Methadone - Lifer

[4DQSAR]

@Them Witches - I'm uncertain if buprenorphine is displaced by fentanyl but as I mentioned, the one report I read said sufentanil was prescribed. Stuff that requires the presence of equipement to deal with respiratory collapse i.e. only IN a hospital.

A few people seem to think norbuprenorphine is significant but I found a paper that demonstrated the fact that norbutorprenorphine is actively transported out of the brain. Yes, it MAY have some peripheral activity, but in knockout mice without the transport, norbuprenorphine triggered respiratory collapse. So in clients who may not have an efficient P-glycoprotein transport are at risk of fatal overdoses.

I did try to find data on fatal overdoses and they measured the levels of norbuprenorphine. But we don't REALLY know as nobody is actually keeping a systemtatic count of fatal buprenorphine intoxication. I could not work out why every paper cited a 2007-2011 study... until I checked and the answer was that no later study exists. So we don't know how dangerous buprenorphine is. Again, being an old drug it avoids the makers having to invest in what is termed 'stage 4' trials AKA pharmakovigilance AKA paying for studies.

 

[Jnowhere]

Well, I am on bupe 2mg pills for MAT OUD, all that shit haha, but since I have chronic pain as well then IMO, no not at all. When I started about 5 years ago, I was not in any pain at all and now that I am, I see no contrast.

I am willing to try anything, trying to obtain a script for opioid painkillers will never happen for me, so I'm not trying to burn through every med in hopes of getting to opioids eventually. The thing with the Butrans is that I guess that buprenorphine in really low increments does help with pain. I mainly hear that people who got switched to them from full opioid agonists are super upset because it's not helping like their prior scripts, and those all got yanked out from them when switching to the Butrans patched.

I just meant more bupe to, help with the pain. I have no idea about bupe, in regards to pain management. It is an opiod and I wondered if more would help, that's what I meant.

Methadone? It is an OUD MAT drug, and kills pain. Highly addictive physically, and horrible withdrawals. But it is a strong opiod. Doctors will prescibe it for very very, short term serious pain. Or for long term pain management, sometimes.

However, From what I have read, most hate it, and some love it.

I could give you advice; on the best type of doctor, to get scripts for real pain, easier.

However, I got banned for a while and another point.

I, am a pain patient. I know and have known, personally many doctors.

I tell the truth and I am called a sexist and a racist. Sorry, but I know this well.

How am I a racist when I mentioned doctors; who were of a different race?
Who, will help if you really have pain.

Also all the new docs, were trained to treat pain without opiods, if possible.

If not, then they are just a druggie. Next patient.

This is weird. The democrats caused this. However, the Republicans agreed.

Ah, common ground. Making people suffer.( no, lol). I blame both parties. However, this is Obamas fault.

You, it would just be a better chance. But, I can't give out the truth here.

Also, if you can take being on what is referred to as, " Liquid handcuffs": That would cover the MAT opiod and it is strong pain killer. Primary used as a OUD MAT drug,(but it is a very strong synthetic drug, opiod).

However, it is used when other opiods are ineffective. ( depends on the doctor).

It is longer lasting and 5-10 times as strong a morphine. It was created to deal with, a morphine shortage before WW2, in Germany.

How bad is the pain? Have you tried methadone? Is the pain chronic and serious, enough to go on Methadone?

 

[rplate81]

I just meant more bupe to, help with the pain. I have no idea about bupe, in regards to pain management. It is an opiod and I wondered if more would help, that's what I meant.

Methadone? It is an OUD MAT drug, and kills pain. Highly addictive physically, and horrible withdrawals. But it is a strong opiod. Doctors will prescibe it for very very, short term serious pain. Or for long term pain management, sometimes.

However, From what I have read, most hate it, and some love it.

I could give you advice; on the best type of doctor, to get scripts for real pain, easier.

However, I got banned for a while and another point.

I, am a pain patient. I know and have known, personally many doctors.

I tell the truth and I am called a sexist and a racist. Sorry, but I know this well.

How am I a racist when I mentioned doctors; who were of a different race?
Who, will help if you really have pain.

Also all the new docs, were trained to treat pain without opiods, if possible.

If not, then they are just a druggie. Next patient.

This is weird. The democrats caused this. However, the Republicans agreed.

Ah, common ground. Making people suffer.( no, lol). I blame both parties. However, this is Obamas fault.

You, it would just be a better chance. But, I can't give out the truth here.

Also, if you can take being on what is referred to as, " Liquid handcuffs": That would cover the MAT opiod and it is strong pain killer. Primary used as a OUD MAT drug,(but it is a very strong synthetic drug, opiod).

However, it is used when other opiods are ineffective. ( depends on the doctor).

It is longer lasting and 5-10 times as strong a morphine. It was created to deal with, a morphine shortage before WW2, in Germany.

How bad is the pain? Have you tried methadone? Is the pain chronic and serious, enough to go on Methadone?

I found out about the Obama thing a couple years back. I'm not going to make it a partisan issue, but fuck that guy for that

The thing about buprenorphine that I do know is that if you are trying to catch any high from it, less is always more. I think under 2 mg makes it have more of a full Agonist type feeling. I'm not sure I haven't tried doing that. Also, from what I have researched, they dose the Butrans patch in mcg's not milligrams so super tiny increments works better for pain, at least that's what they want you to believe.

I'm not sure if you caught it before in this thread, but I've been on methadone maintenance before and I am actually reconsidering going back on it, although this time for pain. Myself being on both methadone and buprenorphine for years, I can confidently say that methadone works way better for physical pain.

Another thing I will admit is that I have obtained fake percocet M30 pills & I did test them, came back positive and I did try them. No justification, but I am on buprenorphine, so that was blocking some of it, but made a chance of an overdose less. I also did not shoot or snort the pills. I smoked tiny pieces, and I would not smoke more than one pill in 24 hours because I was obviously petrified. Tbh, I don't think that I felt anything from it. I had a ton of them but disposed of them after smoking probably 20 pills over the course of like 2 months.

 

[4DQSAR]

I may be wrong but I was under the impression that in the first human trials in which buprenorphine was given as an analgesic, their is a plateau at around 400μg (SC) which if buccal or sublingual formulations only have circa 40% bioavailability would be 1 mg every six to eight hours. These figures match BNF prescribing information. Quite a narrow window in fact.

Oh, but I note that since last year they have increased the maximum dose for treating opioid dependence from 16mg/day to 32mg/day.

In the words of Johnny Rotten 'Ever get the feeling you have been cheated?'

 

[puke]

I can't speak about the mental or physical pain you're dealing with but I can tell you getting off methadone was quite easy for me. Now I was only on 100mg because I've heard some people on here with what I considered astronomical dose which I can't understand why a councilor would let them get that high but once you get past the dread of going down a few mg every 2 weeks you should realize it was purely the fear of the pain that kept you on so long. The withdrawl can be dealt with if you take it slowly.

 

[Them Witches]

@Them Witches - I'm uncertain if buprenorphine is displaced by fentanyl but as I mentioned, the one report I read said sufentanil was prescribed. Stuff that requires the presence of equipement to deal with respiratory collapse i.e. only IN a hospital.

A few people seem to think norbuprenorphine is significant but I found a paper that demonstrated the fact that norbutorprenorphine is actively transported out of the brain. Yes, it MAY have some peripheral activity, but in knockout mice without the transport, norbuprenorphine triggered respiratory collapse. So in clients who may not have an efficient P-glycoprotein transport are at risk of fatal overdoses.

I did try to find data on fatal overdoses and they measured the levels of norbuprenorphine. But we don't REALLY know as nobody is actually keeping a systemtatic count of fatal buprenorphine intoxication. I could not work out why every paper cited a 2007-2011 study... until I checked and the answer was that no later study exists. So we don't know how dangerous buprenorphine is. Again, being an old drug it avoids the makers having to invest in what is termed 'stage 4' trials AKA pharmakovigilance AKA paying for studies.

That is just it. Drug medical trials typically happened when they are trying to put a drug on the market. Medical trials should extend for tolerant patients at different times stamps and for cancer patients of stage 2,3,4 levels. Without extended trials, dependence and tolerance is not fully understood.

 

[Slightly_Paranoid13]

Ok, that's what I thought! Methadone is better if you have an actual chronic pain condition and I think 30 degree scoliosis is a chronic pain condition. If it weren't for my chiro adjustments, I'd be completely effed. I just don't want to have to go to a clinic at 6:00am every morning for an unknown amount of time. I have an appointment with my doctor soon and will see what he would do in my position.

 

[Them Witches]

Ok, that's what I thought! Methadone is better if you have an actual chronic pain condition and I think 30 degree scoliosis is a chronic pain condition. If it weren't for my chiro adjustments, I'd be completely effed. I just don't want to have to go to a clinic at 6:00am every morning for an unknown amount of time. I have an appointment with my doctor soon and will see what he would do in my position.

You do not have to go to a clinic or MAT to be prescribed Methadone. Most PCP/MD or family doctors can prescribe it. The best PO (oral) brand is Mallinckrodt. They make PO tablets - 5mg, 10mg, and 40mg. There are pharmacies that sell Methadose oral solution not affiliated with a "clinic or MAT" and the oral solution comes in 1mg/1mL regular and 10mg/1mL concentrate

 

[4DQSAR]

That is just it. Drug medical trials typically happened when they are trying to put a drug on the market. Medical trials should extend for tolerant patients at different times stamps and for cancer patients of stage 2,3,4 levels. Without extended trials, dependence and tolerance is not fully understood.

How would one do that ethically?

If someone is prescribed a specific opioid to control severe chronic pain, a clinician isn't going to change a patient's medication as part of a trial which by definition would result in some patients suffering MORE pain.

A lot of opioids have been licenced only to be withdrawn from the market simply because clinicians tend to go with what they know. Desomorphine (Permonid), phenazocine (Narphen) and a whole long list of opioids have been withdrawn because clinicians saw no clinical advantage so did not prescribe them. I would keep an eye on oliceridine (Olinvyk) because it's quite likely to be the next 'new' opioid to be withdeawn since clinicians see no clinical advantage.

 

[Them Witches]

How would one do that ethically?

I have some ideas but I really do not know how to answer.

I guess it would be more of a survey and controlled observation mixed with opioid rotations in a full circle. Documenting how much of an MME is needed for each painful condition based on patient's duration of opioid treatment. Placebos would have to be administered to document dependence issues and allow "recovery dosing."

I do not know the answer how to do the studies. I just have these suggestions at the moment.

 

[4DQSAR]

Buprenorphine has been trialled for treatment of chronic moderate-to-severe pain in cancer patients. The two problems are that buprenorphine demonstrates a plateau in it's analgesic activity BUT because it has such high affinity, the researchers were forced to use tramadol for breakthrough pain. The latter not being very satisfactory as only the (1S,2S) enantiomer had significant analgesic activity when buprenorphine is competing for opiate receptor occupancy.

The plateau combined with the high affinity really do mean if tramadol isn't sufficient to deal with breakthrough pain, a patient may end up in hospital where an opioid with an affinity high enough to break through the buprenorphine blockade can be prescribed. I've heard of sufentanil being used and that is a medication only an anethetist (or possibly a registrar) could prescribe. Yes it has a large TI but it's still 500-1000 times more potent than morphine so can only be given when respiratory support is available.

At least in the UK it seems that in cancer cases morphine is still the preferred option with oxycodone and hydromorphone being prescribed in cases where the side-effect profile of morphine make it a less desirable option. My consultant mentioned his belief that oxycodone was the best option because of it's high oral bioavailability and large TI. In essence, if a patient is recieving palliative care, does the fact they become physically dependent matter? He mentioned that a couple of palliative cases were taking over 400mg of oxycodone per day which on one hand is insane, but on the other hand means that if a person only has months to live, at least they have the highest quality of life for those months.

Buprenorphine having that plateau is good in terms of safety, but the narrow TI means it's more suited to patients whose pain level is unlikely to change and who would be likely to demonstrate the side-effects common to full agonists. Elderly patients might be an example. If morphine or similar cause confusion or loss of balance, it's an extra risk. Yes they have pain severe enough to require medication but if they fall or have an accident due to being zoned out on morpine, it's not to their net benefit.

Bentley and his team at Edinburgh spent a decade studying what are commonly known as 'Bentley compounds' (bridged oripavines) and they discovered both etorphine and buprenorphine and here is the twist - the original goal was to find a cheap alternative to codeine in [P] compound analgesics (e.g. Co-codamol).

Kenneth Bentley

Kenneth Bentley was a world authority on the chemistry of the morphine alkaloids, and made important advances in the treatment of pain and drug dependency. Derived from the opium poppy, morphine

www.thetimes.com

So, looked for codeine replacement, found elephant doping drugs.

 

[Them Witches]

Buprenorphine has been trialled for treatment of chronic moderate-to-severe pain in cancer patients.

Many reports say it does not work well for pain. In the US, they are trying to remove patient's full agonist opioids and replace them with Bupe.

He mentioned that a couple of palliative cases were taking over 400mg of oxycodone per day which on one hand is insane,

400mg sounds great to me lol...

Bentley and his team at Edinburgh spent a decade studying what are commonly known as 'Bentley compounds' (bridged oripavines) and they discovered both etorphine and buprenorphine and here is the twist - the original goal was to find a cheap alternative to codeine in [P] compound analgesics (e.g. Co-codamol).

They succeeded finding something much stronger than Codeine for sure. Some of those Bentley compounds are insanely strong. This is where and when Nitazines were discovered.

There was a recent drug bust in Seattle, WA of "pressed M-30's (rainbow colors aka Skittles) that contained only Carfentanil. Crazy stuff. I am glad they are rainbow colors clearing marking them as not legit Mallinckrodt 30mg IR Oxycodone.

 

[4DQSAR]

The US pharmacutical industry is setting itself up to repeat Oxycontin i.e. while buprenorphine cannot be patented, formulations CAN and HAVE been patented. I'm sure it will be vastly over-prescribed to the point that serious harm will occur but it will take a decade or more for those harms to be investigated, tested and confirmed. By then any legal action will not really alter the profitability of the drug.

I did a few back-of-a-fag-packet calculations and knowing Bentley demonstrated that in man, the analgesic plateau occurs at around 400µg and it is about 32.5 x morphine in it's analgesic activity, that's similar to around 13mg of morphine.

So I suppose in the US it might be an appropriate alternative to hydrocodone, but not oxycodone let alone hydromorphone, levorphanol and the strong opioids that are mostly reserved for palliative care or indeed people who have undergone a severe traumatic injury. In the latter case especially, it's not only accepted but considered clinically significant that strong opioids produce a state of mental detachment. In fact, in the UK diamorphine (heroin hydrochloride) is mostly reserved for victims of myocardial infraction and it appears to increase short-term survival rates. I assume because severe pain will result in the body dumping monoamines into the blood stream which is going to increase blood pressure, heart rate and so forth.

I can only assume those huge doses of oxycodone are used in patients who are tolerant and who have severe intractable visceral pain. I mean, why not? Addiction just doesn't matter if someone has a life-limiting disorder. Uncertain how the US defines palliative but in the UK we generally use it to describe a person who is expected to die within six months.

But someone alerted me to a danger specific to buprenorphine that I was unaware of. One metabolic pathway is N-dealkylation to norbuprenorphine and that compound is known to produce respiratory collapse. The reason buprenorphine doesn't kill as often as some other opioids is because like loperamide, norbuprenorphine is actively transported out of the brain. But are we certain everyone has the same P-glycoprotein (P-gp) levels? Are we sure people taking large doses of buprenorphine are aware that it could increase the toxicity of loperamide?

The more I look, the more dubious facts I learn about buprenorphine. But I think the biggest lie is that while Bentley et al tested buprenorphine as a treatment to reduce the AWS of opioids, they used a calculated dose and that dose was reduced to zero over a 7-14 day period (but the buprenorphine was being given every 8 hours). How did that become 32mg/day and maybe in a few years we might consider a taper?

 

[Slightly_Paranoid13]

I spoke with my Dr today and he agreed that Methadone might be the better medication overall given my chronic scoliosis pain. I just don't want to be like my dad (who also has it) who refuses to take pain pills other than NSAIDs and is always complaining of back pain. I don't want to spend my retirement in pain, I'm sorry, I just don't. I've done my research on Methadone and it's not as big of a pain in the butt as I thought. If I travel, I can go to clinics in the areas that I go or get doses from my local clinic to last me. Like I said, I don't plan on ever coming off of it. I might switch back to Suboxone at some point if I do decide to get off of them. But the quality of life for me is so much better when I have a long acting opiate in my system. I fully believe an old doctor of mine that said I don't produce endorphins like normal people do - given my genetics (23 and me). It matches my experience as I have always struggled with anxiety and depression (both 9 out of 10's) and if my body did produce endorphins normally, I assume I wouldn't have as bad anxiety/depression as I have always had since I was 12.
Thank you all for the helpful posts. I would still like to hear from people that have been on both and their experiences.

 

[4DQSAR]

@Slightly_Paranoid13 - I don't know where you are based but in the UK, methadone prescribed for pain is in the form of 5mg tablets which is obviously much more practical that having to manage bottles of methadone linctus. But I also considered asking about methadone and there were several issues that made me reconsider. Methadone is only prescribed for pain by s[ecialists and since people metabolize the drug at different rates, the dose has to be titrated which here could take a while. The other is that from time to time there have been shortages of the pills and a pharmacy cannot substitute methadone linctus if the pills are unavailable.

Now none of the worries may apply depending on where you are. I just felt it worth mentioning because I really did struggle with my current medication and find out all I could. As things turned out, someone here on BL was anle to suggest a simple hack that has made a massive difference.

 

[Slightly_Paranoid13]

I spoke with the director of the clinic in my area and she was just awesome. There were zero judgement vibes coming from her and she sounded supportive. I mentioned how well I've been doing on Suboxone but want to give Methadone a try for a number of solid reasons. She said I could keep seeing my primary care doctor for all of my other meds or I could have the clinic take over those meds too. I don't want ANY of my current meds touched except for the benzo I am taking as needed. That script can go for all that I care because I am pretty sure that at the right Methadone dose, my anxiety baseline will be much lower. Again, Suboxone feels "speedy" to me, while Methadone feels calming. She said if worse comes to worse, I could always fall back to Suboxone. After the holidays, I am going to skip my Suboxone for 1 full day and then go in the clinic the next day. Also, I will be sure to not have a benzo in my system as I have heard that some clinics won't dispense your Methadone if you have a benzo in your systeem. Is this ALWAYS true? I take the smallest dose of it and only as needed and take about 3-4 times a week. She said my insurance MAY pay for some or all of the treatment. The price out of pocket isn't too bad though.
She said that Methadone is a great drug that has received a bad reputation. There is no evidence that Methadone causes tooth damage directly. Albeit, it does make your mouth dryer leading to not having the much needed saliva that helps protect our teeth. I think it's a great drug too and excited that it is actually looking like a good option. She also said that it DOES NOT get into your bones - it's a myth.

@4DQSAR, you said - "Now none of the worries may apply depending on where you are. I just felt it worth mentioning because I really did struggle with my current medication and find out all I could. As things turned out, someone here on BL was anle to suggest a simple hack that has made a massive difference." What is this hack you're talking about?

 

[marcoman]

I spoke with the director of the clinic in my area and she was just awesome. There were zero judgement vibes coming from her and she sounded supportive. I mentioned how well I've been doing on Suboxone but want to give Methadone a try for a number of solid reasons. She said I could keep seeing my primary care doctor for all of my other meds or I could have the clinic take over those meds too. I don't want ANY of my current meds touched except for the benzo I am taking as needed. That script can go for all that I care because I am pretty sure that at the right Methadone dose, my anxiety baseline will be much lower. Again, Suboxone feels "speedy" to me, while Methadone feels calming. She said if worse comes to worse, I could always fall back to Suboxone. After the holidays, I am going to skip my Suboxone for 1 full day and then go in the clinic the next day. Also, I will be sure to not have a benzo in my system as I have heard that some clinics won't dispense your Methadone if you have a benzo in your systeem. Is this ALWAYS true? I take the smallest dose of it and only as needed and take about 3-4 times a week. She said my insurance MAY pay for some or all of the treatment. The price out of pocket isn't too bad though.
She said that Methadone is a great drug that has received a bad reputation. There is no evidence that Methadone causes tooth damage directly. Albeit, it does make your mouth dryer leading to not having the much needed saliva that helps protect our teeth. I think it's a great drug too and excited that it is actually looking like a good option. She also said that it DOES NOT get into your bones - it's a myth.

@4DQSAR, you said - "Now none of the worries may apply depending on where you are. I just felt it worth mentioning because I really did struggle with my current medication and find out all I could. As things turned out, someone here on BL was anle to suggest a simple hack that has made a massive difference." What is this hack you're talking about?

Can you please update your post as I am inyerested how it works out for you, thanks and good luck, man.,

 

[neversickanymore]

a major problem with methadone.. i’m not sure with bupe is methadone needs to be dosed every six to eight hours to control pain. It’s dispensed every 24 hours to make money for replacement therapy.

Methadone replacement therapy is often run by the dregs of the medical community and THAT is really saying something.

It’s also a marginalized population with limited backing

 

[4DQSAR]

@4DQSAR, you said - "Now none of the worries may apply depending on where you are. I just felt it worth mentioning because I really did struggle with my current medication and find out all I could. As things turned out, someone here on BL was anle to suggest a simple hack that has made a massive difference." What is this hack you're talking about?

Inhibition of CYP3A4 using a cheap and freely available product. It just meant a pain pill that SHOULD have lasted for twelve hours only lasted about seven or eight hours. This cause problems because in essence, I was immobile for over half the time I was awake.

I don't fully understand the risks and benefits of consuming it so don't feel it appropriate to name it.

 

[JackARoe]

I can't speak about the mental or physical pain you're dealing with but I can tell you getting off methadone was quite easy for me. The withdrawal can be dealt with if you take it slowly.

Funny you should say that. I got off methadone 3 times in my history. Long time ago. All kicks were hard, but after 5 weeks started feeling much better. But I had a friend (RIP) that was known to be a baby about most things. He got off of being on methadone after 3 years. Slow taper, even stayed at 1 mg for a month then jumped. He said he did not have withdrawal. A lot of his friends sort of laughed at that knowing him. But he sort of proved if you go slow enough it can be easier. He was not one to exercise and he smoked like a chimney. So yeah.