methadone, buprenorphine and other opioid pharmacotherapies

[Ashley]

As Crankinit said, there are groups state by state that may be useful to get in contact with. In Victoria, for example, there's 'The Pharmacotherapy, Advocacy, Mediation and Support’ (PAMS) Service.' PH: 1800443 844.

Harm Reduction Victoria's site also has the contact details of the harm reduction/drug users associations of Australia, state by state.

..and in NSW, these is the Methadone Advice & Complaints Service which you can reach on: 1800 642 428.

A.

 

[KountCrackula]

Fun fact: your body can only consume 16mg of Buprenorphine within a 24hr period so it's useless taking more than 2 8mg. My doctor explained this to me.

 

[Acanthus]

Is anyone else utterly disgusted at the character of the general methadone/suboxone user? Every time I go to get my 'dose' there is some barely coherent freak arguing for 15 minutes with the kind pharmacist who nevertheless tries hard to put up with their constant crap. They never have any money, or they forgot their script, or they want more than is prescribed, and just all round idiocy (of course it's always someone else's fault, never their own). As if this wasn't bad enough, they smell so bad that I have to hold my breath. They emit this foul miasma which is a combination of very old tobacco, fetid sweat, and feces. In fact more than a couple of times I've been convinced they've actually shat their pants. I'm genuinely embarrassed to be on the same medication, and associated in any way with these degenerate creatures.

 

[Crankinit]

Fun fact: your body can only consume 16mg of Buprenorphine within a 24hr period so it's useless taking more than 2 8mg. My doctor explained this to me.

There's been a lot of debate about this, with numbers from 4 - 32mg cited as the "ceiling dose," but never with any hard evidence to back up a specific number that I've seen.

My personal experience is that higher doses (over around the 8 - 12mg mark, I've never experimented with specifics below that) still make a difference, but they provide diminished returns compared to other opiates. 24mg didn't feel like 12mg x2, as it would with other opioids, instead it felt more like a 20 - 30% increase in potency. There's also the increase in duration, which is handy (although I find that without at least a small redose in the morning, the day is going to be uncomfortable no matter how much I took the night before, but that could just be psychological).

 

[brighton]

Is anyone else utterly disgusted at the character of the general methadone/suboxone user? Every time I go to get my 'dose' there is some barely coherent freak arguing for 15 minutes with the kind pharmacist who nevertheless tries hard to put up with their constant crap. They never have any money, or they forgot their script, or they want more than is prescribed, and just all round idiocy (of course it's always someone else's fault, never their own). As if this wasn't bad enough, they smell so bad that I have to hold my breath. They emit this foul miasma which is a combination of very old tobacco, fetid sweat, and feces. In fact more than a couple of times I've been convinced they've actually shat their pants. I'm genuinely embarrassed to be on the same medication, and associated in any way with these degenerate creatures.

This is why I pick up my suboxone in the afternoon.

 

[Erikmen]

Fun fact: your body can only consume 16mg of Buprenorphine within a 24hr period so it's useless taking more than 2 8mg. My doctor explained this to me.

I just read yesterday that less is more. You'll feel better with 8 mg than a higher one. Why?
Anyone interested to explain?
I am struggling to come off methadone. Had done that for too many years. Is subs just as bad, y wonder..
very difficult to quit too, but it seems to be more effective.

 

[drinkfekarse]

I just read yesterday that less is more. You'll feel better with 8 mg than a higher one. Why?
Anyone interested to explain?
I am struggling to come off methadone. Had done that for too many years. Is subs just as bad, y wonder..
very difficult to quit too, but it seems to be more effective.

For some, the less is more seems to create a greater full agonist experience. My experience mirrors Crankinit's. Increasing the dose from 6mg to 8mg gave me a noticeable buzz.That was from a relatively small pod/seed habit. That buzz disappeared quickly with bupe tolerance. Transitioning from methadone to sub can be a pita. 8mg or more might keep away the horrors initially, but any sort of high would be unlikely. If you want to achieve a buzz from sub, you would likely have to taper down to 2mg or lower for a few weeks and then try a 4mgish dose. bupe is a strange beast. Some love it ,others hate it. Def worth a try to get off methadone.
Best of luck to you.

 

[Acanthus]

Crankinit is spot on in his explanation. It's similar to Michaelis-Menten kinetics (http://en.wikipedia.org/wiki/Michaelis–Menten_kinetics). Until I read his post I never understood what people meant by 'less is more' with buprenorphine. Now I understand that people are just trying to get the most withdrawal-reducing effect of the drug over an obviously extended period of time. I misinterpreted the 'less is more' saying as "if you take 4mg you'll get a better (possibly more euphoric?) effect than 16mg," which is obviously nonsense.

 

[Christ!]

Crankinit is spot on in his explanation. It's similar to Michaelis-Menten kinetics (http://en.wikipedia.org/wiki/Michaelis–Menten_kinetics). Until I read his post I never understood what people meant by 'less is more' with buprenorphine. Now I understand that people are just trying to get the most withdrawal-reducing effect of the drug over an obviously extended period of time. I misinterpreted the 'less is more' saying as "if you take 4mg you'll get a better (possibly more euphoric?) effect than 16mg," which is obviously nonsense.

With me, being on a lower dose I enjoy the effects much more than when I'm on a higher dose. This is contradictory to everything we learn as opiate addicts Maybe the receptors have a chance to clear out a bit more between doses so there's more of a contrast or something. To me taking 4mg is more euphoric than taking 16mg (once I'm adjusted to that amount)

Also - Doctors tend to prescribe far higher doses than people need to stave off withdrawals, lots of people find they can get away with much less than the original amount they decided on with their doctor. As you mentioned.

Been on lots of different doses over a long time. "better" is very subjective. Taking more would certainly result in more of the drug in your bloodstream. I've tried many times to take extra as a treat but it's never been worth it - not that it made me more sober on higher doses, it just feels all crappy. Skipping a day while on 4mg and then doing 6mg might be slightly more enjoyable - doing the same but going to 12mg I'd find less enjoyable...which seems odd. ymmv.

 

[StudebakerHawk]

^^^
AFIK , as my GP once explained to me , I understand that doctors are not allowed to prescribe Schedule 8 analgesics for treatment of withdrawals [ unless those specifically for treatment of addiction , such as methadone , bupe , etc , ]

Sort of like a " Catch 22 " situation ..... they can , for example , prescribe Oxy , morphine , etc , until one is addicted , if they are prescribing for pain treatment .
But ironically , once you're addicted they can continue prescribing if pain persists ; but not for treatment of the addiction..... [ or so was kindly explained to me , before leaving the surgery without the desired script ... ] .

 

[Crankinit]

Iirc, (I haven't done any reading on the subject in a while) there's some speculation that one of the metabolites, I believe norbuprenorphine, is a full opioid agonist, instead of a duel agonist-antagonist, and that by taking lower doses, you avoid completely blockading the opioid receptors, allowing the norbuprenorphine to become active and providing something closer to a full agonist high. That said, I've never read anything beyond a few anecdotal accounts backing the theory up, and I've never taken a dose low enough to find out. You might find more info on the subject in the Other Drugs section.

 

[brighton]

Had my first takeaway at the weekend. After 2.5 months on suboxone in NZ. According to my case worker this is actually a bit early, they seem to be more flexible with suboxone as opposed to methadone - methadone is daily dosing every day for the first six months.

 

[Crankinit]

methadone is daily dosing every day for the first six months.

And that's definitely gonna help addicts get their life together...

 

[Christ!]

Iirc, (I haven't done any reading on the subject in a while) there's some speculation that one of the metabolites, I believe norbuprenorphine, is a full opioid agonist, instead of a duel agonist-antagonist, and that by taking lower doses, you avoid completely blockading the opioid receptors, allowing the norbuprenorphine to become active and providing something closer to a full agonist high. That said, I've never read anything beyond a few anecdotal accounts backing the theory up, and I've never taken a dose low enough to find out. You might find more info on the subject in the Other Drugs section.

Thanks man will have to try and find some solid information on it.

And that's definitely gonna help addicts get their life together...

By far my biggest source of drugs have been found while waiting in line for my dose Regularly offered benzos or to buy/sell spare doses of methadone and suboxone. People meeting there to go and get some dope after their m-done, off their heads on ice etc. Got to be one of the most non-therapeutic environments I can think of apart from prison.

Last Christmas while grabbing my take aways a group of creepy looking dudes starting hassling me for some. Said 'No, sorry mate don't have enough' - 'aw common bruv, I'll fuck you rotten - 'nuh sorry mate' - (different guy in super creepy voice) 'he wasnt farrrkkkinnn asskkin bruv' (very crazy look in his eyes) - I smiled because I thought they must have been joking but they gave me the dead eyed stare - they followed me as I was walking off and luckily this other big samoan dude who I'd known for years came around the corner to get his dose and told them to back off. Apparently one of them had just come out of prison for rape and burglary. Needless to say I only go to my chemist at busy times of day now...

Don't get me wrong there's awesome people who are on the program...90% of them are harmless and friendly if you strike up a conversation, even the people who have spent time in prison are usually decent. It's not helpful to put all these people together in the one spot every morning though...because not everyone is on the same page in wanting to work on their recovery. I've seen people who've been estranged for years meet again at the chemist and fall right back into old patterns when they get back in with their drug using buddies.

 

[Crankinit]

By far my biggest source of drugs have been found while waiting in line for my dose Regularly offered benzos or to buy/sell spare doses of methadone and suboxone. People meeting there to go and get some dope after their m-done, off their heads on ice etc. Got to be one of the most non-therapeutic environments I can think of apart from prison.

Last Christmas while grabbing my take aways a group of creepy looking dudes starting hassling me for some. Said 'No, sorry mate don't have enough' - 'aw common bruv, I'll fuck you rotten - 'nuh sorry mate' - (different guy in super creepy voice) 'he wasnt farrrkkkinnn asskkin bruv' (very crazy look in his eyes) - I smiled because I thought they must have been joking but they gave me the dead eyed stare - they followed me as I was walking off and luckily this other big samoan dude who I'd known for years came around the corner to get his dose and told them to back off. Apparently one of them had just come out of prison for rape and burglary. Needless to say I only go to my chemist at busy times of day now...

Don't get me wrong there's awesome people who are on the program...90% of them are harmless and friendly if you strike up a conversation, even the people who have spent time in prison are usually decent. It's not helpful to put all these people together in the one spot every morning though...because not everyone is on the same page in wanting to work on their recovery. I've seen people who've been estranged for years meet again at the chemist and fall right back into old patterns when they get back in with their drug using buddies.

Jesus yeah, that sounds even worse than I was thinking. Really makes me appreciate being in a less central suburb. In over 3 years I've only once bumped into another maintenance patient, a woman who looked a little worn down but seemed polite. Apparently there's a third, another man on suboxone, but I've never bumped into him.

 

[brighton]

I just found out that my family has known about the suboxone for months. My sister opened a letter addressed to me which happened to be about the program and instead of bringing it to me ( the sensible, obvious option) she took it to my parents and now all my brothers and sisters know as well as extended family and of course every family members best friend too. I DONT KNOW WHAT TO DOOOOOOOOOOOOOOO.

Anyone been in this situation??????????



3 VBs and 2 zopiclone = silly floppy relaxed brighton

 

[footscrazy]

^ That's pretty shitty, especially that it got spread around so much while noone spoke to you. In terms of what should you do - what's your main concern? Are your family judgemental people or something? I think it really depends on how they're taking this, and what their opinion of the situation is, as to how you should deal with this.

If they've known about it for months (and it seems like you weren't aware of that), maybe they aren't judging you for it, but just didn't know how to bring it up with you. Maybe they're waiting for you to be ready to tell them.

 

[Crankinit]

My family have known for years - I mean they must, given I'm lazy about disposing of the suboxone packaging and so the plastic wraps are often on my desk/in my bin (not to mention all the "walks to the shops" followed by conversations where I can barely talk cause my mouth is full of disgusting, suboxone-flavored saliva) - but never once brought it up. They're kinda repressed like that

 

[spacejunk]

Great post foots. I hope you are doing alright

 

[Erikmen]

Had my first takeaway at the weekend. After 2.5 months on suboxone in NZ. According to my case worker this is actually a bit early, they seem to be more flexible with suboxone as opposed to methadone - methadone is daily dosing every day for the first six months.

Seriously? After my 3rd year stabilized on methadone I would only go to the doctor once every 3 months.
Besides I had to travel a lot and take all my prescribed meds for almost a month. Medical reports and all.

As often say, while on Methadone (7 years ) I had the most normal and "sober" life.
It was an effective medication when I learned how to deal with the side effects.
Other than that, no cravings, no drinking and it was all fine by me. Even refused other opiates once.
I knew I would lose it plus the withdraws. I managed to rationalize my way out of that situation.

now that I'm off methadone everything is so much more consuming and difficult.