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Opioids Methadone Mega Thread and FAQ

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sixpartseven

sixpartseven

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I decided to make this FAQ to be a companion to the buprenorphine FAQ phrozen created. With these two FAQ's, anyone considering some for of opioid maintenance will have two resources to use to compare and contrast the differences of the two drugs, helping them come to a decision of which drug would be better for them.

Some of the information contained in the FAQ was not authored by me. I have listed all the sources used at the bottom of the post.


Methadone FAQ

What is it?

Merck methadone information

Methadone is a full mu-opioid agonist. Methadone also binds to the glutamatergic NMDA (N-methyl-D-aspartate) receptor, and thus acts as a receptor antagonist against glutamate [1]. NMDA antagonists such as dextromethorphan, ketamine, and ibogaine are being studied for their role in decreasing the development of tolerance to opioids and as possible for eliminating addiction/tolerance/withdrawal, possibly by disrupting memory circuitry. Acting as an NMDA antagonist may be one mechanism by which methadone decreases craving for opioids and tolerance [2].

Methadone, a long-acting synthetic narcotic analgesic, was first used in the maintenance treatment of drug addiction in the mid-1960s by Drs. Vincent Dole and Marie Nyswander of Rockefeller University. There are now 115,000 methadone maintenance patients in the United States, 40,000 of whom are in New York State and about half that many are in California [3].


What is a normal dose?

There really is no normal dose. The dose required for maintenance therapy is highly dependent upon the dose of whatever other opiate you were using before getting on methadone. However, most clinics normally start you at a dose between 40mg and 60mg, and increase by 5mg or 10mg every day or two until you get to the required dose.

The most common and traditional dosing regimens, however, tend to fall far short of providing optimum or even sufficient results for a number of patients. This is due to the ceilings many clinics place on dose levels [4].


What are the withdrawals like?

The withdrawals from methadone are similar to every other opiate, although they have been reported to be much more severe if the dose is too high when the patient cuts off usage. Physical symptoms include nausea, sneezing, vomiting, diarrhea, sweats, chills, joint pain, elevated blood pressure, fever, runny nose, and increased tear production.

The psychological symptoms can include depression, anxiety, paranoia, panic disorders, delusions, decreased sex drive, prolonged insomnia, and fatigue or exhaustion.


Is there a ceiling dose?

No. Your dose of methadone can be increased as high as it needs to go. One thing to consider when that starts to happen is maybe entering a detox program to get your dose back down and possibly even taper off of it completely.


What is methadones bioavailability?

The bioavailability is between 40 - 80%, with a half life of 24 - 36 hours [5]. The Wikipedia article has it listed as 40 - 90%, and more than one other source, including Bluelights own thread on bioavailability, have put it closer to 80 - 90%.


Other Notes:

  • Methadone is Schedule II in the US.
  • It is metabolized by the enzymes CYP3A4, CYP2B6 and CYP2D6 [6]
  • Half-life: 24 - 36 hours
  • Drug Test: Not detected in standard 5-panel test, but can be tested for.



1, 2 - Wikipedia Article on Methadone - Mode of Action
3 - Methadone Maintenance Treatment
4 - Wikipedia Article on Methadone - Dosage
5 - ChemistryDaily.com Encyclopedia Entry on Methadone
6 - Wikipedia Article on Methadone - Pharmacology
 
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I took the FAQ portion of phrozen's buprenorphine FAQ and copied it, adjusting it to pertain to methadone, so credit goes to phrozen for the layout, questions, and some answers that went unchanged.

Q: How long after my last methadone dose can I take an opiate and feel its effects?
A: With methadone, the higher the dose, the more heroin it can block. It also depends on how long you have been taking the methadone. Wait at least 24 - 36 hours before trying to dose another opiate if you want to be sure you feel the full effects from it.

Q: Is methadone a good replacement for buprenorphine?
A: Maybe. Some people with a high enough opiate tolerance may not be held by bupe at any level, even at the highest(ceiling) possible dose. Methadone does not have a ceiling dose, so your dose can be raised as high as it needs to be raised to make up for tolerance. You should research both before deciding what to go on, as they both have different positives and negatives in regards to their use.

Q: I'm thinking about switching from bupe to methadone. At what bupe dose should I be when I switch?
A: Switching from bupe to methadone is MUCH easier than switching from methadone to bupe. The latter means you would have to taper your dose of methadone down to around 30 - 40mg before making the jump. Going bupe to methadone, you dont have to get your bupe dose down, because again, methadone does not have a ceiling and the dose can be taken as high is it needs to be taken to compensate for tolerance.

Q: Will I still have cravings on methadone?
A: Its possible, but since methadone is a potent mu-receptor agonist, generally the cravings will be well taken care of. But, if your dose isnt at the exact place it needs to be (too low), you may experience some cravings.

Q: Is methadone good for depression/anxiety?
A: Just like any other full-agonist, it can cause depression. And again, like other full-agonists, it will help ease anxiety.

Q: Is it safe to shoot methadone?
A: No. It can cause many of the same complications as shooting other pills. The best advice is to use a micron filter if you absolutely must try to shoot. If you get liquid methadone from the clinic, you should most definitely not shoot it. The sucrose and syrup contained with-in are horrible for your veins.

Q: Is methadone recreational?
A: Yes. It is a full mu-receptor agonist. Someone using methadone for maintenance purposes may not be able to get high from it unless they take a very high dose, but for someone who is not on maintenance and has a somewhat low tolerance, it is perfectly recreational.

Q: Can you overdose on methadone?
A: Yes you can. Methadone is very potent and very easy to overdose on. Be careful and always start small.

Q: Can I still get high on other opiates if I'm on methadone?
A: Yes. You can "shoot through" your dose of methadone with a larger amount of your prefered opiate than normal, but the risk of OD is huge in this scenario. Its best to wait 24 - 36 hours, that way you can feel the full effects of the opiate without risking a massive OD.
 
Additions

On May 22, 2008, the DEA issued a Final Rule in the Federal Register increasing the number of patients a clinic can prescribe controlled substances (such as methadone or buprenorphine) to for the purposes of "maintenance or detoxification". Prior to this new rule, the maximum number of patients was 30 and has been raised to 100. Drug treatment practitioners must notify the Secretary of Health and Human Services in order to qualify under this rule

Law:
Canada: Schedule II
Germany: BTM Anlage 3

Source

For ones who choose to inject Methadone Syrup, please read this
 
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Recreational Methadone dose for first time opiate user

Don't tell me to UTFSE
I have and most of the posts are people who are on methadone, or are talking about equivilincy with other drugs

I am on 'done myself so I have no idea what a good dose would be if a non-opiate user wanted to get smashed

Please any help would be apppreciated,
sooner the better, as it may stop someone i know doing too much
 
Just dont bro, unless your idea of being high is a 24 hour puke fest. Methadone is for those with some tolerance and experience with opiates. Start with 5 mg if you are non-tolerant and non-experienced. DO NOT EVEN THINK ABOUT REDOSING BEFORE THE 4 HOUR MARK and even at that point the answer of a prudent person would still be NO if you do not have a tolerance. You can OD on methadone quite easily if you lack tolerance and do not know how to handle opiates.
 
I had 5, 10 mg pills of methadone... My first time ever dosing I took 20 mg. It was a good relaxing high that made me itch like fuck. I was not nauseus at all and have no tolernace to opiates. The day after I took 1 10mg pill with little to no effect. I say for your first time dosing take 20 mg.... just my opinion tho.

I have 10 mg left and wish I had saved 20mg for tooday... Is there anyway to make the feeling stronger with only 10 mg?
 
^ DO NOT listen to that guy. 20 is too much for someone with no opiate tolerance. I'd say starting off with 10 mg is alright, although it affects everyone differently.

My first time, I took 10mg with no tolerance and felt amazing. The next morning I took 10 more and puked for 24 hours. Methadone has a really long half-life, so you just have to be careful about re-dosing. As in, don't, IMO.
 
TwistedReality said:
^ DO NOT listen to that guy. 20 is too much for someone with no opiate tolerance. I'd say starting off with 10 mg is alright, although it affects everyone differently.

My first time, I took 10mg with no tolerance and felt amazing. The next morning I took 10 more and puked for 24 hours. Methadone has a really long half-life, so you just have to be careful about re-dosing. As in, don't, IMO.
Click to expand...

Pretty good advice all around. Absolutely do not take 20mgs to start off. That is WAY too much for someone with no tolerance. I would take 10 and even if you aren't high as a kite within an hour or so, I would leave the rest alone. As has been mentioned, methadone lasts a long fucking time and IME can come on pretty slow and then all of the sudden.....Wow. Have fun and be careful. Methadone is nothing to fuck around with.
 
a good dose for somebody weighing at least 160 pounds would be like 7.5 mgs or so. This is is they don't use opiates and don't have a habit and that should fucking floor them. giving them a full 10 mg may be too much. MethaDeath if you ask me but that's just my experience with the program and the juice itself... ;)
 
Great thread sixpartseven!!!it was coming from someone in the near future anyways but you did a great job! I mean, why shouldnt Methadone have its own mega thread? M'done and Suboxone/Subutex all treat opiate addiction which is what a lot of us suffer from or havehad some run-in with.we needed this.Great job again sir.:)
 
I'd like to add that methadone can be much more dangerous than other opiates. I've overdosed twice from that shit. The second time I had a heart attack, went into a coma, respiratory arrest, pretty much was dead for a few minutes.

Opiate naive people do not need to fuck around with methadone whatsoever and even tolerant users need to be careful when using this drug.

^ 10 mg of methadone made me puke for 24 hours when I first took it. I would suggest 5mg and if you don't feel anything after 2-3 hours take another 5mg
 
What are you guys on? Methadone is only slightly stronger than hydrocodone. I have no tolerance and it would take me 40mg just to get a decent high.
 
Methadone is a lot different than other opioids. It is a potent opioid, about equal to morphine mg for mg if I remember correctly. Good euphoria and analgesia. The problems start with it being a full mu receptor agonist with a 24+ hour half life. Opioid naive individuals keel over all the time. If you are not an addict and take 10mg Methadone today, then another 10mg tomorrow, only 5mg from the day before has been eliminated from the body. Keep on going and pretty soon your breathing goes and you die. Or, dose a day or two and take benzo's or tranqs- respiratory depression, death. Methadone has the distinction of being the only full agonist with a 24+ hour half life on the market in most of the world (LAAM has been discontinued and Dipapanone is ultra rare in the UK). The resurgence of Oxycodone products in the early to mid-90's (culminating with the introduction of OxyContin) was a direct result of spikes in Methadone RX's and fatal overdoses [interesting note, since the last 10 years of Oxy abuse headlines, Methadone is back in chic in the pain management community]. Doc's would much rather RX an extended release formulation of a short/intermediate acting opioid like Morphine (MSContin) Hydromorphone (Palladone/HydromorphContin) OxyMorphone (Opana) etc rather than Methadone.

This country could benefit from the European model of Methadone clinics though. Federal regulations here are unreasonably tight, state regulations are often even worse. Many states severely limit take homes (i.e. maximum you can earn is 3 take home doses a week), limit the highest dose a patient can be given for maintanence (often 80-100mg), are extremely strict on failed urine screens (up to and often including kicking patients out of the program).

The Europeans for the most part have lax Methadone regulations. Patients will not be kicked out for missed attendance, failing drug screenings, coming to the clinic high, etc. The purpose of medicated maintanence treatment for opioid addiction is to keep the patient enrolled in treatment, and working toward whatever goals the patient wants to achieve. It should be seen as a victory for the patient and clinic that they are there at all.

Like the British and other European nations, we should also have IV Methadone available for oral resistant addicts. Generally IV Methadone is only for a brief time, but can be administered indefinitely with the same risks/drawbacks as oral Methadone maintanence.

One of the Scandinavian countries (I forget which one) tried administering oral Palfium (Dextromoramide, an extremely potent short acting mu agonist, similar to Heroin in effect) to Methadone maintanence patients who continued to inject Heroin on top of oral Methadone. The results were very promising, most had given up IV Heroin + oral Methadone for a controlled RX of oral Palfium + oral Methadone. Palfium is almost as effective orally as IV, and is able to break through even extremely high dose Methadone maintanence doses.

The tools are out there to make Methadone treatment even more effective, and also more accepted by even long term, hardcore addicts. Benzo abuse is rampant among MMT patients in the US, and has killed thousands. If a potent oral breakthrough craving medication were available to every MMT patient, I'd guess that most would stop trying to boost their Methadone with other drugs.
 
plutoniumboss said:
What are you guys on? Methadone is only slightly stronger than hydrocodone. I have no tolerance and it would take me 40mg just to get a decent high.
Click to expand...


If anyone here is looking for info on a good methadone dosage to start out with ... please do not listen to this person, this is way too much for an opiate niave person to take.

Start out small, 10-15mg's max is all you will need. If you feel you really need more wait at least 3 hours, because it can take that long for you to feel the methadone.
 
^ +1. Always start low and work your way up. And remember, methadone is a long acting opioid; if you fuck up, you're fucked for hours if you get sick and possibly fucked permanently if you're not careful.
 
^ I doubt 1mg would even be a threshold dose for an adult. Why would anyone go through all that effort to steal only 1mg, knowing the pills come in a minimum dose of five times that?

I have three explanations (in order of increasing likeliness, although 2&3 are a close tie):
1.He is a ridiculous medical anomaly, and his experiences do not reflect how strong methadone is.
2. He doesn't know how to use a scale.
3. The trip report is anti-methadone propaganda. Or just plain literary bullshit.
 
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