I will not take other opiates again, the reason for increasing my dose was because my tolerance increased a lot after several months, I do not recommend taking doses as high as myself, I am also dependent on benzos, legitimately prescribed also does 4 years, so I have been safe from seizures.
I will continue with the methadone for a while, then I will reduce the dose as the doctor indicates and I will switch to kratom for a while. Why had I questioned my addiction? When I showed my mother what you wrote, she said, "I wish it were true that you are not physically dependent"
You told us that you lived with your mother who doles out the methadone tablets prescribed by doctor, and then twice I referred to your young age which you didn't challenge, and then you said that you're locked down with your mother but you go outside to smoke pot which your mother allows, so everything you said indicated that you're under control of your mother, so then after you asked if you'd be eligible for MMT in the US i made a point of saying you'd need to be 18 and physically dependent for the last 12 months.
You asked the question if you'd be eligible in the US. But before that you asked if you'd have abstinence after your methadone detox. Those two questions of yours started all the back and forth. Would you have preferred someone just gave you immediate answers like yes or no?
That's kind of what I did two weeks ago telling you that after the detox you'll probably be in the same place you were in before the detox and that's why you'd have the best chance of success with intensive counseling, both individual and group. But it seems there's no counseling as part of this detox program and you very clearly have a high level of anger and a volatile temper that wasn't apparent when you were machine translating.
Use your real voice if you want to get the best answers. And oh, one last final gift to you is to say that without counseling as part of this methadone-assisted detox and without seeking insights into the motivation for your drug use, there's another very important element that in the US i think omitting it especially with a 21-year-old given methadone for detoxing from poly-opiate usage and heavy dependency is the lack of monitoring of your drug usage by drug testing. You doctor apparently doesn't know or care whether you continue to use the codeine and the tramadol as before. You asked me something like if you'd be better off with the weaker opiates, but i told you to take the methadone and don't take the other opiates. In the US a doctor who prescribed methadone for an assisted detox of a 21-year-old without any surprise drug testing would be risking serious trouble. Even just regular pain management uses drug testing and they include blood titer levels to see if the blood levels are consistent with the dose being given. But it seems you have nothing like any of that to worry about.
Back then you didn't say that you process codeine/apap 30/500 tablets and take 300 mg codeine at once, or that you take well over 400 mg of tramadol a day, all you'd said was that you take both codeine and tramadol every day and you get them without a prescription and you didn't say anything about withdrawals. The only time you mentioned withdrawals was on April 16 when you asked if you'd have abstinence syndrome at the end if the methadone-assisted detox. But you didn't say how many of the 5-mg tablets you take per day, just that your mother had 40 of them. So i didn't know what your methadone dose was and I didn't know what doses of the codeine and tramadol you'd been taking.
All you said about them was that you take both drugs every day but that what you were concerned about was your use of morphine and oxycodone which you said you abused and you wanted to stop using the morphine and oxycodone in quantities that make you lethargic and sedated.
I posted a link to the article on CYP2D6 metabolism about how some people have low levels of that enzyme because your levels might be high as opposed to low. And maybe that's why you find the tramadol so euphoric. The lab test they mention is now routinely used in pain management so I mentioned it because you might have the opportunity with help from a supportive doctor to get that test just to better understand your own body and how you are reacting to and craving these drugs.
Tramadol and codeine together as your daily opiate usage is not a good combo because they both rely mostly on CYP2D6. Codeine all by itself can have a plateau effect where people can only convert about 200 mg at a time so if they take more than whatever their CYP2D6 can convert anything extra is wasted and excreted unchanged or maybe converted to something undesirable and uneuphoric. So if the codeine and the tramadol both deplete your CYP2D6 you'd be better off using just one or the other, not both in the same day.
I think the reason for dose escalation with the tramadol like taking over 1000 mg a day is because people are trying to get a buzz like they'd get initially, before they depleted the CYP2D6. It'd be like pushing on a string. They keep adding more and more tramadol and getting no effect and those were the people getting seizures.
And i don't know if it's a good idea to rely on just any benzo to protect you from tramadol-induced seizures. The two benzos with longest use for epilepsy are Valium and Klonopin where Klonopin was labeled specifically for epilepsy way back. You would be much better off if you could take just codeine and avoid the tramadol.
You said the reason for escalating the tramadol dose was your increased tolerance all of a sudden. Well, what if it was because of CYP2D6 depletion rather than tolerance per se? What if your tramadol "tolerance" went up because of using both codeine and tramadol together?
