Deciding to split-dose methadone: benefits versus disadvantages (including Suboxone)

[elvis_wears_nikes]

Hello there bluelighters!

I have been on methadone maintainace for a little over two years now. I have remained on a stable dose of 100mg once a day for most of that time. Luckily, I have managed to firstly reduce then later abstain from illicit opiates completely while being maintained on a decent dose of methadone. In doing so, I have regained much need stability back in my life and, although, I have had issues with benzodiazepines during this time, I have also managed to gradually titrate down my dose of diazepam and have eventually succeeded to withdraw from benzos altogether. Doing so has probably been the most challenging thing I have ever had to do and has required a great deal of time as well as mental health.

Prior to being on methadone maintaince, I attempted Suboxone (buprenorphine/ naloxone) treatment with limited success. I kept relapsing and I felt it did not take the edge off cravings and thinking about heroin quite the same as methadone did for me, bearing in mind I also had a relatively high tolerance to heroin where I was using upwards of 3 grams a day. There were benefits I did experience from Suboxone over methadoneand they were the longer duration of action of buprenophine which seemed to be positively correlated with an increased dose. Also, I did not experience as much lethargy, fatigue and reduced motivation on Suboxone which have not really become an issue on methadone until recently. I do, however, also experience recurrent depression so those symptoms may have some overlap with the side-effects of methadone.

Since I have been on methadone, from 30mg gradually up to 100mg, I have experienced the most therapeutic effects for only 22 to 24 hours of the day irrespective of dose. At times this has been an issue particularly if I have taken my dose late where I have started experiencing uncomfortable withdrawal symptoms. I am aware that Suboxone has a slightly longer half-life and perhaps I am a fast metaboliser of methadone but overall I have experience a greater positive effect with methadone on my illicit opiate addiction. Also I do not yet feel ready to start reducing my dose just yet as I feel like I need to recover 'completely' from my benzo use as I do not want to start substituting drugs again as I have done in the past!

What has changed is that I am soon about to start volunteering at my local drug and alcohol clinic and I have been thinking about the impact that methadone might have as I have not yet worked since I have been on methadone. I have been concerned about the side effects of increased tiredness effecting my ability to perform and work for a full 9 hours. As well as my experience of the particular short therapeutic duration of methadone and this has made me consider splitting my once daily dose of 100mg to two doses of 50mg 12 hours apart.

I would like to hear from anyone who has experienced splitting their dose of methadone and how this has impacted them both positively and negatively.I know I need to weigh up the pros and cons as what I will be gaining from splitting my dose would be a longer duration of action and hopefully fewer side effects but I will also be losing the peak therapeutic dose and possibly experience withdrawal symptoms from doing so.

Any advice, experiences or thoughts would be kindly appreciated!

 

[Purposefull]

I tried dose splitting for a very short period (about 2 months) and did well with it, but of course the clinic always knows best. My then wife had left which didn't really bother me. I was actually kind of glad to not have her drunk ways in my life, but the clinic or someone at the clinic decided that split dosing and takeouts wasn't for me telling me that it was my fault she was a drunken lout.
Well, anyway it was back to once a day dragging myself into the clinic every day and I never again got back to takeout status, but did manage to completely ween myself off of methadone over a few years and walked out the door of the place totally drug free with a middle finger salute to the clinic that was about to lose my $20 a day income plus whatever money the state gave them for treating me like a criminal.

Now, because of various injuries I'm back on the treadmill looking for a new clinic in a new town. I've reached the point where I know that I need help cleaning up my act..

 

[elvis_wears_nikes]

I can relate to your stigma completely fella... I have also faced discrimination for being on methadone. Luckily the drug services are free in the UK which really does help as I have never met a rich junkie! At the moment I am on three weekly pick-up and it's not going to get more frequent than that as I guess giving that giving someone 300mg of take-home methadone is enough to potentially kill 6 opiate-naive people so I am pretty fortunate to have a bit more freedom with my dosages. My clean urine screen for opiates have also helped gain some trust. I know that either way it going to take a while to completely be free from methadone but the lifestyle I have now is definitely more 'stable''. Sadisticly I do miss the chaos in a way and I would be lying if I said that the boredom and loneliness is not a struggle at times. I guess we all have our crosses to bear and mine is addiction. I am grateful that I am doing a bit of volunteering and hopefully it will help towards my recovery. But I definely feel like I need to be a bit further down the path before I think about coming off of methadone... I think I will try splitting my dose on a day that I am not a work so I can save my ass if I start withdrawing!

 

[herbavore]

It sounds like a good plan to try the dose-splitting on a day you are not working. And hey, that is really great that you are going to be working there--you have so much to offer.

I deal with a lot of fatigue and lack of motivation myself. In my case it has nothing to do with drugs (auto-immune, age and a lingering mild depression) and I have found that taking things a few short hours, or sometimes even minutes at a time is the way to go. For instance if I look at the whole day/week/month I can get paralyzed by my own perception that my responsibilities are overwhelming. But if I simply force myself to concentrate on one thing for a short duration of time, I can be more productive and ironically the productiveness itself is an antidote to fatigue.

I'm really excited for you that you are going to be doing this.