Excited about the remarkable anti-addictive
properties of memantine a number of methadone patients decided to use it to
get off methadone. They were all people who had been on methadone for opiate
addiction for 2 years or more, and wanted to get on with their lives. Most
were ‘stuck’ on methadone in that even small decreases in dose caused a
fairly unpleasant withdrawal syndrome. They had generally been on methadone
for several years and had a long opiate addiction history. A few weren’t ‘stuck’ but just hadn’t
decided to make the move off of methadone until the memantine opportunity
came up and made them think about it.
Out of around fifty patients who decided to use memantine one dropped out
because he felt too strange to continue it (“giddy, disoriented”) and one
stopped it because of fatigue and nausea. The rest continued without
problems. A few had transitory mild side effects that went away after the
first couple of days.
The protocol was as follows:
Take one tablet (10 mg) and wait an hour. If you are feeling more or less OK take another tablet and wait an hour. Continue until the total dose is 60 mg or you feel that taking another tablet would make you feel too strange, or side effects are unpleasant. Every two days take the dose you could tolerate on the first day, but all at once, not spaced out an hour between tablets. If side effects, whatever they are, are developing and making you feel lousy, take fewer tablets every 2 days. If you could only tolerate one or two tablets the first day but are feeling fine as time passes try increasing the dose. If you feel that taking a smaller dose every day would be better for some reason go ahead and do so. Do not take more than six tablets every second day or three every day.
After starting the memantine, take only one half to two thirds of your usual methadone dose, leaving the rest in case you need it later. If you develop withdrawal symptoms, you can take the unused portion of your daily methadone dose. The worst that can happen is that memantine doesn’t help, and you start to get withdrawal symptoms, in which case you take your usual daily methadone dose and you will then feel fine. If the memantine prevents withdrawal then you can continue to not take one half to one third of your prescribed methadone dose. At the end of a week on a lower dose of methadone ask to have the prescribed dose lowered and continue leaving one third to one half unused each day.
The patients were told: "Experiments have shown that this drug MAY be helpful for getting off methadone, but we aren't sure about this. It works by reducing tolerance to opiates. If it works for you you will find less withdrawal when you lower your opiate dose, and you won't find opiates so addictive - that is, you will feel less compulsion to take them. If it doesn't work, you will feel withdrawal as usual and a compulsion to take opiates, as usual. The prescribed dose of methadone won't be lowered unless you ask for this to happen. You will take less than your usual dose of methadone, keeping the rest in case the memantine doesn't work and you need your usual full dose. If the memantine 'works' you will get by with a lower dose of methadone, and the prescribed dose will be lowered at your request until you are off the methadone. The worst that can happen is that the memantine doesn't 'work' and you will need your usual dose of methadone. The correct dose of memantine is not known and will be some combination of what you can tolerate and what you fell is 'working'. You may be able to tell if the memantine is 'working' by noticing that you don't feel as compulsive about taking your methadone as you usually do.
About two
thirds of the patients lowered their methadone dose by a third each week and
were off methadone after three or four weeks. About one third of the
patients showed signs of ‘Protracted Abstinence Syndrome’ when they got down
to 10 or 15 mg of methadone and had to slow down their weaning process.
Almost all patients got off methadone completely in six weeks or so, but a
few had to go slowly due to 'Protracted Abstinence Syndrome' and were lost
to follow-up. All patients who could tolerate the memantine (the vast
majority) reported remarkably reduced Acute Withdrawal Syndrome and all
patients reported a remarkably changed attitude to opiates - they didn't
'care' about them any more. Memantine didn't seem to prevent "Protracted
Abstinence Syndrome'
All reported a remarkable and immediately noticeable effect of the
memantine. They no longer cared about taking their methadone dose! Instead
of their daily methadone being a daily priority (often the first thing they
thought of on waking in the morning) they found they weren’t particularly
interested in taking methadone any more, and only took it because they were afraid
they might get withdrawal symptoms if they stopped it completely. There was
no ‘urgency’ about taking it, and they often left in until later in
the day. They were amazed by their changed attitude to methadone, and
were astounded that it ‘didn’t matter' any morel. Several people forgot to
take their methadone on several occasions and only took it when they started
to get some withdrawal symptoms. A few missed one day’s dose completely on
several occasions and didn’t get withdrawal until the second day without
methadone. One man ‘forgot’ (so he said) to take his methadone for six
consecutive days and only resumed it when he started to get mild withdrawal
symptoms on the seventh day!