methadone, buprenorphine and other opioid pharmacotherapies

[Crankinit]

Yeah I'm not sure if the price makes sense for 'hi' [sign form] [hand over strips/pills] 'have a nice day.'

But I guess who's going to do anything about it? Drug users are an easy target as it is, and the pharmacies or clinics or whoever have all the power in the relationship.

 

[Methadonia2010]

edited ...

^ (Cranky) I don't know for sure, but I spoke to my bupe doc about the price as like I said, mine is at the high end price wise. He said that it's upto the pharmacy to set the price, and he said that as I'm getting 5 takeaways a week there's really no reason for it being so high, which suggests to me that the price is a dispensal fee, to cover the time it takes the pharmacist to give you your dose.

Which bugs me it seems there's no set price with dispensing, it's up to each Pharmacy. I would rather see a sliding scale, or depends on the persons financial position. I know there is some paper work, but if a pharmacy has X clients and its turning over a good profit, surely those who don't work can pay less. Ive heard interstate it's very high , i couldn't afford to be on it. The Uk / Canada have Gov covered dispensing.

 

[Methadonia2010]

Sorry Methadonia I've had to remove all the prices in your post to conform with our guidelines here. We don't allow prices for anything to be posted.

I hear what you're saying though, I'm paying the max you had listed there, and it's definitely a considerable expense for a poor student like myself.

No problem that's ok I wasn't Aware . I hope it can be changed one day, I know a few were behind it few yrs ago, Thats it students/Pensioners/Unemployed it's a big chunk. My idea would be Federal funding to the Pharmacy' for it, and 2nd place perhaps a set fee like normal scrips $5 per month.

 

[Stato]

I'd been addicted to Codeine in high doses ever since my doctor decided I didn't need xanax anymore, was using up to 1gram of dihydrocodeine and 1.5 grams of codeine (often at the same time) nearly ever day.

I sought help and found a private prescriber who put me on 8mg suboxone film daily, which was great for the first month... I was able to abstain from opiates no problem, dosing every day @ 8mg... (YUCK suboxone tastes terrible)...

My last appointment fairly recently had me bumped up to 16-32mg (I can choose a dose range daily) and 3 takeaway doses a month.... I lasted 2 weeks and relapsed on wednesday night after not dosing suboxone since saturday night.... I had an imperial pint of rikodeine. (1x 200ml, 3x 100ml @ 19mg/10ml dihydrocodeine). I remembered how awesome opiates are and it was very apparent how the suboxone was not doing anything for the cravings (just my weak mind in that department).

Phoned my doctor up yesterday, he put me on 40-80mg of methadone after a short discussion on how I was spitting the suboxone out, and how my first really good sleep was when I relapsed, how I woke up with energy and was able to spring out of bed and go to work, instead of crawling out sick as a dog (often vomiting each morning from the morning sickness).

... So I had my 40mg methadone yesterday, a brown syrup (5mg / ml ) which put me at a measly 8ml of liquid to swallow (apart from rinsing the cup with water)....

40mg of methadone was a slow onset, slightly slower than dihydrocodeine/rikodeine (methadone being around 3 hours to feel peak effects, rikodeine being about 2 to peak). I took it at 7pm last night and it's 8AM now, my pupils are still constricted, I still had slight itches... most importantly I slept really well and just like codeine I woke up and was able to spring out of bed early and get to work and feel absolutely refreshed and not sick in any way.

The scary thing is that methadone had everything the rikodeine high had, except it lasts longer. I can see why It's referred to as liquid handcuffs. Has anyone else gone off their codeine/smack/oxy/dhc/morphine/etc and switched to suboxone or methadone? At this moment in my life I feel that methadone will meet my needs in terms of cravings, withdrawals and my wellbeing... I've got a few months before I even consider coming off methadone.

Sorry to derail to methadone treatment but I'm specifically interested in codeine/dhc and whether the replacement therapy has helped anyone here long term?

 

[Sustanon]

Ive been thinking of going onto maintenance. How does it all work? Are there any doctors in Western Sydney that can prescribe suboxone without having to go to a clinic? I dont mind dosing at the doctors or the pharmacy / dispenser or however it works. Trying to kick a nasty 3-4 year habit of codeine + dxm and heroin habit (with occasional pharm abuse)

The clinic that is 5 mins from me is public and the waiting list is years, I dont mind paying for it either I just dont want to go to any clinics and sit there with the hardcore users whove been in and out of jail etc etc. Makes me feel really uncomfortable. My usage has been secretive anyways so id like to keep it that way. I called the opiate hotline and got a few numbers of private doctors but none of them answered there phones?

There are a few private clinics roughly 30-4 mins from me, now I know so many people travel enormous distances just to get there medication although im working extremely long hours and there are days where I start and 7am and finish 9pm so I have no time to get to a clinic. Im only free about 3 days / week where I could go in. i dont ant to seem like a drug seeker or doc shopper by asking take aways right away but I definitely cannot attend daily like the hotline suggested me to. How do u guys do it who hold full time jobs working such long hours? Can u tell them which days ud like to go in to get ur meds, councelling etc? Thank you to anyone who could help me out.

 

[footscrazy]

^ I found my doc just by going to a gp, and she referred me. Of course, you should also check out the Australian Opiate Withdrawal Maintainance Medication Prescribers thread, could be useful. The hotlines can be helpful too, I'm not sure if it's called direct line in NSW but there would be something similar (or maybe that's what you called). Actually, I found this here:

Alcohol and Other Drugs Information Service (ADIS)

A confidential, anonymous information, advice and referral service. For information about drugs, including methadone, safer injecting advice, parent advice and detoxification. 24 hours a day, 7 days a week- (02) 9361 8000 or toll free for country areas on 1800 422 599

I'm really glad I went through a doc and not a clinic because straight away I got 7 days takeaway, and going to the chemist just once a week made it convenient. Plus I was given a list of heaps of chemists which I could choose from, probably about a hundred all over Melbourne, so it was easy to find one close to me. I imagine it'd be pretty similar in Syd. My doc was pretty cool with me, he wasn't condescending at all and gave me responsibility straight away, which I appreciated - I would've hated being treated like a low life junky at a clinic.

Stato, may I ask why you were bumped up to 16-32mg from 8mg? It seems like such a massive dose. Was it because you were getting cravings? I often think that doctors way overestimate the amount of bupe or methadone someone needs; I've found even after a couple weeks straight on heroin I don't need more than about 3mg bupe to hold me. But then again, I believe the amount that holds cravings at bay is quite a bit higher than the amount which will simply hold you from wd's. But, I also think docs/chemists have a vested interest in putting people at higher doses, so they stay on maintenance for longer and keep paying for it. I recently rang my pharmacist to stop picking up my bupe and I could tell how disappointed she was losing a cash cow like me.

I'm in two minds about using maintenance after using mainly codeine/dhc, especially when it's such high doses like you've mentioned. I feel that you're raising your tolly massively and potentially putting yourself in a worse position than where you started - and resigning yourself to a very long taper or else much worse wd's than codes if you try to do it cold turkey. I also think that maybe too much is expected of maintenance sometimes; my opinion is that deciding to go on maintenance is a big decision pretty much equal to quitting - you're deciding that you're not going to get high every day, which ultimately, I think, is the biggest thing when it comes to quitting an addiction. It's not an easy step for sure and it's why I keep alternating between bupe and using every day.

Then again I know there are some benefits from going on maintenance - buying your opioids legally (or not having to visit a shitload of chemists) as well as probably being easier to taper than an opie that gets you high. Ultimately everyone should be able to choose what treatment they want too, and I can respect that...I just think, perhaps, that doctors and chemists are not promoting the most helpful solution when maintenance is promoted in every situation, and raising your dose is hardly ever warned against.

I don't know if you remember or saw this thread Stato, but it describes someone going from codeine to bupe then methadone, and I think it really documents how going on maintenance can really make life a whole lot worse for someone. The OP was also, I think, searching for maintenance that met his needs in terms of cravings, wd's and wellbeing, but that search instead just led to him making things worse and worse for himself, with ever increasing doses of bupe then methadone in search of a something I'm just not sure it's reasonable to expect of maintenace. My 2c anyway. I hope it works out for you.

 

[Stato]

Stato, may I ask why you were bumped up to 16-32mg from 8mg? It seems like such a massive dose. Was it because you were getting cravings? I often think that doctors way overestimate the amount of bupe or methadone someone needs; I've found even after a couple weeks straight on heroin I don't need more than about 3mg bupe to hold me. But then again, I believe the amount that holds cravings at bay is quite a bit higher than the amount which will simply hold you from wd's. But, I also think docs/chemists have a vested interest in putting people at higher doses, so they stay on maintenance for longer and keep paying for it. I recently rang my pharmacist to stop picking up my bupe and I could tell how disappointed she was losing a cash cow like me.

So I was on 8mg daily for a month, and like I said got bumped up to 16-32mg because I explained that It's extremely hard for me to be on home detention and working full time, as well as having to schedule trips to the chemist daily.... via corrections. So the doctors reasoning to me was that he would increase my dose which should (in his mind) fend off cravings and allow me to regulate my doses down to 3, maybe 2 doses a week. This was definitely the case.... and I was happy to do so because the stuff tasted fucking terrible.... and even worse when you have 16mg shoved down your throat as a minimum. It was alright when I got my takeaways though because I could get 32mg if I wanted.

I'm in two minds about using maintenance after using mainly codeine/dhc, especially when it's such high doses like you've mentioned. I feel that you're raising your tolly massively and potentially putting yourself in a worse position than where you started - and resigning yourself to a very long taper or else much worse wd's than codes if you try to do it cold turkey. I also think that maybe too much is expected of maintenance sometimes; my opinion is that deciding to go on maintenance is a big decision pretty much equal to quitting - you're deciding that you're not going to get high every day, which ultimately, I think, is the biggest thing when it comes to quitting an addiction. It's not an easy step for sure and it's why I keep alternating between bupe and using every day.

Yeah, the thing that ultimately had me turning to maintenance was my life situation and the fact I was using Opiates to help my depression and anxiety, and that I am drug tested on home detention bail.. so therefore If I am tested and show high morphine levels or heroin or anything else I'm done for... That's a pretty big motivator. plus the $40-50 per dose habit was pretty substantial and I was leaning towards smack and the needle.... $40-50 per day and I was unemployed at the time. -- So that's what drove me to maintenance, and what drove me to methadone from suboxone was me calling up my doctor and advising him I was quitting the suboxone cold turkey and going back to other opioids, as in my mind after a relapse drinking over an imperial pint of rikodeine felt fucking amazing... I had the best sleep in a long time, I actually got high (abstained from sub for 3days), my anxiety faded and I woke up refreshed, no aches and pains like I'd been getting on suboxone trying to do a 2-3 weekly dose.

I very much do want to quit, I'm holding a white collar IT job, working full time, but it's a lot easier for me to manage the issue now (Legally) than risk getting thrown in gaol for breach of bail and/or turning to the needle.

I should mention I was obtaining US 30mg IR oxy's and heroin on occasion (smoking, snorting and I prepped a few shots for IV but never succeeded due to my vein structure and visibility). So prior to suboxone those were a part of my problem too, along side poppy seed tea, often I'd use up to 1.5kg of poppy seeds with 600mg or 1200mg codeine (2x mydol boxes) and/or even rikodeine on top. I had a reasonable sized problem, and I have experienced withdrawals from trying to stop the suboxone I was on.... I threw up on the bus to work and had to pull a sick day and go and dose suboxone.

I don't know if you remember or saw this thread Stato, but it describes someone going from codeine to bupe then methadone, and I think it really documents how going on maintenance can really make life a whole lot worse for someone. The OP was also, I think, searching for maintenance that met his needs in terms of cravings, wd's and wellbeing, but that search instead just led to him making things worse and worse for himself, with ever increasing doses of bupe then methadone in search of a something I'm just not sure it's reasonable to expect of maintenace. My 2c anyway. I hope it works out for you.

I'll read that thread now, just reading the title I can say I was blown away from suboxone when I first had 8mg...I was semi high.... and now I'm blown away from methadone @ 40mg after being on 8mg suboxone. (Yes, my dose is 16mg but after a few days of that I used my 3 take aways @ 32mg so I could just take suboxone as needed.... still Have like 9 strips in the fridge, heh)

Methadone definitely gets me high, just like rikodeine, except with a long half life and not having to drink 600-1litre of liquid is good.... It's good feeling high, now I know why they call it liquid handcuffs. Suboxone did not have that feeling I just couldn't stand the stuff... It made me sick.

 

[Stato]

I can't believe that thread! going to 16mg suboxone from a 400mg codeine habit?! Wow. I really wish it were legal to treat opiate addiction with shorter lasting opiates, It'd make withdrawal a cakewalk compared to methadone and suboxone because of the shorter half lives on drugs like heroin.... so for those who actually want to see themselves OFF the stuff, it'd make it easier to tolerate...... but for those abusers and people who are unable to quit, there'd be abuse of the meds as they'd need to be taken unsupervised at some stage of the day due to the half life.

 

[cassandragemini]

I'd like to see extended release morphine available as an option like in parts of Europe. Also having the option to be able to do a short taper on 30mg codeine pills when coming off 'done/bupe/morphine or as a taper (like a rapid bupe taper) instead of going on a program at all could be good.

 

[cassandragemini]

Also stat it's not the high that earned methadone the nickname 'liquid handcuffs'. I'm glad things are working out for you at the moment man, it's a big relief when your addiction's not ruling your entire life eh. Be wary with methadone though, it's no miracle cure. Codeine and heroin withdrawal is rough but has nothing on what you will go through coming off 'done, that stuff is in a league of it's own.

 

[Crankinit]

I'd like to see extended release morphine available as an option like in parts of Europe. Also having the option to be able to do a short taper on 30mg codeine pills when coming off 'done/bupe/morphine or as a taper (like a rapid bupe taper) instead of going on a program at all could be good.

Yeah this would be an excellent step forward. I don't think it's totally off the table over the coming years, the Howard goverment tried to push through a heroin maintenance trial in the 90's, but America threatened them with all sorts of nastiness if they did so they pulled it off. Now that we live in a different world with a much less black and white view of drugs, where outright opposition to the War on Drugs is growing commonplace, I could see it happening within the next decade or two if someone organized a push for it.

Australia has in the past, in a lot of respects, been fairly cutting edge when it comes to treating opioid dependence, it'd be nice to see us catch up to Europe again and get to the cutting edge of drug policy as we move into a post-WOD world.

 

[Sustanon]

I used to say the same thing about codeine, if someone switches from codeine to bupe its a much safer option IMO as Ive realized. Im also using a lot of smack but would love to get off codeine so I dont slowly kill myself and for various other reasons. I have never used methadone but from what I heard its extremely addictive, nothing like bupe though.

 

[Stato]

Today I went up to 50mg, with the dose startng at 40mg on thursday.

I have to admit I'm fucking SMASHED. Nodding quite hard.. Took me 23 minutes to type this post.

I'm going to take it up to 55, 60 and then see how the effects feel my script allows me to go up to 80mg if needed/wanted. counter producit. All I know is it's making me feel great (less undesirable effects).

My doctor had thoughts of treating me as a pain patient instead of maintenance, I wonder if he'll bring it up again and what he might have n his mind.

 

[Sustanon]

How serious was ur opiate habit? Ur tolerance must be through the roof like no one else on here. Ive only had bupe a few times here n there recreationally and 2mg got me a nice high, 4mg and I was nodding nearly. I stopped usually at about 3-4mg as it made me feel quite sick. I did crush and rail it so Im not sure if that is what may have caused it.

 

[Stato]

Holy crap, apologies for the above post... I was nodding quite hard and therefore it doesn't make much sense!

My opiate habit was 30mg IR Roxicodones, up to 100mg per dose, once in a blue moon.... - Daily was at LEAST 1200mg codeine + Rikodeine (380mg dihydrocodeine) on top... at least/minimum.

I was blasted for 3 days on the suboxone 8mg after transferring to it when i stopped my use. Not in a good way, just disorientated.

As of now I'm on 50mg methadone, which is great... just a simple drink it down and walk out and go about my day. . Easy, Qick and effective.

 

[footscrazy]

How serious was ur opiate habit? Ur tolerance must be through the roof like no one else on here.

Well, if it wasn't before, it is now Stato, give it another week or two and you'll probably never get high off codeine/dhc again. At least not without a massive break.

To get high off bupe, to even feel it, requires a low tolerance. In my opinion if you're able to get high off bupe, there's no need to be on any more than 1mg max a day. Bupe is most recreational at low doses, because it's likely that a metabolite of buprenorphine, norbuprenorphine, is more recreational, being a stronger agonist than bupe. Taking less than 1mg bupe that will mean there are more open mu receptos for the norbuprenorphine to bind to. If you take more than 1mg, all the receptors will be blocked by bupe by the time you've metabolised norbuprenorphine.

I think it's so unfortunate that the only treatment offered to opioid addicts is methadone or bupe, as if it's a one size fits all approach. When it comes to people using for the most part opioids such as codeine or dhc, I think maintenance will in a lot of ways make their situation so much worse. Even 8mg of bupe will raise someone's tolerance enough in a couple of weeks that they're extremely unlikely to get effects off codeine or dhc in the foreseeable future. I think, then, that the addict who starts on maintenance with a lower tolly, and who still wants to get high, is encouraged to seek out stronger opioids - they now have to, if they want to feel anything. Unfortunately, for someone who wants to get out of black market opies, it's the only option, but I think the negatives of maintenance are understated whilst the benefits are overblown. I think maintenance is sometimes built up to be a replacement of someone's daily opioid in all respects, when in reality, it's not going to be anything like that, at least in the long term. Maintenance is pretty much quitting - it's choosing not to get high anymore, it just prevents the physical withdrawal.

 

[cassandragemini]

^ I totally agree.

Bupe and methadone are two completely different monsters, apart from both having insane half-lives. (or is it half-life's?) It's been a while since I failed English. Stato I would recommend trying to stay on as low a dose of 'done as you can, within a month or two you won't really be getting high off it at all at any dose and believe me it's a bitch to taper on, even dropping small amounts especially at lower doses can have you in god awful withdrawal for the couple of hours before you can get to the chemist to dose. I can't stress that enough, it's not worth what you're getting out of it now.

Sus do you guys have directline in NSW? I'd recommend giving a service like that a call (like what footsy posted) and talking through your options. I can help you out with any questions if you want to pm me. OST and everything that goes with it can be confusing and tricky and there are definitely some things that you would want to know before you take the step.

 

[full of opiates]

Could anyone please offer me advice?

I'm on prescribed pain meds because I need an operation. I've gone from codine, to tramadol, to bupe, to Oxy (contin & norm), then to Fent patches (up to 100mg). When that stopped working, I was changed to Jurnista (slow release hydromorph), which I started at 80mg daily but then decided I need to cut back cause they were messing with my head too much.

So during the past 3mths, I have worked my way down to 32mg daily. My problem is, a few months ago, I discovered how to IV the jurnista & now I can't go more than a day (2 max) without IV'ing at least half of my dose & taking the rest orally.

I did manage to go a couple of weeks without IV'ing but I felt terrible & unable to function every single day. So I am IV'ing again. I know it is not healthy but nobody knows my secret & I am stuck. I'll be having the operation soon & I'm worried about my IV habit. I can't seem to quit it on my own.

Should I be considering talking to my gp about a maintenance program? I'm worried he will stop or cut back my pain meds if I tell him I've been IV'ing them & I can't stand the thought of going back into that zombie state where I can't function. Is there some way I could get help with this without my gp knowing?

Sorry for the long post but I could really use some advice.

 

[Christ!]

I'd love to see a study done on the effects of bupe/methadone maintenance on people who have smaller habits. Would be very interesting to see the long term functioning of some of these people who end up on a huge dose for a codeine habit or similar. I think it can be really detrimental and there needs to be some awareness.

Bupe at high dose dropped lots of my cognitive function scores after a year of being on it. Social life suffered (always feeling tired after work, just 'couldn't be bothered' lots of the time), my interest in music dropped (which has come back since getting off). There's no doubt maintenance can be a life saver for lots of habitual opiate users, but people need to be made aware of what they're getting themselves into - and I don't think there's much of that currently.

Not sure about your question full of opiates. Someone will be able to give you some advice, hang tight

 

[tentram]

ATODS(government funded), detox/rehabilitation program or another private GP who specialises in maintenance (either bupe or methadone) is the only way you can own up to your problem without your current doctor knowing. the only way he can find out are if you give permission for the files be transferred to him for one reason or another. it's worthy noting that if you visit ATODS (Alcohol Tobacco and Other Drugs Services) they keep it on your file.