Opioids Cocaine can cause precipitated WDs in methadone patients?

[rhun]

I checked the search engine, but didn't see this exact question asked. However, I did see that a lot of people have combined methadone and cocaine without any bad reactions.

When I did my intake just over a month ago at my methadone clinic, one of the RNs told me that to make sure and not do coke because it would cause precipitated WDs for people physically dependent on methadone.

Now, this sounded a little fishy to me at the time. I know something like buprenorphine could bump the methadone off my receptors and cause precipitated WD since bupe has a much stronger affinity. But that's another opiod, not a stimulant. I asked dad, who's also a methadone clinic and very educated about methadone and drugs in general, and he said the RN was incorrect.

I'm still curious, however... Does anyone know why she would say that? And if there's any logic behind it?

 

[cj]

Coke wont cause PW;s but it could speed your metabolism up which could make the done where off faster. I really doubt it would be an issue though. Nurses are always good for some anti-drug propaganda.

 

[NeighborhoodThreat]

^Indeed. Cocaine will not cause precipitated withdrawals in patients taking any opioid. Cocaine's mechanism of action is completely different from the opioids.

 

[Znegative]

Yea, like both of the above said, cocaine does not cause a precipitated withdrawal syndrome. Precipitated withdrawal can really only occur when an antagonist (Naloxone, Naltrexone), or a partial agonist (Buprenorphine, Pentazocine, Nalbuphine) are consumed by a person dependant on opiates (usually full agonists). There are certain drugs like Phenobarbital, that induce many CYP450 enzymes, causing the decrease in decreased serum concentration of methadone (the opposite effect of common potentiator's like cimitizine). However, as far as I know, cocaine does not interact with CYP450.

Like Crimson Junk said, it's possible that the cocaine speeds up ones metabolism, causing the methadone to wear off faster. However, I'm more inclined to say (based on my personal experience with the two) that Cocaine and other stimulants by themselves produce symptoms that are similar to opiate withdrawal, especially when a large quantity is consumed, and during the crash phase. Changes in body temperatures (cold/hot flashes), anxiety, racing heart, sweats, insomnia, diarhea etc, are all side effects of stimulant abuse as well.

 

[Hiltoniano]

Honestly coke usually feels better, a LOT better, when on opiods. I mean it's really bad idea to mix, especially iv, because of the risk of polydrug addiction and the negative effects of speedballing. But I see no way that it could induce precipitated WD. It's not like it knocks the opiods out of the receptor or even interacts with opiod receptors.

 

[Znegative]

Yea, when you speedball with heroin, the whole point is that the heroin takes over right after your about to come down off the coke, there would be no point to the combo if one canceled out the other.

 

[rhun]

Thanks guys for the prompt, well thought out responses. That's pretty much what I already thought, just wanted to confirm since you wouldn't think a RN at a methadone clinic would say something totally off base. Well, maybe you would, but typically e my clinic is actually very knowledgeable about methadone and other drugs, unlike 90% of the doctors and nurses out there. At the time I remember thinking that cocaine didn't effect opiate receptors and therefore were unlikely to cause precipitated WD but I was in mild WD at the time (they require it for intake) and didn't feel like bringing it up.

My dad said it's one of the few drugs that methadone patients can still get high off of so he thinks she said that to discourage use. Currently I'm only taking methadone, I'm not using drinking or using any other drugs. Once in a while I do find myself fantasizing up shooting up again but I only had one relapse. Unfortunately the last three months before switching to methadone it was IV and I got completely hooked to the needle. I've never IVed anything other than heroin though and I heard coke is pretty corrosive anyway so regardless of whether the nurse is wrong I'm not really tempted. Like I said above, I used heroin once since I started the methadone and by then my dose was too high and it didn't work anyway. Part of me was frustrated that I don't even feel the methadone and the other part of me just wanted to see if I'd reached a high enough dose where H wouldn't be able to get to my receptors.. and I pretty much just missed the needle, ugh.

I've been in the program a month. I was clean 3 months off a year long Oxy habit before I went back to H and picked up the needle. Do any of you have experience with methadone? I'm at 75mg. I'm thinking of tapering to a very low dose now that I'm used to my dose. It's not like I get high off the methadone so there doesn't seem any point in staying this high. I'm almost positive I have an endorphin deficiency and I've also had depression/anxiety as long as I can remember so after going CT the three months I was clean I was completely crippled, I literally could not function. So I'm not ready to go off unfortunately, but methadone is such a strong opioid I don't want to spend years of it on my life just because the clinic will let me and that's what everyone else does.. so I might as well try and see if a low dose will work.