Opioids In Canada - Can One be on MMT and Still Take Necessary Benzodiazepines

[Druidus]

I'm just interested if it's possible to retain benzodiazepines as part of your medications, even if it or the methadone is just reduced, when you are in methadone maintenance therapy, in Canada, specifically Ontario.

I've been told repeatedly that the answer is no. Is that just for clinics maybe, and a private addictions M.D. would be more probable to allow for this?

The trouble is, my anxiety is too high, and I've had seizures, so I really can't stop taking my benzodiazepines, not feasibly. But I'd really love to get on methadone for a short time to level out a while and just focus on studies, rather than always trying to find ways to stop the flow of money out of my hands and into my veins. Even if I have more control than before now, when I was truly addicted, I still would rather never use intravenous opiates, and I haven't reached that point of making it possible yet, even after one year without use at all. I mean, I made the year, but things really didn't get better, so I started using occasionally. It got bad a few times, but I always knew how to bring it back into the manageable range. But methadone for a while is cheaper and healthier, and could really improve my life. If I weren't afraid of asking about it.

I don't know where to go. I wish I knew doctors in the area who handled this sort of issue. I just got one, though, after a year, and I am still not close enough to him to even discuss my benzodiazepines other than requesting my refills, so I really don't want to bring up something I won't be able to bring down after.

 

[Swimmingdancer]

Yes, a "private" MD is going to be much more likely to presrcibe benzos to a methadone patient than a clinic will, but it really depends on the doctor. I live in Canada and am on methadone maintenance and have been prescribed benzos (although only short term before things like dental work) but when I was at a methadone clinic benzos were forbidden as they assumed that anyone who has ever had a drug addiction could not be trusted with any drug and was only trying to get high. They also tested for benzos in the random drug tests. If you are going in with a legit prescription for benzos already then they might be more likely to let you keep taking them but I'm not sure.


If your doctor is ok with letting you stay on benzos they might lower your benzo dose initially to make sure that the methadone doesn't potentiate the benzos.


ETA: Personally I would never recommend methadone for anyone who wasn't severely physically dependent on opioids already. The withdrawal symptoms are the worst thing imaginable and last for months. And it's very easy to end up taking methadone for much longer than you'd planned. If you only use opioids ocassionally are you sure you want to be chained to going to the pharmacy every day? Have you explored other options for helping with your opioid use, such as counselling, supplements, acupuncture, non-opioid meds, etc?

 

[Druidus]

Believe me, I have. I really don't like that part of methadone. But I will have all the tapering time in the world, using poppy seed tea, should I need it, and honestly, it might just be best off for me to try this because life just isn't working while unmedicated. And I'm running out of chances.

What else can I try that I haven't? I can't stop going back, even if only for binging vacations, and I've got to change that. I don't even mean to be on it for a full year, I was thinking just until I finished this coming year of uni and keeping the dose as low as absolutely possible. Then when I'm tapering, if I experience issues, resort to seed tea.

 

[Swimmingdancer]

I didn't plan to be on methadone for a full year and I ended up on it for 10 years. Many people I know planned to be on it for a few months and stayed on it the rest of their lives. One thing that most people don't realize about it is the longer that you are on it the worse the withdrawals get. I would recommend that you try to stay on it for as little time as possible and keep your dose as low as you can. The withdrawals I have now when I lower my dose by just 1mg are equivalent to when I would stop cold turkey back when I had only been on methadone for a few months. It's absolutely brutal. So taking all the time in the world to taper off it is not something I would recommend to anyone who doesn't want to be on methadone for life.

Also, once you are on methadone and a confirmed addict, expect the way you are treated by medical professionals to change drastically.

Of course, if you truly feel that methadone is the only thing that will keep you from using then it's often better than the roller coaster life of a dope user. But if you are not physically dependent than why do you think it will keep you from using? All it does after about the first month or so is prevent withdrawal symptoms. Most people start using their opioid of choice on top of their methadone once the initial honeymoon phase is gone (or often even right away). If you are going to use methadone then I would use that time to make some major changes in your life, try to work on the reasons you use dope in the first place, learn different ways of coping with life, and do things to prevent yourself from using illicit opioids (like moving, or erasing our dealer's number from your phone, etc). Work on your health and mental health, try some non-opioid meds to see if they help, etc. Good luck!

Feel free to let me know if you have any other questions about the methadone program in Canada Sorry if I sound anti-methadone. Just want to make sure you are informed because most doctors/clinics just tell you what you want to hear and/or the info they're given by the pharmaceutical company. When I started methadone I was told that one could taper off methadone whenever and experience no withdrawal symptoms whatsoever, and that methadone eliminates all drug cravings, both of which were lies.

 

[Druidus]

I'm well aware of the issues involved. I'm studying for a neuroscience degree, but I won't get there if I can't find a way to avoid using other opiates occasionally, because that just draws me into a world where I can't function from. At least, I function poorer when dealing within it.

Methadone for me would be free eventually due to my coming status recognition as an Amerindian. Laughable, really, at 1/32nd Amerindian, but I won't complain, free medications, amongst other benefits, is amazing. That saves me a lot of money, as I have no job this is good.

I DON'T plan to gain a physical addiction. I plan to use the methadone at an extremely low rate, something that I wouldn't even feel with the tolerance I now have. And if I can, save it up for those times when I really want to binge, so I have something I can use without going to the black market. I've used methadone recreationally a number of times, and once took it myself from a black market source for 2-3 weeks when trying, the first time, to come off hydromorphone at a ridiculous level.

A recreational dose for me is at least 45mg. I've taken 120mg+ and been ok, despite being on benzos and some alcohol too. Nodded hard though. And yes, I know how dangerous that is. It lasts 24-h for me at least. I do this once every few tendays if I can't find my DOC, hydromorphone when I really want to use. I keep the dose at the lower end of the spectrum, usually, if I do use methadone.

I don't think I need it everyday. But I do think it will help me used sporadically to assuage a craving or a couple days of them, with long stretches between uses. I really don't want to gain a full addiction to an opiate again, so I would likely only even attempt this if I thought I could hide not using the full amount prescribed or hopefully not even using at all some days.

I'm just being honest, I'm likely going to use it recreationally occasionally, but that will be in PLACE of what is fucking my life up academically, financially, and with my family. Methadone could save me, if I can use it like this. And it's not willpower that'd stop me from occasional use because I consistently go long periods without hydromorphone, much longer than its withdrawal phase, when I could easily attain some at little cost for a bit. I think having it as an option would prevent me from seeking other options, when I decide to seek this kind of drug. I'll keep looking for other ways, but I don't think anything else has helped much at all, other than occasionally going ahead and doing some. It stops me from using daily, multiple times, at high doses, and it also stops the problems I had while on my year and a bit clean of opiates, which I couldn't manage while attending university.

I just can't deal with a constant battle to not get addicted again, to the needle, in particular. It's a war I can never win, only perpetuate infernally. But not using basically ruined my life too, so I'm doing the only thing that works at all, for me.

 

[Swimmingdancer]

Generally when prescribed methadone in Canada they make you go to the pharmacy every day to get it (at least for the first few months) and you have to take it in front of the pharmacist, so I have no idea how you would hide that you are not taking it all or be able to only take it sporadically. Most pharmacies will even check to make sure you've actually swallowed it all by making you talk to them etc. People don't generally get take-home doses for quite some time. And your doctor or clinic will randomly test your urine to make sure you are taking your methadone (although they rarely check the actual quantity of methadone in the body). So I'm not sure how you could be on legally prescribed methadone without getting physically dependent on it.

In addition, in order to get on methadone in the first place you have to prove that you are already physically dependent on opioids. This usually entails a questionnaire and a series of drug tests, often spaced out like every other day for a week or something like that to make sure you have opiates in your system consistently.

I'm kind of unsure what your plan is... Are you saying that you basically want some free methadone so you can use it recreationally once in a while instead of your opiate of choice? Or that you are going to take just a small amount that you won't even feel? Or both? I'm not sure how taking a small amount that you won't even feel is going to help anything, unless you are physically dependent to opioids and just using methadone to alleviate withdrawal symptoms. Taking a small dose that doesn't make you "high" is not going to eliminate cravings, especially done just once in a while.

Sorry to be the bearer of bad news, it just doesn't sound like legally prescribed methadone is going to provide what you are looking for unfortunately. It's not something you can just take when you feel like it. I think your only choices are to not take methadone at all, to take it every day in the prescribed dose, or to purchase it on the black market.

 

[Druidus]

I just thought it would give me the time to slow my use. I mean, I have slowed down, but not fast enough. I feel I could keep going, or at least comfortably stand still, with this drug as an option instead of having to use an illicit drug for the purpose. The negatives are ruining my life, but I still can't stop, so I have to find some alternative.

Also, if it's a pill and not the juice, I have the ability to pocket a couple decent sized pills deep behind wisdom teeth, and I can hide it easily while talking. I can also briefly semi-swallow a single large pill for a couple minutes, before either it slips and I swallow, or I cough it back out. I don't think I could easily find a way to do that with juice, so I'd have to be getting a pill version if I could do it at all. I knew someone who was prescribed pills of methadone out in the eastern regions of Canada.

I really do appreciate your concern, I'm just in kind of a tight situation, quite a bind. I'm trying to walk the trapeze wire out while still functioning in the rest of my life. I've put too many years of school off for drugs.

Edit: Also, the sporadic low dose use would be to generate detectable metabolite levels in my urine, and just enough for that.

 

[Swimmingdancer]

One thing I was just reading that I thought you might find interesting was that benzos can potentially prevent brain damage caused by methadone. Basically, methadone is an NMDA antagonist and animal studies have found NMDA antagonists to cause brain damage. GABA-A receptor agonists are used to effectively prevent any neurotoxicity caused by them. This is why in medical settings when strong NMDA antagonists are given they are co-administered with benzos or other drugs that suppress NAN.

Just thought that might have some relevance to the topic of benzos and methadone

 

[Druidus]

That's very interesting, thank you most heartily for that; I'm actually going to look into it out of sheer scientific interest...

 

[Swimmingdancer]

I just thought it would give me the time to slow my use. I mean, I have slowed down, but not fast enough. I feel I could keep going, or at least comfortably stand still, with this drug as an option instead of having to use an illicit drug for the purpose. The negatives are ruining my life, but I still can't stop, so I have to find some alternative.

Also, if it's a pill and not the juice, I have the ability to pocket a couple decent sized pills deep behind wisdom teeth, and I can hide it easily while talking. I can also briefly semi-swallow a single large pill for a couple minutes, before either it slips and I swallow, or I cough it back out. I don't think I could easily find a way to do that with juice, so I'd have to be getting a pill version if I could do it at all. I knew someone who was prescribed pills of methadone out in the eastern regions of Canada.

I really do appreciate your concern, I'm just in kind of a tight situation, quite a bind. I'm trying to walk the trapeze wire out while still functioning in the rest of my life. I've put too many years of school off for drugs.

They won't give you pills. Sorry. Methadone tablets are only prescribed in Canada for severe chronic pain (dying of cancer etc) in people who have never had a drug problem or for a very few maintenance patients in very unusual situations who have been on methadone for years and have had consistent clean drug tests and have a good reason for needing the pills. I am prescribed pills and I had another doctor report my doctor to the College of Physicians for giving them to me. Thankfully he still prescribes them to me but he is in a different city 5 hours away and no other doctor (and I've tried many) will prescribe me the tablets. They all said this was absolutely unheard of other than for very short periods of time for air travel to a foreign country in patients who had been clean from all other drugs for a minimum 3 years. And I am only prescribed them because I fit all the criteria I mentioned above (in very unusual situation, have been on methadone for years, have had consistent clean drug tests for years and have a good reason for needing the pills). I was only given liquid for a very long time when I first started MMT.

 

[Druidus]

Aw, probably unworkable then.

I can always megadose poppy seed tea, I guess. But it's unpredictable, and more suited to actually tapering, IMO. If it's underwhelming, I always blame potency and want to up the dose, but that leads to bad places. But you can taste the bitter opiate alkaloids in the tea as a measure of potency, at least. Still costs me in the dozens of dollars for a solid days doses. But I guess it's really not worth rocking the boat at all if I'll be getting juice.

Thanks for all your help, bro.

 

[Swimmingdancer]

Yeah, sorry it wasn't what you were hoping to hear. Good luck with everything. Have you tried a serious supplement regimen? Or various anti-depressants? Or yoga? Or a whole bunch of things like that in combination?

Any info/advice about poppy tea would be interesting to me. It's one of the few things I haven't tried. Have you ever used it to taper off opiates you were physically dependent on?

 

[Druidus]

That's ok, reality wasn't designed for me or for anyone, this kind of thing happens.

I've tried supplements, can't afford them now. Anti-depressants tend to cause development of mania type states in me, if not horrible side effects. Not yoga, but I meditate often, it helps keep me sane. I even switched to other drugs, started using stims more, started smoking. Being on higher doses of benzodiazepines, daily, has a similarly helpful effect on my functioning, but it's hard to get a doctor to increase to the levels I needed for that.

I'll write a good post about poppy seed tea, and then post it in a couple mins. Yeah, it can be awesome, and yes, I've tapered off of a high multiple times per day hydromorphone habit with it. Didn't relapse for over a year by using opiates other than the tea, and actually stopped the tea after a month of tapering.

 

[Druidus]

Two older posts of mine I'll just put here in quotes describe most everything:

I've been there, man.

My advice: If you do get sick, purchase some poppy seeds in bulk. Get a lot, several kilos. Now get a couple gatorade/powerade bottles, or, even better (more squeezable) ~700ml plastic pop bottles. Put poppy seeds inside the bottle, filling it aout 3/4 to 4/5. Now fill it with slightly warm water, not at all hot, until it covers the seeds nicely. Make sure the water seeps to the bottom.

Shake that every few minutes for 30-45 minutes. After, use a clean sheet to cover the mouth of the bottle and strain all the liquid through into another container. Squeeze the seeds to get every drop, and I even do another wash of the seeds to get any leftover product.

What you get is a decent amount of morphine. Of course, one bottle isn't a lot of it or anything, but we're trying to quit, right? Drink that, wait 1-2 hours, and guage your level of sickness now. It should be DRASTICALLY reduced. If you need another bottle, go ahead and make one. Use the tea for 3-4 days, then stop.

If you do it right and don't go overboard on the tea (there's no limit to the amount of morphine you can collect), you'll be able to completely negate ANY withdrawal symptoms. Completely. I've used this method several times to quit, and as long as you don't use the morphine tea too long, you won't withdraw from it, because of the relatively low doses you're taking.

If you made a LOT of tea, like 4-6 of those bottles, you'd get a righteous nod from it. But you need to stick to as little as possible. Aim to JUST make the symptoms go away so you are functional, don't aim to get high. The success of this method depends on your determination to function on the ground, not to keep flying, if you know what I mean. It's all up to you, and you CAN fuck up, but it gives you what you need so that you aren't in hell.

It's just maintenace for the withdrawal. Trust me, it works. It's very worth it. I was able to quit IV'd dilaudid (ridiculous doses) and STILL go to university using this method.

I hope it helps you, man.

Btw, quitting IV opiates, or any route of admin., really, is incredibly easier if you use the OTC resources available to one in need. Loperamide, or Immodium, actually helps a lot when taken in massive doses. People say it doesn't cross the BBB well enough to be psychoactive. That's bullshit, IMO and IME. Butr we're talking fifty plus milligrams. I needed over 100 per dose. That's over fifty pills, and it's so expensive it might as well be from the street. Less helpful, I find, is the codeine you can get OTC in many countries, though only 8mg tablets here, combined with 15mg of caffeine each and a ton of acetaminophen to CWE out. The caffeine stays, mostly, so it kind of really sucks.

The best thing, barring methadone or suboxone, which many cannot get on (or off, I've heard), is poppy seeds. I'll stand by them to the grave. They don't get completely washed of opium latex, especially in bulk stores; meaning you can have morphine/opiate tea. Just find a store with cheap bulk poppy seeds, test it by using 300mg to measure potency, if any. I could use a kilogram to a kilo and a half and actually catch a nod. Used two to three times a day at the dose you need to kill the cravings and the withdrawal symptoms, it's a Godsend. And you can slowly reduce the dose every two or three days, more if you need it. Until you feel if not the best, at least good, without opiates in your system.

I'm amazed they're legal, lol. So ridiculously cheap compared to street prices. Five to ten bucks gives you a good day, two if you stretch it. You can't inject it, and as long as you don't dose it too frequently or too heavily, it's relatively safe. People have died from it, though, so be careful. Test the potency of every new batch, it varies quite a lot, not all seeds have the same latex coating left. You could OD on as little as a kilo if it's too potent. If anyone asks why you buy so many poppy seeds, tell them you absolutely love poppy seed cakes and other baked goods. It's still legal to have whatever amount, until the minute you start making the tea, which would be considered a preparation of morphine.

To make the tea, simply put your dose of seeds in a container, fill to a little above the seeds with WARM water, and then shake/let sit for thirty to forty mins. Strain the seeds from the liquid, and squeeze them inside the container to push out the water they soak up. Rewash the seeds, same drill, but don't combine the washes. Taste the first wash, and it shouldn't be unpleasant, but rather, earthy, tealike, and, here's what to taste for: bitter! You can generally gauge the strength of a particular wash by tasting for bitterness alone. Test that, taste the second wash. Still bitter, but very noticeably weaker. Still diminishing returns don't crop up too much till the third wash, which I don't bother with.

Dose every six to ten hours, depending on need, and stabilize without the horrors of withdrawal. Literally, folks, you can KILL the symptoms completely; I cannot praise this stuff enough. To anyone trying to quit, please, just give seeds a try. You won't regret it. It literally saved my life, I wouldn't have got on the bus to leave street opiates behind without it; I just took enough seeds for two weeks and left.

It sounds too good to be true, and it almost should be, lol, but I swear, this is legitimate. Poppy seeds, at least from bulk stores (IME), contain more than enough morphine for opiate tapering, and even if you don't want to quit, you can get a damn good high from it, even a nod. And it's long lasting, so you don't need to redoes that much at all. In fact, I could get by on one strong dose a day, but I took a second one around supper time in order to mitigate symptoms upon waking the next day.

Seed tea, FTW.

A few other things. With a really high tolerance, you could need upwards of a couple kilos, per dose, if you want a recreational dose, not the low doses I suggested previously. Always start low though. Also, the level of both white and brown sediments on the seeds has to do with potency. Some seeds are black, and cleaned well, some are grey-to-white, suggesting opium latex left behind, and sometimes you find dried latex which is brown. PLEASE, potency test each new batch of seeds before you start dosing high. And if it tastes WAY too bitter, you're probably right, and while it doesn't happen often, you just got a big dose, so drink less. People have actually died from this stuff, overdose is possible, do not underestimate the seed tea just because of it's legality and availability.

The faster you drink it, the faster the onset and initial come up. It does last a long time, too, before your symptoms start to come back. Theoretically, you could evapourate the tea for a while to get a product that could be taken as an enema for a rush type feeling, but not really, because the stuff goes kind of bad even overnight, certainly by 36 or so hours.

I've sought, for ages, a way to extract the pure morphine salts from the opium latex on seeds, but I've come up with nothing safe enough to attempt, IMO, to produce an injectably pure product. I can get close, to a plate of small amounts of solvent, some insoluble powder, and a very unacceptable level of lipids. I don't know how to separate the alkaloids from that mess after that. But you CAN capsule the "extracted" gunk to take it in pill form.

 

[RorerQuaalude714]

Depends on the doctor and the patient. At the addictions clinic that I go to, my addictions doc has a bunch of patients that are on MMT and benzos and other CNS depressants like Cesamet. He just monitors them very, very closely and he only allows this if another specialist (in most cases psychiatrists) scripted the benzos and are aware of the patient being on MMT or bupe and do regular followups in addition to the addiction doc's followups. He also only allows other CNS depressants to be taken if there is a proven tolerance to both opioids and benzos. He allows me to take clonazepam and zolpidem while I'm on Suboxone due to the fact that my shrink prescribed them, I have a tolerance to them and that I'm being monitored by both docs and have a flawless track record when it comes to not abusing my meds since getting clean and sober. If a patient has a regular pattern of abusing their meds or pissing dirty, then they're usually taken off the benzos, and in extreme cases, permanently kicked out of the clinic. My addictions doc said that specifically nitrazepam and diazepam are the benzos to avoid most while on bupe or MMT and he generally won't allow those, except in some EXTREMELY rare instances. He's more than a bit iffy on temazepam as well. It generally all boils down to the patient's track record when it comes to demonstrating a commitment to sobriety and a very careful consideration and monitoring of all risk factors involved and regular communication between the doctors.

 

[BananasAndOranges]

Some clinics are WAY to stricrt on this and its annoying I know some clinics will kick you out if you dont taper off in their amount of time.

 

[Swimmingdancer]

Thanks for all the info and advice about the poppy seed tea Druidus. I think it'll be pretty difficult and expensive to find enough seeds for any long-term use though. Plus don't stores get suspicious if you come in and buy kilos of poppy seeds? Have you tried poppy pod tea?

One thing that my doctor recommended for anti-depressants is starting on Lamotrigine first. It is an anticonvulsant, mood stabilizer and used as an adjunct in treating depression, so it sounds like it might be very helpful with your situation since you said you get seizures and anxiety and are prone to mania when you've taken anti-depressants in the past. What they usually do is start you on Lamotrigine a couple weeks (or more if you want to see whether the Lamotrigine is effective all by itself) before starting the anti-depressant. The anti-depressant I would recommend if you haven't tried it is Bupropion. It is an atypical anti-depressant so many people who haven't responded to other anti-depressants find it very helpful. Plus it has less side effects and contraindications that most other anti-depressants. The second one I would recommend (if Bupropion doesn't work) is Duloxetine. Do you have a good doctor?

 

[Druidus]

Thanks for all the info and advice about the poppy seed tea Druidus. I think it'll be pretty difficult and expensive to find enough seeds for any long-term use though. Plus don't stores get suspicious if you come in and buy kilos of poppy seeds? Have you tried poppy pod tea?

One thing that my doctor recommended for anti-depressants is starting on Lamotrigine first. It is an anticonvulsant, mood stabilizer and used as an adjunct in treating depression, so it sounds like it might be very helpful with your situation since you said you get seizures and anxiety and are prone to mania when you've taken anti-depressants in the past. What they usually do is start you on Lamotrigine a couple weeks (or more if you want to see whether the Lamotrigine is effective all by itself) before starting the anti-depressant. The anti-depressant I would recommend if you haven't tried it is Bupropion. It is an atypical anti-depressant so many people who haven't responded to other anti-depressants find it very helpful. Plus it has less side effects and contraindications that most other anti-depressants. The second one I would recommend (if Bupropion doesn't work) is Duloxetine. Do you have a good doctor?

Lamotrogine amplified my mood issues, oddly, and caused blackouts. Buproprion works, but I can't sleep anymore, and it doesn't fix everything. I've been awake far too long to care to look up duloxetine, what is the brand name? Sounds familiar, but I doubt I've been on it.

I'm currently on olanzapine 10mg at night, mirtazapine 15mg at night, soon to be 30mg, trazodone 100mg at night, and my clonazepam.

 

[Swimmingdancer]

Lamotrogine amplified my mood issues, oddly, and caused blackouts. Buproprion works, but I can't sleep anymore, and it doesn't fix everything. I've been awake far too long to care to look up duloxetine, what is the brand name? Sounds familiar, but I doubt I've been on it.

I'm currently on olanzapine 10mg at night, mirtazapine 15mg at night, soon to be 30mg, trazodone 100mg at night, and my clonazepam.

That sucks. It's so frustrating trying to find things that work for you and it can make it so easy to rationalize using opioids because they are the quick answer.
But nothing fixes everything ;-)

Duloxetine is Cymbalta.

 

[TaSiPtR]

I completely agree with Swimmingdancer on this one MMT can be a life saver but only & I mean ONLY get on it if you have a moderate to sever opiate addiction and have tried all other options i.e detox. I personally used it as a last resort & only got on it after 6 detoxes not failed detoxes either I just kept relapsing aafter a few weeks months it got worse my habit that is after every subsequent detox before I got on the programme I was using 600mg per day of morphine. Just my thoughts and opinions but I hope they may be of some value to the OP.