Opioids Help me help a friend on methadone who still abuses other opiates

[ReversiblePulpitis]

Hello everyone. Im a chronic pain patient and a health professional student. I'm mostly a browser of the boards here to keep up on news regarding my opana as well as keeping up on general news and trends regarding the world of opioid pain medications.

I've got a good friend who is in a methadone maintenance program following a few years of illicit opioid abuse that in part put an early end to his college career. He is an intelligent gay guy in his mid twenties. He claims that his use and abuse began out of an effort to treat some form of self diagnosed leg pain/RLS and from my POV quite a bit of anxiety. He does the blind dosing but believes he is in the ballpark of a 40mg dose after having started at I believe around 80. His DOC has always been oxycodone in whatever form. He always has and continues to claim that his goal is to come off the methadone and treat his leg issues with a ten mg hydro condone script that he continues to get on the side monthly.

Despite knowing what he does about the methadone and his long term goal, he continues to abuse
Oxycodone on a daily basis. He either insuffulates 30mg Roxi or microwaved 60mg OPs, depending on what he can get illicitly. If it helps provide any insight into the psychological component of this, he prefers the treated OPs as well as intranasal despite the low BA of oxy via nasal and despite the questionable efficacy of a microwaved OP.

Anyway, I'd say he averages 60mg a day but up to 120. He spends a good amount of money on this habit, I'd say *snip NO PRICES PLEASE READ THE RULES* a day on top of his done, and being a part time server, I'd say he spends every bit of his extra money every single day.

I know there are worse habits in the world, but as his friend I hate to see him spend what little money he does have supplying what I believe to a purely psychological habit. I was hoping that I could get some advice here on what to tell him seeing how he can be very logical when he wants to be.

Surely his methadone does not allow any of his oxy to reach his receptors and have any affect other than placebo? Could I get an idea of the smallest amount of methadone it would take to not allow this oxy he uses to even have an affect?

just the other day he was telling me that some of the roxii he purchased had apparently gotten moist at one point so was a shade darker than usual. Even though it was perfectly fine, he basically had put himself into a psychological withdrawal minutes after snorting it. It was ridiculous.

Any advice or preferably cold hard facts regarding methadone and his attempts at abusing the oxycodone would be great. My goal is to try and help the guy save money and help hold onto his goals. Whenever I ask him about just going back up in his methadone dose, he abruptly changes the subject.

Just to clarify a little... I'll ask more directly, there is no way that he could be achieving a high or even a buzz or analgesia, or anything...period, from 30mg of oxycodone snorted at a time while under MMT at his dose, is there?

I just want to help him get to the root of the real problem, what I believe to be psychological, through whatever means may it be therapy for instance. I hate to see him wasting what money he does have, put himself at risk by buying from several different dealers for several different people, and get himself further away from his end goal when he's abusing oxycodone in the most inefficient ROA to begin with, only to have this drug to be having zero physiologic impact in his CNS whatsoever.

he not only purchases for himself, but for a handful of others as he's designated himself the middle man, and has also admitted he's basically hooked to his routine of making these runs, wasting gas money, driving across the city every single day, if not twice a day. Another one of his psychological quirks is that he refuses to allow anyone direct access to these dealers, even when one or more of them wouldn't care. That way he maintains control and supervision of what and how many people buy, in part to make sure that no one buys so many that there isnt any left for him, seeing as how he can only afford to buy maybe 3-6 pills a day, and Im sure he's probably also has manipulated the cost to his advantage.

So obviously he has a huge issue with control, amoung other things.

I just love the guy and want to help him see the error in his ways.

 

[NeighborhoodThreat]

Are we talking about you or your friend here? Either way, prices are not allowed.

I've merged your posts together, please use the edit function in the future. I'm going to move this thread on over to Other Drugs.

BDD--> OD

 

[effie]

A "blocking dose" of methadone is generaly considered to be 60-80mgs but it does seem to vary..

Have you had a good chat with him about what he gets from the oxy? It sounds like there certainly is a big psychological component - has he considered drugs counselling to try to help address this? A lot of people still use along with their maintenance and it is certainly something a drugs counsellor would be familiar with.

Alternatively, he might do better on buprenorphine - has he considered this or discussed it with his maintenance doctor?

At 40mgs methadone I imagine he would feel something from 120mgs oxy, but not a huge amount compared to if he was not taking methadone.

He's lucky to have a friend who cares so much about his wellbeing, and I would certainly try to encourage him to talk about why he continues to use the oxycodone, but unfortunately sometimes there isn't much we can do except provide someone with the facts and our opinions, and let them know that you are there to help him if/when he decides to address his oxy habit. The fact that he changes the subject means that if you push it too hard you might just push him away - it is very difficult to help someone who doesn't necessarily want to hear what you have to say. Good luck

 

[ReversiblePulpitis]

Um, I'm a chronic pain patient on 45mg oxymorph per day and hydrocodone for BT. My friend is on MMT and abuses the oxycodone... Neither of which drug is used for a diagnosed medical condition. Ive abused before, seeing as how taking one extra pill counts as abuse, but this is two different people. I don't see the point in playing the swim or my friend game. I don't know you people and you don't know me, what would be the point. I happen to also be a man and can own up when i need to. Thanks for asking though. Edit: don't mean to come off abrasive, but I was a little offended that someone would suggest I was lying.

 

[Swimmingdancer]

It's not impossible that he gets an effect from the oxycodone while on methadone. The effects of methadone vary greatly from person to person, depending on their brain and metabolism, their tolerance, how long they've been using it, etc etc etc. Methadone does not always do a good job of blocking other opiates, (and even when it does it's only lessening the euphoric rush, not the more subtle effects which create physical dependence). There is no magical dose of methadone that will make him not want to use oxys anymore. Although a higher dose might help somewhat. He may have a cross-tolerance from using the oxycodone while taking methadone that means that if he were to stop taking the oxys, his usual methadone dose would not be enough to alleviate withdrawal symptoms.

So you can't really assume that his use of oxys is purely out of psychological addiction and not physical dependence. In addition, mental addiction is very real and even harder to kick than physical dependence, so even if you could assume it was only a mental effect that doesn't really help things much. Also, just because he isn't taking these drugs with a doctor's blessing for a diagnosed medical condition does not mean he isn't self-medicating or wasn't initially using them for pain. The majority of opiate users are self-medicating for either physical or emotional pain.

Unfortunately, you can't help someone who doesn't want your help or doesn't think they need help. They have to come to that conclusion on their own, and it take a lot of growth and hard work to get to a point where you can even take methadone without wanting to use other opiates. Having said that, raising the methadone dose could be beneficial and does help alleviate drug cravings for some people. I would say that unfortunately all you can really do as a friend is be supportive and non-judgmental. You may be able to gently promote harm-reduction methods to try to enable him to function with his addiction and try to have it have the least adverse impact on his life. Nothing you can say is going to convince him to give up using, it may just alienate him and make him want to lie to you about his drug use.

Sorry I couldn't be more "positive", I know this is probably not what you were hoping to hear Good luck.

 

[dittybopmonster]

i dont think youre lying about ur identity...however you in the posts you have given us you have failed to provide a very important piece of information.....

HOW MUCH METHADONE IS HE ON?

We dont know if his dose is being blocked or not without knowing what his meth dose is. Please provide that. If it is something like 10 or even 20 mg a day, then yea he prolly feels like oxy. If hes on say 50mg +, then hes prolly not feeling it.

 

[Tommyboy]

HOW MUCH METHADONE IS HE ON?

He does not know the dose, as the program does something called "blind dosing." Some MMT and detox facilities take part in this type of dosing for certain reasons. The OP said that his friend thinks that the dose may be around 40mgs after having started at around 80mg, but there is know way of knowing.

 

[Swimmingdancer]

HOW MUCH METHADONE IS HE ON?

He does not know the dose, as the program does something called "blind dosing." Some MMT and detox facilities take part in this type of dosing for certain reasons. The OP said that his friend thinks that the dose may be around 40mgs after having started at around 80mg, but there is know way of knowing.

Yes. Plus, even if we did know exactly how much he was taking there is no way we could give a definitive answer as to whether he gets any effect from the oxys - as I already mentioned, methadone affects different people very differently. But if he is on around 40mg he should very likely be feeling something from taking over 100mg of oxycodone a day. Not to mention that if he stopped taking the oxys 40mgs (or whatever) of methadone wouldn't be enough to keep him from getting withdrawal sickness.

Some clinics do blind dosing, where the patient doesn't know exactly what dose they're on, because it may make it easier to taper the dose if the patient doesn't know when their dose is being lowered. For example, they may not have as much anxiety and any withdrawal symptoms they report are more likely to be taken seriously and not just seen as psycho-somatic based on their anxiety and expectation of feeling sick if they knew their dose had just been lowered.

 

[ReversiblePulpitis]

Effie,

First of all thank you so much for your reply; I respect your opinion and am honored that you'd grace my post with your insight and interest!

I am a little unsure of his current dose, but it's good to know for future reference that 60mg is probably a good approx minimum to consider as a blocking dose. I believe he has been in the program since about last April of 2011, where I believe he told they started him out at 80mg, but from that point onward have been blind-dose-reduction (if that's a correct way of calling it that). If you were to take a wild guess, what ballpark mg do you think he could be at, assuming an average conservative reduction protocol? When I said I thought he was at 40mg, it really is what I "think" he may be around considering something he said to me based off something he overheard his counselor saying from another room, so I'm not totally sure that 40mg is accurate. Anyways, hehe, moving on.

RE: What he gets from the oxy? He most often snorts them mid-late night after work by himself where he lives in his grandma's basement, prefers to do them alone to zone/chill out on the couch to calm himself down, calm "his leg pain/legs down", with the ultimate goal of nodding out as well as helping him to fall asleep. I don't think he usually uses prior to the clinic @ early afternoon, and Im not quite sure if thats due to abstinence or a lack of pills. I've come to the conclusion that if the money and dealer supply are available, he makes a run everyday. So, it seems to me that considering he only purchases on average 4 at a time, he most likely uses them up everynight. He has a boyfriend, but they really don't seem to spend a lot of time together, other than the boyfriend spending the night with him maybe half of the week. He's made it clear that he prefers the pills to the boyfriend (without actually saying so), however he tells me how he'll get upset if the bf comes over prior to he having had his "pill" time. His bf isn't aware of his use outside of the clinic, even when my friend will insist he be left alone when they are together when he is zoning/"nodding" out. It has never sounded like much of a healthy relationship. He otherwise has no friends, other than me, and Ive only known him for less than a year after I met him through my wife's work, and other than that just the few guys he makes runs for.

The subutex/suboxone recommendation is an excellent one. Have any ideas of how I should approach that?

I do really care about the guy's well being, this habit is without a doubt keeping him from returning to and finishing college. He has a passion for chemistry, and knowing how intelligent he is, I just hate to see he waste anymore of his life, money, and relationships.

A "blocking dose" of methadone is generaly considered to be 60-80mgs but it does seem to vary..

Have you had a good chat with him about what he gets from the oxy? It sounds like there certainly is a big psychological component - has he considered drugs counselling to try to help address this? A lot of people still use along with their maintenance and it is certainly something a drugs counsellor would be familiar with.

Alternatively, he might do better on buprenorphine - has he considered this or discussed it with his maintenance doctor?

At 40mgs methadone I imagine he would feel something from 120mgs oxy, but not a huge amount compared to if he was not taking methadone.

He's lucky to have a friend who cares so much about his wellbeing, and I would certainly try to encourage him to talk about why he continues to use the oxycodone, but unfortunately sometimes there isn't much we can do except provide someone with the facts and our opinions, and let them know that you are there to help him if/when he decides to address his oxy habit. The fact that he changes the subject means that if you push it too hard you might just push him away - it is very difficult to help someone who doesn't necessarily want to hear what you have to say. Good luck

 

[ReversiblePulpitis]

Swimming & Tommy:
Thanks for stepping in to help clarify to the other poster (and to other readers perhaps) what I said about the "blind dosing". I wasn't aware that not all clinics didn't offer this. You guys nailed it on the head though, its supposed to act as a mechanism to keep the patient from experiencing any negative perceived physiologic/psychologic feedback from being aware of their actual dose. I think its quite ingenius actually. However therein lies the heart of the issue Im having with my friend, who I'll refer to as J. Is it not defeating the purpose of the blind dosing and the dose reduction to begin with if he is supplementing with the oxy? I totally agree with what you said, Swimming, I'm not here to judge his feelings of pain or withdrawal at all! I myself had my own problems getting into pain management being an otherwise healthy appearing 28 year old young man. My problem/his problem is the effect of his supplementation on his life when he has healthier options: going back up in his methadone dose, try to be seen as a pain patient and be treated with other opioids, or perhaps even giving subs a try. As I said, making these daily runs for oxy for not only himself but a handful of others is obviously putting him in several less than ideal situations. He's spending every last dime he has a server, he's spending 2-4 hours/day driving around spending gas money and time constantly also putting himself at risk of arrest (even if it were due to an otherwise harmless traffic stop followed by a search), it's this need he feels to fulfill what the methadone isnt achieving that keeps him from pursuing his college and professional career, and then finally it gets in the way of his personal relationships... he chooses using these supplemental oxy doses over being with his boyfiend or friends or even family.

Sorry for the run-on paragraph, but do my concerns make sense? I'm not judging his oxy use for treating any sort of pain or withrawal symptoms, even though being his friend, I know from personal experience that there is an overbearing an irrational psychological component to it. Not that, that cant be real - but when, for instance, he thought one of his oxys that was slightly darker than the rest (bc it had gotten moist but was intact and at that time completely dried back out), he thought he wasn't getting his oxy and started to have a withdrawal-esque panic attack. That make sense why I say that about his psych component?

He just has other healthier options that would allow him to lead a better life, IMO.

He's a logical guy, and I know if I say the right things in the right way, I can make an impact. I just need some ideas of what it is I can do and say.

I really appreciate it guys/gals!


EDIT:

I wanted to add something to the discussion re: his oxy dose. He may take up to 100mg/day over the course of an afternoon-night depending on the day, but there are plenty of times when he gets home from work and may snort a couple 30mg roxis, one at a time. And the claim is that he gets relief from each and every 30mg pill. Is there still a possibility, considering a maybe 40mg approx methadone dose, that he gets real physiologic analgesia? Or is there a better chance that its to satisfy a placebo effect? Again, this is specifically in regards to these occasions where Im aware of him using these oxys in a limited 30mg-ish manner, and still claims relief. This seems to be an excellent example for me to use when speaking to him about it, if theres a small chance that only 30-60mg could be having an analgesic effect... and the money he spends on just those one or two pills adds up over the course of a week, month, etc.
I'm probably getting too particular with these questions for you all to be able to give me accurate advice, but I thought it may be worth mentioning. Again, thank you so much.

 

[Znegative]

Well he must be on a pretty low dose to feel the oxycodone, and yeah it probably is fucking up his dose reduction, but at the same time, methadone is so much more potent than oxy, that it would probably only be like adding an extra five or ten mg of the methadone.

My abuse of opiates has also really screwed up my college performance, I'm like a quadruple sophomore right now going back to school on the 30th. Opioid addiction is real hard, and I hope you're friend the best. I'm sure you told him how you feel about seeing him in such a condition, but maybe make it real clear how his use is effecting you. Alot of us addicts have no problem hurting ourselves, but we usually do care about how other people are effected, no matter how hard we try to block that out and compartmentalize our actions and emotions