[bluelight admin: this, as I found it, was a detailed request for info & discussion on the methods, pros, & cons of using methadone to facilitate a gentler withdrawal from heroin (Classification probably 'Other Drugs Forum')]
This is my very 1st day being an official greenlighter (low privileged probationary user) and I promised myself to not say anything for at least a bunch of weeks til I get to know the bluelight culture and protocols a great deal better, and gosh I had to run into your request for helpful info while you do a do-it-yourself type full blown heroin detoxification!! If this was simply a request for a pharmacological analysis of your plight I would have passed on this, but alas your experience is a tiny subset of more than the last 18 or so years of my own life's direct experience, so I can offer you lots of stuff I learned both through book study but more by experiencing your situation many many times myself.
A. Methadone is a potent, highly addictive synthetic opioid that is unusual from most other opioids in three ways: 1. it is very long acting, 2. at doses above 75mg/day (avg. maintenance range is 80-120mg/day, unless person is taking another drug, such as phenytoin (Dilantin®) or phenobarbital, or a set of other specific agents that speed up the metabolism/elimination of methadone. this requires higher daily doses, sometimes up to 300mg or more! This is due to 3. Methadone is metabolized by the liver's cytochrome P450 system, unlike almost all other opioids that metabolize via glucuronidation. The implication of this is that the P450 system can be overloaded easily, as it can only rid the body of limited drug levels over time, while the glucuronide process can metabolize *any* amount of morphine in the *same* amount of time. Or, if 50mg of methadone is eliminated in 4 hrs, 100mg is eliminated in 8 hrs, while with morphine, if 15mg is eliminated in 4 hrs, 30mg is also eliminated in 4 hrs. The cytochrome P450 system can become "oversaturated" leading to a longer presence of methadone in large doses in the body. Additionally, drugs that share the P450 system for metabolism are subject to interact with one another, since these substances are competing for very limited enzyme receptors that are subject to becoming temporarily "used up") the drug will maintain its effects but plateau off, meaning taking more will stop increasing its agonist effects (analgesia, euphoria, sedation, satiation against deprivation of other opioids you were taking) but taking more can still increase ADRs (adverse reactions) such as respiratory depression, coma, and death.
Sadly methadone used for opioid maintenance and/or withdrawal is very tightly restricted to formally licensed "methadone clinics" that almost all share some bad things in common (I have been to 4 of them in 3 states and every one of them did the following): treat patients like borderline criminals unworthy of any level of trust that is normal to almost all non-methadone doctor-patient relationships, the threat of denying the next day's methadone dose if the patient breaks or does not perform intricate sets of rules set by the given clinic and resulting in a kind of borderline master-slave dynamic, regardless of that patient's cooperation and behavior. Also, other than the methadone, through daily urinalysis, a methadone patient cannot use any recreational drug(s) other than methadone and, if given special permission, certain benzodiazepines that the patient was already being prescribed prior to joining the methadone clinic. I'm not going to hunt down the exact percentage now, but approx 80% of patients who stay on maintenance for at least 6 months is committing themselves to continue with methadone maintenance for the remainder of their lives.
B. If you must go the legal route of being prescribed an opioid to make heroin withdrawal more gentle, I strongly recommend you use buprenorphine HCl. In the U.S. and much of the world the brand name for this is called Suboxone®. Mixed with it is 0.2-0.8mg of naloxone HCl, which is the narcotic antagonist in common use, added to make sure the patient does not attempt to inject buprenorphine, which hugely amplifies the effect, or said another way allows one to only need 1/7th of a dose to produce the same effect. Buprenorphine is in general a powerful opioid that is not absorbed orally (swallowed like a pill). Nor does naloxone work orally. It is generally given by coating a water-soluble tiny 4 x 8 mm square of plastic-like film with both buprenorphine and naloxone. This square is placed sublingually under the tongue for 10 min. which allows the buprenorphine to get absorbed, and the noloxone being not absorbed, mixes with saliva and eventually gets swallowed and never enters systemic circulation. I personally participated in Phase III clinical trials for buprenorphine as a drug that can be used as an alnernative to methadone, back in 1992. This drug is a mixed agonist-antagonist opioid with a complex pharmacology that is mostly the same as morphine and other potent opioids, but has significant differences too. See: suboxone.com and read everything including the full professional prescribing information intended for doctors. (If needed, have a link to a good medical dictionary handy).
The advantages of buprenorphine instead of methadone are significant: The most important one is that, even though it is a very powerful opioid one can get high on (unless!: you are tolerant to heroin, oxycodone, or other opioids first), some doctors who have taken special training and have an ammendment to their DEA registration number licensing them to prescribe it, it is a Schedule III (CIII) narcotic, allowing refills and having basically the same level of restrictions that benzodiazepines have, instead of it being in Schedule II like methadone, morphine, oxycodone, hydrocodone, etc. You, to start, would go to your doctor once per week instead of daily with methadone. You would not be treated almost like a criminal. You would not be subject to 20-60 tedious clinic rules and constant urine tests. It works just as well or even slightly better than methadone for short-term detox use. And it is significantly less likely to force you to use it for the rest of your life.
C. Now, if I were me, I would do things a bit different in your exact situation assuming I were YOU but with my memories, drug knowledge, and life history. I cannot be sure that my way through your connundrum is what you should select, precisely because I am *not* you and do not possess your life. But follow me here, as a set of tactics to consider, and also sleep on it (that old advice really is a wonderful idea provided you have the luxury of time enough to use it). 1. Heroin withdrawal is a 2 week nightmare. You will feel like your gonna die but you actually have no danger of death, unlike some other drug classes. Diarrhea is severe. Treat that with Immodium A-D® or generic loperamide HCl 2mg tablets, no Rx needed. Get a doctor to write a script for clonidine HCl 0.2mg tablets, generally employed for treating high blood pressure. Read up on any unfamiliar drug you consider using on yourself, over and above your doctor's knowledge and consent. Remember: the ultimate responsibility starts and ends with oneself! Clonidine will control the "cold turkey" hot & cold abberations in the body's temperature control that is a hallmark of opioid withdrawal. As for actual vomiting, you must simply get it over with when you feel you must. Attempting to hold down an angry stomach is a losing battle--and once you are done you will experience a nice feeling of relief and calmness that will be a welcome respite. Eating only clear chicken broth and similar easy-digested foods will limit the vomiting phase which only lasts a few days anyhow. Attempt to secure around 20 tablets of diazepam 10mg (Valium®). You will know you are at the stage of needing them when you find you cannot sleep at all. Take one tab about midday and another tab at bedtime. (Do not take more than one at any given dose. More will use up your supply too fast and lead you to make stupid mistakes on top of all the bad stuff happening to you anyway! Besides, the tabs you do not use will come in handy after withdrawal is over & done with). --> Try to allocate 1-2 weeks where you do not have to work, perform, drive, go out, take tests, etc) <-- I've gone thru about 9 severe opioid withdrawals with no helper medications around. Truly cold turkey. And the thing is, its the anticipation that is terrible. Actually doing it is bad but not too bad and is done and over with soon enough not to worry. The final preparatory step is to attempt to secure yourself approx. 30 Percocet® 5mg tabs. They will absolutely take the edge off the suffering. But the trick is, to only use 1-2 tabs at a time, and to never use more until at least 12 hrs is up. This way, the withdrawal will proceed to completion. You need an iron will here. I really mean just that. (And since I am me, here, the strategy avoids trading one enslavement for another)
D. If, in the future, after withdrawing, you still need a dose of opioids: almost all post-addicts and ex-opioid lovers will still have that brain circuit remaining all the rest of the person's life. The error is to let society, medical science, your own guilt/programming, or another person to convince you that you have lost your free will to act as you choose and to change course when desired. They are wrong once you practice your power of choice. You are a robot only until you decide that you are not one, and then, hard at first but easier and easier with practice, via your choices you show yourself that your sovereign powers remain intact when used. I have never lost my love for certain opioids. What I have chosen for myself is to partake only once in a while, and since I never liked being "on the nod," I never go above mild-to-moderate doses. If I repeat with a second dose, I never take a third. If I use on one day, I never use on tomorrow's day. Some can be good. Much more and it turns around and bites you! It really is that simple when reinforced with endless practice with no exceptions, for me at least.
E. The very best luck and fortune! You can succeed here. Study up first. There's a lot of technical stuff you need to know before you start your plan. Don't take my word for anything. Find out for yourself, it is your life.
-lylastar
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