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Methadone Dangers?

S

Stiffeno

Bluelighter
Joined
Oct 10, 2011
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141
Location
Sydney Australia
Im currently on 32mg of Buprenorphine and in the next few days im going to be switched onto 30mg of Methadone. Now ive been reading a lot of threads and forums where a lot of ppl are complaining about the dangers and having friends died from taking the Methadone. Granted a lot of these posters were recreationally using the Methadone not full on addicts, but what kinda risks who i have...given that ive got a 32mg bupe tolerance?

I know that you should avoid alcohol due to it also slowing your breathing, so i will stop drinking all together (im a social drinker for the most part). I just dont wanna be in a hue amount of danger...oh and i wont be taking anything else like Benzo's..just my Anti-depressant.
 
You'll be ok with 30mg since you have a massive tolerance with that 32mg of bupe. Always a good idea to ask if you're unsure though! :)

You're right on the money with staying away from benzos and alcohol. Methadone by itself is dangerous, but if you mix it with other depressants it can very easily kill you.

If you get take aways be careful not to keep upping your dose because you don't feel it - it takes a long time to reach peak effect, and it'll be still working for a long time afterwards...sometimes people will redose 12 hours or so in because they don't think it's effecting them anymore, and end up ODing.
 
Yeah i was reading about how ppl were ODing due to the long half-life, by their 2nd day dose they still have a few mg of their 1st day dose left in their system. As you said i have a tolerance pretty high now that ive been on 32mg bupe a day for a month now, and before that was on 16mg a day (and would often double dose 32mg every 2nd day).

I just dont want any nasty surprises, but i think i should be ok coz this place is a full on Methadone clinic, not just some GP prescribing it who has no experience with the drug and prescribing it at the right doses. I feel a little more relaxed about the idea of Methadone now with you mentioning my Bupe helping with tolerance :)
 
You will be fine on that dose after being on the buprenorphine. As was mentioned, it takes a couple of hours to kick in and has a long half-life. Good luck with the methadone, I hope it works out well for you. :)
 
The "danger" of methadone is nearly non-existent IF takem for Opioid Substitution Therapy (aka Medically Assisted Therapy aka "Maintenance") IF one takes it as directed by their medical provider and doesn't consume other heavy psychoactives like benzodiazepine, etc. The rocketing death rate associated with the substance is due to Chronic Pain patients being prescribed the substance. This is because its analgesic value tops out at between 8 and 12 hours while the substance's Half Life averages 36 hours. In other words, a person taking methadone for pain only gains less than 13 hours pain relief. Consuming more at that point is extremely dangerous given that it takes, on average, 72 hours before it is entirely out of one's system. At the 12 hour mark you have at least 85% of the substance in your body.

Bupe is only a good alternative if you have a short history of usage. The metabolic ceiling is 24mg, 32mg being an off label dosage by practicioners trying to stretch the parameters to accomodate more addicts. At 24mg, equigesically the methadone equivalent is around 70 though, forgive me I'm too tired to do the math (so noone should use that info as is, check it). 30 mg is the usual threshold of treatment of addicts, the dosage you begin at but perhaps you may find it sufficient as is.

As for scare stories about it being difficult to detox from methadone, they are subjective nonsense. The symptoms are very mild compared to morphine and heroin but usually last three times longer.
 
I overdosed twice from methadone.

The first time was basically just me being young and dumb. Well I knew better to take 60mg more of methadone on top of 100mg I took earlier.

The second time, I blacked out after drinking and taking benzos, but I only took 40mg that time. I woke up two days later in a coma and had a 10% chance of living. I am one lucky SOB, the Man upstairs has to be looking out for me.
 
wiggi said:
I overdosed twice from methadone.

The first time was basically just me being young and dumb. Well I knew better to take 60mg more of methadone on top of 100mg I took earlier.

The second time, I blacked out after drinking and taking benzos, but I only took 40mg that time. I woke up two days later in a coma and had a 10% chance of living. I am one lucky SOB, the Man upstairs has to be looking out for me.
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Dayum that sounds scarey O_O, i polished off the last of my bottle of Cowboy alcohol the other day as i swore im not going to drink OR take valium (or other benzo's) while on Methadone...ive got a 3 year old son and i dont wanna risk me life for a high!

Plus i get urine tested :P
 
Rachamim I very much respect your opinion when it comes to opioids but don't you think its a bit contradictory to call the difficulty of detoxing from methadone subjective nonsense? I mean if its subjective then how is it nonsense, if it varies from person to person then how are you going to tell anyone that getting off of methadone wont be difficult? That statement seems a little bit irresponsible tbh.

I think its pretty well documented that many people can have great difficulty getting off methadone, and to give any other impression to someone starting on it is not in the interest of HR.
 
Someone mentioned that 32mg bupe is something like 70mg Methadone? how come they have started me only on 30mg if i was so high up on bupe dosage? for safety or will they slowly up the dose over a few days/weeks?
 
A few things:

It's not very meaningful to calculate dose equivalences with bupe. Buprenorphine is a partial u-agonist with a non-linear dose response curve. In other words - at some dose you have reached the maximum effect you will get; higher doses will simply extend the length of action. The plateau dose varies greatly from person to person. Given that - it's virtually impossible to do dose-equivalence calculations - especially when comparing bupe with full u-agonists like methadone (or heroin, or morphine, or oxycodone etc etc).

Another factor with buprenorphine as opioid substitution therapy is the route of administration. Sublingual bioavailability also varies considerably from person to person - and also to some extent on the form of the drug. Currently, sublingual tablets are prescribed in Australia (buprenorphine or buprenorphine/naloxone). Any portion of tablet that is accidentally swallowed is effectively lost (poor oral bioavailability). If you are putting 4 8mg tablets under your tongue you are probably going to end up swallowing some. By 1 Sep 2013, the tablets will be off the PBS and everyone will be on the film preparation (see the threads in OD to check that out) - which should be easier to use and reduce accidental dose loss.

32mg is on the high side - indicates to me probably alternate day dosing, combined with perhaps some dose loss in administration and/or low bioavailability for that person.

30mg is a typical starting dose for methadone - you would be going back to your doctor fairly frequently for the first couple of weeks and having your dose adjusted to get you comfortable.

Stiffeno you will get top notch advice from your state drug user organisation - eg NUAA in NSW, HRVic in Victoria etc. You can get contact details from the AIVL website www.aivl.org.au
 
I was on 32mg every day not alternate day dosing, though a few months back i was on 16mg a day and would almost entirely double dose 32mg so i wouldnt need to go every single day. I think my doctors will raise my Methadone dose for sure coz the 30mg i took today didnt seem to do much...if anything =/. Not too impressed with Methadone so far....then again i have only taken 1 dose, so ill give it a little more time!
 
Drug Mentor: No, it is true. Look, physical withdrawal doesnt begin until the substance is entirely eliminated meaning that a perspn who has been on maintainance for at least two months will not go into withdrawal for at least 72 hours. Yet, addicts swear they are sick if they miss a single day. Should they miss two consecutive days they are climbing the walls and yet the irrefutable truth is that they are good for the first three days. Placebo Theory is very inÞeresting.

Saying that something is "subjective nonsense," in this context is dealing with the psychological aspect, as in psychologically people can imagine anything they want but in terms of clinical reality, it is nonsense. There are of course variabilities, some people have genetic abnormalities related to their enzymatic pathways while others may be on protease inhibitors and/or other substances that greatly effect their individual metabolic parameters. When speaking of Half Life and Evacuation Time it relative to the average adult. However, that is only concerning time, not the intensity of physical withdrawal symptoms. 100 addicts out of 100 may tell you how bad it is but an educated person usually won't. Personally, doing a cold turkey off of two decades at 220mg every 24 hours left me able to skin a cow and calf that died in birthing. Compared to morphine and/or heroin (the latter being only a delivery vehicle for morphine) was a hell that is difficult to describe.

Yes, people can have a very difficult time getting off of methadone, PSYCHOLOGICALLY. I suggest anyone interested in that aspect to do the proper research.
 
Stiffeno: OST parameters, internationally, are based upon the AMA, or American Medical Association. AMA Guidelines stated an opening parameter of between 20 to 40mgs at initial dosing. Virtually all practicioners use 30mg as a safe but effective median. Of course, equigesically people such as yourself can tolerate much more but they usually don't individually tailor parameters in clinics. They allow an increase four hours after your initial dose for another 10 to 20mgs but I have only ever found one clinic that did that despite the Guidelines allowing it.
 
Stiffeno you seem to be in Sydney - check the relevant NSW guidelines here

Rachamim - distinguishing between "physical" and "psychological" withdrawal is a bit old school and not terribly helpful - only the subjective experience of withdrawal counts. The problem with the model you use to describe withdrawal is that it risks catapulting us back 20 years to a time when people said cocaine wasn't addictive because there was no physical withdrawal syndrome...
 
rachamim said:
Drug Mentor: No, it is true. Look, physical withdrawal doesnt begin until the substance is entirely eliminated meaning that a perspn who has been on maintainance for at least two months will not go into withdrawal for at least 72 hours. Yet, addicts swear they are sick if they miss a single day. Should they miss two consecutive days they are climbing the walls and yet the irrefutable truth is that they are good for the first three days. Placebo Theory is very inÞeresting.

Yes, people can have a very difficult time getting off of methadone, PSYCHOLOGICALLY. I suggest anyone interested in that aspect to do the proper research.
Click to expand...

I'm not sure about that. Physical withdrawal can still occur when the substance hasn't yet been entirely eliminated....I know with bupe it's taken me 72 hours for the true physical withdrawal to start, and there certainty would have been some still active in my body.

If you look at it like this - Methadone patient @ 220mg per day stops taking dose and we'll say it takes 72 hours for withdrawals to start in earnest. If withdrawal only starts when the substance is entirely eliminated, then theoretically you could dose that patient 10mg and the withdrawals would automatically stop. That doesn't sound right? I'm probably misinterpreting you. Even after 108 hours the patient would still have 27.5mg of methadone on board...so that's not an entire elimination. I'd imagine the peak of physical withdrawal would be when the active dose in the blood reaches 0, but not sure of this.

I'm totally with you on the placebo thing. Especially with someone on bupe maintenance for an extended amount of time, missing a day or even two days shouldn't cause any significant physical withdrawal effects.

I think the power of the mind can't be understated when talking about maintenance patients coming off their medication. Go at it with the an open mind and the right mindset and your chances increases massively, going into it with thoughts of how awful it's going to be from horror stories you've heard off junkies and obviously it's going to be rough.
 
Hajime said:
30mg of methadone wont cover a 32mg subutex/suboxone habbit...
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Yeah ive heard this from a few ppl, so far i havent gotten sick...but then again there still may be bupe left in my system. Every night i go to sleep i keep expecting to wake up sick as a dog.

I guess over the next 2 days ill know for sure! I actually have a scheduled appointment on...err...Thursday with my Methadone doctor (2 days from now) so ill see what he does in terms of my Methadone dose. As you said 30mg Methadone wont cover a 32mg bupe habbit, but im sure my doctor will touch on that subject on Thursday...i hope O_O.

Edit: Just rang the clinic and double checked my appointment details. The card i was given said 17/12/11....as far as i knew it was this Thurdays, but the card said 17th of December, anyways i gave em a call and it IS this Thursday, the woman wrote the date wrong lol

Edit 2: Oh ayjay thanks for the link to that rules and guildlines PDF, reading it now :)
 
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Withdrawal doesn't start when the blood concentration reaches zero. It starts when it is low enough that not enough opioid receptors are being activated and all those compensatory mechanisms the brain had in place start to show. There is constant equilibrium between the drug in your blood and in your bodily tissues (including drug bound to plasma protein). As your body eliminates some of the non-bound drug, the drug that was protein bound then goes into blood to try and re-balance the equilibrium. This goes on and the level of drug remaining in the body continues to drop and eventually the level remaining will not be enough to keep the opioid addict well.

This is a simplified version of how it works of course.

And the comments about withdrawal being subjective and having important psychological aspects are very correct. The psychological aspects can be the hardest to treat and deal with, and may persist long after the physical symptoms have subsided.
 
Rachamim while you are certainly more knowledgable about opioids than myself a lot of what your saying doesn't really make sense to me. As Christ! pointed out if it required zero methadone in the system to feel withdrawal then any dose of methadone would prevent withdrawal, but it doesn't. What your saying might look good on paper but by the time you apply it to a real life scenario I don't think it works out. By the way, I know people on methadone that can skip a day just fine and quite often do for a number of reasons so I don't quite buy that junkies are just too stupid and psychologically dependant to know whether they are sick or not, I think that atleast for some people the physical withdrawal is worse than your making out.

Even regardless of how severe or not severe you think it is, consider people can get habituated on codeine (like the OP incidentally), cannabis and even fucking chocolate! It doesn't seem in the interest of HR to suggest detoxing from methadone is easy, nor does it seem particularly accurate. Just my 2c.
 
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