Opioids Unprescribed Methadone - Accumulation Effect

[monkeybackisland]

Didn't want to put this in the MMT thread since i'm not on MMT, but I've been searching the forums for hours and am increasingly freaking myself out.

I've already been beating myself up for this ridiculously stupid situation i've put myself in, just FYI.

Usually I'm on bupe, but I went away for a month and had nada for a good two weeks, but I bought dope and was using 1g-1.5g a day for a week. (I get withdrawals after just 2 days of using now)
I had to get on a few planes, and wasn't keen on hiding dope in nature's pocket: been there/done that/isn't worth the anxiety. So I picked up 400ml methadone, which i've used before and needed about 60-70ml to stave off withdrawal symptoms. For some reason this time, even though my habit was 1.5 grams I've been scared of ODing, so started as follows:
Day 1- 50ml, but 4 hours later I was still very fucking sick. Took another 10ml, still sick, took another 5ml. Total intake 65ml, still had massive pupils, sweats and a bit of diarrhoea but dealt with it.
Day 2- woke up feeling pretty horrid, took 60ml, waited 4 hours then took 15ml. Total intake 75ml, feeling better than day before but still massive pupils and not quite right.
Day 3, woke up feeling ok, took 60ml, felt a little bit off though still so took another 10ml 4 hours later. So 70ml

I intend to wait 3 days after this meth runs out then go back on subs but I'm concerned about this accumulation effect, apparently dosing high is a really bad idea at first because methadone accumulates and you can OD without necessarily raising your dose.
I keep checking my pupils and they're still fine, not small at all, but I am super exhausted and have felt a bit nauseous since last night.

The peak effect of methadone is apparently around 4 hours after ingestion, so do you think that if after 4 hours from dosing I haven't OD'ed then it's safe to assume I can go to sleep and won't OD while i'm sleeping? Genuinely quite terrified of going to sleep now.

Sorry if this is rambling and incoherent, I've been feeling a bit dizzy, as if i'm in withdrawal from SSRI's kinda dizzy. (I'm also on escitalopram which I know increases the concentration of methadone) the main thing I'm going by at the moment to convince myself I can go to sleep and not die is that my pupils are still BIG. Fairly big anyway, and I don't feel high at all.

Anyone able to help a guy out here?

 

[negrogesic]

Sounds like you don't have much to worry about as far as overdosing on methadone. I assume the concentration of the solution was 1mg/ml, correct? If you were in danger your pupils would be pinpointed and you would feel very high. In the abundance of caution perhaps sleep in the recovery position (on your side, using pillows to support the position) in case you somehow did take too much. If you have the luxury, have someone check on you. Note i think youre fine but this is out of an abundance of caution (ie it might relieve your anxiety by sleeping this way if your afraid of sleeping). Its what i do somethings just in instances in which im concerned i might have taken to much (ie., oh shit this seem sketchy, make sure ill sleep like this just in case).


I was on 380mg of methadone a day years ago, and have taken single doses of 600-800mg a few times (please, no one attempt this, as this will equal certain death for 99% of individuals), and never felt concerned about ODing (nor had any sense i was in danger -- albiet im a fool). The only time i felt like I was going to OD on methadone was when i was hospitalized for a surgery and they recklessly decided to give me my daily methadone dose 380mg (which i had always taken in split doses) in a single IV dose. That time i was literally about ODing as i went into uncontrollable nodding and felt it had to breathe. I also didnt alter them to it, and in fact played off my obvious sedation as being unrelated as they could sense something. It took everything within me to seem alert when they came and checked on me. This was of course because it felt incredible, although it frankly pretty scary at times.

My bigger concern for you is getting back on bupe when you have sufficient methadone in you as to not precipitate withdrawals...

This position reduces the risk aspiration:

 

[HoldBack]

Sounds like you don't have much to worry about as far as overdosing on methadone. I assume the concentration of the solution was 1mg/ml, correct? If you were in danger your pupils would be pinpointed and you would feel very high. In the abundance of caution perhaps sleep in the recovery position (on your side, using pillows to support the position) in case you somehow did take too much. If you have the luxury, have someone check on you. Note i think youre fine but this is out of an abundance of caution.


I was on 380mg of methadone a day years ago, and have taken single doses of 600-800mg a few times (please, no one attempt this, as this will equal certain death for 99% of individuals), and never felt concerned about ODing (nor had any sense i was in danger -- albiet im a fool). The only time i felt like I was going to OD on methadone was when i was hospitalized for a surgery and they recklessly decided to give me my daily methadone dose 380mg (which i had always taken in split doses) in a single IV dose. That time i was literally about ODing as i went into uncontrollable nodding and felt it had to breathe. I also didnt alter them to it, and in fact played off my obvious sedation as being unrelated as they could sense something. It took everything within me to seem alert when they came and checked on me. This was of course because it felt incredible, although it frankly pretty scary at times.

My bigger concern for you is getting back on bupe when you have sufficient methadone in you as to not precipitate withdrawals...

This position reduces the risk aspiration:
View attachment 14321
View attachment 14320

I agree, the fact that you posted that suggests you are not in danger.

Methadone is most dangerous when 1) a chronic pain patient switches their rx to methadone and 2)Co administration of benzos.

Yes, the respiratory depression effects outlive many of the other effects, but I think your level of tolerance will keep you from entering dangerous territory.

In my experience, when I first started mmt, the onset was quick (much quicker than it is now). Peak was in 1-2 hours (whereas it’s more like 4-6 hours now, 2 years later at 140 mg).

 

[negrogesic]

Its been 10 years since ive been off all that ultra high dose MMT (few people ever get of 380mg/day -- those are lifers 99% of the time), but you just reminded me that yes, methadone kicks in much faster in the beginning (peaking fast) then because slower acting. I used to IV the methadone oral solution (no one do this, this is very unhealthy) and the onset peaks at maybe 25 minutes. It is also twice as potent IV in the literature (in practice instead of 2:1, it seemed it was more like 1.5:1). I remember being at the wedding for my sister, and going into the bathroom to IV oral methadone. The fucked up part, because the oral solution is so dilute and my dose so high, i had to IV it in huge volumes (had to use a 10cc syringe, multiple times, to get the dose). All that non sterile oral solution, full of flavoring, propylene glycol, sugars, being injected (it burned) in the viens.

But man, what a beautiful ceremony. I will never forget my sister standing there with the sea in the background -- it was actually pretty emotional which is surprisingly considering that i was so high.

(To be frank i remember little of the ceremony, i remember the bathroom injection of 80ml of oral methadone, i remember my ankle killing me as it was swollen from serious survery caused by me jumping of my apartment on benzos), i was on crutches. I remember i played the piano (not for the ceremony, there was just a piano there) and the rest is unclear. What a beautiful ceremony though.

 

[monkeybackisland]

Ha, nice journey you had there at sea. So It seems I was paranoid about the methadone for no reason, since I never felt any effects over my 5 day tenure of use. Still had dilated pupils and didn't feel the general opiate feel in any way at all. I'm an absolute freak when it comes to withdrawal, I went c/t from a 2g a day habit when I ran out of my supply travelling once, with no comfort meds, and I actually slept a lot. Especially during the first 24 hours, but whenever I'm sick in any way my body seems to knock itself out. I don't know if me having ADHD and H gives me so much energy I can stay awake for days has anything to do with it. I waited about 3-4 days and went back on the buprenorphine, worried that it might not even touch the sides since 75ml methadone only barely managed to hold me to a functional state. It led to some horrible depression though, for the first few days, and a massive argument with my husband. I acquired a 30 day script of bromazépam which I've used in about 3 days.

On my second day without the methadone, Tuesday last week, I had one of the most significant job interviews of my life. Thankfully I wasn't feeling too bad, and I had some benzos which normally I have a high tolerance to, but I did fall off one of those rideshare electric scooters that are everywhere in Paris so I maybe took too many. I think I might have got the job though, since they're asking my to fill in my personal details on their intranet and have asked me for two references quite savagely -I got three emails in one day to chase them up.

I'm thinking though, I do want to get clean, I really want to be clean and have the energy and laughter and light in my life that I used to have before I started using. But this was also a part in my life before siginificant trauma and losing my best friend. Since then I've only been severely irritated by most activities, though I put on a cheerful facade. Inside though, alone, I just go to bed and have no interests, goals or dreams. So I'm thinking of switching to methadone for a while, to help me in this new job. Without opiates, on buprenorphine too - I get wildly emotional when things go wrong and burst into wretched uncontrollable tears. It's the undealt with grief and trauma I'm certain. But I think being on methadone might help me to be confident and outgoing at work.

I've avoided the idea of going on methadone for about 5 or 6 years, but with multiple relapses and a general hatred of buprenorphine as it does nothing but relieve the worst of withdrawals... it seems like an utterly pointless drug for me to be on. I actually went back on the heroin and then the short term methadone hoping that after that stint, i'd only suffer the most mild of withdrawals. (this method worked for me in the past. pretty much zero discomfort on two occasions, probs 'cause I wasn't hooked on the methadone.)

I want to be engaged with life, I wanna exercise, I mean I used to be so damn fit and up for anything. Depression is a real bastard. I'm on antidepressants, have tried pretty much all of them - fluexotine, sertraline, velnafexine (worst w/d with that one, brain in a washing machine style dizzyness) citalopram, escitalopram. None work really. The only thing that worked was heroin, but I know that's damaging and unsustainable, and after a while you just become a zombie needing a fix to get well. Will methadone let me live out my life if i'm not on it for too long for the honeymoon phase to wear off?

My doctor is willing to do a 14 day supply of short acting opiates following a course of methadone for 6-12 months, then to wait 24 hours and go back on buprenorphine for a quick taper, when I feel ready to give all this up for good.

Apolz for the essay, and muck kudos to you all for the advice, truly helped me from my own paranoia.