Methdone prescribing question

[dangermouse7831]

Methadone prescribing question

I was hoping someone could help me understand a bit more about Methadone Maintenance Treatment (MMT) in Australia.

I've been addicted to Opiates for roughly 2 years. I started on Oxy, but within 3 months I was using Heroin. Never injected, only snorted.

At my worst I was snorting 2 grams of high purity Heroin per day. For the last 6ish months I have been on roughly 1 gram high purity per day.

I tried to quit a few times on my own. Earlier on it was easier, but now it's just so hard. I finally caved and spoke to a Doctor.

I tried Suboxone for a few weeks. It took 16mg/day before I stopped getting withdrawals a few hours prior to dosing. I was still craving and got up to 24mg/day. At that dose it felt super speedy, and I was still craving 24x7. I was clenching my jaw and feeling high. Uncomfortably high. It also drove me to drinking heavily to tolerate these feelings. So I stopped it and went back on Heroin until my next doctors appointment.

I am now on methadone. Day one I had 35mg, and it was as if I took nothing. My withdrawals began just as they do normally. So I went back to the doctor that very same day and got increased to 50mg/day.

At 50mg I was still withdrawing severely so I took Heroin on top. I am now on day 3 of 55mg and don't have any other opiates. I am still withdrawing. I took some dexamphetamine on top which has calmed the withdrawal slightly, but it's still ever present.

The doctor said 50mg was the max he could start me on, and my script says I can go up by 5mg every fourth day. I understand why, but this feels painfully slow. The withdrawals seem to come back every day BECAUSE I'm taking methadone (i.e. the withdrawals haven't stopped 6 days in because I still take opiates (methadone) daily).

So, my question is whether my script is normal, or too conservative? What were others scripted? I'm in the ACT if it makes a difference.

I can get back to see him mid week, but if this is the most I am allowed then there's kinda no point in going back. If others have been prescribed faster increases then I'll go back and ask for the same.

Thanks for reading!

 

[JoeBloggs]

I was started on much less when I was on it years ago, but my dose increased by 5ml every day until I was stable. That was in WA, and 6 years ago though. I withdrew for a bit at first but it really wasn't that bad. I think it might be at the doctors discretion, and perhaps your doctor knows or suspects that you used on top of your dose, or perhaps he has concerns because you started on suboxone and didn't see it through. Or maybe he's giving you the maximum of what's allowed in ACT. Usually prescribing doctors want their patients to be as stable as possible as quickly as possible, I don't think he is trying to fuck you around.

Personally I think suboxone is much more manageable than methadone, and once your stable on it you can go a day without dosing and not get sick. Not that you should go a day without dosing, just pointing out that it has a long half life. It's weird that you were having withdrawals whilst on it before dosing each day, part of me is inclined to think that it might be psychosomatic. It's strange that you say your dose made you feel speedy too, I never experienced anything like that from it at all. Mind you I was also on 20mg of diazepam daily with my dose the entire time I was dosing.

Ultimately though, it sounds like it isn't really working for you at the moment. If you can get an appointment with him mid week I'd take it and discuss your concerns with him. He probably won't increase your dose any further by the sound of it, but maybe he'll give you some diazepam or something else to help with the initial withdrawals. If you can get through them and stabilise without needing to increase your dose too much you'll be in a better place than what you'd be stabilising on a massive dose.

 

[dangermouse7831]

Thanks for the reply Joe. I am currently taking Ativan as needed, and was also taking it when on the Suboxone. I have a good variety of benzos at my disposal. I also totally agree that the Suboxone is much more manageable, but for me, it was really unpleasant.

The side effects from Suboxone may have been psychosomatic, but the withdrawals I've been experiencing since I started methadone are real. Vomiting, diarrhoea, uneasiness etc...

I agree in that I don't think my doctor is trying to mess me around. What I do think is that he doesn't want to accidentally give me too much and have me overdose. I can understand that point of view but I also think it comes with its own set of problems. When inadequately treated, people use on top - which is probably just as dangerous.

I upped my dose to 60mg today and actually did get a bit of relief for a few hours. That was an unexpected but welcome surprise. If it's the same tomorrow I'll stick this out, otherwise I'll head back to see him.

 

[JessFR]

In my experience, the rules regarding how much you get and how fast you can increase seem fairly arbitrary.

In NSW I've been started on at most 40mg and usually 30mg and been put up as fast as 10mg every 2 days. And I've seen it be as low as 5mg every 4 days. Seems to depend on the Doctor doing the prescribing.

I think for a serious habit like yours, 5mg every 4 days is a joke.
I was on methadone and failed to stay off heroin and kept using and missing doses for years.

Then I changed to a private clinic, I told them I needed to go up as fast as possible or I'd just fail again, and shockingly they listened. Put me up 10mg every 2 days and I finally got to a worthwhile dose. Have never missed a dose or used heroin in the month and a half since. It's my most successful attempt at getting clean ever. The retards at the old clinic felt listening to me would be too dangerous for my health. So they refused to let me go up faster than 5mg every 3 or 4 days. And because of that I kept using and because I was still using I'd miss doses and cause I'd miss doses I'd never get above 45mg max. Idiots.

Take my advice. If they won't let you go up fast enough to get on enough methadone that you don't feel you need heroin all the time. If you can, consider going to another clinic or another doctor.