Opioids Methadone

[Anthonysymington1967]

Hi, I’m on 30mg methadone a day , I use to do upwards of 900 mg DHC dihydrocodeine a day , my question is would the 30 mg methadone block the DHC? If I did use DHC on top of methadone how much less should I use? Any advice would be appreciated , thanks

 

[Nicomorphinist]

My one experience with this was when I was on Codidol (DHC 120 mg x4) around the clock for chronic pain and was given levomethadone (Polamidone) linctus for a violent dry cough . . . there are different effects which this family of open chain opioids block -- if you are looking for a rush from chewing the DHC tablets, I am not sure if the blockade could be safely overcome simply because of the relative affinity for the mu receptor of the two opioids. If it were me, I would titrate the DHC up from zero 15 mg at a time to see, for example, when the nod sets in. Additive analgesia can happen -- this because the very definition of a full opioid agonist is that it need occupy no more than 20 per cent of the opioid receptors to have a maximal effect, so you should have several million receptors ready and waiting for that DHC.

Speaking of the blockade, buprenorphine would scare the bejesus out of me because if someone does a bunch of oxycodone or anything else trying to overcome the blockade, there is the extreme affinity of buprenorphine for opioid receptors. They really need to approve diprenorphine, the preferred antagonist for the bridged oripavine derivatives, for human use because in a case like that, naloxone may not cut it.

Come to think of it, the Polamidone experience was right around the time the doctors switched me from IR codeine and ER DHC to ampoules of dihydromorphine and MST-Continus, so maybe the blockade was a bigger thing.

 

[Anthonysymington1967]

My one experience with this was when I was on Codidol (DHC 120 mg x4) around the clock for chronic pain and was given levomethadone (Polamidone) linctus for a violent dry cough . . . there are different effects which this family of open chain opioids block -- if you are looking for a rush from chewing the DHC tablets, I am not sure if the blockade could be safely overcome simply because of the relative affinity for the mu receptor of the two opioids. If it were me, I would titrate the DHC up from zero 15 mg at a time to see, for example, when the nod sets in. Additive analgesia can happen -- this because the very definition of a full opioid agonist is that it need occupy no more than 20 per cent of the opioid receptors to have a maximal effect, so you should have several million receptors ready and waiting for that DHC.

Speaking of the blockade, buprenorphine would scare the bejesus out of me because if someone does a bunch of oxycodone or anything else trying to overcome the blockade, there is the extreme affinity of buprenorphine for opioid receptors. They really need to approve diprenorphine, the preferred antagonist for the bridged oripavine derivatives, for human use because in a case like that, naloxone may not cut it.

Come to think of it, the Polamidone experience was right around the time the doctors switched me from IR codeine and ER DHC to ampoules of dihydromorphine and MST-Continus, so maybe the blockade was a bigger thing.

I was just wondering at what dose does methadone start to block other opiates , I was told it’s not really till after at least 50mg

 

[Nicomorphinist]

I was just wondering at what dose does methadone start to block other opiates , I was told it’s not really till after at least 50mg

That is what I have heard, with 60 mg also being a common figure -- what is mainly blocked is the rush (rapid, often histamine release enhanced physical effect of a narcotic shot) and/or the bang, which is the rapid increase in euphoria. Were methadone a partial agonist which needs 75-100 per cent of the opioid receptors to work, the situation would be a lot worse.

I suppose that synchronising your doses so that you are taking the DHC 30 minutes before your methadone is due could improve things if I read the question aright.

The antitussive and analgesic duration of action for methadone are more on the order of 4 to 9 hours rather than the 15 to 36 that it can suppress withdrawal symptoms, so that may be something with which to work.

Are you at 900 mg of DHC per 24 hours now, or wondering how to work back towards it? Is the methadone for pain control, maintenance, or both? If it is maintenance or detoxification, as I described in another thread, extended release DHC is being used more and more as an outright replacement for methadone in a number of Central European countries, and the tablets used, like MST Continus (morphine hydrochloride ER) have the advantage of producing a rush and bang if they chewed and washed down with Coca-Cola for example, a possible cure for sudden craving episodes, meaning that a second script for IR morphine, dextromoramide, ketobemidone, or smack is not always needed for all of the patients.

 

[Anthonysymington1967]

Th

That is what I have heard, with 60 mg also being a common figure -- what is mainly blocked is the rush (rapid, often histamine release enhanced physical effect of a narcotic shot) and/or the bang, which is the rapid increase in euphoria. Were methadone a partial agonist which needs 75-100 per cent of the opioid receptors to work, the situation would be a lot worse.

I suppose that synchronising your doses so that you are taking the DHC 30 minutes before your methadone is due could improve things if I read the question aright.

The antitussive and analgesic duration of action for methadone are more on the order of 4 to 9 hours rather than the 15 to 36 that it can suppress withdrawal symptoms, so that may be something with which to work.

Are you at 900 mg of DHC per 24 hours now, or wondering how to work back towards it? Is the methadone for pain control, maintenance, or both? If it is maintenance or detoxification, as I described in another thread, extended release DHC is being used more and more as an outright replacement for methadone in a number of Central European countries, and the tablets used, like MST Continus (morphine hydrochloride ER) have the advantage of producing a rush and bang if they chewed and washed down with Coca-Cola for example, a possible cure for sudden craving episodes, meaning that a second script for IR morphine, dextromoramide, ketobemidone, or smack is not always needed for all of the patients.

the methadone is for maintenance to stay off the DHC , I was just wondering what I could get away with DHC wise ok top of the 30mg methadone that would give me a wee buzz but also be safe

 

[Anthonysymington1967]

Th

the methadone is for maintenance to stay off the DHC , I was just wondering what I could get away with DHC wise ok top of the 30mg methadone that would give me a wee buzz but also be safe

Oh and the 900mg DHC was purely recreational, started low and rose over 16 years ?

 

[Nicomorphinist]

Th

the methadone is for maintenance to stay off the DHC , I was just wondering what I could get away with DHC wise ok top of the 30mg methadone that would give me a wee buzz but also be safe

That actually sounds quite plausible, and if it were me, I would try titrating the DHC dose a little at a time starting from zero or as low as you can go. You can always take more medication, but taking less after the fact generally requires things like gastric lavage and dialysis. A lot of the DHC potentiators also help out methadone quite well, with cyclizine and hydroxyzine being ones commonly used by doctors for exactly this purpose. Diazepam used to be big too, but the FDA and European Medicines Agency both put out warnings in 2010 about concomitant use of benzodiazepines and narcotics increasing the risk of falls.

Dihydrocodeine also has one metabolite 100 times stronger than morphine, so Cytochrome P450 II-D-6 and perhaps III-A-3 come into this as well, so maybe promethazine or grapefruit juice could make a difference with both the acute effects of the methadone and the effects of the DHC. You can also tweak the duration of action of the methadone by altering systemic pH -- it lasts longer with antacids and is eliminated more quickly with Vitamin C, lemon juice, vinegar &c.

The DHC was a problem, then? Do the doctors know it can be used as a replacement for methadone and is probably better for the heart in a lot of people? Depending on the locale, you may also have the option of replacing both drugs with extended-release morphine or even a six-month hydromorphone polymer implant and/or Norplant-type device.

 

[Anthonysymington1967]

I’m sure they do but they just won’t use it that way over here , I’m in uk, not sure where you are

 

[Nicomorphinist]

I am in Austria and I believe the DHC and MST Continus maintenance methods were invented here, about 20 years ago, I think by the same U of Vienna/Allgemeines Krankenhaus crew that invented Rapid Opioid Detox in the 1980s.

Is the DHC you are taking the extended-release waxy tablets, the Paracodin linctus, or tablets like DF-118?

 

[Anthonysymington1967]

It’s the plain DHC 30mg so more like the DF-118 as in there’s nothing mixed in with them. I just wanted to check there would be no major harm if for example I took my 30 mg methadone and then maybe at most 300mg DHC , or at least know what to expect if there was going to be too much harm. Obviously I wasn’t going to take 30 mg methadone and then take 900 mg DHC like I used to , that be mad

 

[Nicomorphinist]

It’s the plain DHC 30mg so more like the DF-118 as in there’s nothing mixed in with them. I just wanted to check there would be no major harm if for example I took my 30 mg methadone and then maybe at most 300mg DHC , or at least know what to expect if there was going to be too much harm. Obviously I wasn’t going to take 30 mg methadone and then take 900 mg DHC like I used to , that be mad

So I think you could set aside a day to do this, preferably in a house full of people or have someone whom you will call at a certain time so that if you are passed out and miss making the call they will come looking for you, and then start at baseline first thing in the morning and then do 60 mg more of the DHC every 4 to 6 hours until the effect sought is reached. Do you get a couple of ampoules of naloxone with each of your methadone fills by any chance?

What you are aiming to do is very common with methadone maintenance and doctors often do a second prescription for anything from codeine to dextromoramide to oxymorphone for the instances of craving and the like.

The chemical dissimilarity of methadone and DHC will be of help to you as well. It is either methadone, dextromoramide, or dimethylthiambutene which is the least cross-tolerant with morphine and close relatives.

 

[Anthonysymington1967]

Yes have naloxone and think I will take your advice mate, thanks so much for the advice

 

[axe battler]

The 30mg won't so much block your DHC as raise your tolerance to the point it will be less effective.
I would work my way up slowly with the DHC as the combined effects may be too much.
Better safe than sorry

 

[Anthonysymington1967]

Yeah sounds safe. Weird thing is the fact I was doing 900 mg DHC daily means the docs thought 30 mg methadone wouldn’t touch me but actually it got me a little high

 

[Nicomorphinist]

Yeah sounds safe. Weird thing is the fact I was doing 900 mg DHC daily means the docs thought 30 mg methadone wouldn’t touch me but actually it got me a little high

Did you also get comparable analgesia from the methadone?

What I have found out is that there is actually a lot of variance in de facto equianalgesia ratios, and especially with a switch like from morphine or DHC to methadone, if one has unusual metabolism especially, they may have to start conservatively and actually hack out the de facto ratio -- for example, hydromorphone is actually 10 times stronger than morphine for me rather than 4 to 8 times and oxycodone is less than 50 per cent as strong, so they found that out and put it in my file so I didn't have problems in the future.

Also, if you have a view to replacing the methadone with the DHC for a day to see how it works, I would think that 17 to 40 hours would be the ideal washout period for the methadone and then maybe 8 hours on the other side to wash out the DHC. When I have done washout intervals betwixt different medications, I have chosen a somewhat tolerable and very clear-cut early withdrawal symptom like mild rebound pain or runny nose to indicate that the washout was more or less done.

 

[Lucy20]

I highly doubt you would feel the dhc .

 

[Zonxx]

after taking 100mg worth of methadone to try it, i instantly fucking regretted it due to my morphine / oxy / dilaudid not working for an entire fucking week on one day i said fuck it and doubled my daily morphine dose to 800mg and no go

 

[Nicomorphinist]

The blockade seems to be the idea behind methadone, buprenorphine, and dihydroetorphine as maintenance medications -- but they also can cause all sorts of unnatural actions that people don't like and the whole cardiac thing. Just give people a choice of those two or three and extended-release and immediate-release codeine, DHC, morphine, hydromorphone, oxymorphone, piritramide, dextromoramide, and so on -- a very useful thing for all this would be some kind of Smack-Contin and some dry ampoules or powdered smack or maybe some dipipanone & cyclizine for craving episodes . . .

 

[Zonxx]

The blockade seems to be the idea behind methadone, buprenorphine, and dihydroetorphine as maintenance medications -- but they also can cause all sorts of unnatural actions that people don't like and the whole cardiac thing. Just give people a choice of those two or three and extended-release and immediate-release codeine, DHC, morphine, hydromorphone, oxymorphone, piritramide, dextromoramide, and so on -- a very useful thing for all this would be some kind of Smack-Contin and some dry ampoules or powdered smack or maybe some dipipanone & cyclizine for craving episodes . . .

you think an extended release morphine per say would alleviate a methadone blockade? (im asking this because my doctors told me he's retiring somtime in a few years but wouldn't tell me when because he doesn't know, and being a heavy opiate user that puts me in an oh shit bubble because heroin is way too expensive to maintain my current dosages BUT i do have access to a methadone source thats pretty cheap) but if i go that route one day and obviously doctor shop and get legitimate medications again id want to know how to get rid of the methadone block quicker than waiting 2 weeks or who knows how long

 

[Nicomorphinist]

you think an extended release morphine per say would alleviate a methadone blockade? (im asking this because my doctors told me he's retiring somtime in a few years but wouldn't tell me when because he doesn't know, and being a heavy opiate user that puts me in an oh shit bubble because heroin is way too expensive to maintain my current dosages BUT i do have access to a methadone source thats pretty cheap) but if i go that route one day and obviously doctor shop and get legitimate medications again id want to know how to get rid of the methadone block quicker than waiting 2 weeks or who knows how long

Not really, I favour MST Continus and other opioids as alternatives to methadone. What I read about the Dutch dextromoramide programme is that Palf does break the blockade and gives a blast of euphoria which keeps patients off the streets looking for smack . . .