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Starting methadone maintenance

so if i am ten days in on my methadone at 60mg should I get it lowered or switch quickly before I get my receptors "too bogged down" ??

I don't wanna be on this stuff forever, but right now its been such a blessing because i don't use heroin... but 60mg might be a little much?
 
If 60mg is keeping you off heroin and taking your medication as prescribed, stick with that. At least for now, if it's keeping you from getting high it is the right dose to be on - especially at the beginning where you're at now.

Whatever dose works for you is the dose you should be on, especially if it has only been 10 days and you're not using methadone just to detox. If 60mg is the dose you need to eliminate cravings, stick with that. If it's not enough, raise it. If you like you can try experimenting and lower the dose 5mg, see how it goes for a week, and if you still aren't having cravings you can keep lowering the dose 5mg a week until you start feelings crappy and the cravings come back.

It's recommended that when methadone is started the patient finds whatever dose works for her - which will be different for everyone. Once you've stabilized on it and started establishing healthy habits, then is the time to try reducing your dose to find what the lowest tolerable does is.

Taking 60mg each day for ten days is unlikely to require you to wait an entire five days before taking buprenorphine to avoid precipitated withdrawal. It probably wouldn't take you more than 48hrs tops before you could safely take buprenorphine, although the longer you can hold off on taking the buprenorphine after your last dose, the more effective it will be all around.

Remember that everyone is different. None of us can predict exactly how long you will have to wait to safely avoid precipitated withdrawal. Safe to say it will probably be more than 24 hours and less than five days. In my case, if I was in your situation, I'd probably dose the buprenorphine about 36-48hrs after my last dose of methadone. Others will have to wait longer. Once your body starts telling you it's in withdrawal (anxiety, insomnia, RLS and/or diarrhea and nausea for me), that is pretty much a sign that it's okay to take buprenorphine.
 
motiv311 said:
so if i am ten days in on my methadone at 60mg should I get it lowered or switch quickly before I get my receptors "too bogged down" ??

I don't wanna be on this stuff forever, but right now its been such a blessing because i don't use heroin... but 60mg might be a little much?
Click to expand...

60mg is a pretty low dose. Most people at my clinic are closer to 100 as that is considered a blocking dose. I know for me I couldn't stop shooting heroin until it completely stopped getting me high.
 
I do 15mg and homemade thc edibles and smoke :) Might as well stay as low as possible, the buzz lasted for a few days for me and now the 'done just makes the weed a lot better, plus major pain relief. I'm glad I didn't try for a higher dose.
 
The standard "blockade" dose is generally considered to be somewhere between 65-100mg, 80mg is somewhat of an arbitrary choice but it is what many American clinics will shoot for in terms of balancing craving reduction and opioid tolerance. Some clinic cap the dose at 65mg, others 80mg, and yet other 100-120mg. Many clinics don't have a cap.

I mean, with powerful enough dope, or simply enough dope, it's possible to get high on both buprenorphine and high doses of methadone. But with high doses of methadone there are so many side effects, and you've become so tolerant to a full agonist potent opioid already, that you really don't feel the dope much.

Everyone is different though. I only really needed 90mg at my highest dose, and frankly a big part of the reason I even went up that high at all is because I liked the all day buzz. And even once I got down to 30mg dope has very little effect on me. I know people that have been on 40mg and never needed an increase, and others who needed to go all the way up to 180mg before they started to stabalize. Do what you need to do to stay healthy, the actual mg number of your dose is kind of arbitrary.

Of course it takes less time to taper off a lower total dose, but the whole withdrawal process isn't night and day different. Methadone withdrawal is going to be methadone withdrawal, even if kicking 180mg is a little hard to compare to 5mg. But regardless of the dose anyone can properly, painlessly taper given enough time and patience.
 
Motiv- you said you were going to wait until mid 2016 to switch to subs right? If you do, please just wait to take the subs until your start feeling bad. I think most can at least agree on that.. By mid 2016 the methadone will be settled in your system. If you aren't sick, there's no reason to take it anyway. So just wait until you start feeling bad.

The only time I tried it, I had waited until I was in horrible withdrawal and I still got pwd but I must be the exception lol
 
im just worried about depression from the "downer" effect of methadone.... over time I know with powerful opiods , i start to get depressed , and tahts what I worry about.
 
If opioids tend to do that to you, and they have a depressant effects on a lot of people, that is something to be concerned about. But honestly as long as the dose doesn't get crazy high I don't see it being any really more significant than buprenorphine. But then who knows, maybe you would find that you respond poorly to methadone and better to buprenorphine or kratom or something else that's used as a kind of detox/maintenance therapy. Everyone's different.

I did notice that I got a wee bit depressed on methadone, but it took higher doses of about 80-90mg and it didn't start till I'd been on it for more than a few months. The depression went away completely when I lowered my dose down to 20-40mg.
 
So I was told 30mg for 3 days then 40mg for 3 days then 50mg etc until I'm comfortable.so today was the 4th day I asked if I was getting a dose increase because I'm still not comfortable and last 2 days been having real bad cravings! So when I went to the window to get my dose I asked and they said no I wasn't getting my increase? Wtf? They said the doctor put the 30mg for 3 and the 40mg for 3 days in the note but didn't actually order it...so they told me if I wanted a increase to talk to my counselor so I did and he put the order in.im a little pissed because one of the nurses said nope that's it that's what the Dr said 30 and that's it! I'm really fuckin confused.makes me want to say fuckin it not go back and just go grab some shit! I just don't get it it's like my addiction isn't sufficient enough to get a fuckin increase...I read the Manual it says positive UA will result in loss of take homes and another section says positive UA could lead to involuntary detox? Can anyone shed some light because I'm sure fuckin confused ><
Sorry for rambling on but...
 
Don't worry about your post, confusion is a big, intrinsic part of the process of starting methadone maintenance for the first time. I definitely remember going through basically the same BS you are right now.

The thing is that clinics are more often than not very disorganized especially in terms of administration and internal communication. Funk ups, like with the doctors order getting screwed up, are fairly routine.

Different clinics have different policies regarding dirty UA, take homes and involuntary detox. Make sure you read the patient manual carefully and go over it with the clinic director/manager. Note I said the director and not your case worker/counselor. More often than not the counselors don't know much more about how the clinic works than patients. This is especially the case with most clinics because the counselors are just psychology/PsyD/LCSW students doing their internship and will only stay at the clinic as a counselor for 6-12 months. So if you need to find some info about something, clarify a policy or review your standing regarding take homes and UAs at your clinic make sure you talk to the director. My clinic likes us to talk to our counselor first, but then you can always still make a follow up appointment with the director. Some directors are better than others of course, as with travel counselors and nurses, so YMMV.

Generally you can have as many dirty UAs during the first one to three months, although don't expect to get take homes any time soon. After a certain point you will start getting restrictions if you habitually test dirty over and over and/or constantly lie about your drug use. Ultimately that may lead to an administrative detox, the nature of which will vary from clinic to clinic.

Make an appointment with the clinics director to review your concerns about their policy with. In terms of dirty UAs, until you are at a dose that is holding you a bit better you don't really need to worry about it. Of course methadone works much, much, MUCH more effectively when you're not using on top of it, and there isn't much worse than a habit to heroin AND methadone. Generally you get a warning for your first dirty UA after you've been clean for a while, then the next dirty UA you lose take home priviliges, and further ditties UAs may eventually result in administrative detox.

It may also be a good idea to schedule an appointment with the head clinic doctors (this is generally the doctor who's name is on your methadone prescription) to go over medication policy and whatnot. The director is ultimately who you need to talk to to get the correct info on their policies regarding takehomes, dirty UAs, administrative detox and the like. It's good to establish good rapport with the head doctor too though, as it will make adjusting your dose a little easier in the future (just make sure you schedule your appointment with the right doctor because most clinics will have more than one doctor come in depending on the day, although there is only one head doctor who's name is on your methadone prescription - ask the director which doctor it is and when he is there if you aren't sure).

And btw, most clinics don't test for cannabis, but most are really strict with benzos and opioids, especially without a script but even with one sometimes. Certain clinics won't even allow patients to be prescribed benzos, although these aren't generally the norm.

And to be clear I'm speaking to methadone clinics in the US, particularly the private ones (which are the vast majority of them here). Other countries have much better, more humane and effective policies regarding methadone clinics. Here in the US each clinic is different though, so you need to find out your specific clinics policies.
 
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The clinic I go to is a privately owned clinic in the u.s as well before I started I was on kolonopin 1mg for about 2 months for anxiety but had a opiate habit long before.i don't care much for benzos to be honest and I don't smoke much herb anymore because I tend to get panic attacks from certain strains.i did join the methadone clinic really wanting to get clean and I honestly do want to the first couple days weren't so bad without using any opiates but today has been very hard on me.my savings have been spent and pretty much everything nice that I owned has been pawned or traded so I don't have any ride nor can take a bus...so I've been walking 1 1/2 hours each way to get my dose physically and mentally it's been kicking my ass.i know that 30mg just isn't the dose for me because I'm having real bad cravings and this morning I was feeling like I was in some decent withdrawals and was walking in some light rain so I was getting a little angry and when I got there they said no about getting the 40mg because of something the doctor did wrong or I misunderstood..I'm a good listener so that can't be it lol
Then the nurse comes up to the front desk where you check in and like threw her hands up and was like nope 30 and that's it! I felt like saying who the fuck are you to say anyways? The way I see it is if I'm going to be kept at 30mg and still be uncomfortable then what's the point of even going back.but I'm going to keep my head up and just give it more time to see what they do.and for now while I am still uncomfortable I'm just going to use to take the edge off until my dose is increased to where I'm good.no way are these people there going to measure my habit when they don't even know the extent of it . because I know when I'm good and when I'm not!
 
Yea, and unfortunately a lot of people who work at these clinics, particularly the dosing nurses I've noticed, seem to have some power/inferiority complex. It's like they enjoy exercising what little authority and power over patients they have. A lot of them are really nice and caring in their work, but other dosing nurses are a huge PITA. I hope you get your dose figured out and stabilize asap! You certainly have the right attitude and deserve to get the support you need and have actively sought out for yourself to get your recovery jump started already!

Good luck with everything. We're all rooting for you here!

P.S. And yea stick with it! Give it some more time, at least a couple months. By three months in you should be stabilized to the point where you're not feeling sick and the cravings, if they haven't gone away completely, have become fairly insignificant compared to what you're experiencing now. It sounds like it will take some time, but you'll get to where you want to be with your new medication.

Dealing with the methadone clinic is something I absolutely hate, but in a way it's actually a kind of good thing. It prevents me getting comfortable dealing with it, thus having to put up with the clinic bullshit is a strong motivating factor in my desire to get off the stuff as soon as I can. Granted it doesn't help me with succeeding while I am taking (and hugely benefiting) from the medicine, but it is what it is.

Once I'm ready, I cannot wait to get off it so I never have to step foot let alone see a clinic again!
 
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Toothpastedog has pretty much covered everything I was going to say, I couldn't have said it better myself! I've been going to one of the clinics here in north FL for almost 4 yrs and have seen a lot of total b.s. and experienced a lot personally... i.e. the clinic saying the new rule isn't them, it's the state of Florida requiring the new boxes for take homes when u know for a fact, because of guest dosing and picking up at a clinic on vacation personally, that other clinics in the state don't even make u have a box at all, just a brown bag; being told TOTALLY incorrect info about policies and procedures (while, nicely trying to explain to that counselor a bit of reading comprehension so she can understand the CLEARLY STATED POLICY TAPED ON HER WALL, 1 take home is possible between days 31-90, eligibility doesn't begin at day 91, sigh.) But I digress... welcome to the clinic, where confusion, paperwork backlogs, miscommunication, bitchy nurses at the dosing windows, occasionally having a 2 hour long line because out of 9 dosing windows only 2 or 3 are open that day cause all the nurses called in and 2 more are on break, the rare but maddening counselor with a sadistic streak, not trying to scare you but don't let this frustrating shit stop you from the reason we put up with it- kicking that nasty monkey off our backs. Don't assume that these nurses realize you need to go up in a day or two remind them everyday look at their computer and see that I put in for an increase, has it gone thru, etc., every every time. That is a very low dose to hold u captive at for 3 days... I went up 5mgs every day (my clinic started me and most all the chicks at 25, dudes got 30) till 50, then by 10mg till about 70, then it was about every few days till I stopped going up at 150... I probably shouldn't have gone as high as I did I've had no need to keep going up after about 90 100 but still had that addict mentality and was chasing the high. Started going down a year or two ago and it hasn't been difficult yet I'm down to 50 but I've been stuck here for a while I'm getting nervous cuz I'm starting to get back into a real junkie State of Mind... does your clinic have a bulletin board that the clients can use for postings? Ours has one right by the front entrance where you can post if you're looking for rides, offering rides, setting up carpools, renting a room, jobs, etc. If not, maybe suggest starting one... Good luck! I hope I was able to give you a bit of insight and let u know, there is hope at the end of this struggle. The key is to keep trying.
 
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The dosing nurses were actually very nice about the whole situation! The nurse that did some things before I saw the doctor for the actual physical is the one who put her hands up like nope 30mg and that is it.tommorow I want to be honest and just tell my counselor that I took a couple hydrocodone to take the edge off.because the methadone I realize is starting to ware off at night time.im just scared I'm going to be told to leave or be kicked out of the clinic.i over think things all the time and I'm a very worried/anxious person as it is and I've used opiates to self medicate.im sure there has been plenty of people the first week use while getting comfortable unless they had no tolerance to opiates.because 30mg definitely isn't touching my tolerance that's why I said to my counselor they act like my habit isn't enough
 
Absolutely don't worry- the reason everyone is there is because they are an addict. They won't kick you out. You are not the first person that had to use back up at the beginning, in fact during my intake the counselor that handled it flat out told me to expect needing to use in addition to my dose for the first few days or more due to the fact they start everyone lower than needed and because of the amount of heroin and pills I used daily for the last 10 years or so before biting the bullet and trying the clinic. They won't kick u out. I was told to be very specific when describing what's going on at night, requesting to go up.... like don't just say it's wearing off- I don't feel good. You need to tell them you're having restless legs, anxiety, nausea, runny nose/ watery eyes, excessive perspiration / cold sweats, unable to regulate body temperature, be graphic and be detailed the better your chances of them not giving you any problems going up
 
Exactly, as sweetz said they WILL NOT kick you out for that.

Especially if you're honest and upfront about it all with them, demonstrate your (to us here obvious) desire to get clean and your priority goal related to methadone where you want to get to a point where your dose holds you, allowing you to function normally and get to a point where you can really start getting into and engaging in your recovery.

Until you've stabilized, it's actually pretty much expected you'll use because you're still dealing with major cravings until you do stabilize. You're basically expected to use the first 10 days of being on methadone, it's just that common.

Most significantly, you should tell your counselor and see the doctor to tell him about this incident. If anything this information, that you needed to supplement your dose because it wasn't holding you, will provide them with evidence and an ideal reason they would need for increasing your dose ASAP because it's proof that your current dose isn't even coming close to cutting it - because otherwise you wouldn't have used!

Being honest and up front about what happened will do nothing but good things for you and your experience in the clinic because it will help them help you better. Every day when you dose make sure to mention to the nurse that you're still feeling sick before you dose in the morning - i.e. that your dose isn't holding you. Also make sure to mention you're still having mad cravings.

Again, mention this to the dosing nurse when you take your dose EVERY DAY until your dose has increased to the point it's holding you and your cravings are starting to go away. And make sure to see the doctor at least once every two weeks for the first month or two to make sure he understands the same things.

Being up front and specific about your continued symptoms that are evidence of your not being anywhere near stabilized yet will support them in increasing your dose. Don't chase the high if you can stop yourself, but also don't let yourself suffer needlessly.
 
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Let us know how it goes tomorrow. Take it from the both of us, you are NOT the first to have this experience and hopefully our comments have helped to show that what you are experiencing and having happen with the clinic aren't unique to your clinic, rather the norm, unfortunately. They are there to help you, but won't act with urgency unless you put your foot down sometimes.

We can't emphasize this enough: Be specific!! and go into detail when describing what's going on with the dose, i know toothpastedog and I have said this a few times, that's how crucial it is for you to do. That is your key to seamlessly going up till FULL RELIEF. That means no dts and the craving will also be pretty much nonexistent as well. And don't worry, if you are like the majority of us you will try and see if you can get high after a month or so, and you will find that you likely will not be able to no matter how good the dope is or how much you take. It's just part of recovery and the clinic staff not only know this, they expect those types of things to happen. This is not their first rodeo.
They won't kick you out unless you are combative in line, threaten staff, sell shit in the parking lot, or otherwise engage in some other sort of extreme reckless dumbshit or general douchebaggery ? while on the grounds. And then they'll do a rapid decrease at least, not cold turkey you. The drug screens are there to determine if you should be given specials and earn take out privileges, not kick people out. If you fail everytime (like some people I know at my clinic who have been going for years and still use benzos w/o a scrip, coke, or whatnot) they still won't kick you out, you just better get used to going there EVERY DAY, including holidays.

It gets better and you wont feel so confused about the ropes once youve been going for a bit. Keep up the hard work, it is an effort if it was easy to do none of us would have struggled so hard to get clean. I will be thinking about you, hope you find relief soon.
 
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So I went in today and checked in they told me to go see my councilor because I had to do my daily breathalyzer and sign my recovery goal sheet.so soon as I walked in his office I of course said hello and good morning like I always do to pretty much everyone I see.and I took a seat and did exactly what you guys told me to do! I told him I had a slip up and I took a few pills and I said that I was getting very restless and agravated and starting to feel some withdrawals.then I went and got dosed and they uped me to 35 MG today.so that is a good thing I am happy even with the 5mg difference.and I will keep asking to be increased as long as I have to so I won't have any cravings/withdrawal symptoms.so the advice definitely worked! Thank you very much.like you said once I get the feel of things I will be ok! :)
 
IDied said:
The dosing nurses were actually very nice about the whole situation! The nurse that did some things before I saw the doctor for the actual physical is the one who put her hands up like nope 30mg and that is it.tommorow I want to be honest and just tell my counselor that I took a couple hydrocodone to take the edge off.because the methadone I realize is starting to ware off at night time.im just scared I'm going to be told to leave or be kicked out of the clinic.i over think things all the time and I'm a very worried/anxious person as it is and I've used opiates to self medicate.im sure there has been plenty of people the first week use while getting comfortable unless they had no tolerance to opiates.because 30mg definitely isn't touching my tolerance that's why I said to my counselor they act like my habit isn't enough
Click to expand...

Everyone continues to use at first until you get to the right dose. They are not going to kick you out. In fact I have failed every drug test at my clinic over the last 7 months for all kinds of drugs and I am not even close to being kicked out. You will figure out the rules and bureaucracy as you go but you are 100 percent not getting kicked out unless you kill someone in the parking lot.
 
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