (although everytime I raise the dose I have exceptionally poor sleep for a few nights), but I am extremely depressed, apathetic, and worst part  -- physically weak, until at least 4-5pm the next day. Dosing the methadone at approx. 5AM when I wake up doesn't seem to give but the most minor of comfort. I have restless feet, chills, and just a general reminiscent feeling of opiate withdrawal. I don't feel this is from solely tapering the methadone down, as I'm going very slow (lowering 0.1mg every week), although I accept the slow taper could of course be making me feel crap too.

 

But I believe it is mostly the LDN causing me the issues, as I don't feel decent until many hours after my dose of methadone, when normally it takes less than hour to kick in. The half life of the main naltrexone metabolite is about 16 hours, and this coincides with when I start feeling better. It feels like the opioid receptor blockade is taking too long to lift. I could try lowering the dose of LDN, but then I feel like I wouldn't get as much benefit. Since I've relapsed numerous times and have had to take steps back on my taper, unfortunately, I can't present a very scientific and accurate representation of what I've gone through. I'm just going by feel.

 

So I only get about 4-6 hours of feeling OK everyday. It feels like I'm in slight withdrawal everyday, and I believe the naltrexone metabolite which antagonizes the opiate receptor is hanging around too long in my system.

 

I had elevated liver enzymes while on the opiates. I also picked up some sort of intestinal infection from plugging (rectal administration) of street heroin without sterilizing the solution. I am finding that occasionally, as I up the dose of LDN, I get quite sick for a day, and last time I threw up, had chills, diarrhea, but then felt better. I've been struggling with this mystery bug until recently, when I added probiotics and fixed my diet, and I have much less tenderness and pain and symptoms of the issue anymore. I believe LDN helped restart my lagging immune system (morphine has been shown to suppress immune activity).

 

Anyways, I think maybe my liver is sluggish and not processing the metabolite of naltrexone fast enough. I started taking Sam-e and Turmeric for liver health benefits. I will source some TUDCA as well. This method is all based on assumptions as I cannot find a willing physician to work with me. I am also on self-administered TRT with testosterone cypionate at approx 200mg a week (a high dose, but I am focused on competing in MMA as recovery allows.) I was feeling some excess estrogen effects but after adjusting my diet and starting the Sam-e, I feel like my liver is probably doing a better job at clearing the build-up of estrogen. I am not using an AI and am hoping to continue without.

 

Anyways, just wondering if anyone could give me any input on my process. Should I lower or hold my dose of LDN, or continue titrating up as I lower the methadone to 0mg? After the cycle of sickness and misery over the years I really cannot look forward to another protracted withdrawal period. I hope my efforts in pushing the dosage of naltrexone up will mean whatever withdrawal when I finally come off methadone (after about 6 months on-- too long), won't mean I suffer extensively. I know I have to pay the piper but the whole point of taking the LDN is to calm microglia and lower opioid tolerance which in theory should mean my physical dependency to opioids is slowly waning, even as I continue to dose methadone.

 

In fact, I know of a few people who claim to be able to take opiates like kratom, or reasonably low doses of oxycontin, everyday, and then dose LDN at 3-4.5mg at night, and be able to start and stop the opiates without ever feeling withdrawal. This would be ideal for me, as truthfully, it is hard for me to think that I can never have a dose of oxycontin for the rest of my life. I have suffered physically and mentally for years and although I am working on addressing my issues with healthy methods like therapy, it is just too much for me to admit that I will never be able to feel the warmth and bliss of synthetic opioids ever again. True junkie mindset right there, but it is what it is.

 

 

 

Physical activity and the satisfaction and endorphin high from exercise and lifting weights and training in general used to be my panacea, until I was severely injured and started the opiates. I couldn't get the happiness from lifting weights or fighting anymore, so I took drugs to replicate that feeling. I neglected healing physically in favour of numbing myself with drugs. I wasted years of my life and health. But I am working hard to getting back to a positive place where fitness and competition are the main drivers of my life. I also suffer from PTSD and associated mental issues which have meant that me and opiates felt like a perfect fit. I rarely got messed up high, in fact, the first thing I would think after snorting a line or popping a pill and feeling it kick in -- "my god, I finally feel normal". Really. I rarely if ever nodded out or became incapacitated. Opiates, for me, like many others, abolished the physical pain which ruled my life for years, and took care of the depressive mental issues I had as a result of these circumstances and the feelings of opportunities and relationships missed out on. I still deal with this aching emptiness. To be honest, I'm only getting off opiates because I don't have a safe and clean supply for pharmaceutical grade drugs and the deleterious health effects and criminal aspect of using street heroin / fentanyl is too dangerous to continue.

 

just wanting some guidance from anyone that might have knowledge or experience in the area. Even if nobody has any straight answer for me (I understand that my explanation of my position doesn't really give a clear picture of my health and progress), just some motivation to continue taking LDN and suffering while I get off the methadone would be great. I intend to go overseas to continue training in about 4-6 weeks, and I really need to be complete off the methadone and feeling good. As it stands, my gym sessions are uninspired and weak. I'm hoping that the TRT, which I just got back on after falling off for a bit, helps alot with energy and strength. I feel so weak during the day, I can barely force myself to use my muscles to walk.

 

Thank you for reading, and considering

Edited by Uncas_669, 23 June 2017 - 12:08 AM.

[kittenwizard]

EDIT: changed and added stuff

 

It sounds like 2.25mg of Naltrexone is too much. Disregard other people who can take a small amount of opioids while taking Naltrexone at night without precipitating withdrawal because you're in the same situation as them. No shame in needing a different plan. Sounds like it's antagonizing the opioid system too much and like you said you are feeling like youre withdrawing moreso then you should. I think your correct and you are.

You shouldn't be going that high with Naltrexone if your on an opioid in my opinion, let alone a long acting one like methadone. From what I gather, short acting opioids and people with little/no dependence can be used with 1.5-4.5mg Naltrexone but it's tricky getting the dosing timing correct. My partner was on 1.5mg at night with 10mg oxy in the morning and when he got increased to 4.5mg  he complained a lot about having withdrawal symptoms most of afternoon/night. Its tricky making sure the Naltrexone is taken before bed and has enough time between the Naltrexone and your next short-acting opioid dose to clear enough to allow some opioid activity. But regardless that not your situation. Drop the Naltrexone dose down or you will feel this for the entirety of your taper, which pretty much guarantees you won't actually finish the taper going through constant withdrawal hell. You even admitted you have relapsed already because of these symptoms - that means this method isn't working and your doctor needs to know he's making you worse.

I would suggest dropping the Naltrexone dose down to the Ultra-Low-Dose range which is something like 2-50mcg per day for the tolerance/dependence reduction effect to work, and then taper your methadone down down in a way that if your not withdrawing you drop the dose by 5-10% for a week and see how you feel. If you're good again, drop it another 5-10% and continue until your low enough that you can get off and up your Naltrexone.

It just sounds like your doctor doesn't understand that it's not like a dose drop in methadone means you increase in Naltrexone. That's not how it works. Once you hit a certain point with Naltrexone your pushing out whatever opioid you got (depending on binding affinity I think) you have regardless of the amount of the opioid. Youre supposed to stop increasing the Naltrexone before you hit that point if you even do increase it during taper. Once you're off opioids then the Naltrexone dose can increase to make sure your body upregulates opioid receptors and endogenous opioids so that you don't feel the craving of needing an exogenous opioid anymore, and even if you took it you will go into precipitated withdrawal which would be an even bigger deterrent to not use again.

The way this is currently going now is that this process is going on worse then without Naltrexone at all which is absolutely the wrong way to get someone off of opioids. I commend your resolve thus far but I fear you're only hanging on by the skin of your teeth and sooner or later you will drop out of this treatment entirely and just think you're stuck on opioids forever. Maybe you do need an opioid because of your pain, but if you can get through this and see where your baseline is you might find that you can keep your dose low with the use of ULDN indefinatly due to its effect on preventing tolerance/dependence from forming. Just think of this whole ordeal as you getting rid of your tolerance and seeing where your pain is at when you stabilize without them. If it's too difficult right now to think this is the end of opioids and that keeps you from completing your taper, then don't think of it as the end if that's what gets you to the other side where you can make a better informed decision about getting back on opioid treatment or doing something else. 

 

Here is some ULDN info that might help. 

https://www.khemcorp...search-summary/

 

Edited by kittenwizard, 02 October 2017 - 02:40 PM.