Opioids Is it possible that lack of sleep reduces metabolism of methadone (and possibly other opioids)?

[Bomb319]

And vice-versa - oversleeping increases clearance of methadone or possibly most substances? I've been on methadone maintenance since 2013 and haven't used any illegal drugs since then. The problem is that it seems to have a WILDLY different half-life in my body for which I haven't been able to consistently identify a reason. Sometimes it lasts such a short time that I can start yawning 8 hours after a dose and have disrupted, uncomfortable and fragmented sleep with vivid dreams, significant increase in sense of smell, and...well, you know...opioid withdrawal symptoms - despite taking my dose only just that morning. Other times, I can miss 2 whole days and there are few withdrawal symptoms. The ones that ARE there are typically the early ones. If I were to do that in a "low efficacy" period, I can be absolutely miserable with symptoms FAR beyond anxiety and the psychological (extreme chills and sweating, big change in sense of smell, enormous pupils, nausea and vomiting and in particular, sneezing fits. I have yet to think of a mechanism that could explain how these clear WD symptoms could only be in my head). If I feel lousy, I often won't/can't eat for a significant amount of time before I pick up my next doses. That's why I figured that a prolonged empty stomach could be the reason for this, but even THAT seems to be variable. I also take Nexium (esomeprazole) daily since the most obvious culprit seemed to be variable stomach acidity.

Yet the past several times I've been through this, I seem to be more or less OK if I've been awake all night for one or two days if I've missed doses. So far, that correlates with longer methadone effect more than any of the other potential factors I've identified. Is this just a coincidence as it was with everything else I've tried to think of, or is it actually feasible that drug clearance increases during sleep? Conversely, OVERsleeping before my dose seems to make it worse, which certainly seems to add additional evidence to this possibility. As the purpose of sleep (at least in part) is to rest, repair, eliminate toxins, etc., it doesn't seem too far-fetched.

 

[GetMeOutOfThisCRAP]

Lack of sleep?

I don't think so. I definitely have not noticed any difference in the strength of effects even on 0 hours of sleep.

 

[Bomb319]

No, never the STRENGTH of the effect, just its elimination half-life. It's the variable amount of time until withdrawal that I've noticed, not the effect of the drug itself.

 

[Branggen]

I used to have the same problem when I was on methadose the stuff might just be badly mixed or something

 

[Branggen]

Can you get the morphine caps in Kelowna?

 

[GetMeOutOfThisCRAP]

No, never the STRENGTH of the effect, just its elimination half-life. It's the variable amount of time until withdrawal that I've noticed, not the effect of the drug itself.

Ah, I see what you're saying.

I'm actually interested in people's answers. Sometimes (with the same dose and exact same brand, etc. down to a wire) the effects last 2 hours and other days the effects last 30 minutes lol. There's probably something to what you're asking. Of course the digestive system is so complicated. Fatty food is known to potentiate opioids. I'm wondering if sleep has anything to do with the metabolism for opiates too.

 

[Bomb319]

Can you get the morphine caps in Kelowna?

Oh yeah, I'm sure I could. I've tried all variations of methadone (red syrup, Matadol-D, and now on old formulation), and no real difference. I feel like that would be a step backwards though, even though I know logically they're both full mu agonists. I've been lowering my dose by 5 mg each appointment (done over the phone since March) every 4 weeks.

 

[somnilicious]

And vice-versa - oversleeping increases clearance of methadone or possibly most substances? I've been on methadone maintenance since 2013 and haven't used any illegal drugs since then. The problem is that it seems to have a WILDLY different half-life in my body for which I haven't been able to consistently identify a reason. Sometimes it lasts such a short time that I can start yawning 8 hours after a dose and have disrupted, uncomfortable and fragmented sleep with vivid dreams, significant increase in sense of smell, and...well, you know...opioid withdrawal symptoms - despite taking my dose only just that morning. Other times, I can miss 2 whole days and there are few withdrawal symptoms. The ones that ARE there are typically the early ones. If I were to do that in a "low efficacy" period, I can be absolutely miserable with symptoms FAR beyond anxiety and the psychological (extreme chills and sweating, big change in sense of smell, enormous pupils, nausea and vomiting and in particular, sneezing fits. I have yet to think of a mechanism that could explain how these clear WD symptoms could only be in my head). If I feel lousy, I often won't/can't eat for a significant amount of time before I pick up my next doses. That's why I figured that a prolonged empty stomach could be the reason for this, but even THAT seems to be variable. I also take Nexium (esomeprazole) daily since the most obvious culprit seemed to be variable stomach acidity.

Yet the past several times I've been through this, I seem to be more or less OK if I've been awake all night for one or two days if I've missed doses. So far, that correlates with longer methadone effect more than any of the other potential factors I've identified. Is this just a coincidence as it was with everything else I've tried to think of, or is it actually feasible that drug clearance increases during sleep? Conversely, OVERsleeping before my dose seems to make it worse, which certainly seems to add additional evidence to this possibility. As the purpose of sleep (at least in part) is to rest, repair, eliminate toxins, etc., it doesn't seem too far-fetched.

I don't have scientific articles to back it up but I would say Yes. I have been on and off methadone for 20yrs and I have thought this exact same thing myself. I would say food and stomach acidity play a big part in absorption but sleep definitely seems to increase methadone clearance.

May I ask what dose you're on because I was debating going up but If my memory is correct than my body will adjust to my new dose and I'll have the same problem again? I just recently got back on methadone after being off the juice with a number of clean years.

 

[Branggen]

Oh yeah, I'm sure I could. I've tried all variations of methadone (red syrup, Matadol-D, and now on old formulation), and no real difference. I feel like that would be a step backwards though, even though I know logically they're both full mu agonists. I've been lowering my dose by 5 mg each appointment (done over the phone since March) every 4 weeks.

Its hardly a step backwards oral morphine is one of the weakest opiates, its how I got off. They consider it the third step approach after suboxone and methadone but I think it should be 2nd if not first. The main benefit of the oral morphine is that it isnt metabolism and half life that cause the pills to last 24 hours its the actual physical mechanisms built in to the pill, so fast metabolism wont effect it. Also with methadone taper i always found that because of half life for a while you would feel okay then all of a sudden start feeling really bad at a certain dose, with the morphines you are gonna notice every reduction pretty equally

Another option which I always did was split the methadone dose, they should be willing to give you carries for half the day so you go in take half dose and leave with the other half