2 types of methadone - methadose

[rclark231]

I have heard there are 2 types of methadone in use - one with an antagonist included in the medication - and the other without - meaning one is more potent than the other . I believe it is called racine methadone ? - or something like that . was wondering if anyone knows anything about this? - I have been on methadone maintenance for 20 years , and some time ago , the program I go to changed from methadone to methadose - a crappy generic brand of methadone .There is a big difference , somedays I feel like I am getting a really low dose of med, other days it is a little better , but never to the strength when I first got on the program. I used to get an energenic feeling an hour after I took my dose - now I get insomnia, hot cold flashes ..the whole nine yards : whenever I try to talk to my program about it - they tell me maybe I have the flu!! ..unbelievable. there are many negative issues about the methadone maintenace clinic system - but for the money I am paying - I think I should be at least getting a brand of methadone that at least maintains me.In CT the diffent clinics in different cities dispense different type's of med - some give dolphine(the pills) , or the diskets(the 40mg biskets) or the syrup..my clinic gives the green liquid - that comes out of a pump..It Sucks.. would like to hear other peoples opinion/info on the subject

 

[NeighborhoodThreat]

There is no methadone formulation with an antagonist. Methadose is methadone, racemic methadone (meaning an equal mixture of levomethadone and dextromethadone). Levomethadone is 2x as strong as regular methadone. There exists levomethadone, however, that is not used in the United States.

Methadose is made by the same company that makes methadone for distribution. No difference in the generic methadone itself. You may be feeling an adverse reaction to something in the medicine (fillers, etc) but not the methadone.

 

[rclark231]

Thanks for info - racemic was the word I was looking for ,and levomethadone, I don't understand why they do not use the levo -meth in this country , because now I remember reading somewhere - they use the levomethadone in Europe. But I can still tell difference in type(or I should say form) of methadone I am taking , recently when I was in hospital - was dosed with 2 diskets (40 mg each)and 2 10 mg dolphines = total :100mg. and man, did I feel the difference. actually felt good for the first time in a long while. my clinic gives the green liquid (comes out of a pump clear and they then add a little green colored water) ..and it sucks

 

[Johnny 5 Eagles]

Cheaper to produce and the law maintains that they are allowed to sell racemic mixtures as a whole dosage. some clinical points to consider: Racemic methadone has a stabler effect in a dosage response curve while levorotatory methadone has a long Area under Curve indicating a longer half- life profile. I believe it all comes down to cost. Dextrorotatory methadone is an NMDA antagonist which essentially caused an up- regulation in the u- receptor. Tolerance and effect on pain may be less enhanced. I suspect you now feel the total effect of what WAS in your dose. D-methadone probably enhanced your subjective feeling due to the effect on the NMDA. Which maight explain your feeling of excitation and stimulation. Wanna know how to get that back? Use DM- dextromethorphan in a methadone/; dextromethorphan Ratio of 1: 0.75. That is 1 mg of methadone to 0.75 mg of DM. 100mg of meth/ 75mg DM. I use this ratio when my pain is really bad as I cannot elevate the dose on the methadone too high or I will run out. Let me know.Thank you. There is a patch in West Germany for this very reason. Antagonism of the NMDA receptor seems to have a significant therapeutis effect.

What I meant is that in the West German(probably defuct but ssismilar since the wall fall), DM-dextromethorphan is used as an NMDA receptor antagonist and is used as a co- analgesic to try and diminish the effect of narcotics on the u- receptor. When this is accomplished things like tolerance and addiction are mitigated and pain as an entity has a dimished effect on the nerve as a whole. DM is dispensed as a patch that delivers about 90 mg over a 24 hr. period.

 

[stivsmegg]

yeah i have been on them all except the green liquid and the only one that made any actualr difference was the 40mg disketts(dispersible tablets) seemed to hold me longer, also it seems years ago methadone held me longer but i think it comes down to the fact that you have developed a tolerance, if you have been on it 20years than yes you are not going to feel that old 'magic' anymore sorry. i have been on a program most of the tme since 98 and i start to get sick on the 22hour mark, i dose at 4 am cuz i cant sleep past then, that is if i even get sleep. for me cannabis helps a ton!

 

[jaspersilence]

Nothing against you,but taking one thing for 20yrs,and then switching,may have psychosomatic effects.It's very normal with change.I would tell your Doc. to switch you back,or find another program administrator.I wish you good health,and happiness my friend

 

[Misterman13]

I have been going thru the same issues. My counselor recommended I try increasing my dose. I went up by 10mg and feel a lot better. But still not where I used to be. So I went up 10mg more and I feel great again! I have that energy again. No more insomnia! Yay! So just to fill you in, when I moved to CT I felt the methadone wasn't working like it used to. Sweats, insomnia, lack of hunger, and the HOT N COLD FLASHES SUCK!! And embarrassing too when in public. Anyways I see this was back in 2012. I hope you have figured it out by now.
Please let me know how you fixed the problem. Thanx

 

[Stdocta]

I know this is an old thread but that’s
bullshit I was on the red methadose liquid for two years withdrawals every night....um. I switched clinics I get the 40 mg orange diskettes and yeah they’re a LOT stronger even the clinic doctor knows it and says it’s and it holds me longer so methadone beats that bulshit methadose any day!!! Some people just are inexperienced and believe whatever they read from big pharma

 

[Beefy]

Yes, I heard of this methadose brand. It is a cheaper form of methadone. To be honest, IDK what type I get at my clinic, but it does give me energy and controls my mood. The counselors and doctors at the clinic even say that it's a great mood stabilizer.
That's why I'm so hesitant on to switching to suboxone. I have mental illnesses and methadone makes me happy or at least, keeps my mood elevated. I actually saw the bottles at my clinic and they do say methadone on them.

 

[Lorne???]

Ugh...

My parents liked methadose, and literally everyone who tried a particular clinics liquid, or someone who went to the clinic who got methadone tablets, from uh, that Tanuki, well, I think literally everyone mentioned (sometimes in legitimate anger) that the liquid was weaker/tablets were syringe ; and I never mentioned it, people who ended up trying both all disliked the liquid, some implied they were cheated. I admit 10 tablets hit harder than 100mg of liquid (at that clinic) yet taking it every day, it was more a problem of consistency

Anyway, there are several types of methadone, and pretty much all of them shall meet bio equivalence, which is, 85-120% I think(At worst 80-125%) so pretty much, with legit md scripts, your getting racemic methadone

Not a big fan of this thread...

 

[Keif' Richards]

I think everyone has covered the most important information here. OP, the medication that you are thinking of, that contains both an agonist and an antagonist is Suboxone, with Buprenorphine being a mixed agonist/antagonist itself (complicated explanation) and the Naloxone (Narcan) being a full Opioid antagonist. Methadone is dispensed as a racemic formulation: LevoMethadone and DextroMethadone. The Levo isomer is an Opioid agonist and the Dextro isomer is both an antitussive (cough suppressant) and an N-Methyl D-Aspartate (NMDA) antagonist.

While it's true that the Levo isomer produces the effects desired by Opioid users and maintenance programs, but the Levo isomer, as an NMDA antagonist can also have useful applications for certain types of pain. That's about as far as my limited knowledge goes however.

It's highly unlikely that the Methadone you are receiving is of a significantly reduced potency. I'm not saying it's impossible, but it's very, very unlikely. If, indeed the problem is being caused by a different brand of Methadone, then I would put my money on one of the inactive ingredients in the solution producing some kind of allergic reaction. I'm guessing here. The supporting evidence I have for believing that the Methadone is legitimate, is that, if it were truly the case that the Methadone in question was not as potent all of the sudden, it would actually provoke a major public health crisis.

I don't know how many people go to your clinic, but I'm from Lowell, MA, which is a town similar to New Haven in a lot of ways. We had about 800 people at my clinic and another 1,000 at the clinic on the outskirts of town. Practically every town in MA has a clinic. If, all of the sudden, the strength of the Methadone solution provided was reduced by half, you would instantaneously be in the midst of a twilight-zone-esque scenario. Literally thousands of junkies being re-introduced into the community in an instant.

It would just be hard to ignore. I believe whole-heartedly that Merck would have no problem giving bunk drugs to the addict population if they thought they could get away with it. I believe the for-pay clinics would gladly try to cut their costs in half if they thought they could get away with it. The problem is, I don't think they could get away with it. Also, Methadone is very cheap to produce. It's one of the least-costly aspects of a clinic's overhead actually. I don't have anything other than my observations to back this up, so don't just take my word for it please.

 

[Lorne???]

^ Plus I think they prefer people being on a high dose, because methadone is produced by many manufacturers and is fairly cheap(afaik) and, someone on a very high dose is less likely to even attempt to go back to street drug; I mean you would easily need a quarter gram of oxy to equal ~100ng methadone. Sometimes the doses are crazy.. Ine case report had. Guy on 300+ mg, who had heart trouble after being put on that dose, yet refused to lower dose, and had a pacemaker put in instead
( Note that methadone prolongs the qt interval in massive doses)

I dont know who would really “need 300mg, the way clinics titrate they would be adjusted well before that it would seem(patients in severe pain switching from massive opioid doses, is different of course)

In the end, non one knows, however as Kief said it is highly unlikely; some brands may be more consistent that others, and there are isolated incidents, though in the end you are recieving a product/ service, and if it is a medium-large size clinic, Kief makes a good point that half strength methadone would become noticeable, and would be a gamble, and they could lose patients and more money at the very least. Again, this is a good point that Kief brought up. It would probably be an individual, or maybe a pair of people, at a smaller clinic, not the institution as a whole and less likely with hundreds, or more at a clinic. Some of that is speculation, however some is just based on what we know about the system, and certain facts of MMT. Most of this has been covered OP, you are free to switch clinics if you are able financially/Geographically.

Not being rude just saying, we don’t know, it could be an inactive Ingredient causing it, again from my colleague (not the binder!), point is we don’t know

Think the best way to really tell is go 40 hours w/out a dose, and tell us if you wd, and if a dose fixes it, and another dose has you normal. That is undesirable, yet could help demonstrate efficacy (Or over time if everyone from both sides dislikes it, that would demonstrate something) Hopefully it works itself out

 

[Chronicpain54]

I've never been to a Methadone clinic, but I'm prescribed it. The only thing I wanted to say is that Methadone is so cheap that I was prescribed 150 10mg pills for less than my $10 copay. The only medicine I take that is cheaper is klonopin. I would hope they wouldn't spend time increasing doses just to screw you by watering it down.

To the Mods, I know we aren't supposed to talk about prices so I just mentioned my copay for all my medicine instead of exactly what I pay for it.

 

[Beefy]

Becareful about the clinics you go to. I've been to a clinic before, as many people also have. Where they want you there forever. If you try to come down on your dose, they'll make 100 excuses as to why you shouldn't. So don't go too high of a dose and then try to titrate down. They won't let you. They keep you stuck there forever.
That happened at the first clinic I used to go to. They kept making excuses, and I could never meet with my counselor because his excuse was that he had too much paperwork. So I just walked out and went back to doing dope. But I'm so grateful to be at a clinic now that's connected to a very big hospital, and they will take you down if you ask them, without any questions.

 

[Lorne???]

Yeah, some of the doses are insane

@Chronic: Your general Co-Pay should be just fine to post ( What do I know though?) %)

 

[Keif' Richards]

Guys, while I'm totally no averse to discussing the malicious intent of for-pay Methadone clinics, this probably isn't the best place to do it. I am thinking about trying to create a nice little thread dedicated to said discussion, but I'm not totally sure where we should put it. I understand the the "logistics" and practices of clinics might not seem like straight-up Harm Reduction, I might disagree.

If there are clinics out there putting patients on ever-increasing and unnecessarily high doses of Methadone (and Buprenorphine for that matter), I think it ultimately does effect the health of our community, so is worth discussing. I think we could maybe put something up in Drug Culture, but I'm open to ideas.

This is not an attempt to detract from you OP. I actually think that your issue could be absorbed into a thread of this nature. Perhaps a place for reasonable complaints, comments and issues with Methadone clinics somewhere in Drug Culture? For-pay Methadone clinics operate in the same morally reprehensible area as for-pay jails and prisons. When profit is openly put ahead of the health and well-being of human beings, it's the "clients" who lose.

 

[raQ]

I think everyone has covered the most important information here. OP, the medication that you are thinking of, that contains both an agonist and an antagonist is Suboxone, with Buprenorphine being a mixed agonist/antagonist itself (complicated explanation) and the Naloxone (Narcan) being a full Opioid antagonist. Methadone is dispensed as a racemic formulation: LevoMethadone and DextroMethadone. The Levo isomer is an Opioid agonist and the Dextro isomer is both an antitussive (cough suppressant) and an N-Methyl D-Aspartate (NMDA) antagonist.

While it's true that the Levo isomer produces the effects desired by Opioid users and maintenance programs, but the Levo isomer, as an NMDA antagonist can also have useful applications for certain types of pain. That's about as far as my limited knowledge goes however.

It's highly unlikely that the Methadone you are receiving is of a significantly reduced potency. I'm not saying it's impossible, but it's very, very unlikely. If, indeed the problem is being caused by a different brand of Methadone, then I would put my money on one of the inactive ingredients in the solution producing some kind of allergic reaction. I'm guessing here. The supporting evidence I have for believing that the Methadone is legitimate, is that, if it were truly the case that the Methadone in question was not as potent all of the sudden, it would actually provoke a major public health crisis.

I don't know how many people go to your clinic, but I'm from Lowell, MA, which is a town similar to New Haven in a lot of ways. We had about 800 people at my clinic and another 1,000 at the clinic on the outskirts of town. Practically every town in MA has a clinic. If, all of the sudden, the strength of the Methadone solution provided was reduced by half, you would instantaneously be in the midst of a twilight-zone-esque scenario. Literally thousands of junkies being re-introduced into the community in an instant.

It would just be hard to ignore. I believe whole-heartedly that Merck would have no problem giving bunk drugs to the addict population if they thought they could get away with it. I believe the for-pay clinics would gladly try to cut their costs in half if they thought they could get away with it. The problem is, I don't think they could get away with it. Also, Methadone is very cheap to produce. It's one of the least-costly aspects of a clinic's overhead actually. I don't have anything other than my observations to back this up, so don't just take my word for it please.

I am struggling woth the same or a similar thing. On the same dose everyday, some days it works OK and other days not. The main problem I have believing its all the same is that the taste is so different.
I have thought of everything I could possibly think of and I am wondering..... could it be a simpler thing of.... when the person is pouring it from a big bottle into the smaller take home bottles, if the big bottle is just taken off the shelf and NOT GIVEN A GOOD SHAKE.... could that mean that the active ingredient is not equally dispersed throughout the whole bottle....so the stuff at the top will be much weaker than the stuff at the bottom?
It is the only common sense reason I can come up with.
As I've said, I notice a difficult taste each day but also difficult viscosity.
I am also going through the menopause so that is getting blamed for the hit flashes but I am so sure that I am also having varying strengths in my 'done.
Getting anyone to listen is difficult too as I sound crazy if you don't know me.

 

[Keif' Richards]

I see that you're located in the United Kingdom. The UK and the US have a lot in common in terms of how and when Methadone Maintenance was implemented. This is mostly because The US pushed this same Methadone protocol on all nations, whereas the UK had a successful Heroin Prescription program that had been operating more or less since the first day of drug prohibition took effect.

Anyway, my point is. we live in nations in which Methadone administration has been highly synchronized from place to place. It's highly unlikely for a clinic to give a client a different dose on a different day. There are typically multiple safeguards in place for this sort of thing. The only centers not using digital maintenance for their programs are going to be in developing countries (In Cambodia, I saw a program where the nursewould see a patient, then take a certain number of pills out of a giant sugar bowl).

I'm not saying it's not possible, but it's not something worth worrying about. Methadone has a highly variable bioavailabilility profile fom person to person and even moreso, from the same person from day to day based upon the acidity of their stomach, their diet, medications etc. This variability could easily be Methadone's greatest failing in terms of its usage as a maintenance medication. It wouldn't be strange for someone to alter their absorption by 10%-20% in a single day if they say, took some tums, ate a grapefruit and so on.

Case in point, I feel what you're experiencing is mostly normal. I generally take some tums begore my morning dose and it seems to keep t fairly constant from day to day. I encourage you to try this and see how it makes you feel.

 

[raQ]

Thank you ever so much for your reply. You have reassured me so much. I was looking into if coffee could cause malabsorption too. Even toothbrushes before going to get it.
I've just been told that Boots have just got an newer cheaper brand they were using which could have something to do with it too.
I will give the tums a go, avoid coffee before hand and leave it an hour before having my 1 coffee of the day.
Thank you for yr help. From Rachel xx