I just started a Methadone Maintenance Treatment Program...

[issokay]

I just started my MMT (Methadone Maintenance Treatment) Program yesterday morning. After about 6 hours of paperwork, giving all of my medical history, orientation I guess you could call it, I got my first dose which was in liquid drinkable form. I had to wait around for about 30 minutes after I dosed so they could make sure that I didn't have an adverse reaction.
My first dose was 30mg, which they said was a very low dose. I'm not familiar with methadone personally. I haven't used it before, I only know what I have heard about it, and nothing I've heard has been very consistent. The reason I decided to go this route is because lately I've been abusing my Norco prescriptions, then I would end up spending hundreds of dollars in a month trying to buy more through, obviously, an illegal source. It was so difficult at times to find more Norco that heroin was something that was, in my situation, much faster & easier to get, and far cheaper than the pills of which I could easily take 20-30 or more in a single day. I would sometimes be able to get oxy, but those cost even more than the hydrocodone. I decided that I need to quit risking my freedom doing all of these illegal things, so I decided to look into the Methadone clinic. They increased my dose today (this is my second day) from 30mg to 40mg. I do get sick when I run out of the hydrocodone, especially when I take a lot at once. Also on my drug test they gave me, I showed up positive for methadone already. They informed me that the dealers around here have been putting methadone in the heroin around here so that you come off of it faster and need to buy more sooner. Lame. My questions are this:
1) Is the methadone used to help people kick opiates the same as methadone used for acute pain, and what is a typical dosage that a doctor would prescribe to someone for pain relief using methadone?
2) Is my 30mg (now up to 40mg) dose of methadone a typical dose used to start me off at?
3) I have legitimate prescriptions for Norco, Ativan, & Baclofen. The Ativan is 2mg 3 times a day, as i have panic attacks as well as insomnia, the Norco is for pain from a rotator cuff injury & Rhabdomyolysis from about 2.25 years ago. The Baclofen is a muscle relaxer for cramps and severe muscle spasms. I spoke with the doctor at the clinic today, he knows about my medication and he didn't express to me any interest in having me try to get off of the Ativan or the Hydrocodone. In fact, he told me to only take the medicines which I've been prescribed, no others, and of course, no drugs. Should I not have to worry about any interaction with the Ativan (a Benzo) at this time since I'm still on what they consider to be a very low dose of Methadone?

They told me that methadone actually blocks the euphoric effects of opiates/opioids. I'm wondering if the methadone that I'm on will also provide me with some pain relief that I am actually prescribed the Norco for.

Any answers would be greatly appreciated. If you have something else to add that is some information that you think may be useful to me, that would be welcomed as well.

I hope that I posted this in the appropriate area. I'm a new user...

Also, I'm wondering if I'm taking an extreme approach to quit taking the Norco... I don't think I'm super-addicted to them as far as tolerance goes, I still have to take like 8 to get a good high from them (norcos) so I have some tolerance, is Methadone an ok solution for me? How dangerous is Methadone for someone who doesn't do several grams of heroin every day...

Thanks,
-Issokay

 

[Lord Armagoth]

How long and how much hydrocodone are you taking? I have personally never had withdrawls from vicodin and I have abused the hell out of it in my younger years. I did the methadone matinence program about a year ago. They started me on 30mgs and I eventually got to 100mgs per day of the red liquid. I got a probation violation and went to jail. let me tell you that the withdrawls on that were very bad. Not as intense as heroin but much longer. I think it ended after 19-21 days. I've seen doctors prescribe it for pain in usually 10-20mgs doses, but that depends on ones condition. It will help you to a degree with your pain, However over time you will develop a tolerance for the drug. Methadone helped me because I knew I couldnt kick my addiction. I would have periods of sobriety but I always ended up using. Its used to help ease withdrawl and block opiates. I once took 90 mgs of morphine while on the program and it didnt do anything to me. I met people at the clinic that were at doses of 300-350mgs a day and had been on it for 8 plus years. The doctor acctually told me that not eveyone can taper off of methadone and stay on it for the rest of there lives and thats ok. That kinda blew my mind. If it works for you I say stick with it. It will keep you off the opiates if you really want it. My suggestion though is dont let your dose get too out of hand. Good luck!

 

[Tommyboy]

1) Is the methadone used to help people kick opiates the same as methadone used for acute pain, and what is a typical dosage that a doctor would prescribe to someone for pain relief using methadone?

Yes, it is the same methadone. The only difference may be the form that it comes in. Pills are generally prescribed for pain, whereas liquid or diskets dissolved in liquid are used to dose people on MMT. It's the same thing though. The dosages used to treat pain will vary depending on severity. I think that 10mg pills are common, and they may be prescribed 4x a day, give or take. I know of someone on here that is prescribed 40mg for pain.

2) Is my 30mg (now up to 40mg) dose of methadone a typical dose used to start me off at?

Yes, and they usually stabilize most people on 60-80mg, and if they need more, the dosage is increased until cravings subside.

3) I have legitimate prescriptions for Norco, Ativan, & Baclofen. The Ativan is 2mg 3 times a day, as i have panic attacks as well as insomnia, the Norco is for pain from a rotator cuff injury & Rhabdomyolysis from about 2.25 years ago. The Baclofen is a muscle relaxer for cramps and severe muscle spasms. I spoke with the doctor at the clinic today, he knows about my medication and he didn't express to me any interest in having me try to get off of the Ativan or the Hydrocodone. In fact, he told me to only take the medicines which I've been prescribed, no others, and of course, no drugs. Should I not have to worry about any interaction with the Ativan (a Benzo) at this time since I'm still on what they consider to be a very low dose of Methadone?

Don't take more than what you are prescribed of the ativan, and never combine it with alcohol if you are taking it with methadone. The methadone will provide you with pain relief, so I would hold off on taking any of the norco if you don't need it. Methadone is very sedating, so I don't think that you will need as much ativan as usual, particularly you evening dose.

 

[issokay]

Lord Armagoth:
I was going through 120 pills within 5 days. Sometimes up to 30 a day or more, to answer your question.

Thanks for the info, Tommyboy

 

[Tommyboy]

Were you doing a cold water extraction on those norcos? If you are going to take more than 8 or 9 at a time, you should really do them to get the apap out of the pills.

 

[issokay]

No, I wasn't doing CWE... I was taking the 325mg of apap not 500, though. I did a CWE one time and I felt like SHIT. I don't think it worked. What's the best way to do that anyway?
Also, another concern I have is that since I was not doing heroin as much as I was taking Norco, is Methadone still right for me? At times I wonder if I'm taking a somewhat extreme approach at this. (MMT)

 

[effie]

H there issokay, welcome to BDD!

I'm going to move this over to OD as they have more experience in MMT

Good luck!

BDD > OD

 

[issokay]

I'm also wondering if taking Methadone is a good step for me, because it takes me like 8 or so Norco to get a good high, but I was occasionally doing oxy and heroin, heroin in pretty small amounts, and since there were times that I wasn't able to get any opiates when I ran out of pills that I just felt like shit and sometimes it would be a week or more before I got the RX filled again, I don't want to be doing something too extreme, you know... so I just want to know that this is appropriate for me.

Ok thanks.

effie:
I am having trouble figuring out how threads are organized. When I go to OD I am unable to browse through there with any sense of direction and am unable to find my thread that you moved there. I wasn't able to find this thread by browsing either. I had to search for my user name. Is this common?
Thanks
Justin

 

[-Guido-]

30mg is a typical dose. Once you feel comfortable, stick with that dose. Don't raise it to something insane because you will only end up giving yourself a tremendous tolerance to all opiod and opiates. I have seen so many new guys at the clinic bullshit their way to 130mg+ and now they are kicking themselves in the ass; Because the higher the methadone dose, the longer it will take for you to taper off if and when you decide.

 

[issokay]

Does the methadone give a high at any point? What's the purpose of trying to get on a higher dose? I know some people want more, just wondered why... And is the sole purpose of methadone just to keep you from feeling high if you do take an opiate?
Thx

 

[horsehead007]

fisrt post

Hi, I'm new here but I know a lot about being on methodone.
I'm from the UK so we don't really have prescribed oxys etc (please btw, if I'm doing something wrong tell me, I don't know how this site works) but there is a lot of heroin.
Methodone (as you probably know) is just a substitute, but not JUST a substitute. The thing with meth is that it offers you the chance to change your social circle and also break your day to day cycle of scoring and all the gubbins that go with it.
I think if you can sustain on 30mls that's great, but only if you feel comfortable with that. There's nothing worse than double doing (taking street drugs and meth on top) it basically doubles your habit, so if you are going to use oxy, don't take the meth, better still, don't take the oxy! (easier said than done.
After a period of time, and in YOUR OWN time, when you're ready, you can start to reduce on your script. What I did was come down from 100mls a day to 15mls then switched to buperenorphine, which i find give me a much clearer head, plus its a partial blocker, so any use of oxy or meth wouldn't affect you.
It took me 3 months to get down and make the transition, I was focused on a goal but didn't rush it. Take it at your own pace.
I hope a little piece of what I said helps or brings you comfort in some way. Like I said, this is my first post, I hope I haven't offended anyone. Peace.

 

[Znegative]

Yeah I would try to stay at around 40-50mg of methadone. At my clinic they maid you go up to seventy to make sure it would block other opiates but if you can avoid going up that high, it'll make it easier to come off of in the end.

You should be fine with you're Ativan and baclofen, but don't do anymore benzo's as its easy to overdose mixing the two

 

[Tchort]

Does the methadone give a high at any point? What's the purpose of trying to get on a higher dose? I know some people want more, just wondered why... And is the sole purpose of methadone just to keep you from feeling high if you do take an opiate?
Thx

Methadone has several purposes in the medical field. As a pain killer, it is pretty much equipotent to Morphine, though with NMDA Antagonism (which is a big aid to people with specific types of chronic pain or pain issues in general). It is long lasting, and despite the medical textbooks that put the length of analgesic action for Methadone at 6-8 hours, some (dare I say many) pain patients report feeling pain relief far longer than this. So it is an instant release opioid that can be used similar to an extended release opioid (MS-Contin, OxyContin, OpanaER).

For MMT, Methadone serves several purposes as well. If your goal is to detox with Methadone, there is a 21 day *Gold Standard* treatment; the Physicians Desk Reference and other sources (AMA etc) say that the first line treatment for opioid addiction detox is a 21 day taper with Methadone.

For short or long term maintanence, Methadone does several things. First and foremost, your dose starts between 20mg-40mg a day for the average clinic/patient (there are exceptions, though 30mg is generally what most American MMT clinics prescribe new patients) and go up from there. The first 'goal' is to get you to a dosage that completely eliminates physiological withdrawal syndrome for 24 hours. Once this is accomplished, the next step is generally to find out the dose that will end your cravings for your drug of choice for at least 24 hours (i.e. until your next dose of Methadone). For some people this is the same dose that eliminates opioid withdrawal symptoms; for most or many more they need a dose higher than a dose that would simply eliminate withdrawal symptoms, as craving control is an important part of changing your physiology from the biological changes done to your body and brain by opioid addiction. The generally recognized 'average' range for therapeutic MMT is 80mg-120mg. Meaning, at a dose within this window, most MMT patients have their withdrawal symptoms eliminated and no longer feel the intense cravings for opioids. The third 'goal' of MMT is to get you to a high enough dose and a large enough build up and tolerance to Methadone to eliminate the possibility of getting high on 'normal' amounts of recreational doses of opioids. Meaning, it would take a very, very expensive amount of Oxycodone or Heroin or Oxymorphone etc to overcome the high opioid tolerance the therapeutic dose of Methadone creates. Methadone does not 'block' other opioids the way Buprenorphine does, it just raises your opioid tolerance far higher than normal or even above normal doses of Heroin/Oxycodone/etc would be able to get you high. At this point your body chemistry changes (in both MMT and BMT), and the addictive behavior and physiological changes done to you by active addiction can be 'fixed', reversed, healed.

The amount of time you spend on MMT and the dose you take, and the reasons you are in an MMT program are all important and unique to you. Some people spend the rest of their lives on it; most get off of it within a couple years. I was on it just over 5 years before transitioning to Buprenorphine maintanence. Some people get on Methadone so they can stay at a low dose and get high when they can, and not be ill when they can't score dope. Some people get on MMT until they can straighten out personal and financial or social issues, then get off of it. Some people get on it for the long haul and taper off when they're ready. Some people recognize or believe they will go back to their addictive behavior if they get off of Methadone maintanence so they stay on it for life, but maintain a high quality of life and live the way they wish and do what they want with their lives without the addiction monkey fucking things up. Your unique situation is for you to figure out and your MMT counselor can help you a lot with this, as can Methadone Anonymous meetings.

Pain patients on MMT are not uncommon. A number of them attended the clinic I spent most of my MMT time at. As mentioned above, Methadone is a good tool for pain patients who require opioids for medical conditions unrelated to addiction, but for various reasons couldn't manage outpatient use of opioids (i.e. situations where the mix between pain issues and addiction issues spiral out of control)

 

[Tommyboy]

No, I wasn't doing CWE... I was taking the 325mg of apap not 500, though. I did a CWE one time and I felt like SHIT. I don't think it worked. What's the best way to do that anyway?
Also, another concern I have is that since I was not doing heroin as much as I was taking Norco, is Methadone still right for me? At times I wonder if I'm taking a somewhat extreme approach at this. (MMT)

Yea, I know you were talking about 10/325 since you said norco, and I said to do a CWE if you are doing 9 at a time because 10 would be 3250mg of apap at a time, and you shouldn't exceed 3000mg in a dose, or 4000mg in a day. Even if you were only taking 20 of them, thats 6500, which is 2500 of the max daily amount. Liver disease is a very real thing, and it has become more common recently due to all the tylenol people have been eating.

I don't know if you mentioned anything about suboxone here, but I would suggest that, unless your pain is really bad since suboxone will block other opiates, and may not treat your pain like methadone will. Methadone seems a bit extreme though.

 

[issokay]

Part of the reason I wanted to do the methadone is so that it would also help with pain, but mainly because I don't like eating that much acetaminophen. I've had my kidney and liver checked and they say that it's fine but that I have a little bit of a fatty liver due to other past drug use. I figure as long as I don't go up to a high dose that this will work out for me, I'm planning to leave the country for a year and a half in mid-April, so I want to be on a low enough dose that I can still get off of it by then.

 

[Pjkt2501]

If you've already developed issues with your liver (fatty tissue) you need to take extra good care of it so it doesn't escalate to a much more serious condition by not giving it time to rest and heal itself.

Methadone may be for you, but breakthrough pain will be tough to manage due to its high binding affinity.

 

[issokay]

...high binding affinity.

What do you mean by that?

 

[Pjkt2501]

The ability of the drug to bind to mu-opioid receptors in the brain, and systemically. Methadone has a greater "strength" while attaching, that it won't allow a lesser drug a look-in. Opana IR is one of the few that I imagine wouldn't have difficulties, and Opana is about as strong as it gets (oxymorphone).

Suboxone for instance is known for its ability to block other opiates - this is due directly to the aforementioned reason.

 

[issokay]

Oh, gotcha.

 

[Tommyboy]

The ability of the drug to bind to mu-opioid receptors in the brain, and systemically. Methadone has a greater "strength" while attaching, that it won't allow a lesser drug a look-in. Opana IR is one of the few that I imagine wouldn't have difficulties, and Opana is about as strong as it gets (oxymorphone).

Suboxone for instance is known for its ability to block other opiates - this is due directly to the aforementioned reason.

I didn't think that binding affinity had anything to do with methadones blockade effect. It's more that your body is so used to having a high dose of an opiate in it 24/7 that you won't feel adding some more of an opiate. It would be like a hardcore alcoholic that drinks straight liquor all day, expecting to get something out of sipping on a wine cooler.

Methadones blockade effect is completely different than the blockade effect from suboxone which is from the higher binding affinity.