Opioids Methadone 80 mg equivalent to?
- Thread starter Erikmen
- Start date
sekio
Bluelight Crew
- Joined
- Sep 14, 2009
- Messages
- 21,994
If you're on 800mg of methadone a day, it's pointless to even try other opioid drugs. Your tolerance is incredibly high. A narcdotic dose converter suggested that the equianalgesic dose of oral oxycodone would be over 1500mg in that case, or more than a gram of of 100% pure heroin.
Converting large methadone doses to other opioids is hard to do though, because methadone has multiple modes of action other than just opioid receptor activation. So take these numbers with a grain of salt.
Converting large methadone doses to other opioids is hard to do though, because methadone has multiple modes of action other than just opioid receptor activation. So take these numbers with a grain of salt.
Seriously 800mgs? Wow, Yah you're not gonna feel opiates at all, that dose is huge. I got up to 180mgs & thought I was crazy, which I was.
Hammilton
Bluelighter
- Joined
- Sep 2, 2008
- Messages
- 3,435
I don't think the real problem with converting methadone doses to other opioids is due to the multiple modes of action, as you're basically converting for opioid receptor activation, not total analgesic activity, ie, you're finding the dose that will provide a level of activation equal to the other drug to account for tolerance and fully prevent withdrawal.
Instead the real problem lies with the way methadone is absorbed, metabolized and perhaps even stored (in the liver, it's been suggested). Here you tend to have greater tolerance than you'd expect for dose size (well, not here with this case, as no one would expect anything but an enormous equivalent dose). Actually, the real problem is not coverting from methadone but TO methadone. There the strength of methadone is usually underrated, and is easy to overdose when going from something to methadone.
Honestly, it seems almost (perhaps not so almost, actually) criminal for a clinic to put someone on a dose that high. I've heard of clinics pushing higher doses on people, but not to that extreme. That seems like an attempt to retain patients, more than anything. "How can we prevent people from quitting methadone and switching to suboxone or going back to heroin or pills?" "Oh, how about we give them doses so high that even if they try to switch they'll never manage to find a dose that'll get them well, much less get them high!" "Yeah, good idea, these guys are addicts, they won't complain, we'll even charge them more!"
how <i>did</i> you end up at a dose that high? That's ridiculous. Sekio is right, you'd have to spend maybe, 1500 bucks to buy enough oxy to get high, once. You'd be spending maybe 3 grand a day, that'd be over a million dollars a year. You could maybe get a volume discount, but you'd be clearing out multiple dealers supplies per dose, shit, you'd be clearing out pharmacies entire inventories. I just can't wrap my head around an 800mg dose of methadone. I have heard of doses that large before, but that was in a book that discussed the early days of mmt in Florida where methadone was given in an ambulatory basis, like suboxone is today, which basically allowed patients to take as much as they wanted to.
Instead the real problem lies with the way methadone is absorbed, metabolized and perhaps even stored (in the liver, it's been suggested). Here you tend to have greater tolerance than you'd expect for dose size (well, not here with this case, as no one would expect anything but an enormous equivalent dose). Actually, the real problem is not coverting from methadone but TO methadone. There the strength of methadone is usually underrated, and is easy to overdose when going from something to methadone.
Honestly, it seems almost (perhaps not so almost, actually) criminal for a clinic to put someone on a dose that high. I've heard of clinics pushing higher doses on people, but not to that extreme. That seems like an attempt to retain patients, more than anything. "How can we prevent people from quitting methadone and switching to suboxone or going back to heroin or pills?" "Oh, how about we give them doses so high that even if they try to switch they'll never manage to find a dose that'll get them well, much less get them high!" "Yeah, good idea, these guys are addicts, they won't complain, we'll even charge them more!"
how <i>did</i> you end up at a dose that high? That's ridiculous. Sekio is right, you'd have to spend maybe, 1500 bucks to buy enough oxy to get high, once. You'd be spending maybe 3 grand a day, that'd be over a million dollars a year. You could maybe get a volume discount, but you'd be clearing out multiple dealers supplies per dose, shit, you'd be clearing out pharmacies entire inventories. I just can't wrap my head around an 800mg dose of methadone. I have heard of doses that large before, but that was in a book that discussed the early days of mmt in Florida where methadone was given in an ambulatory basis, like suboxone is today, which basically allowed patients to take as much as they wanted to.
Lorne???
Bluelight Crew
- Joined
- May 3, 2014
- Messages
- 2,558
Remember that methadone conversion is not linear; the higher the dose, the more potent it becomes. I have never heard of a dose that high. Cancer patients can get up to hundreds of Meg's a day, but 500mg is the most I have ever heard of. Honestly I struggle to believe it.
But the opioid converter Sekio used was wrong. At that high a dose, it would be 10-20x as potent as morphine(30x more potent according to some sources)
So it would take AT LEAST 8'000mg chronic oral morphine. Even if we ignore the dose-related increase in potency, chronic methadone is automatically 3-4x as potent as oral oxycodone, so that is at 2400-3200mg oral oxycodone. But the half-life of oxy is so much shorter, you'd need twice as much as that to maintain. So, going by the above dosing strategy(which is conservative, since ever conversion chart available day's such obscene doses of methadone are at least 10x, and possibly even 20-30x as potent as oral morphine) the following would be a list of *ROUGHLY* equivelant doses
(And please note, the following doses ignore half-life, meaning you would actually need multiple doses to maintain. But then again, opioids have a dose related duration of action(with very large doses having a much longer duration) so at these ungodly doses, who knows how they would last!!!)
Anyway, a rough list is as follows:
Oral oxycodone: 2400-3200, or up to 8000. According to some sources.
IV oxycodone: 1200-2400mg
(Chronic) oral morphine: at least 3600mg, but 5600-6400mg using the "standard" conversions, though based on the methadone "Fudin Factor"*, it would take at least 8000mg, and possibly up to 20'000mg(yes, 20'000 fucking mg!!!)
IV morphine: Again, at least 1200mg, but up to 2400mg using the "standard" conversion, and up to 6'000mg with the Fudin factor(though IV morphine is roughly equipotent to IV oxycodone, so I can't imagine it would take that much.
IV oxymorphone: 120-240, or up to 360, using the "standard" conversion
IV hydromorphone: 180-520.
Oral Tramadol: ...
Just kidding!!!
Hydrocodone(oral): 3600-6400, using the "standard" conversion, up to 16'000 via methadone fudin factor...
(No, I am not kidding. Granted, I'm not sure any dose of hydrocodone could approach fucking 800mg of methadone due to it's low binding affinity, however it's binding affinity is only slightly lower than oxycodone's, and in any case, opioids don't have a ceiling effect(bupe/codiene/tram excluded) so technically, it should be possible)
And finally:
IV Diamorphine: Somewhere between 720-1600mg, though using methadone fudin factor, it could take a few thousand...
And they're ya have it!!! Good luck getting high!$$$
But the opioid converter Sekio used was wrong. At that high a dose, it would be 10-20x as potent as morphine(30x more potent according to some sources)
So it would take AT LEAST 8'000mg chronic oral morphine. Even if we ignore the dose-related increase in potency, chronic methadone is automatically 3-4x as potent as oral oxycodone, so that is at 2400-3200mg oral oxycodone. But the half-life of oxy is so much shorter, you'd need twice as much as that to maintain. So, going by the above dosing strategy(which is conservative, since ever conversion chart available day's such obscene doses of methadone are at least 10x, and possibly even 20-30x as potent as oral morphine) the following would be a list of *ROUGHLY* equivelant doses
(And please note, the following doses ignore half-life, meaning you would actually need multiple doses to maintain. But then again, opioids have a dose related duration of action(with very large doses having a much longer duration) so at these ungodly doses, who knows how they would last!!!)
Anyway, a rough list is as follows:
Oral oxycodone: 2400-3200, or up to 8000. According to some sources.
IV oxycodone: 1200-2400mg
(Chronic) oral morphine: at least 3600mg, but 5600-6400mg using the "standard" conversions, though based on the methadone "Fudin Factor"*, it would take at least 8000mg, and possibly up to 20'000mg(yes, 20'000 fucking mg!!!)
IV morphine: Again, at least 1200mg, but up to 2400mg using the "standard" conversion, and up to 6'000mg with the Fudin factor(though IV morphine is roughly equipotent to IV oxycodone, so I can't imagine it would take that much.
IV oxymorphone: 120-240, or up to 360, using the "standard" conversion
IV hydromorphone: 180-520.
Oral Tramadol: ...
Just kidding!!!
Hydrocodone(oral): 3600-6400, using the "standard" conversion, up to 16'000 via methadone fudin factor...
(No, I am not kidding. Granted, I'm not sure any dose of hydrocodone could approach fucking 800mg of methadone due to it's low binding affinity, however it's binding affinity is only slightly lower than oxycodone's, and in any case, opioids don't have a ceiling effect(bupe/codiene/tram excluded) so technically, it should be possible)
And finally:
IV Diamorphine: Somewhere between 720-1600mg, though using methadone fudin factor, it could take a few thousand...
And they're ya have it!!! Good luck getting high!$$$
Lorne???
Bluelight Crew
- Joined
- May 3, 2014
- Messages
- 2,558
Oh, I forgot to mention: the *. Methadone fudin factor is a conversion system that deals specifically with methadone. But there are two problems:
First, the fudin factor(and related conversion methods) are used when converting TO methadone, not from it, and thus, they would almost certainly over-estimate the dose when converting FROM methadone.
and
Secondly, I don't like the fudin method to begin with, I mean methadone is far more potent than people realize, but the figures using that method are ridiculous. I mean they claim that, when switching from 1'000mg of chronic oral morphine, methadone is 20x more potent(some sources say 15.) In that case, someone on 1'000 mg morphine would be started on 50mg methadone(or at most, 75) which is fucking stupid.
To really demonstrate how ridiculous this "conversion method" is, they're is a case report, about a guy, who was prescribed 3 oc 80's a day, for a total of 240mg oral oxycodone. (BTW, 240mg oral oxycodone is equal to 60-80 chronic oral methadone) but anyway, they use the amazing "fudin" factor, which claims 240mg of oxy is equal to 40mg of methadone. Then, to really fuck with with the guy, they reduce the starting dose by 25%, to account for "cross-tolerance", even though the methadone Fudin factor already takes cross-tolerance into account.
So they switch this poor guy from 3 oc 80's per day, to 3 methadone 10's per day, with oxy for breakthrough(it didn't say what dose)
So, my point, is that I think we can all agree 240mg oxy is far better than 30(or even the original 40mg) of methadone. So I would ignore the crazy "Fudin" figures above and go with the "standard" conversions. Either way, the doses are insanely high...
First, the fudin factor(and related conversion methods) are used when converting TO methadone, not from it, and thus, they would almost certainly over-estimate the dose when converting FROM methadone.
and
Secondly, I don't like the fudin method to begin with, I mean methadone is far more potent than people realize, but the figures using that method are ridiculous. I mean they claim that, when switching from 1'000mg of chronic oral morphine, methadone is 20x more potent(some sources say 15.) In that case, someone on 1'000 mg morphine would be started on 50mg methadone(or at most, 75) which is fucking stupid.
To really demonstrate how ridiculous this "conversion method" is, they're is a case report, about a guy, who was prescribed 3 oc 80's a day, for a total of 240mg oral oxycodone. (BTW, 240mg oral oxycodone is equal to 60-80 chronic oral methadone) but anyway, they use the amazing "fudin" factor, which claims 240mg of oxy is equal to 40mg of methadone. Then, to really fuck with with the guy, they reduce the starting dose by 25%, to account for "cross-tolerance", even though the methadone Fudin factor already takes cross-tolerance into account.
So they switch this poor guy from 3 oc 80's per day, to 3 methadone 10's per day, with oxy for breakthrough(it didn't say what dose)
So, my point, is that I think we can all agree 240mg oxy is far better than 30(or even the original 40mg) of methadone. So I would ignore the crazy "Fudin" figures above and go with the "standard" conversions. Either way, the doses are insanely high...
I've heard of it that high. My father bought a book "recovery options" when this first happened with me.(Good book.) A professor in a southern state was on like 900 mgs. And it's hard to believe but possible. You can get ur tolerance really high. And with methadone say ur on it 30 years, you could get it that high. Getting high off other opiates pretty much impossible.
Mr.Scagnattie
Bluelighter
- Joined
- Feb 3, 2004
- Messages
- 12,850
That is the most ridiculous dose of methadone I've ever heard. Did you get that high taking it on your own? Or from an actual clinic? Because any clinic who would let someone get even close to that high, should be shut down immediately.
Rybee
Bluelighter
- Joined
- May 29, 2013
- Messages
- 1,305
Took the words out of my mouth. I know long term users have a high tolerance. There's high, and then there's just ridiculous.
Since you've not replied since your first post, I can only think that you've written 800mg as a typo or have mistaken your dose...
I just can't fathom how that's possible.
Mr.Scagnattie
Bluelighter
- Joined
- Feb 3, 2004
- Messages
- 12,850
^^
Yeah it really just makes no sense.
Yeah it really just makes no sense.
Rybee
Bluelighter
- Joined
- May 29, 2013
- Messages
- 1,305
Having flicked through some of your past posts you've mentioned 800mg's once or twice. Being a user of strong opiates for 20 years and methadone for 7 years...
If you're on 800mg by someone else's directions, there's some serious mismanagement and negligence involved in your care. Serious mismanagement.
If you're on it by your own choice... I absolutely wont judge, but I am speechless.
edit: quite a good tool for anyone else curious as to dosage calculations:
http://opioidcalculator.practicalpainmanagement.com/disclaimer.php
2nd edit: Some great posts from you on BL Lorne??? keep it up :D
If you're on 800mg by someone else's directions, there's some serious mismanagement and negligence involved in your care. Serious mismanagement.
If you're on it by your own choice... I absolutely wont judge, but I am speechless.
edit: quite a good tool for anyone else curious as to dosage calculations:
http://opioidcalculator.practicalpainmanagement.com/disclaimer.php
2nd edit: Some great posts from you on BL Lorne??? keep it up :D
Last edited:
brutus
Bluelight Crew
- Joined
- Nov 30, 2006
- Messages
- 8,631
Your doctor should have his/her license revoked for putting someone on such a high dose of methadone. I've heard of people taking 800mg of oxycodone a day, but 800mg of methadone just blows my mind. Please don't combine it with any other CNS depressants because you would likely die. Pray that you don't get into a serious accident or require surgery because there's no way a doctor will pump you full of the amount of opiates needed.
Mr.Scagnattie
Bluelighter
- Joined
- Feb 3, 2004
- Messages
- 12,850
Ha. Unbelievable.
sekio
Bluelight Crew
- Joined
- Sep 14, 2009
- Messages
- 21,994
Typo of the year award
If you're on 80mg methadone, that's a lot more manageable, but still a lot. If you want to do other opioids, you should wait a few days to wash some of the methadone out, and then start with maybe 100mg oxycodone and move upwards. Better to take too little than too much.
If you're on 80mg methadone, that's a lot more manageable, but still a lot. If you want to do other opioids, you should wait a few days to wash some of the methadone out, and then start with maybe 100mg oxycodone and move upwards. Better to take too little than too much.
Mr.Scagnattie
Bluelighter
- Joined
- Feb 3, 2004
- Messages
- 12,850
Yeah 80mg's a typical maintenance dose. It's enough to block most of the feeling from any other opiate, so in order to feel anything, you'll have to wait a couple days with no methadone.
OntarioGuy
Bluelighter
- Joined
- Nov 26, 2008
- Messages
- 1,887
Id rate methadone at 5:1 potency with oral oxycodone so ur 80 mgs of methadone would be 10+ of 80s or so. My clinic counts it at a 10-15:1 ratio with oral morphine and about 5:1 with IV morphine
to the guy who said IV Oxy and IV morphine are on par I have to disagree. I'd say IV morphine is twice as strong as oral or IV Oxy ime.... When I was scripted 6x 200 mgs of morphine a day I used iv that's 1.2 grams of morphine.in withdrawal IV Oxy barely helped unless I used a 3 cc rig to bang 5 oc 80s or something
to the guy who said IV Oxy and IV morphine are on par I have to disagree. I'd say IV morphine is twice as strong as oral or IV Oxy ime.... When I was scripted 6x 200 mgs of morphine a day I used iv that's 1.2 grams of morphine.in withdrawal IV Oxy barely helped unless I used a 3 cc rig to bang 5 oc 80s or something