Using Heroin when on Methadone Maintenance

[slortaone]

i dont know many people at all on MMT but the few i do know still shoot smack. they're on about 35mg doses if i remember correctly, and they still nod all over themselves after a fat shot. im not around them enough to know what they're doing wrong/right. i know a guy who used to be on 65mg and is now down to 35mg, he could go higher but doesnt want to, which makes me think you need to try to lower your methadone dosage... its pretty insane the doses you are doing and feeling next to nothing from it.

how much smack were you using at your worst??

 

[Christ!]

Before I was on Methadone, when I used up my entire line of credit, savings and borrowed thousands of dollars from friends and family, I was using a minimum of a gram a day, more after I'd just picked up or was depressed or just fiendish for whatever reason. The max I'd do was 2 or 3 grams a day, but that was rare. Now I only buy enough for 1 or 2 shots, so usually a 1.7 or a 3.5.

I think getting on the methadone was a really good choice bro. Seems like when people start getting into heavy debt is when they start getting near the end of their rope. Wouldn't be a very good situation to be in I can imagine.

I always used to think methadone would add to the chance of a heroin OD...but someone posted something on here that suggested that wasn't the case at all.

Your biggest risk by far is alcohol and benzos so just be really careful with those.

Methadone produces it's 'blocking' effect by raising your tolerance so high that it'd take huge amounts of heroin to get the rush and same euphoric effects as before. (AFAIK) Lots of people on methadone still use heroin though, and I've seen people nod out as slortaone mentioned....most of them say it's not worth it afterwards, and mostly a waste of money.

 

[rachamim]

Tommyboy: First, you are confusing Binding Profile with Affinity, which is merely one aspect of the former. You seem to be...well, actually you ARE confusing mathematical values. Kd, nM, mM, Ki, DR...these all signify different values. If you want to learn about Affinity a great place to begin would be Receptor Occupancy followed by Mass Action Kinetics.

On your comment about methadone having a "lower profile," profiles arent lower OR higher, they merely articulate properties. If instead, you meant to say that methadone has a lower Affinity Value (Kd), yes, correct, but who said otherwise. A nano molar trumps a micro molar any day of the week. The way to properly express it is, the smaller the Dissociation Constant, the greater the affinity. To reiterate, methadone has the highest receptor affinity of any opiate/opioid, affinity being the firmness with which a chemical binds to the receptor. Bupe is a mediocre proxy whose antagonism, metabolic ceiling and psychoactive deficiency render it worthless to most Opioid Substitution clients. If a person has a low volume habit and/or a habit of short duration (usually coupled with relatively short history of usage), bupe would probably be a good fit. Its ability to "block" is tied to its antagonism though that can be defeated as many here know.

 

[Crankinit]

Bupe is a mediocre proxy whose antagonism, metabolic ceiling and psychoactive deficiency render it worthless to most Opioid Substitution clients. If a person has a low volume habit and/or a habit of short duration (usually coupled with relatively short history of usage), bupe would probably be a good fit. Its ability to "block" is tied to its antagonism though that can be defeated as many here know.

That's not true at all dude. Plenty of people find bupe helpful, myself included. Stop projecting your own opinion onto the population at large.

 

[SpiritFolk]

I am with Crankit here. Bupe was the last stage of maintenence (which was still being on it for over a year) after H and methadone. It was the best maintenance drug as it lasts long, you can't use easily, and it's easier in my opinion to taper off than Methadone.. I don't think I would be as clean as I am today if it wasn't tapering of bupe and then into rehab..

 

[rachamim]

Crankinit: "Plenty of people" are still a very small minority. Any substance with a metabolic ceiling will always have only limited value. The people gaining benefit from Bupe could just as easily gain the same benefit from methadone. The advantage is not in the substance (unless the user has a history of overdosing on methadone, due to bupe's higher safety profile). I am glad that bupe is available because it allows people a choice, indeed, DHC and heroin itself should also be allowed more widely. Tell me, what benefit do you personally gain from bupe that you could not gain from methadone?

 

[Christ!]

The bupe ceiling is high enough for heaps of people. I would say for the majority of opiate addicts in Australia, it would be sufficient (yes, I'm guessing)

Even people using tons of good heroin, or hundreds of milligrams of oxycodone multiple times a day have been able to transition to bupe easily, without even having to use the maximum dose. That doesn't mean it's for everyone, but I think it's far more effective than you think.

Benefits of bupe -

Less fatigue than methadone.
Doesn't seem as hard on the body (I don't have any links to back that up)
Blocks receptors so if you want to use, you'll likely have to wait three days for the bupe to clear.
Gave me energy when I had my dose in the morning. Other people have noticed this also. (more so than methadone)
It's further away in it's actions from regular opiates, whereas methadone is a full agonist like heroin/morphine/oxy
It's believed to be easier to come off (this hasn't really been proven yet I don't think)
Overdose is almost a non-issue.
In some countries you can get a month of take aways at once. (like in the US, however....it costs much more than methadone there)



I'm sure I could think of more but just got off a night shift and my brain is a bit slow I'm sure others will list some other benefits.

For people that aren't set on giving up opiates, maybe bupe isn't as effective. If you still want to get high, than methadone is a pretty good option...and once you're on a decent dose of methadone is can be almost impossible for some people to switch to bupe.

Crankinit: "Plenty of people" are still a very small minority. Any substance with a metabolic ceiling will always have only limited value.

Technically true but I think you'd have to be a doctor treating lots of patients with bupe to get a good idea of who it works for it, and who it doesn't. Maybe looking at rates of bupe vs. methadone patients in the last few years would give a better idea of whether it's a very small minority of opiate dependant people or a larger amount.

 

[Crankinit]

^ I'd be interested in seeing those numbers myself.

Crankinit: "Plenty of people" are still a very small minority. Any substance with a metabolic ceiling will always have only limited value. The people gaining benefit from Bupe could just as easily gain the same benefit from methadone. The advantage is not in the substance (unless the user has a history of overdosing on methadone, due to bupe's higher safety profile). I am glad that bupe is available because it allows people a choice, indeed, DHC and heroin itself should also be allowed more widely. Tell me, what benefit do you personally gain from bupe that you could not gain from methadone?

For one, it has a fraction of the side effects. Dental issues, weight gain, fatigue, mood problems, etc. all of these are regularly reported in methadone patients at a far greater rate than bupe or full agonist opioids.

Considering that, and the fact that methadone is much harder to detox off, why would I use methadone if bupe works for me without a problem? It tickles my opioid receptors and kills my back pain enough to keep me happy and functional and kill cravings, and I have a not-inconsiderable opiate tolerance. And this is only anecdotal, but tolerance doesn't seem to climb up the way it does with full agonists, it's just as effective now as it was 4 months ago when I started taking it.

That's not to mention that, where I live at least, bupe is far more accessible than methadone. In SA, methadone requires you to go to a clinic, which (quite aside from being a long travel time from my house and being full with no waiting lists) means being subjected to urine tests, looked down on and treated with suspicion by doctors and having to subject myself to the crowds that hang out there. With bupe all I have to do is see my usual doctor once a month and rock up for my dose.

 

[SpiritFolk]

Yeh I found Bupe to suit me better. Things I like -

I could get back in the workforce. I couldn't on methdone from either having minor w/d every morning which were small but I definitley needed to leave where I was and make it to the clinic straight away.

I also had more energy and motivation as Christ! and also looked less wasted.

Could resist the urge to shoot pointless shots of H, as where on methadone I still tried to get high and waste $$.

Also being able to poo again was nice too. yay.

 

[Crankinit]

Also being able to poo again was nice too. yay.

L0l. This too. It's less frequent, but not problematic, unlike full agonists.

You know you're a junky when you can have a discussion about bowel movements Though it's not as bad as 'who has the worst veins.'

 

[SpiritFolk]

^^ Haha yeh totally, I rememer thinking that too... but the who has the worst veins discussion takes the cake. 'I've got mad caves in my arms man...' lol

 

[opi8]

What is the best dose to switch from methadone to bupe? I've heard some people say 40mg, others 30 and one said 20. I know this is something to talk to my doctor about, but I thought I'd put it out there and ask for suggestions who've actually "been there, done that".

It's not that I didn't want to go on bupe in the first place, it just didn't hold me because of my tolerance. The take aways seem much easier to get, and the most important factor for me is apparently it's easier to taper off. Maybe this deserved it's own thread, but fuck it. Hope you mods don't mind. It is still relevant to the original question, if you don't look too hard

 

[rachamim]

Christ: Everyone of the benefits (of bupe) that you listed were either old wives tales or else can be gained with methadone. A month of "take homes" is available even in the US IF the client is in compliance. Being easier to get off of? That is a psychological issue because in physical terms it really isnt anyy different at al. Hard on the body? Wive tale. Blocks for three days? Methadone almost always blocks at least eight days. Energy in the morning? Psychological and you can see the same thing with any drug of choice. You are correct that bupe has a higher safety profile but I had noted that. Still, IF you take methadone as directed you are in no greater danger. That single, tangible benefit only avails itself to those who will use other substances with methadone...something noone should do.

If most Aussie addicts would be sufficiently dosed with 60mg of methadone then yes, as you claim, most would be fine with bupe. Of course in reality it has never been like that. If bupe were that suitable you would see it pushed more by the powers that be...leaa diversion, greater safety profile...it just doesnt do the trick unfortunately.

 

[rachamim]

Crankinit: Methadone ruins teeth? Look, if you educate yourself on Old Wives Tales you will never get anywhere. That is one that iscabsolutely false. It is true than many methadone clients have horrid teeth but this is due to the fact that no addict will see a dentist while active in their addiction. After a decade or two they get on methadone and eventually gain enough stability to worry about their dental hygiene. Having only noticed their horrid teeth while on methadone they deduct that it is the methadone.
Weight gain? Most junkies arent hitting up the buffet as they run the streets. With stability those neglected facets are in the forefront. Mood swings? What addict does NOT have them? As for your question about why you wouldnt take bupe IF bupe works for you...that is entirely subjective.

 

[Dr Phibes]

If you really want to stop using then don't subject yourself to years of methadone addiction. I came to herion addiction the opposite way. I was addicted to methadone by way of endless supply of pyseptone. My first IV was a 10mg pyseptone. You will never have that feeling again.

Methadone is so hard to beat. My withdrawal didn't peak till about 5 days after stopping, although I wouldn't know if it could have got worse.Using herion to beat methadone then about 5 days to beat herion addiction it seems backward to gjve more additive drugs to get off less additive drugs.

 

[Christ!]

Also being able to poo again was nice too. yay.

Yeah that's definitely one of the advantages :D, bupe doesn't seem to have nearly as strong a constipating effect as other opiates.

Another would be that it doesn't seem to kill libido as much as other full agonists. Seems like some people on methadone have their sex drives entirely wiped out.

Bupe will wreck your teeth just as bad as methadone I think. It's caused by reduced saliva in the mouth, bad bacteria moves in pretty quick without saliva....I've always countered this as best I can with brushing my teeth three times a day and chewing gum.

What is the best dose to switch from methadone to bupe? I've heard some people say 40mg, others 30 and one said 20. I know this is something to talk to my doctor about, but I thought I'd put it out there and ask for suggestions who've actually "been there, done that".

Sorry that I can't speak from personal experience! 30mg is recommend as the max dose you want to be on when changing to bupe, but you want to shoot for as low as you can get. The transition isn't easy but if you do a really slow taper on the methadone you can barely notice it (apparently) - switching to the bupe and getting used to it after methadone can be a bit tricky, and might take a few weeks to adjust properly. If you search around a bit on google you'll find reports of people who switched successfully and explain their experiences with it.

rachamim -

From wikipedia - http://en.wikipedia.org/wiki/Buprenorphine#Buprenorphine_versus_methadone

In terms of efficacy (i.e., treatment retention, mostly negative urine samples), high-dose buprenorphine (such as that commonly found with Subutex/Suboxone treatment; 8–16 mg typically) has been found to be superior to 20–40 mg of methadone per day (low dose) and equatable anywhere between 50–70 mg (moderate dose),[21] to up to 100 mg (high dose)[22] of methadone a day. In all cases, high-dose buprenorphine has been found to be far superior to placebo and an effective treatment for opioid addiction, with retention rates of 50% as a minimum.[21][22][23][24] It is also worth noting that while methadone's effectiveness is generally thought to increase with dose, buprenorphine has a ceiling effect at 32 mg.[25] That is, while a methadone dose of 80 mg will likely be more effective than a methadone dose of 60 mg (see Methadone dosage), a buprenorphine dose of 40 mg will not be more effective than a buprenorphine dose of 32 mg.

Unfortunately some of those references are to sources that I don't have access to

 

[rachamim]

Christ: I dont want to sound as if I am ragging on everything you say but Wikipedia is entirely worthless. It is entirely consumer generated content and although it did finally implement an editorial process as such, it does not consist of even rudimenrary fact checking. Any site that tells you Black Tar is acetylated opium needs to be laughed out the door...but...Jimmy Wales, the site co-founder, warns his readers NOT to use the site as an academic reference so that it is difficult to heavily criticise a site that states clearly it is not to be taken seriously, as opposed to the scores of readers who take it upon themselves to do so.

That said, its secondary hyper-links can be worthwhile if patiently researched. I will discuss the particular secondary source in which bupe is said to exhibit superior client retention...if you actually follow the hyper-link you will see an interesting example that focuses on a meta-analysis of 13 clinical trials involving methadone in France. France by the way, is the only nation where bupe outpaces methadone...and is only because the state pushes it. In fact the analysis showed a HIGHER drop out rate. It also showed that bupe users tamper with their medication, on average, two years after induction, showing that the metabolic ceiling is insufficient for most bupe clients. I need to add, the metabolic celing is equigesically 60mgs of methadone so that unless a client is sufficiently sated with 60mgs of methadone- a sub-therapeutic dosage- bupe is pretty much useless vis a vis Opioid Substitution Therapy.

 

[Tommyboy]

Crankinit: Methadone ruins teeth? Look, if you educate yourself on Old Wives Tales you will never get anywhere. That is one that iscabsolutely false. It is true than many methadone clients have horrid teeth but this is due to the fact that no addict will see a dentist while active in their addiction. After a decade or two they get on methadone and eventually gain enough stability to worry about their dental hygiene. Having only noticed their horrid teeth while on methadone they deduct that it is the methadone.
Weight gain? Most junkies arent hitting up the buffet as they run the streets. With stability those neglected facets are in the forefront. Mood swings? What addict does NOT have them? As for your question about why you wouldnt take bupe IF bupe works for you...that is entirely subjective.

The horrid teeth from methadone is also because a lot of people crave sweets while on methadone, which are bad for teeth. If weight gain is only from having a more stable life, then that would mean that people on suboxone would experience this as well. I wonder how the two groups of patients would compare if data was taken to see if weight gain was more prominent in one group than the other. My suboxone constipation was pretty horrible, so I would say they are both about the same in that aspect, with the severity being dose dependent of course.

IME bupe is the easier of the two to get off of, but this isn't the thread for such an argument.

 

[Crankinit]

I don't buy your argument that bupe is useless if you tolerance exceeds the level where you would be put on 60mg of methadone. I know mine certainly does, but bupe has been a lifesaver for me. It kills cravings, keeps my mood up and makes my back pain controllable and non-debilitating. So if that's the case, what the hell does methadone offer that bupe doesn't?

I'm not suggesting that people should be forced to use bupe over methadone, and honestly don't understand why you're so defensive (except that people get like that about their drugs), but I do dispute your claim that bupe is insufficient for proper maintenance, or that it only works for those with a low tolerance, because I'm living proof that that isn't true.

In an ideal world, patients would be able to pick their opioid of choice and receive the dose they require every day, but the reality is that bupe and methadone are the only two options right now (outside of certain clinics in Europe). If one works for someone, why push them to use the other? If a patient is perfectly happy with bupe, what do they have to gain by using methadone instead?

And unless you have the numbers to back it up, I don't buy that the those happy with bupe consist of a 'very small minority.'

In my experience (admittedly limited, I don't know a lot of other people on maintenance), a lot of the anti-bupe crowd are those who go onto maintenance expecting to get high and nod off all day. They know bupe won't do this, so they swap to methadone hoping that a full agonist will. Except of course their tolerance goes up and within a few weeks they're back to staying well with a bit of analgesia and heightened mood, which is exactly where they would have been if they stayed on bupe. They convince themselves that it will automatically be inferior because it's 'less' of an opioid than methadone, when in the context of maintenance, they achieve largely the same effect and result.

 

[Christ!]

Christ: I dont want to sound as if I am ragging on everything you say but Wikipedia is entirely worthless. It is entirely consumer generated content and although it did finally implement an editorial process as such, it does not consist of even rudimenrary fact checking. Any site that tells you Black Tar is acetylated opium needs to be laughed out the door...but...Jimmy Wales, the site co-founder, watns his readers NOT to use the site as an academic reference so that it is difficult to heavily a site that states clearly it is not to be tKen seriously.
.

Wikipedia is pretty worthwhile I think...but you're right, you do need to check the references and keep in mind what limitations it has. I sometimes forget to keep this in mind and take wiki on face value - not a very wise thing to do I'll do some proper reading up when I have a bit of time, because I find this kind of thing interesting.

Christ: I dont want to sound as if I am ragging on everything you say but Wikipedia is entirely worthless.

I don't take it personally you have far more personal experience than me, and have probably read a lot more on the subject.

There's so many variables when trying to assess how effective an opiate maintenance drug is. A girl I know was on bupe for about a year, was going well with it, ended up tapering off it for 6 months before relapsing with heroin - when she tried to get back on the bupe it didn't 'hold' her like it did before, she stuck with it for a few weeks before deciding to ask her doctor for methadone, and it ended up working very well for her....the odd thing was her dose was only 35mg, far short of the 60mg that would match up with the bupe ceiling. Maybe she just became accustomed to full opiate agonists? and since bupe was a partial it wasn't doing the trick anymore?

I don't think you can rule out bupe completely at this point as 'almost useless except for people that have very low tolerance, which is a very small percentage of opiate dependant people' (paraphrasing)

I'm not saying methadone is bad or anything. It's changed HEAPS of peoples lives for the better. For some people bupe is a better choice, and for others methadone will be the better option. I think lots of people underestimate how powerful bupe can be, but I can't really prove this... It'll take many more years to make any definite judgements on its efficacy IMO, and more studies done to get an accurate picture.

I guess the best advice to people considering either bupe or methadone treatment - if you're in a stable enough environment, and take it as directed...give bupe a go first. The transition from bupe-methadone is much easier...and at least you'll know if it's right for you or not.