Kratom Been holding off my bipolar meds because been taking kratom. Think I’m being too cautious?

[Juicewrldfan]

So, long story but went CT off 16mg subs so had to take kratom. I was stopping since I got on bipolar meds I should have been on all along.

I want to take my meds today because I’m starting to get manic but I’m worried about the cyp2d6 pathway being inhibited as that’s the main one abilify uses. I don’t think lamictal does but I’ll have to double check.

I took one dose of kratom at about 4am but been taking it daily for days now and like 100g a day filtered in tea total per day. So it’s more likely about 50 grams.

Would you be concerned? Am I just being overly cautious?

 

[Snafu in the Void]

Are you concerned about kratom inhibiting the abilify, or vice versa?

I would worry more about direct interaction, and not enzyme inhibition.

Kratom itself inhibits 2d6, and 1a2, and 3a4.

 

[Juicewrldfan]

Are you concerned about kratom inhibiting the abilify, or vice versa?

I would worry more about direct interaction, and not enzyme inhibition.

Kratom itself inhibits 2d6, and 1a2, and 3a4.

Yeah. I’m only worried about enzyme inhibition really. But I think I’m putting too much thought into the enzyme inhibition. Mainly because I know one time it shouldn’t hurt if it’s normal doses but if it jumps my dose up 200 percent or 400 percent then that is what I’m worried about

 

[Keif' Richards]

Hey @Juicewrldfan

I've been watching your progress for the past several weeks. I don't want to overload you with unwanted advice. I do feel like I'd be missing an opportunity if I didn't though. so here we go.

You've definitely been bouncing around all over the world of both illicit and licit substances. I'm not gonna tell you exactly what to do. I will tell you that you need to decide on a course and commit to that until you see where it goes. If that means taking your Bipolar Medication, great. If it means getting back on Buprenorphine, then that's fine too. Hell, there's nothing blatantly wrong with doing both. You seem to be in a really chaotic state right now. When things are so chaotic, it becomes difficult for us addicts to gain perspective on our lives.

I'd be curious to ask why you got off Buprenorphine in the first place. I know a lot of people, myself included, who have ended maintenance prematurely, only to find that their best intentions, often in obtaining "freedom" were not the best move. If you're unable to stop using Opioids, it's probably best to stay on maintenance. Even if maintenance drugs aren't the "perfect" option from a physiological/pharmacological perspective (Heroin for instance, has better statistical outcomes than Methadone), this is often offset by the societal impact of having a legitimate, reliable means of obtaining your drugs.

Don't make any rash decisions. Think it through and let me know if you have any questions at all. You can hit me anytime and I'll do my very best to help you out. This means both pharmacology and the spiritual/mental side of things.

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Now that I've made myself look like a pompous know-it-all, which is my style, onto your actual question for this specific thread.

If we're speaking purely of the potential for a dangerous interaction, there is nothing that I can see at first glance that I find worrisome. We know that ~50% of all pharmaceutically active substances known to man have metabolism mediated by the various enzymes of the P450 superfamily. With this in mind, it's not strange to find that different substances you're taking are metabolized via related enzymes.

At any rate, if your medications are keeping you from the cycles of mania/depression, then you should definitely take them. If the alternative is that you're too manic to exist within society, then I would say that is your only option. At least if you can keep your mood cycles stable, you have the ability to rest on some kind of foundation. From here, you can make more rational decisions regarding your medications.

This is all just my opinion. We aren't doctors, though at times, I feel psychiatrists aren't really doctors either, at least compared to say a heart surgeon. A heart surgeon can't spend his entire day guessing wildly at how to do a quadruple bypass only to maintain the respect of his profession reagardless of how many people die on their table. Rant over.

Good luck buddy. Hit me up anytime.

 

[Juicewrldfan]

Hey @Juicewrldfan

I've been watching your progress for the past several weeks. I don't want to overload you with unwanted advice. I do feel like I'd be missing an opportunity if I didn't though. so here we go.

You've definitely been bouncing around all over the world of both illicit and licit substances. I'm not gonna tell you exactly what to do. I will tell you that you need to decide on a course and commit to that until you see where it goes. If that means taking your Bipolar Medication, great. If it means getting back on Buprenorphine, then that's fine too. Hell, there's nothing blatantly wrong with doing both. You seem to be in a really chaotic state right now. When things are so chaotic, it becomes difficult for us addicts to gain perspective on our lives.

I'd be curious to ask why you got off Buprenorphine in the first place. I know a lot of people, myself included, who have ended maintenance prematurely, only to find that their best intentions, often in obtaining "freedom" were not the best move. If you're unable to stop using Opioids, it's probably best to stay on maintenance. Even if maintenance drugs aren't the "perfect" option from a physiological/pharmacological perspective (Heroin for instance, has better statistical outcomes than Methadone), this is often offset by the societal impact of having a legitimate, reliable means of obtaining your drugs.

Don't make any rash decisions. Think it through and let me know if you have any questions at all. You can hit me anytime and I'll do my very best to help you out. This means both pharmacology and the spiritual/mental side of things.

----------------------------------------------

Now that I've made myself look like a pompous know-it-all, which is my style, onto your actual question for this specific thread.

If we're speaking purely of the potential for a dangerous interaction, there is nothing that I can see at first glance that I find worrisome. We know that ~50% of all pharmaceutically active substances known to man have metabolism mediated by the various enzymes of the P450 superfamily. With this in mind, it's not strange to find that different substances you're taking are metabolized via related enzymes.

At any rate, if your medications are keeping you from the cycles of mania/depression, then you should definitely take them. If the alternative is that you're too manic to exist within society, then I would say that is your only option. At least if you can keep your mood cycles stable, you have the ability to rest on some kind of foundation. From here, you can make more rational decisions regarding your medications.

This is all just my opinion. We aren't doctors, though at times, I feel psychiatrists aren't really doctors either, at least compared to say a heart surgeon. A heart surgeon can't spend his entire day guessing wildly at how to do a quadruple bypass only to maintain the respect of his profession reagardless of how many people die on their table. Rant over.

Good luck buddy. Hit me up anytime.

Hey man, yeah I got off bupe because I was always coming up short on my script and withdrawing and this last time was bad because instead of 2 days I ran out 5 days early and that wasn’t cool.

I just feel like methadone having supervised dosing would work better for me at least for now. Then it’s hard for me to mess up my dose. Though I will say that I made an appointment at a new addiction center (to me) because I feel like my current place is just money hungry. He wants me to do THREE hour long sessions a week (therapy).

While I don’t really mind, their counselors are inadequate and I’ve been seeing the same addiction/trauma therapist (I have DID along with BD) and I just can’t afford 400 a week long term alley for therapy appointments. So when my insurance restarts I’ll be screwed so made an appointment with a more corporate like place that only requires one a week and has a full fledged psychiatrist to help with my BD meds as I stopped them from writing me adhd meds because I just abuse them. I told them strait up this past appointment that I abused the meds they gave me to force them to stop quitting it for me as I told them I didn’t want them in the past and they talked me into it.

I don’t think I need adhd meds. In fact I think they are a great harm for me. Some addicts can handle it and take them as prescribed. I clearly cannot and I’m done trying to. I truly want to be soberish or at least not trapped by addiction. What I mean is I think occasionally taking weed is fine. Some ppl with BD can’t because it triggers mania or psychosis. I don’t feel like it does that to me. (But could be wrong as I’m not good at self awareness part of my brain for that has shrunk as it does in people with BD)

I agree wholeheartedly that I need to decide what I want to do and do it. And I decided. I started back my BD meds today which sucks because I woke up manic feeeling euphoric and all that today. It is truly an amazing drug; mania when it’s good that is. There is of course bad mania which consist of irritability and an extreme “gangster “ mentality as I also switch personalities at times to this really hard thugged out narcissist.

But that’s a personality I guess I created to get thru hard times in my life (trauma) so idk I’m getting therapy to reintegrate my parts into a cohesive whole but it’s challenging and we just started.

Yeah I don’t really feel psychiatrists are doctors either he same sense as heart surgeons and the like. But with things like BD and psychosis I’d say they are definitely important in treating.

Thanks for letting me know I have been all over the place on here because it helps me to see that I do have BD. It’s a weird illness where everyone I feel like is in denial nearly or get denial every so often.

 

[Keif' Richards]

Hey @Juicewrldfan thanks for the information. That definitely paints a clearer picture.

Everyone is different, though I feel you're definitely a candidate for Methadone maintenance. It could be just what you need. I know us addicts have a deeply-ingrained desire for freedom for obvious reasons. For this reason, the Methadone clinic gets a lot of negative press from the addict community. It's my belief that the majority of what is said about clinics can be worked around. For instance, I talk to people every day who will not enroll at the clinic due to the feeling of being "controlled" by the clinic despite the glaringly obvious notion that they are already completely controlled by a drug dealer who doesn't care if you are well, sick, living or dead. Sure, a lot of clinics are for-profit enterprises and that's bullshit. Unfortunately, this is one of those sad moments in life that I describe as "playing the game".

Sure, the clinic is gonna tell you when to jump and how high. However, do this for a few weeks, do well and you're already getting every other day takehomes on your way to a weekly or even monthly prescription. The daily dosing is a great way to initiate a stable foundation for you.

I am versed enough in the Methadone Clinic system that I could work full time as a drugs-concierge, educating people on both the politics and pharmacology of their treatment. I've dealt with for-pay clinics. I've dealth with clinics run by the city/state. I have experience with both the red and the blue, if you will.

Can you tell me where you live? That would be really informative in telling you what to anticipate.

Addendum: If you're currently only messing with stuff like Kratom, the induction process with Methadone is likely going to give you some positive Opioid-feels for the first couple of weeks. Sure, getting high isn't our purpose here, but it's a little something to look forward to and keep you motivated.

 

[Snafu in the Void]

it’s normal doses but if it jumps my dose up 200 percent or 400 percent then that is what I’m worried about

From all of my armchair science knowledge, I believe even with maximal inhibition of 2d6, you would probably see a 30-50% increase in plasma levels, and it would probably take at minimum several days to weeks for this to even manifest into a problem.

and you can always offset this increase by simply taking less of the pill

probably worth taking the risk if it helps with mania

(obligatory this is just speculation not medical advice)

 

[Juicewrldfan]

Hey @Juicewrldfan thanks for the information. That definitely paints a clearer picture.

Everyone is different, though I feel you're definitely a candidate for Methadone maintenance. It could be just what you need. I know us addicts have a deeply-ingrained desire for freedom for obvious reasons. For this reason, the Methadone clinic gets a lot of negative press from the addict community. It's my belief that the majority of what is said about clinics can be worked around. For instance, I talk to people every day who will not enroll at the clinic due to the feeling of being "controlled" by the clinic despite the glaringly obvious notion that they are already completely controlled by a drug dealer who doesn't care if you are well, sick, living or dead. Sure, a lot of clinics are for-profit enterprises and that's bullshit. Unfortunately, this is one of those sad moments in life that I describe as "playing the game".

Sure, the clinic is gonna tell you when to jump and how high. However, do this for a few weeks, do well and you're already getting every other day takehomes on your way to a weekly or even monthly prescription. The daily dosing is a great way to initiate a stable foundation for you.

I am versed enough in the Methadone Clinic system that I could work full time as a drugs-concierge, educating people on both the politics and pharmacology of their treatment. I've dealt with for-pay clinics. I've dealth with clinics run by the city/state. I have experience with both the red and the blue, if you will.

Can you tell me where you live? That would be really informative in telling you what to anticipate.

Addendum: If you're currently only messing with stuff like Kratom, the induction process with Methadone is likely going to give you some positive Opioid-feels for the first couple of weeks. Sure, getting high isn't our purpose here, but it's a little something to look forward to and keep you motivated.

Meh…I got stuck in this box. Lol.

Wait here we go. I live in Ohio. I started methadone today but tbh still feel like I’m withdrawing from subs but only gave me 30ml I guess it’s the law and they will increase me to 59 by Thursday and next week I can go up more I think because I think they said we can only go up twice a week but I could be wrong.

Tried to potentiate with omeprazole but it was an hour after I dosed so likely did nothing. So meh.

But I agree. The Reddit for subs all shit on methadone when I brought it up but I think it gets a bad rap because the daily dosing and more strict regs.

I also agree daily dosing should be good for me until I’ve had a period of stabilization. Maybe a couple months idk. The three therapy sessions a week is wild to me plus my actual therapist who I will never quit if 7 years outside the clinic. Their clinic therapists are inadequate and I end up being more of their therapist while they tell me about their kids and their mental health issue kinda annoying actually.
This is a mess.

 

[Juicewrldfan]

From all of my armchair science knowledge, I believe even with maximal inhibition of 2d6, you would probably see a 30-50% increase in plasma levels, and it would probably take at minimum several days to weeks for this to even manifest into a problem.

and you can always offset this increase by simply taking less of the pill

probably worth taking the risk if it helps with mania

(obligatory this is just speculation not medical advice)

That is relieving to hear. I guess it’s not a big deal if I take a dose today then sense I’m still withdrawing. Kratom.org said don’t take it with methadone because it will potentiate it but maybe they mean synergy likely both but I think it’s a low risk now.

I restarted my BD meds today tho. Only took abilify so far 10mg if it makes it 15 no biggie.

Thanks man!

 

[Keif' Richards]

That is relieving to hear. I guess it’s not a big deal if I take a dose today then sense I’m still withdrawing. Kratom.org said don’t take it with methadone because it will potentiate it but maybe they mean synergy likely both but I think it’s a low risk now.

I restarted my BD meds today tho. Only took abilify so far 10mg if it makes it 15 no biggie.

Thanks man!

I'm not gonna say the warning is not relevant. However, the whole "don't take an Opioid with another Opioid" is standard fare as far as liability warnings go. Although Opioids certainly have different effects, it's my belief that it is easier to visualize your usage simply by saying an Opioid is an Opioid and looking at it as total intake, as opposed to trying to figure out the minute differences from one Opioid to another.

Thanks for the update. I know Ohio is probably a bit more conservative than where I'm at. I also understand that Ohio is on the list of top consumers of illicit Opioids. This works in your favor, as the Fentanyl crisis has radically altered the way people are inducted on Methadone i.e. they will bring you up to a higher dose faster.

The previous guidelines were generally a maximum starting dose of 30mg Methadone with the possibility of titrating up to 60mg Methadone in the first week. As you've probably seen already, the nurse who doses you will typically apply a test known as the COWS. The main takeaway with these evaluations at the window is, bring the heat. Show up to that window sweaty, trembling, snot running down your face... you can even break down in tears if you're willing to take it all the way.

Anyway, your experience at 30mg Methadone is absolutely par for the course man. Almost nobody goes to the clinic on their first day and walks away with their habit under control. As you go up during your first week, you will get increasing relief. By the time you get to 60mg Methadone, I'm pretty sure you will be feeling better.

After the initial titration period, which typically ends at a maximum of 60mg Methadone, they will likely be able to bump you by 10mg Methadone at the very most every 5 days. This 5 day gap is supposed to be, "alright I'm stable, but let's test the water and go up as needed". If you're still dope sick, make sure you vocalize this to your prescriber and the staff.

Keep us posted dude. We've all got your back in this endeavor.