Opioids Methadone Mega Thread and FAQ

[Peanut21]

Liquid Methadone

sooo i got some and i have it in a glass cup and im saving it for when im sick and it seems to be dissipating (no no one is taking it i live alone) do i need to keep it refrigerated orr?

 

[ocpheend]

you dont need to keep it in the fridge but i would cover the glass or put it in some sort of closed container to prevent it evaporating, you wont loose drug from it evaporating though it will just most likely taste more bitter and it would likely take some time for it to evap to that point. dont worry itl all b gud. it does taste better cold though and i say that from experiance ive bin on methadone maintenance for almost 2 years now.

cheers.

 

[Captain.Heroin]

Unless you're injecting your methadone (and please, never do that) I am sure it will be fine.

How long do you want/need it to last, a week?

 

[Peanut21]

im saving it for a dry day where i have no $

 

[triiper]

the methadone is not evaporating, only the water inside. so youre not losing anything, you solution is just getting stronger

 

[brutus]

^ How would it be getting stronger?

Cover up the methadone or pour it into a bottle with a lid. Doesn't really matter where you keep it unless you plan on saving it for months, if so then put it in the fridge and avoid excess sunlight or heat.

 

[ocpheend]

i think by stronger he means as the water evaporates the mg/ml ratio gets higher on the methadone side, for example if it was a massive ammount and evaporated quite a bit it could possibly be 1.5mg per 1.0ml

cheers

 

[Captain.Heroin]

^ How would it be getting stronger?

Cover up the methadone or pour it into a bottle with a lid. Doesn't really matter where you keep it unless you plan on saving it for months, if so then put it in the fridge and avoid excess sunlight or heat.

Wiggi tied this up nicely. The question has been answered.

 

[Blackvinegar2]

hey whats up guys? Im sure you guys have seen me mention on other threads already, But I had a moderate black tar heroin habit (1/4gram daily), and got kicked out and everything. Well My dad forgave me, I got to come back home and exactly 1 week ago from today (wednesday) I enrolled at the local MMT clinic... Im very happy with the decision I made to get on methadone. I was worried it was going to be a bad decision, But I used to be on suboxone, and frankly I think methadone is a WAY better choice for me. Suboxone just wasn't effective in killing cravings for me, and it was WAY too expensive. Today I got raised up to 50MG's and its doing a decent job at "holding" me over... Kinda sucked tho, they only started me out at 20MG's the first day I went there and it barely held me over that day. But they can only start you out on 20MG's here in oklahoma I guess its the law. And you can only go up by 5 MG's each day. The awesome thing though is the clinic is only 10-15 minutes away from my house, and there was absolutely NO waiting list for me to get on. litterally I got there at 5am and was completely checked in and had my first dose in me walking out the door to leave at 8:00 AM that day. And it was $80 to start, and this includes a week of medication. And today I had to pay $55 for another week. So thats how much it costs and stuff, basically $55 a week if your on anything up to 100MG's, and its $65 a week for over 100Mg's. Im probably going to go up tomorrow, and ill probably keep going up till I get to around 60-70 Mg's.. Im really curious as to what dose you guys are on!!!! and how much is it for you guys, how far of a drive etc? Im really curious to know!

Matt

 

[gibby_420]

Congrats on your decision to do MMT Matt!

I've been on Methadone for about 5 years, starting MMT was probaly one of the smartest choices I ever made. Here in Ontario the clinics can start you at a miximum of 30mg and up your dose 5mg twice a week. I was not able to quit using dope completly until I was around 110mg, and ended up at 180mg by the time I was done climbing. This is where I stayed until November 2008 when I began to taper to the 50mg I'm at now.

Here in London there are two Methadone Clinics. One is a government funded public clinic and the other (the one I deal with) is a private clinic that also prescribes Suboxone as well. Luckily I have health insurance that covers my treatment entirely.

I you want to know how bad of habit I was dealing with check out Post#401 on Page#17 of this thread.

Best of luck with the MMT!

 

[CocksuckerNJ]

hey BV, congrats on being strong enough and admiting you need help. i also just started mmt and it's been 2 weeks since i started. i plan on staying on it for about a year cause it really takes care of the cravings for me. i haven't even craved for it since i started. and that's rare for me. to go 2 weeks without craving heroin. i didn't have that big of a habit, maybe about 6 bags a day. but still, i wanted to stop wasting my money and doing all the activities that come with the addiction of heroin. so right now i'm at 60mg and the clinic is about 4.5 miles away from my house. but i take a bus and i'm there in about 40 minutes. traffic is crazy here in nyc so that's why it takes so long. but over here, they are allowed to start at 30mgs and go up 10mgs a day. so it was quite fast to get up to the dose i needed. hope you hang in there man and give it time. i would suggest you also get some kind of therapy because most if not all addicts, use to fill a void. so maybe that would be another weapon to use to prevent you from relapsing. that's what i'm doing and i heard a lot of people advise this.

 

[splenda]

hey whats up guys? Im sure you guys have seen me mention on other threads already, But I had a moderate black tar heroin habit (1/4gram daily), and got kicked out and everything. Well My dad forgave me, I got to come back home and exactly 1 week ago from today (wednesday) I enrolled at the local MMT clinic... Im very happy with the decision I made to get on methadone. I was worried it was going to be a bad decision, But I used to be on suboxone, and frankly I think methadone is a WAY better choice for me. Suboxone just wasn't effective in killing cravings for me, and it was WAY too expensive. Today I got raised up to 50MG's and its doing a decent job at "holding" me over... Kinda sucked tho, they only started me out at 20MG's the first day I went there and it barely held me over that day. But they can only start you out on 20MG's here in oklahoma I guess its the law. And you can only go up by 5 MG's each day. The awesome thing though is the clinic is only 10-15 minutes away from my house, and there was absolutely NO waiting list for me to get on. litterally I got there at 5am and was completely checked in and had my first dose in me walking out the door to leave at 8:00 AM that day. And it was $80 to start, and this includes a week of medication. And today I had to pay $55 for another week. So thats how much it costs and stuff, basically $55 a week if your on anything up to 100MG's, and its $65 a week for over 100Mg's. Im probably going to go up tomorrow, and ill probably keep going up till I get to around 60-70 Mg's.. Im really curious as to what dose you guys are on!!!! and how much is it for you guys, how far of a drive etc? Im really curious to know!

Matt

Awesome, I'm glad you're happy with your choice to get on MMT matt! MMT was one of the best decisions I've made in regards to my addiction and getting my life back. I was a depressed mess before getting on MMT, using rediculous amounts of MSContin and was either doped up or withdrawaling every month. This went on for around 4 years so I thought that MMT would be good for me. At first I was a bit hesitant to get on methadone because of hearing all the naysayers who say 'it's liquid handcuffs' or 'bupe is better cuz methadone is sooo hard to get off of.' Well, after getting on methadone I couldn't be happier and don't understand why the naysayers say the things they do about MMT.... bupe never held me off very well and I've had the same experience with you in regards to bupe. I ended up shooting my subutex 8mg tabs because the cravings to 'use' became overwhelming where on methadone I don't have these cravings/problems anymore.

My clinic charges $81 a week for private pay, I pay every Monday. My intake was like $150 (the fee), and it has been $81 a week since then. There is no fee when going over 100mg (it's the same price) and I'm on 150mg because I had a pretty hefty habit in 2008 (taking 20-30x 100mg MSContins a day orally.) The drive in the morning takes about 30minutes round trip, 45minutes if there's traffic. 4 miles away from my house so it isn't too bad.

Good luck! If you get cravings to use or to double-dose your takehomes (if you get sunday takehomes, which most clinics have), increase your dose till you don't get the cravings anymore. The cravings for me to double-dose or to use stopped around 120-130mg, and I've been held off for a full 24-hours since 140mg. 150mg is comfortable and great for me now .

I started at 30mg and went up 10mg a day till 60mg, then after that I went up 10mg per week and got up to 150mg (where I'm at now.) I plan to stay on MMT for a few years at least because it has been a critical aide in helping to re-shape my life and actually have some 'real' stability in my life! I got my first takehome (besides sunday), which are tuesdays, last week. I'm hoping to get my 2nd takehome (including tuesday and sunday) later this month or early march. Hang in there!

I started on MMT last November.

 

[Princess_Poppy]

my intake was only $65, and they were cool and let me split it up since i was broke. that also included the first dose. it is 11 a day for liquid and 12 a day for wafers. i take the wafers. i am lucky, it is like a mile from my house! i can get there in 5 minutes oh yeah, i am on 50mg. i don't want to be on it long, so i didn't want to go up high. it would take to long to taper.

 

[splenda]

my intake was only $65, and they were cool and let me split it up since i was broke. that also included the first dose. it is 11 a day for liquid and 12 a day for wafers. i take the wafers. i am lucky, it is like a mile from my house! i can get there in 5 minutes oh yeah, i am on 50mg. i don't want to be on it long, so i didn't want to go up high. it would take to long to taper.

Nice to hear you're still going strong on MMT! How do you like it so far? I love it. I remember your MMT story because I remember we got on MMT at similar times, back last year early November-ish.

We only have methadose liquid (non-flavored/non-sugar one) at our clinic. They don't even offer the cherry flavored liquid, only non-flavored clear liquid. There's a super ghetto clinic in chinatown that gives out the wafers for takehomes but I prefer to not go there because of how dirty it is and because at that clinic people openly sell drugs outside of it The clinic I go to is in a business shopping center and is very professional and not ghetto at all which makes it very comfortable to go to. We only have two clinics here in Hawaii anyway.

 

[oliphill]

If, for example, someone was using about 1g heroin + ~20mg methadone daily, then they suddlenly switched to just 20mg methadone. Is it possible to fully adjust* to 20mg? How long do you think this process should take?

*adjust as in come to a point where 20mg daily holds the person fully, with no w/d symtoms, for 24 hours.

EDIT; Just found some good info on a research paper some people have written.

When the Dose Is Not "Holding" the Patient

A variety of complaints may introduce the case for more methadone, for example, "I wake up sick; I have a strong urge to fix; I am fixing." There are a number of reasons why the patient who was stable may be having problems in relation to dose.

Perhaps the most frequent cause is the ingestion of other substances, especially alcohol. Any drug that stimulates the liver's microsomal enzyme-oxidizing system may accelerate the metabolism of methadone. Barbiturates and other sedative-hypnotics may also produce this effect.

Specific drugs known to accelerate methadone metabolism, and at times, to precipitate AS, include rifampin (Tong et al. 1981), phenytoin (Dilantin) (Kreek 1978), and carbamazepine (Tegretol) (see table 4). A.J. Saxon (1989) suggested that valproic acid, unlike other anticonvulsants, has no effect on methadone metabolism. Although this opinion was based on only two cases, consideration of valproic acid would be justified when the clinician faces a choice between seizures or abstinence.

Inadvertent administration of opioid agonist/antagonist drugs can also precipitate AS by an entirely different mechanism (see table 4).

Environmental changes and other stresses can cause the patient to perceive that the dose is not adequate and to experience increased drug craving. Events that increase the availability of drugs, such as another addict moving in at home or a "connection" opening nearby, can intensify craving. Dose increases may be quite appropriate in such cases, although efforts should focus on resolving the offending situation rather than relying on more methadone. Conversely, diminished availability of drugs, as may occur in prison or jail, may diminish drug craving.

In the absence of medication or environmental contributions and polysubstance abuse in an apparently destabilized methadone maintenance patient, plasma level determinations should be considered. Figure 3 is an approximation of a typical 24-hour blood plasma curve based on established steady-state maintenance, with the zero-hour dose approximately 24 hours after the previous dose. The data for the figure are derived by averaging a series by Inturrisi and Verebey (1972) and one by Kreek (1973). Both series clearly demonstrated that the peak level is less than twice the trough level. This ratio is important for the clinician who is interpreting methadone blood plasma levels.

At present, 150 ng/ml is generally accepted as the lowest level that will maintain steady-state effect (Dole 1988). The optimum 24-hour mean plasma level may be more in the 400-ng/ml range (Goldstein pers. com. 1991; Kreek 1973; Tennant 1987; Wolff et al. 1991). Loimer and colleagues (1991) suggest that "methadone plasma concentrations of 400 ng/ml necessary to suppress any further opiate action and to provide stabilized maintenance." The optimum dose is the level at which there is adequate methadone to provide constant availability to the opiate receptors. The data for the lower curve in figure 3 are based on experience with an actual patient on 80 mg of methadone daily who persistently complained of waking up sick and having drug hunger. This patient responded to an increase in dose.

Figure 4 illustrates experience with a patient with low zero- and 24-hour methadone plasma levels with a peak that was within normal values but was high in relation to the very low trough levels. In the figure, the peak is more than three times the nadir and the absorption and elimination portions of the curve are much steeper, indicating a rapid change in state. In such a clinical situation, it is likely that the rate of change is as important as, or more important than, the numeric values themselves (see fig. 4).

If the dose is increased in an effort to bring up the 0-24-hour level, the peak level may be excessive, thus exaggerating the abnormal curve. Assuming that the cause for the rapid elimination is not apparent (drugs, urinary pH, etc.), a "split dose" may be indicated to avoid having the patient somewhat overmedicated for a few hours, feeling normal for a while, and still feeling bad or waking up sick later. Figure 4 shows the split-dose desired responses in two so-called "fast Maintenance metabolizers." In both cases, the total dose is the same as for a 24-hour period and the area under the curve is essentially unchanged. What changes is that both the low nadir and the high peak are eliminated, resulting in a smoother clinical response associated with from the flattening of the curve.

Excretion of methadone via the kidneys is pH dependent. Studies have shown that by altering the pH from very acid to very alkaline, half-life of methadone may vary from less than 18 hours than 40 hours (Nilsson et al. 1982). The clinical significance of more modest variation in urinary pH has need anything else for pain. This is not been demonstrated but probably deserves attention in evaluating the patient who is not getting a 24-hour effect from the methadone.

Perhaps the most frequent cause is the ingestion of other substances, especially alcohol. Any drug that stimulates the liver's microsomal enzyme-oxidizing system may accelerate the metabolism of methadone.

This is perhaps my problem. I've started drinking about a bottle of wine a night since I first started on solely 20mg methadone. I had a big feeling I was metabolising the methadone too fast. So perhaps it's time to kick the drink for a bit. Or is 20mg just too low to 'adjust' to?

 

[Cloud_9]

OK... so two prescription pick-ups ago (for chronic pain not MMT) I ran out after about 13 days on a 14 day prescription and by some bug they jumped the date of next pickup forward 4 days for some reason and my doctor who normally prescribes it wasn't even on staff for the Friday before and the week after when I was supposed to have it picked up on Monday, and the covering doctor didn't script it, so I am now more or less zeroed back and after 7 excruciating days I was able to pick it up and I began to experiment with how much I would need to even catch a buss. In short, it was about 280mg taken all at once via plugging, and even that was a mild nod if anything. I've since ran through 2 week's worth in a week and am actually feeling awesome since after a week zeroing back down to nothing and then using enabled me to use shitloads and not really have any withdrawal after 5 days of using 220mg a day at the minimum, so would anyone know just what a roundabout dosage I should just start off with once I get the script filled this coming Monday? This would be for someone who has spent about 4 years at nothing less than 60mg and nothing more than 120mg prescribed, with most of that time around 90mg, with the current past script up for 100mg a day. Would being off for over a week have only a slight effect at best like after going through withdrawal hardcore or will it just be like after the 7 days in withdrawal and picking it up, and flabbergasted as to why I needed 300mg to catch a nod?

PS: METHADONE WITHDRAWAL IS AWFUL! I've never had to fully go through it until last week, but I had enough of the new bensodiasepene that's hitting the grey market (not gonna tell people for fear they burn it out before it gets to shine) and 500mg with a dosing interval at 0.5mg will let you know how I spent the majority of my time in withdrawal. I guess I cheated a bit, but I've been about 5 days in and that's when acute withdrawal just starts to get unbelievably bad in the past, so I wasn't going to go down that path which had me in the ER with a bitch of a doctor saying "YOU USED UP WHAT YOU HAD TOO FAST! IM NOT GIVING YOU ANY" as I sit there trying as hard as I can to look somewhat presentable and refrain from mid sentence screams and those oh so fun random movements that you are forced into. Most every time I've been in the ER for something like that I just got slammed with "YOU JUNKIE SCUM FUCK FACE" stink-eye even though I don't take it for MMT like all the other junkies they must see about a similar subject matter. Luckily the time I accidently took 300mg of oxycodone about 8h before 24mg of suboxone and was in EXTREME withdrawal worse than anyone should ever feel, I was given IV hydromorphone and ativan at 8mg/4mg(?) in a IV they needed to have on me the second I came in because even 45m into everything I was dangerously dehydrated. Once the lorasepam and hydromorphone kicked in I was somewhat better (on top of the 50mg of diasepam I had in the backup junkie drawer for a bad day, and this was a MONSTROUSLY bad day to say the least) and was able to shoot shit with the nurse that just came on after the nurse who gave me the last shot of her shift. I was absolutely sure he was spun as fuck on amphetamine, because his pupils where lol-tastically large, even in those 1000 watt fluorescent tube bulbs they have in rows of 4 with reflectors built into the skylight to keep the ER daylight fresh! After about 2-3hours I was more or less baseline and the cool young dude who was my nurse was like, "well, we don't want you to drive without fluids, so I'm just going to raise this IV drip to the second floor to make it go faster!" He came back 15m later and was kinda pissed that the 2/5ths left from when he made the IV bag line super-hilariously high (higher=more gravity pressure) was still not done draining and just squeezed it to the point just before my vein would blow out, and got about 500ml of saline in me in the time it would take for 75ml! No more cool ER tales though for today, need to get cracking on an all-nighter.... oh amphetamines, what would I be without my favorite medication!

 

[Pegasus]

If, for example, someone was using about 1g heroin + ~20mg methadone daily, then they suddlenly switched to just 20mg methadone. Is it possible to fully adjust* to 20mg? How long do you think this process should take?

*adjust as in come to a point where 20mg daily holds the person fully, with no w/d symtoms, for 24 hours.

EDIT; Just found some good info on a research paper some people have written.





This is perhaps my problem. I've started drinking about a bottle of wine a night since I first started on solely 20mg methadone. I had a big feeling I was metabolising the methadone too fast. So perhaps it's time to kick the drink for a bit. Or is 20mg just too low to 'adjust' to?

I find that many people have this issue of their dose wearing off too quickly when they become adjusted to it. IME, the expectation from the literature creates a false hope that the dose will work strongly throughout an entire day, when that just isn't the case (typically). The drug is going to wear off to a noticeable degree no matter the dose. There are certainly some people that adjust to doses better than others, but there is still undoubtedly a pattern of people raising their dose, staying satisfied for a short time, and shortly thereafter feeling that they need more to last throughout the day.

That said, I don't feel that raising your dose slightly is a bad idea; if you are getting uncomfortable late in the day, a slight increase may work well for you. I just feel I should warn you about repeatedly increasing your dose, since it progresses just like I described above very frequently. This is how most people end up at the very high doses often discussed on here.

Since you were using heroin on top of your methadone, you also are probably having a bit of uncomfortableness from the differences between methadone and heroin. I don't think this is too much of your issue though, because of everything I described above.

 

[oliphill]

^Thanks for your help mate.

On raising the dose, I really wanna get off this stuff for good within the next month. So the idea of raising it just seems like it will make it worse in the future.

I was dead set on switching to subutex, but I've been having second thoughts considering i'd have to go 48hrs to 72hrs with nothing before the switch. People on here suggested a short acting opiate in between, but i can't get my hands on anythng and the doc is unwilling to help in that respect. And I definately dont wanna use junk as i know too well how that will end up..

hmm, i really really dont know what to do. Would love to get funding for a rapid naltrexone/sedated detox, fingers crossed.

anyway we'll see..

cheers for ur help

 

[Eight0Eight]

People on here suggested a short acting opiate in between, but i can't get my hands on anythng and the doc is unwilling to help in that respect.

Methadone>Codeine>Subutex

Switching to codeine for 5-7 days before switching to Subutex will make it a lot easier.

I have switched from heroin to codeine for 3-4 days, before going to subutex - and it was *SO* much easier. The subutex gave me instant 100% relief of WD.

When I went from heroin straight to subutex it would take 4 days before I could even sleep or eat.

 

[oliphill]

Methadone>Codeine>Subutex

Switching to codeine for 5-7 days before switching to Subutex will make it a lot easier.

I have switched from heroin to codeine for 3-4 days, before going to subutex - and it was *SO* much easier. The subutex gave me instant 100% relief of WD.

When I went from heroin straight to subutex it would take 4 days before I could even sleep or eat.

Hmm. Does seem like a good idea. Dihydrocodiene maybe?

I have found a comparison that states 2.5mg methadone = 30mg DHC.

So say I wanted the equivilent of 20mg methadone a day. How would it work, take 240mg DHC a day spread out or all in one go? If I split it to 4 doses of 60mg DHC, would the 60mg 'hold' me ok?