Opioids How to explain to methadone doctor that the dosage is not working out for me?

[purplehaze147]

I was on a couple year run with some of the worst dope you can get in the US (South Philly, I will not name exact part of Philly).

It's was all a mix of super potent fentanyl analogs like 3-methylfentanyl and carfentanil with xylazine (a veterinary tranquilizer for large farm animals most similar to clonidine) and usually barbituates (statistics show allobarbital is the most common one cut into dope, a medically obscure one - I think it's probably easier to make than pentobarbital or secobarbital). It's even purple or blue most of the time, so at least they aren't trying to pass it of as heroin.

The doctor started me off on 40mg, and was pushing for 30mg. I was like that's not going to work. I tried explaining that the number of bags means nothing (1 bag of this South Philly dope is stronger than 10 bags from Newark, NJ and the same price). I can't even get the dope in my state to keep me out of withdrawal.

Up to 85mg of methadone and it isn't cutting it. I had a small benzodiazepine habit, but now that I cut down so much on the dope and am not getting as much barbituates in my I NEED a couple mg of alprazolam per day - I only use 1mg in the morning and 1mg at night. He's acting like it's going to kill me and wants me to go to detox... well I'm afraid I might die in detox because the care is so cookie cutter and the dope I was getting is not from the state I live in and staff can't understand how bad it is.

170mg of methadone is barely enough to hold me over, but I know I'd be able to stop using until I adjust down to 170mg. I might not even need the benzodiazepines since it's only the dope withdrawal that really bothers me.

He only seems to do 5mg dose increases, but I thought the point of methadone program was to find a dosage that I could function on. I need 2x the dosage or more, not another 5mg. I can't stop using fully otherwise.

I work everyday and go to college so impatient is not an option. Since I work everyday I can support my habit just fine if that's what it has to come down to.

 

[Nurse Ratched]

Your post was a little confusing. How many mgs. do you get per day in your dose?

I understand you want more ( and I get the issue with the benzos ) but am unclear what your daily dose is.

Is it 170?

 

[purplehaze147]

Your post was a little confusing. How many mgs. do you get per day in your dose?

I understand you want more ( and I get the issue with the benzos ) but am unclear what your daily dose is.

Is it 170?

No it's 85. I need 170 or more like 250, and that wouldn't completely take away the withdrawal, just make it manageable. At the moment, although I cut down, I still have to use.

For less dope than a price of an energy drink, I get more than 300mg equivalent to methadone in that half a bag. The streets are littered with people who fell out and lost consciousness.

 

[Nurse Ratched]

Okay, I get it now. You just wish it was 170 as 85 isn't enough.

From what I have read on here is that the whole idea of methadone is to keep people stable, not crave so much, and keep them on a slow and steady path of recovery.

If 85 isn't holding you and they will only go up in 5 mg increments can you dose twice a day? I mean I know nothing about the program but the only thing I can see to do is beg the Dr. to give you more as it isn't holding for you and see what he says. The whole idea is to keep people off street drugs and if he thinks you are going to score because you feel like shit maybe he will help you out.

Maybe also you are expecting too much? Do you want to get high on the methadone? Do you miss getting high so you think you need more?

 

[purplehaze147]

Okay, I get it now. You just wish it was 170 as 85 isn't enough.

From what I have read on here is that the whole idea of methadone is to keep people stable, not crave so much, and keep them on a slow and steady path of recovery.

If 85 isn't holding you and they will only go up in 5 mg increments can you dose twice a day? I mean I know nothing about the program but the only thing I can see to do is beg the Dr. to give you more as it isn't holding for you and see what he says. The whole idea is to keep people off street drugs and if he thinks you are going to score because you feel like shit maybe he will help you out.

Maybe also you are expecting too much? Do you want to get high on the methadone? Do you miss getting high so you think you need more?

No. I'm sick if I just take the methadone. And the only part I like about the dope is the instant sleep from the night dosage. It's not very euphoric as it's fentanyl / fentanyl analogs so it either just keeps me stable or if I go up in dosage I'll wonder where the last 30 min went. It's not fun. I like amphetamines and cannabis; fentanyl is just a burden. I do miss the good old opioid high, but those days are gone and I know I can't get like that with the methadone, after a point when your tolerance gets SOO high it isn't euphoric no matter what the dose is unless combined with stimulants.

I'm afraid I'll be kicked out if I say I've been doubling the dose and that seems to bring me to a much more bearable point to where I can stay clean. It's that on top of the benzodiazepine use. Maybe if I just said I doubled my dose it'd be okay, but I always come up for benzodiazepines and cocaine or methamphetamine too.

 

[purplehaze147]

This habit is killing me financially too. I can handle a little bit of daily cannabis, a couple days a week of some methamphetamine, dextroamphetamine or cocaine, and 2mg of alprazolam a day. I'd be fine with that, but throw in the dope/fentanyl habit and my wallet is fucked; no luxuries (besides the drugs obviously). And I can go without weed or stimulants, even benzodiazepines (since I only take a bar of Xanax a day) if I had to, but not the opioids - they need to be around the clock or else I can't function and I lose everything.

 

[somnilicious]

Don't admit to double dosing. They will do everything to cover their asses. There is already an almost irrational fear within the MRT clinics regarding benzos because of the danger of mixing the two. Pretty much your only option is to keep telling them that you're using because your dose isnt holding you, accept their measly increases, while continuing to cut out the street dope. You will just have to slowly increase the methadone while doing your damnest to stop the Fent. You'll eventually get to a dose that holds you. You might have to feel uncomfortable for a bit in order to stop using the dope my friend.

Unfortunately the clinics are setup to cover their own asses for liability purposes, which takes presidence over everything else. They really just aren't prepared to fully cover these new super Fent analogs and poly substance, multi downer dope mixtures. The dosing guidelines were based on years of heroin use so you'll just have to grit it out till it works. I know it's not what you wanted to hear but it's basically your only option.

I would use benzos minimally as the withdrawal is some next level shit. Also cut out all stimulant and cocaine use because I've found that they tend to cause methadone to clear from the body faster. Alcohol also does this to a great extent. You might try to get a little gabapentin to help you adjust because it is great for potentiating methadone and covering up any lingering withdrawal from the fentanyl/xylazine and barbs. Good luck my friend. Hang tight, grit it out and try and use less and less dope till your free. You'll eventually get there and stabilize. It will be worth it.

I'm familiar with xylazine dope, which with the Fent, and barbs definitely adds additional layers of complexity to the recovery process. You're not going to find an easy dose to cover up the withdrawal if you're also addicted to barbs and xylazine.... Taper, taper, taper ,while increasing your methadone. There isn't an easy pain free exit. I'll double down on my gabapentin suggestion though. You might be surprised with how much it could help. Then again I could be wrong and I'm hesitant to suggest another substance to throw on top of your cocktail but definitely taper and stop the stims they clear methadone from the body and aren't helping your withdrawal. You don't need increased excitability when coming off all those downers... Much love and wishing you the best. Time is your friend. Hang in there.

 

[Dextro .45]

They do 5mg increase for safety reasons…..so they don’t get anyone o.d. off large increases in serum levels too large that CNS / breathing issues happen when one’s asleep

Just tell the doc, you’re still sweaty and agitated, and feel like using cause your current Methadone dosage isn’t holding you properly. He should keep increasing your dose by 5mg every few days or at most weekly

They adjust/increase the dosage until patient is stable and free from craving/withdrawal

 

[Keif' Richards]

A therapeutic use of the methadone fluvoxamine drug interaction - PubMed

In patients unable to maintain an effective methadone blood level throughout the dosing interval, fluvoxamine can help increase the methadone blood level and alleviate opiate withdrawal symptoms.

pubmed.ncbi.nlm.nih.gov

This is an article about Fluvoxamine (Luvox) used in a therapeutic context to potentiate Methadone. Not only does it make a dose "stronger" it makes it "better" in a non-linear way. I started using Fluvoxamine with Methadone for a similar reason. I assumed it was my problem that Methadone wasn't cutting it for me. I now believe that it had a lot to do with my unique biology. Unlike Morphine, Methadone follows some pretty twisty/turny pharmacology involving several different enzymes to varying respective degrees.

Fluvoxamine is a strong inhibitor of a couple of these enzymes. Blood levels can easily be boosted by 30%. I have read such things and I can attest to it myself. If you need to chat hit me up, I'm just really tired right now. I can definitely elaborate when I have a moment, but here is perhaps a little bit of hope.

I'm not advising dishonesty, but it was easy as ordering a pizza for me to convince my GP to let me have some. Just say you want to try an SSRI, but you have certain, mild but obsessive traits as this is the commonly held difference between Fluvoamine and similar SSRI's like Fluoxetine. You need to have a reason.

 

[LucidSDreamr]

You're going to feel.somewhat shitty no matter what...especially since you were dependent on tranqs barbs etc.

Just tell.the doctor you havnt slept in days and feel a medium withdrawal all the time and you can't work or function like that. Keep tying.it all back to needimg.to function in real life.

 

[ChemicallyEnhanced]

I would explain it to him bluntly (but politely) and honest, exactly as you just explained it to us.