Misc Methadone varying potency and occasional withdrawal symptoms

[saramajara]

Hey everyone, not quite sure where to post this question, so please direct me to the appropriate forum If this is incorrect. I've done some research and cannot find any information on this topic, so again, please forgive me If this has previously been covered here at blue light... Anyways..

I've been on methadone maintenance for about 3 months, and relatively stable on a dose of 70mg for the greater majority of that time. However occasionally, maybe once or twice a month, as soon as 18 hours after my last dose I begin experiencing withdrawl symptoms and by the time I'm able to get my dose am really uncomfortable and in moderate withdrawl.
Initially I thought it might have something to do with my diet or stomach enzyme differences in that particular day, be ause it happens infrequently and I am otherwise stable and continuously comfortable. But last week I was talking to my freind at my program who go dosed immediate after me by the same nurse out of the same bottle and he said he was also exteamly sick the next morning, actually vomiting and sneezing from withdrawl. And again, he is otherwise stable on his dose on 90mg.

The only conclusion I can come to is that the strength of the medication is not consistent throughout batches? Somedays I even catch a nice buzz, so I really don't think I need to increase my dose. But is this possible? For the potency to vary that much?! FYI my clinic uses generic 40mg diskettes. And yes, I am sure I received the appropriate dose.

Any help as to what is causing me to feel this way, or any ideas as to how to solve it are greatly appreciated.
( I really do not enjoy the mile walk, half hour bus ride, and wait to get medicated when I feel like this. By the time my dose has kicked in I've sweated completly through my clothes and show up to work looking like total hell )

Ps. My counseler denied any variance in strenth of the medication and did not offer any possible solutions. He gave me a really hard time last time I asks for a dose increase, which I thought was crazy because I was under the impression I was on a relatively low dose.. But that's another nightmare story for another time. And honestly I don't even think upping my dose would solve this problem for more than a few weeks. As soon as my body adjusted to the increase, wouldn't I still have my occasional sick days?

Xoxo

 

[Trying2Iso]

If it comes from a pharmacy or clinic and it varies in potency, that is a problem.
FDA would be pissed if they heard that.

 

[saramajara]

That's what I'm saying. I didn't think drugs Ever really varied enough in potency for it to be so noticeable.. But I don't know what else it could be!?

 

[Thomas29]

yeah methadone if your stomach is very acidic you can absorb as LITTLE AS 33% from what i remember reading in a post and with a ALKALINE NON ACIDIC STOMACH YOU CAN ABSORB EASILY 88% Probably in the 90s even but i know the less Acidic your Stomach the more you ABSORB AND LONGER IT LASTS AND OPPOSITE for example if you drank a bottle of Pop with your Methadone Drink I Wait Minimum of 15 MInutes Preferably 1 Hour but i take GABAPentin so I wait 2 that way I am as Sure as I can be that GABAPentin wont Weaken My Methadone maintenance but i know Morphine and I think from Experience all Opioids somehow make you Absorb GABAPentin More Efficiently But you Say Take GABAPentin at the Same the Time without Waiting EITHER 2 hours AFTER OR BEFORE U TAKE YOUR painkillers or methadone and same for Benzos I am not sure if Benzos Potentiate GABAPentin but GABAPentin sure as hell weakens it and when i say it weakens your methadone er morphine and benzos i mean by 50-75% Decreased Absorption in Return for 44% mORE aBSORPTIOn or least 33% IF YOU TAKE the GABAPentin 2 hours later all your oral med is absorbed but the gabapentin can still be potentiated for a maximum of 4 Hours After Morphine is the ONLY CONFIRMED TESTED OPIATE/OPIOID, Possibly Hydrocodone also But I dont know if that was some else to do with Hydrocodone.

 

[saramajara]

I know Tagamet will potentate menthadone, by reducing the acidity in your stomach I'm guessing. But is there any foods or habits that I should like avoid that will raise acids in my stomach? Just avoid acidic foods I guess right?

 

[LiteWerk]

Bmore! Represent! I too was on MMT. Mainly pink liquid when I moved to Cali, but when I was in bmore, I also got the "biscuits". I will start out by saying that in my experience the biscuits lasted just a little but longer than the liquid. I am a slender guy and am generally happy with my body's metabolism, but with methadone I was very unhappy with my metabolism! I would get the sweats in the middle of the night, sometimes before bed. I think its fair to say with the biscuits... you may be looking at a ~1 to maybe 2mg variance, depending on how you slice it.... see what I did there. My buddies and I would potentiate a dose every a couple times a month to get a buzz going, but doing this repeatedly/daily is highly discouraged, as the "occasional, one or twice a month" early withdrawl symptoms you experience will seem like a walk in the park. Long story short, ask for a different counselor if you cant even get a 5mg bump in your dose. Stay under 80. Coming off more than 80mg blows. Even if you do a looooong taper.

ʟɪтⅇωøʀĸ

 

[inthetriptank]

Hey OP
I just got off methadone a few months ago, I was on it for almost 5 years. As I was tapering I (obviously) began to notice that my dose wasn't lasting me close to 24 hours anymore. Did some reading, and found out that because of the acidity of your stomach, less methadone than your total dose could be getting absorbed...I began to take a couple of Tums 15 minutes or so before I dosed, and that helped a lot.

 

[Bomb319]

what the hell - is this seriously one sentence?

 

[saramajara]

So I continued to get sick the next 4 or 5 mornings after writing this post and spoke to a nurse who said my dose probobly just wasn't holding me anymore, and have me a 10 mg increase the next day. I've felt fine since, so hopefully the problem is taken care of, because if this happens again and again every couple months there's no way I can keep increasing. Maybe I need to look into split dosing. Thx for your replies !

 

[Bomb319]

This topic is so familiar. it may as well have been written by me. I've had the exact same problem, and I'm on 220 mg daily! I've done a lot of digging, research and experiments since, and now have a good idea why this is.

First of all, the 24 hour half-life thing is not universal, and even a myth. Several other people I've talked to on various doses have all said the same thing - methadone may be touted as requiring just one daily dose, but everybody has differing metabolisms and it may simply be an effort to standardize something that can't really be standardized. There are other factors as well. As mentioned, the stomach acid issue seems to cause a lot of variation. I also find that methadone is much more sensitive to any other drugs you take, legal or otherwise. When I still used coke, I almost always had withdrawal by morning. I take diphenhydramine which tends to potentiate it after dosing, but at the cost of it wearing off early. Stomach contents also play a huge role. On a completely emty stomach, it will usually hit me quite strongly and quickly. But that rapid absorption often means rapid elimination as well. Finally, I think there are certain actual foods that alter metabolism of methadone since there are some days when I feel absolutely fine after 24 hours and can easily get up and go get my dose, but other times where it inexplicably leaves me a sweating, borderline sick mess even with late w/d symtoms like nausea, sneezing (which used to come on as late as 3-4 days after my last H usage) and general malaise and total lack of energy.

The time of day you dose is also a factor. Since there likely is going to be SOME methadone left in your system bythe next day, if you dose at the same time your total blood levels should be slightly higher than they would be if you dosed with it gone from your system. This explains why people say that MMT increases over time in efficacy. Because of this exact situation, I kept telling my doctor how badly I felt the next day which led to a massive increase to 220 mg from 30 mg in the end. But the irony is that I don't really feel much better the next morning after 220 than I did with 50 or so.

 

[saramajara]

This topic is so familiar. it may as well have been written by me. I've had the exact same problem, and I'm on 220 mg daily! I've done a lot of digging, research and experiments since, and now have a good idea why this is.

First of all, the 24 hour half-life thing is not universal, and even a myth. Several other people I've talked to on various doses have all said the same thing - methadone may be touted as requiring just one daily dose, but everybody has differing metabolisms and it may simply be an effort to standardize something that can't really be standardized. There are other factors as well. As mentioned, the stomach acid issue seems to cause a lot of variation. I also find that methadone is much more sensitive to any other drugs you take, legal or otherwise. When I still used coke, I almost always had withdrawal by morning. I take diphenhydramine which tends to potentiate it after dosing, but at the cost of it wearing off early. Stomach contents also play a huge role. On a completely emty stomach, it will usually hit me quite strongly and quickly. But that rapid absorption often means rapid elimination as well. Finally, I think there are certain actual foods that alter metabolism of methadone since there are some days when I feel absolutely fine after 24 hours and can easily get up and go get my dose, but other times where it inexplicably leaves me a sweating, borderline sick mess even with late w/d symtoms like nausea, sneezing (which used to come on as late as 3-4 days after my last H usage) and general malaise and total lack of energy.

The time of day you dose is also a factor. Since there likely is going to be SOME methadone left in your system bythe next day, if you dose at the same time your total blood levels should be slightly higher than they would be if you dosed with it gone from your system. This explains why people say that MMT increases over time in efficacy. Because of this exact situation, I kept telling my doctor how badly I felt the next day which led to a massive increase to 220 mg from 30 mg in the end. But the irony is that I don't really feel much better the next morning after 220 than I did with 50 or so.

Wow thanks so much. I feel better just knowing someone has the same problem as me and that I'm not crazy. I get the multiple sneezes sometimes too! And same thing, with dope I don't get them to a few days into my wiyhdrawal. My counseler was tell me it was in my head, and I was starting to get paranoid that the nurses might be dipping into our meds! Phew! Well im def. not gonna increase again after hearing your story. Ill just have to stick it out til in ready to taper off.
It some ways I kinda think its a good thing for me, keeps my confidence in check, and reminds me that in still dependent on a substance, and keeps my physically reminds of withdrawl and why I don't do heroin anymore. That pain can be easy to forget. I've noticed a lot of ppl on mmtp think they're magically healed and going to the clinic everyday becomes this huge deal.. So I guess Ita kind of a good thing to be reminded that goin to my program once a week is nothing compared to what I used to put myself thru for dope, and an hour of sickness before my meds is nothing compared to how I used to feel everyday waiting to cop. Idk if that all makes sense I guess I wa just kinda rambeling trying to look for the positive in our situation.
Thx again yo!

 

[Bomb319]

No problem I didn't really mean to suggest that there's no way you should consider going up. If you feel you're still getting a lot of cravings, thoughts of using again and more sickness (especially during the day) then it would be better to titrate up to a dose that you and your doctor both feel is working. I just wouldn't keep going up repeatedly based on morning withdrawal alone, that's all. I totally agree that methadone is a miracle when you think back to what sheer hell it was to constantly have to obsess about getting your next fix, meeting your dealer and not getting ripped off/getting good shit, and above all knowing that after all the shit you had to go through to get your drugs, the countdown to sickness and repeating this all over again begins as soon as you use it. By far the greatest advantage of methadone for me is simply knowing that I will ALWAYS have a reliable, monitored source of opiates daily with no chance of being told they're out, or having it depend on how much money I have. This in turn means that even if I do have some physical withdrawal symptoms the next day, it's only a short time until they will go away because I have a dose coming up. I can't overstate the psychological benefits of this; it all but eliminates the depression ajnd psychological withdrawal and isolation that I always found to occur when I know I won't be able to pick up in the near future.

 

[Bomb319]

By the way, that really sucks that you have to spend so much time to simply go get your dose every single day. I keep hearing similar stories to yours. In Canada we usually get our methadone from the pharmacy just the same as we would get any other prescription. I live 4 minutes walk away from my pharmacy, so even daily witness has never been a big deal for me except for a short time where I worked at a job requiring a 7:30 am start, before the pharmacy opened. I had to leave, I was too sick and uncomfortable at work, desperately and obsessively watching the clock to see if it was time for my break so I could run across the street and get it. Even then it still took an hour to kick in and make me feel better. Hopefully you can get some carries soon. I'm also lucky to have a really great doctor who is empathetic and very helpful. Not only did she bump me up by 20 mg per week when I started and desperately needed some stabilizing dose, she even prescribe me Zopiclone (Lunesta in the US) to help me sleep - something that many methadone physicians are unwilling to do. I really hope you can get all this stuff worked out. It should be quite a bit easier when you get carries.