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  • AADD Moderators: swilow | Vagabond696

Methadone Dangers?

Yeah ive been on MMT for couple years now, my first dose was 30mg and then it gradually went right up to 150mg, and then tapered down at -5mg each month back to 90mg. Which im now steady on! onetime I drank a couple vodkas and later on felt like I was gonna die!! felt like my stomach was churning inside and out and started getting heavy cold sweats and shiver, endedup curling into a little ball, just the smell of my flatmates cigarettes would make me vomit and I couldnt hold down any food or liquid/water, all i could do was lie down and wait till i was ok. Another time I just had 2 social beers at a bbq and it started making me withdrawal, so yeah alcohol just doesnt work with methadone!.
As for benzos I cant really comment on the dangers of benzos cos I really like the odd pill, especially temazepam of all things lol!. Just stay safe and remember to drink alot of liquids/water and brush em teeth+keep an eye on sugar foods etc - also drink milk now and then AFTER your dose, if you like oxycontin then prettymuch forget it, youll need x2-3 of your usual dose just to feel something! I only get 1 takeaway a week which I always double drop, but have found it doesnt really hold me for the next day, just seems to make me feel really sick and the need for more, so now im accustomed to being sick every sunday lol, anyway best of luck!
 
Ayjay: "Differentiating between physical and psychological withdrawal is a bit outdated.": If you are talking about medically prescibed usage for purposes of analgesia then yes, that is true. This isn't a Chronic Pain site, forum, etc. We are discussing Opioid Substitution Therapy (MMT,MAT, etc.) and in this case it is absolutely vital to differentiate. When a person is in treatment for addiction their initial treatment AND their post-medication phase, cessation, etc. ONLY deals with the physical aspect. Psychological symptoms are usally addressed all through treatment by a separate modality.

Hajime: The "evacuation = physical withdrawal" axiom applies to any dosage of methadone IF a patient/user has been maintained at a constant dosing regimen for between 6 to 8 weeks. At that point the patient reaches a stage known as "Therapeutic Dosiing," a plateau of sorts systemically speaking. 10 mgs taken each day at relatively the same time, give or take a median of 6 hours, forms that "resevoir," and so cessation won't immediately lead to detox. People are dosed every 24 hours not because they need to be but because it maintains that resevoir.

"Power of the mind," you are right of course. When I was lying on a jail cell floor in a puddle of urine, 20 hours after dosing, I felt infinitely worse than when I was in a nation that not only had no methadone at all but no street scene I had no choice but to man up and it was then that I subjectively confirmed the reams of clinical data. Knowing its so near physically? Environment, frame of mind, even the weather plays a part.
 
MrBlonde: "Withdrawl does not begin when blood levels reach zero but rather when the relevant receptors lose a significant amount of their load.": Yes, except with methadone. This is why morphine and heroin withdrawal symptoms begin 6 to 8 hours after one's last dosage and not at 72 hours when the substance is entirely evacuated. With methadone you are talking about the opioid with the highest receptor affinity (higher values than even bupe). Try examing the protocol for clinical antagonism as in the case of physical overdose. With methadone you still have a load. To the point where symptoms begin
 
^ That post kind of seems half finished but I still disagree. Methadone does have a high affinity for the receptors but that does not change the fact that it's blood level does not have to reach zero before withdrawal hits. That doesn't even make sense; that zero drug must be remaining before the symptoms start. It's high agonism may mean that blood concentrations can be lower before withdrawal starts, but for them to be zero is not the case.
 
I completely agree with you Mr Blonde I have been on methadone maintenance for 9 years since 21. I have since stabilised been on between 60 - 85mgs I used to abuse my take away doses and can assure you that withdrawals will start anywhere from 24 - 36hrs from last dose for me anyway. Rachamim you are certinaly very knowledgable on this topic & technicaly some of what you say makes sense on paper anyway but in the real world. Good luck on getting stabalised Stifeno once you reach that stage your life i'm sure will improve so that your next dose is not the only thing on your mind from sun up to sun down it's just a few mins out of your morning then on with the rest of your day.
 
Mr.Blonde: Yep, a good portion of my content got wiped out. I will attempt to finish it later time permitting, as well as throw up some references, again time permitting.

Tasip: I am nearly 45 and firsr got on methadone at age 19. I have a lot of "real word experience" but in this case, the clinical data is correct. You mentioned. thinking about methadone constantly, that is a psychological issue, not a physical issue. As for my own subjective backstory. Since becoming addicted at age 17 (medically), there hasn't been more than two hours a day when I haven't thought about opiates/opioids. My ability to detox wasn't based upon my mind somehow changing vis a vis obsessive/compulsive thinking about the substance. I am not opiate/opioid fre now nor do I expect I ever will be. My detox was compulsory based upon my nation of residence not having methadone. When I am here I maintain on morphine, but abroad, when possible, I opt for oral methadone.

The key is to educate yourself to the greatest possible extent while ignoring all subjectivity except your personal experiences of course. People get so worked up about detoxing from methadone but it is that anxiety based primarily upon mis-infor$ation that causes one the most problems.
 
MrBlonde: OK, I think you are hung up on what you perceive to be a dichotomy between receptor load , systemic presence and urinary evacuation. In other words, IF, as I say, methadone (physical) withdrawal begins only after methadone is no longer detectable in the urine BUT while there is still a receptor load, how can there be a receptor load BUT no detectable presence systemically? Right? If so...I think you are focusing on urine evacuation as the only way in which a depleted substance is evacuated from the body. Of course it isn't.

Aside from the substance not being metabolised just so, you need to examine how urine is assayed vis a vis methadone. The fact is, there are two ways in which urine is examined, immuno assay and chromotography. Usually, the first is what everyone is subjected to with the latter reserved for confirmatory testing to rule out false positives and so on. With either method, methadone is usually undetectable by the 72 hour mark. Physical withdrawal of course usually doesn't even begin until AFTER that point for somebody who has reached the therapeutic dosing threshhold. Ergo, you have physical withdrawal without a detectable systemic presence.

I only had time to find one reference that doesn't require an account (Wiley, etc.) So that everybody reading this can, if they choose, examine the dynamic. The reference will show you that methadone isn't detectable by the third day and of course we aren't talking about a chain metabolite detection as is the case with most opiates/opioids (Heroin = MAM, etc.):

http://www.mayoclinicproceedings.com/content/83/1/66.full

If the url isn't viable, use a search engine to access the following: Urine Drug Screening: Practical Guide for Clinicians," reference Table #2.


I don't see that other references are at all necessary since I am sure most reading this can very easily verify the onset time for physical withdrawal from methadone as well as the duration of withdrawal. Simply compare systemic detection with withdrawal onset and duration and voila, the dynamic is at least easily verifiable.
 
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^ I edited the link for you so that it works. I don't see where in the link it states that methadone isn't detectable by day three, and given it's half-life and the variability that can be found in it's metabolism, I find it hard to believe that even in someone taking a once off dose, the drug would not be detectable by the third day. Say we assume a 24 hour half-life, by day three an eighth of the ingested dose is still remaining in the system.

Addressing the first paragraph; no I am not hung up on urine analysis as evidence of systemic presence. Addressing the rest of your post, it is well established that methadone has a long half-life and is much more hydrophobic then an opioid such as heroin (for evidence of this, use chemicalize.org to see the logD calculations). Methadone, at the physiological pH of around 7.4, has a logD of approximately 3.21. In comparison, heroin has a logD of -0.31. Methadone, with this high distribution coefficient, will obviously enter into lipid compartments of the body more readily then heroin and stay in these fat stores and slowly come out of there as part of equilibrium with the rest of the drug stored in the other body compartments (mainly blood and plasma protein binding).

This becomes even more important when you are talking about someone who has been stabilized on methadone and then stops; the WD is slow because of how long it takes the drug to leave these compartments to be metabolized and then excreted.

I just think it is obviously wrong that methadone WD begins when blood concentrations reach zero, and that the length of WD is to do with just how high an affinity the drug has for binding to opioid receptors.

Anyway, it is good to see you posting here again Rachamim... I like having these type of discussions with you. :)
 
Mr Blonde said:
^ I edited the link for you so that it works. I don't see where in the link it states that methadone isn't detectable by day three, and given it's half-life and the variability that can be found in it's metabolism, I find it hard to believe that even in someone taking a once off dose, the drug would not be detectable by the third day. Say we assume a 24 hour half-life, by day three an eighth of the ingested dose is still remaining in the system.

Addressing the first paragraph; no I am not hung up on urine analysis as evidence of systemic presence. Addressing the rest of your post, it is well established that methadone has a long half-life and is much more hydrophobic then an opioid such as heroin (for evidence of this, use chemicalize.org to see the logD calculations). Methadone, at the physiological pH of around 7.4, has a logD of approximately 3.21. In comparison, heroin has a logD of -0.31. Methadone, with this high distribution coefficient, will obviously enter into lipid compartments of the body more readily then heroin and stay in these fat stores and slowly come out of there as part of equilibrium with the rest of the drug stored in the other body compartments (mainly blood and plasma protein binding).

This becomes even more important when you are talking about someone who has been stabilized on methadone and then stops; the WD is slow because of how long it takes the drug to leave these compartments to be metabolized and then excreted.

I just think it is obviously wrong that methadone WD begins when blood concentrations reach zero, and that the length of WD is to do with just how high an affinity the drug has for binding to opioid receptors.

Anyway, it is good to see you posting here again Rachamim... I like having these type of discussions with you. :)
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IQ wise ive always been the most intelligent member of my family (both sides) yet you totally lost me with what you just posted hahah. Then again when it comes to drugs im pretty dumb =/, but hey! Nobody is born knowing everything about everything :p

Edit: Oh and not to shoot down your post, by all means continue...but err whats it got to do with the original question :p?
 
^ I for one and finding the discussion between Mr Blonde and rachamim extremely interesting, and I would have thought you'd find it relevant to your own interests also Stiffeno, if not specifically on the dangers of methadone. The withdrawal from methadone is nonetheless an important aspect worth understanding whilst using it, I would think.
 
Stiffeno said:
IQ wise ive always been the most intelligent member of my family (both sides) yet you totally lost me with what you just posted hahah. Then again when it comes to drugs im pretty dumb =/, but hey! Nobody is born knowing everything about everything :p

Edit: Oh and not to shoot down your post, by all means continue...but err whats it got to do with the original question :p?
Click to expand...

Sorry we have gotten a little off topic but WD is definitely one of the dangers of drug use, and whenever I get the chance to discuss pharmacology I like to jump at it. :)
 
MrBlonde: Thanks for editing the link of course, but I thought I had noted the figure could be found in Table 2, if not, there it is. The proper way to state it though is that it is not detectable by day four (not three), so that 72 hours is the cutoff mark for detection.

Re your second paragraph via plasma, etc, I addressed that when I mentioned "internal resevoir" which is how it is usually expressed. This is in fact why a person regularly dosing at a very low dose will not enter withdrawal any faster than a person on a very high dose. Likewise, it is why the substance is such a great maintenance agent, plasma expression represents a pseudo-time release. BUT this is where you are missing the point, when the internal resevoir begins depletion, it is expressed in a very minute concentration that isn't detectable in urine, nor in blood, which is my point. It isn't that the blood and urine levels reaching undetectable (i.e."Zero") kicks in physical withdrawal- just that WHEN withdrawal begins levels are undetectable, as well as receptor load not being a relevant factor. Plasma though is the key.

On posting, yeah, I limit my posting on opiates/opioids because it becomes maddening explaining the same things over and over but with you I don't mind because for one thing, you are already knowledgable and have the foundation. Phreex, may he rest in peace, ended up leaving Other Drugs, the forum he in fact created, because of the same maddening questions and people insisting over and over. At the time I didn't understand what Preex was talking about but it is burned into me now hahaha.
 
Stiffeno: In Forums Mods are offered a great deal of latitude but the general rule of thumb is that threads twist and turn according to the interests of the participants. This is what makes forums interesting. That said, I will pound the nail and agree that methadone withdrawal, any aspect of it, absolutely relates to your original question. A person should always know as much as possible about what they consume.

Oh, Blonde, I forgot to add above, the phrase in the second paragraph about an equilibrium between plasma depletion and blood and other systemic aspects isn't correct, the plasma release is very very slow whereas the depletion from blood and bodily, etc, is relatively rapid by comparison, unless by "euilibrium" it means to state that "as blood levels decrease there is a corresponding mechanism vis a vis plasma depletion, as in that blood decrease implements initial plasma release." Anyway small but maybe important point.
 
^ Found the table and the data now, thanks. :)

Still though, is the data referring to chronic or acute usage? If a long term methadone patient stopped suddenly, would they have the same urine result as the table suggests?

I understand what you are saying now, that the drug's change in volume of distribution plays a large part in the onset of WD and that this also is why levels may be undetectable when the WD starts. And I still believe that receptor load must play a factor, as this is the fundamental reason WD is happening; the change of distribution of methadone in the body means that less of it is binding to opioid receptors and instead caught in other compartments or 'reservoirs' of the body before being slowly excreted.
 
The bottom line is that both pharmokinetics and physiology are, relatively speaking, in their infancy. The standard theory IS that receptor load plays the largest part but then you have a substance like methadone that doesn't fit that theory. What IS known is that by the time physical withdrawal commences with methadone the substance's presence is undetectable in urine, blood, etc. With the other opiates/opioids withdrawal finishes as the levels become undetectable so methadone really has caused people to re-evaluate the standard thinking.

On urine levels, chronic versus occasional use and whether chronic use leads to slower excretion (leaving methadone detected longer in the urine), in a nutshell, no, both the same. The belief- and I buy into it- is that the built in internal resevoir is where the built up levels are retained and when they begin depleting, in withdrawal, they aren't evacuated through urine but metabolised almost entirely. Therefore that very long detox.

Still, that very long withdrawal has a real tradeoff, as I was saying, the relative mildness of physical symptoms.
 
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