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Herion and Suboxone

hey davis you brought up some really interesting points about methadone and of the dangers of using over the top of pharmacotherapies. When people present for opioid dependance to a clinic is is usually because they cannot manage to self moderate their use of substances. and get to a point where they need to use just to feel normal or not go into withdrawal & the difficult experience that is withdrawal.

The Rx pharmacotherapies are usually more potent and have longer half lives than street Opiods, which is great beng that you only have to administer the dose once per day. Also when you have a long acting drug like methadone it gives some of the opioid high while reducing the clients need to use additional opioids. when people go over say 60mg of methadone per day there is a thereputic blockade of the receptor sites (tolerance above that required to feel the effects of street opioids) but each person is different and dose level will change for each person.

"
Therapeutically appropriate doses of these agonist medications produce cross-tolerance for short-acting opioids such as morphine and heroin, thereby suppressing withdrawal symptoms and opioid craving as a short-acting opioid is eliminated from the body. The dose needed to produce cross-tolerance depends on a patient's level of tolerance for short-acting opioids.
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as people feel the need for more of a scripted Phamacotherapy they will in conjunction with the Dr raise the levels over time, in effect driving up tolerance for opioids. ALthough methadone still has an active dose effect curve
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this is also the reason using on top of mehadone or using other central nervouse system depressants in combination with MMT can be very dangerous- alcohol, benzodiazapines and opioids potentiate (multiply) each others effects but not in a way that you can accurately control or predict. which puts people at risk of respiritory depression (stopping breathing).

suboxone is a much safer drug for treatment of opioid dependnace due to its features of being a partial agonist. But again everybody is different and between the two drugs methadone and Buprenorphine- they seem to cover most peoples needs for treatment. If you.
 
leftwing said:
^yeah

you're generally not going to get a large crowd of people supporting this kind of move around bluelight. the point of starting a program is to keep off the other opiates/oids. if you're not ready to quit then why waste your money and mess with you mental (and physical) health going back and forth in limbo of withdrawal?
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Look I hate to bang on about this - but statements like the one above are judgemental and counter to harm reduction principles. leftwing I believe you are being a little disingenuous when you say you are not questioning people's motives - because the quote above shows that you are.

Happy to debate further - I don't always have a lot of time for the interwebs so it might be a few days before I get back. Maybe we should start a new thread and hash it out properly. I'm sure we can come up with a few more interesting scenarios to flesh out the discussion...
 
the quote above is the exact same sentence i'm referring to as a rhetoric question, something you see so much amongst the bluelight community.

that was nothing personal against the OP whatsoever. that's where you're mistaking me and mincing meaning in what said.

perhaps i didn't word it well, i was high at the time fwiw. i was not being judgemental not what i being counter active toward HR.

i answered his damn question without a hitch for fuck sake.
 
i saw this post the other day and havent had much of a chance to respond to many of the points raised above, but these are important points.

Yes there is a community consesus that people who have drug problems need some sort of assistance, yet there is also a conflicting stereotype around methadone and maintenance treatments, that can stop people from getting the most out of pharmacotherapy treatments.

when people are on programs either way if their still using recreationally on top or more regularly this is a harm reduction approach while it may appear that people are abusing treatment and rub against soem peoples values there are a number of ways in which it promotes harm minimisation;
While people are on treatment;
*there is a reduced need to use
*reduced use = reduced injections = reduced Blood brne virus transmission,
*reduced crime related behaviours to aquire drugs, (increased community saftey)
*Reduced legal presentations in criminal justice system
*reduced adverse health outcome from life of using
*reduced physiological and psychological symptoms generating ned to use
*reduced risk of intoxication related injuries and deaths
*and the list go's on.

If someone has been using for lets say a decade they start on a program one day, they for the induction period of treatment will not be given as much as people need- induction on methadone starts between 15-30mg day for the first week- which is sometimes not adequate for say someones tolerance of 1/2gr heroin day habits, so people might have to use a little more on top of the treatment.

as treatment dosages increases; (bupe daily increase to a max of 32mg, Methadone 5mg incriment every third day- to a max of 120mg) to match where a persons tolerence is people are feeling the effect o withdrawal to some degree- physical/psychological.

behaviourally speaking- it is very rare to see a person change their behaviour patterns overnight- just as it took time to develop an addiction it takes time to retrain (physical and psychological).

this time factor is also a community held value of "get over it, youve got treatment now, take responsibility for your life etc"- i think this has a lot to do with immedicate gratification of this culture- got treatment im fixed all short term goals, but the truth is that most people need time to change. this also influences the ability of treating organisations to get the most out of a pharmacotherapy for clients rapid on and off the program- due to their own internalisation of this short term treatment approach.

i would encourage any person on a opioid therapy to talk to their prescriber if they are using, for some people are not ready to not use opioids again and will continue to do so either way, some people dont want to use and want to change but the pharmacotherapy is not quite right- once a pharmacotherapy is within the clients thereputic dosage level massive personal, social change can occur without the physical need to use to stop withdrawing.

Also by the time you get on to a program the drug experience itself has changed from one that rec users of any drug would experience- there is no longer the same pleasure from intoxication & withdrwal is a physiological and psychological event that can be quite painful. which is the sting in the tail for anyone who is dependant on substances; the more you use the les effect it has on you!!
 
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Just wondering why you guys are saying "Welcome to Bluelight" to someone who has been on it for over 6 years? Is it condescending as in "Welcome to Bluelight [since you asked a nub question, we'll treat you like one]" or you guys genuinely don't look at someone's join date when assuming they are new?
 
ayjay said:
^OK I obviously hit a nerve. I still think what I think but I'm not going to keep nagging you about it :)
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no you didn't pinch a nerve, man:) sall good. i was probably having a shitty day, sorry.

mick sums up a lot of what i wanted to convey but not being a profession or even studying and doing the jobs you guys do i lack a lot of knowledge and at the best of times the words i convey come off wrong,

i would encourage any person on a opioid therapy to talk to their prescriber if they are using, for some people are not ready to not use opioids again and will continue to do so either way, some people dont want to use and want to change but the pharmacotherapy is not quite right- once a pharmacotherapy is within the clients thereputic dosage level massive personal, social change can occur without the physical need to use to stop withdrawing.
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this is what i would advise as well.
 
wazza said:
Just wondering why you guys are saying "Welcome to Bluelight" to someone who has been on it for over 6 years? Is it condescending as in "Welcome to Bluelight [since you asked a nub question, we'll treat you like one]" or you guys genuinely don't look at someone's join date when assuming they are new?
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Wazza I think they're seeing astroboy's relatively low post count and assuming they're a new user without checking the join date. I highly doubt there's anything more than that to it & would put money on them not being condescending. Innocent mistake so to speak and one I've probably made in the past too. :)
 
I used to dose 4mg's of sub in the morning and would be nodding off dilauladid's and oxy by the evening hours. Good shit :) So you dont have to wait as long as some people think.

Somtimes it might be a good idea to take a lower sub dose if you plan on using.

PEACE! ---God i'm so fucing high lol
 
Wazza - what belarki said. Mea culpa - will be more attentive next time

leftwing - no worries :)

MrIbis - I like theory and always interested in drawing lines between theory and practice. Theory without practice is masturbation - fun, but won't achieve much. Practice without theory is like an unguided missile - can blow up in your face ;)
 
New Study: Bluelight and male menstrual cycles!

-Reowwwwwww- lol...

Ah i like a heated debate as much as the next man, but when all my friends start arguing between one another it gets a bit hectic.
 
This is why you jump on a dose of methadone 80mg or less.... That way when you want to use you still can just adjust for higher tolerance. Then when you're truely ready to stop maybe consider tapering down to 50-60mg of methadone and then swapping over to bupe.

I know many of you will argue with my reasoning, but the way i see it if some body wants to use still they will use, if they're using once every couple months compared to twice a day that's excellent and gives the user a much more stable platform to pursue further life improvements. Being on buprenorphine makes this very hard to do. Where as being on methadone dose thats not blocking opiate euphoria you can use very easily, but still have the stable reassurement that you have a dose daily.

Then i think once you get yourself to that point in your mind where you're over the gear all together taper down to 60mg and then jumping over to suboxone or subutex.

Some might think the risk of being stuck on methadone is quite high and while this is true, it is better for the op to do this instead of losing valuable privledges or being booted off the system for not picking up days in a row ect, like using on bupe you just cant do it with the australian system.

Over in the usa buprenorphine has become popular because over there it seems that any old doctor prescribes bupe, and you pick up your monthly load from the chemist, so it's seen as an easier option than a methadone clinic as it allows the user to dose as they please pretty much.

Where as in Australia methadone and buprenorphine are just treated the same they're both daily pick up with the same conditions placed on them. With the difference being methadone is just a full agonist like morphine and heroin, and buprenorphine has such a high affinity for the receptors it dosn't give any other opioids a chance to do their job and it's a partial antagonist...

So in Australia there isn't any reason to use buprenorphine as a maintainence drug unless you're 100% committed to saying goodbye to any highs from opiates or you're really deadset against using methadone.
 
hey 8L4YN3,

i guess my experience would say that many people who want to continue to use do dose adjust their pharmacotherapy to account for continued use. Although i would also say that all of them that continue to use have difficulty and destabilise at some stage going back to using more often, dosing less often and end up seeing me again- i am yet to be proved wrong but im sure there are people out there who manage it. But i dont think it is a good habit to get into as it reinforces the behavioural aspects of adiction which more than likey is conterey to what people generally want.

If your going to use, make it less often, the old adage of less is more is very accurate; the more opioids you use the higher the tolerance grows and the less efect your body experiences. Natures a biatch but hey thats our neurochemistry.

as for bupe or methadone, both are equally good pharmacotherapy treatments. Methadone is more useful for people with higher tolerances to opioids- you just cant make some people comfortable on buphrenorhine at all- switch them to methadone and treatment takes a massive leap forward- people are feling soo much better they usually wonder why they did not do it years ago. the myth of being stuck on MMT is a twofold rediculous statement.

alot of people who dont want to go onto MMT because they get stuck on it for ages is partly twofold erroneous beliefs about treatment. the immediate gratification the is addiction generates a headspace where "i wanna quit and do it as soon as possible" puts people at greater risk both of overdose and withdrawal related issues. Im sorry but things like coming back from addiction/dependence tae time and there is no short answer to a complex and usually reoccurring problem.

People are encouraged to get onto methadone build up to a thereputic dose (usually min 8 weeks) stabilise on that dose, once stabilised people are encouraged to attend to both psychological and social issues thatusually arise in dependence- couls be a number of things such as; health, legal issues, debt, redeveloping personal coping skills, fixing family relationships, building support nextworks, accessing services to assist with these issues. Once a person has not used on a pharmacotherapy for a period of time say 6months , if they want then think about coming down as slow as possible. While using during the stabilisation period you are just reinforcing the behavioural side of the addiction. Physically the prescribers are taking care of the physiological addiction through the Rx of a medicine.

People who jump on and off programs doing only short stints are at higher risk of death due to overdose, reengaging in criminal related behaviour around the need to support a habit. In addition to this the mst successful people who tranisation onto a program and off a program are the ones that get to the right dose, fix their lives and then taper off over a period of two years. Instead people get afraid of this timeline and jump on and off for 5 plus years rather than have comittted to the orignal two years...that is just torture that people do not need.

also for some people the risk of relapse is just too high and some people choose to be on a pharmacotherapy treatmen tfor the rest of their lives- and you know what, that is okay too as they know what is going to assist them to meet thei long term goals to keep safe. I really appriciate clients who want to stay on it while working functionally in society... that take s a tre effort to commit to something for that period of time, and to change your own values around sobriety and what it takes to live a life of your choosing
 
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