Methadone vs Morphine

[4DQSAR]

BTW anyone using methdone chronially (e.g. in substitution therapy) will undergo metabolic changes so that the half-life of the drug is reduced. So I can imagine someone being given a dose that 'works for them' only to discover months or even years later that they find themselves in withdrawal with no alteration in the dose prescribed.

I might add that oral bioavailability of methadone varies hugely between individuals as well. It's these many issues that have made methadone unpopular in the management of pain.

Must be scary to KNOW you didn't cheat even once but slowly your find yourself going into withdrawal each day but so slowly, for a while you will wonder 'is this real or am I imagining it?'

 

[RustyCrackleford]

BTW anyone using methdone chronially (e.g. in substitution therapy) will undergo metabolic changes so that the half-life of the drug is reduced. So I can imagine someone being given a dose that 'works for them' only to discover months or even years later that they find themselves in withdrawal with no alteration in the dose prescribed.

I might add that oral bioavailability of methadone varies hugely between individuals as well. It's these many issues that have made methadone unpopular in the management of pain.

Must be scary to KNOW you didn't cheat even once but slowly your find yourself going into withdrawal each day but so slowly, for a while you will wonder 'is this real or am I imagining it?'

The thing that really stuck out to me, was with this specific girl, it was over a 2 or so day period. She dosed at the treatment center monday, started back at our clinic on a tuesday, and wednesday was in objective withdrawal. Usually id chock it up to some kind of "She lied about dosing, or blah blah" but i drove her to the clinic every day, so she'd be dosing right next to me every morning.

Theres likely factors that im not thinking of, or couldnt possibly know, her body is not mine, but it bothers me to no end not being able to figure out why.

 

[Them Witches]

I havent really looked into it, but anecdotally ive always found peoples subjective reports on differences in potency and dosing in different formulations of methadone.

For example, i had a friend that goes to the same clinic as i do, she went into treatment for a month in a facility across the state, said facility used to give their patients wafers(If i remember right) and before she left, she was on 80mg a day and said she would be blasted most of the day. When she got out she came back to our clinic the next day and was switched to 80mg of the pink liquid(Whatever the brand name is), and it didnt even keep her well. Not just her own self reporting either, id seen the objective signs of withdrawal in her myself. If both formulations are 80mg of active compound then the amount metabolized should be relatively similar if the ROA is the same, despite liquid or wafer form right?

Ever since I can remember, Methadone IR tablets (5mg, 10mg, 40mg) have always been reported to have more of an effect (euphoria and pronounced feelings) than the liquid version. I have had tablets and liquid, and I prefer the tablets.

Apparently, the Methadone 40mg tablets used in the U.S. for MAT are brand name Dolophine. I know that there is supposed to be no difference between generic and brand name active ingredients. The difference between brand name and generic is the FDA allows the generics to be up to 20% weaker. It is hard to find data on this but the data is out there. My doctor says it is more like 15% difference in strength. Again, the data is out there but is not "frontline information."

Example but not Methadone, Sandoz's brand name Fentanyl 100mcg patches are 16.5mg of the active ingredient and Sandoz's genric name 100mcg patch are 16.5mg of active ingredient. However, Watson's generic Fentanyl 100mcg patches are 10mg of active ingredient.

From what I have heard is some Methadone clinics use generic liquid and some use brand name liquid. Some use the concentrated Methadose liquid (10mg/1ml) and administer a smaller ml dose. The situation you are describing may be because one clinic is using brand name and the other generic.

I normally get the generic Oxycodone but a few times the pharmacy was short on the generic and they have given me brand name Roxicodone to complete the Rx. The brand name Roxicodone is slightly stronger than the generic Oxycodone. I have been on Oxycodone for almost 15 years and I could tell the difference.

 

[4DQSAR]

The thing that really stuck out to me, was with this specific girl, it was over a 2 or so day period. She dosed at the treatment center monday, started back at our clinic on a tuesday, and wednesday was in objective withdrawal. Usually id chock it up to some kind of "She lied about dosing, or blah blah" but i drove her to the clinic every day, so she'd be dosing right next to me every morning.

Theres likely factors that im not thinking of, or couldnt possibly know, her body is not mine, but it bothers me to no end not being able to figure out why.

Sci-Hub | Mechanism of Autoinduction of Methadone N-Demethylation in Human Hepatocytes. Anesthesia & Analgesia, 117(1), 52–60 | 10.1213/ANE.0b013e3182918252

I hope the above is of value to you. I'm sure I can find more if you need them. But in essence, it seems that it is accepted (at least by the people who wrote this) that to titrate a patient to the most appropriate dose of methadone takes weeks and I'm prepared to bet for a few, even longer.

 

[Them Witches]

BTW anyone using methdone chronially (e.g. in substitution therapy) will undergo metabolic changes so that the half-life of the drug is reduced. So I can imagine someone being given a dose that 'works for them' only to discover months or even years later that they find themselves in withdrawal with no alteration in the dose prescribed.

I might add that oral bioavailability of methadone varies hugely between individuals as well. It's these many issues that have made methadone unpopular in the management of pain.

Must be scary to KNOW you didn't cheat even once but slowly your find yourself going into withdrawal each day but so slowly, for a while you will wonder 'is this real or am I imagining it?'

Good points. I have been on Methadone for a long time and when I first started taking it the full-life would almost warrant 24hrs before withdrawals starting. Now it is around 18-20hrs before the withdrawals begin. I have been told by a ER doctor that Methadone takes 36-48hrs before withdrawals begin. Obviously the ER doctor does not really know a wide range of data on the drug. Many hospital doctors think if someone takes opiates/opioids regularly for pain management, the patient needs less pain medication for acute post-surgery pain while administering the patient's normal pain medication. The "opioid crisis" has ruined pain treatment for everyone in every way.

 

[Them Witches]

I was reading a report on a pain management patient regarding "ultra high MME doses." One guy was getting Oxycotin 320mg (two 160mg OC's) three times daily with Methadone 180mg and Hydromorphone 8mg every 4hrs... It was for cancer pain but what doctor even considered this was a smart idea..? I would like to meet that doctor.

High MME is considered 200-1000mg. Ultra high MME is 1000-2000mg.

This patient mentioned has 1,440 MME from Oxycotin, 540 MME from Methadone, and 192 MME from Hydromorphone
OR said patient is wearing 11qty Fentanyl 100mcg patches daily

 

[4DQSAR]

I was reading a report on a pain management patient regarding "ultra high MME doses." One guy was getting Oxycotin 320mg (two 160mg OC's) three times daily with Methadone 180mg and Hydromorphone 8mg every 4hrs... It was not for extreme cancer pain either. What doctor even considered this was a smart idea..? I would like to meet that doctor

A few years ago a BLer told me an interesting story. They were in a small hospital ward (4 beds) and one of the other patients was in palliative care i.e. the goal is always to give a patient the best quality of life possible when they have a fatal illness or disorder. Apparently this patient had lasted MUCH longer than was expected so had HUGE tolerance. In the end the consultant asked an anaesthetist to review the medications (plural) prescribed for pain. The anaesthetist apparently set up a slow infusion of sufentanil to replace the others. I mean, that makes sense as sufentanil is not only much more potent than fentanyl, but it's also got a MUCH bigger TI* and I heard this unlucky patient was being given something like 4mg sufentanil/hour. Just crazy amounts.

I've also talked to five clandestine chemists who made fentanyl derivatives... and then prompty broke Rule 1. Of the five two are dead, two are still in the acute phase of opioid withdrawal )even years after they stopped using) and the last one is still in prison. I suppose the only useful thing most people aren't aware of is that the one who made many analogues made it clear that beta hydroxy fentanyl (and beta hydroxy thiofentanyl) were the most euphoric by a large margin. But let's face it, 'the most euphoric fentanyl derivative' is like pointing out that someone is 'the world's tallest dwarf'. A low bar.

*When I say 'much bigger', I mean that even though sufentanil is 10 times more potent than fentanyl, the fatal dose of sufentanil (TI 26700) is higher than that of fentanyl (TI 277).

 

[Them Witches]

Medical MME data has changed again for methadone. they are now saying 180mg of Methadone equals 842 MME. It used to be around 600 MME. This must have to do with the way Methadone increases in strength the higher the dosage goes. I do not see how it would increase that much though..

 

[4DQSAR]

We can only hope that at some point TH-030418 will become the medicine used to treat dependent opioid users. They made thienorphine which is a partial agonist that was clearly intended to replace buprenorphine, but I think this newer compound is tacit admission that for some, a full agonist (or even superagonist) is the more appropriate treatment, initially at least.

Apparently it can be given every 3-4 days. I imagine it's affinity is so high that it would blunt the effects of any street drug (even fentanyl).

 

[Them Witches]

A few years ago a BLer told me an interesting story. They were in a small hospital ward (4 beds) and one of the other patients was in palliative care i.e. the goal is always to give a patient the best quality of life possible when they have a fatal illness or disorder. Apparently this patient had lasted MUCH longer than was expected so had HUGE tolerance. In the end the consultant asked an anaesthetist to review the medications (plural) prescribed for pain. The anaesthetist apparently set up a slow infusion of sufentanil to replace the others. I mean, that makes sense as sufentanil is not only much more potent than fentanyl, but it's also got a MUCH bigger TI* and I heard this unlucky patient was being given something like 4mg sufentanil/hour. Just crazy amounts.

I've also talked to five clandestine chemists who made fentanyl derivatives... and then prompty broke Rule 1. Of the five two are dead, two are still in the acute phase of opioid withdrawal )even years after they stopped using) and the last one is still in prison. I suppose the only useful thing most people aren't aware of is that the one who made many analogues made it clear that beta hydroxy fentanyl (and beta hydroxy thiofentanyl) were the most euphoric by a large margin. But let's face it, 'the most euphoric fentanyl derivative' is like pointing out that someone is 'the world's tallest dwarf'. A low bar.

*When I say 'much bigger', I mean that even though sufentanil is 10 times more potent than fentanyl, the fatal dose of sufentanil (TI 26700) is higher than that of fentanyl (TI 277).

The Bentley Compounds... Sooner or later these will become what replaces "street dope" because of the progression of tolerances. Some of these Bentley Compounds are 8,000-12,000 times the strength of morphine. That is plain scary to me but somehow justified by cartel chemists

 

[4DQSAR]

The Bentley Compounds... Sooner or later these will become what replaces "street dope" because of the progression of tolerances. Some of these Bentley Compounds are 8,000-12,000 times the strength of morphine. That is plain scary to me but somehow justified by cartel chemists

Well, the interesting thing is that thebaine and oripavine are found in large amounts (by weight of dry plant) in the oriental poppy - a species it is legal to grow. Tazmanian Alkaloids also modified the genome of another poppy strain and that one contains even more of those vital precursors. The latter is referred to as 'The Norman Strain' and because it contains no morphine or codeine, it can be grown in open fields, not inside highly secure compounds.

But Etorphine isn't the most potent by a large margin. I think it was chosen because of the many analogues, it was the one whose potency didn't alter much between individuals.

I am simply surprised that no Australian 'seed vendor' hasn't twigged to the fact that people would pay HUGE sums for the seeds of that Norman Strain varient... I think the patent protection period has ended so no legal reason why they can't do so. In fact, they could sell the dry plant.

While Bentley compounds can be a bit of a pain to make, bench-scale would be fine. But how to produce reliable dose units? I've always said that 'windowpanes' used in LSD distribution could be used...

 

[Them Witches]

Well, the interesting thing is that thebaine and oripavine are found in large amounts (by weight of dry plant) in the oriental poppy - a species it is legal to grow. Tazmanian Alkaloids also modified the genome of another poppy strain and that one contains even more of those vital precursors. The latter is referred to as 'The Norman Strain' and because it contains no morphine or codeine, it can be grown in open fields, not inside highly secure compounds.

But Etorphine isn't the most potent by a large margin. I think it was chosen because of the many analogues, it was the one whose potency didn't alter much between individuals.

I am simply surprised that no Australian 'seed vendor' hasn't twigged to the fact that people would pay HUGE sums for the seeds of that Norman Strain varient... I think the patent protection period has ended so no legal reason why they can't do so. In fact, they could sell the dry plant.

While Bentley compounds can be a bit of a pain to make, bench-scale would be fine. But how to produce reliable dose units? I've always said that 'windowpanes' used in LSD distribution could be used...

From what I read Thebaine is at max 2% from raw opium latex and poppy straw. Iran, Afghan, Persian, Swedish, AUS, Spain, and some oriental areas is where the richest Thebaine strains exist. Since Afghan produces 90% of the world's illicit raw opium and poppy straw from 500,000 poppy acres. The timelines of "Operation Desert Storm", "post & post 9-11 Afghan war" aligns with the dramatic spike of demand for Thebaine for Oxycodone production in the United States for the production of Oxycotin. Since the United States and other countries have a limited and regulated yearly quota for Thebaine (which grew to 143 metric tons by 2014), the perfect crime was seizing Afghan poppy without being documented by the INCB legally. The United States was the country in the world that required a sudden dramatic demand for extra Thebaine during that timeline.

Your right... Thebaine is also needed as a starting block for Oxycodone, Hydromorphone, Oxymorphone, Hydrocodone, nalbuphine, naloxone, naltrexone,buprenorphine, butorphanol, and etorphine. it is the main alkaloid extracted from Papaver bracteatum (Iranian opium / Persian poppy).

Johnson & Johnson from AUS is another large exporter of Thebaine rich raw opium and poppy straw.

 

[daturetard]

The laevo-acetyl derivative of R-4066 has a T½ of 22.5 hours and is some x212 methadone in potency. I have pointed this out to various US HR agencies as it's extreme affinity means it will blockade even fentanyl. But for whatever reason(s), nobody is even considering that a new substitution therapy might be needed to deal with the new problems of fentanyl and nitazenes.

Damn man, if only we had people who actually know what they're talking about in RFK's position. There are solutions to shit like fentanyl addiction, the people in power are just not into helping addicts; they just don't wanna fucking see em; send em to 'the farm'.

 

[mirsNeedsHisItch]

Damn man, if only we had people who actually know what they're talking about in RFK's position. There are solutions to shit like fentanyl addiction, the people in power are just not into helping addicts; they just don't wanna fucking see em; send em to 'the farm'.

Its a business.
The government is the same people who Kidnapped People And fed them ridiculous amounts of LSD and those same people later committed iconic murders

They don't care lol

 

[chippermonk]

Damn man, if only we had people who actually know what they're talking about in RFK's position. There are solutions to shit like fentanyl addiction, the people in power are just not into helping addicts; they just don't wanna fucking see em; send em to 'the farm'.

One might think an ex-heroin addict like RFK would be the perfect person for the job, at least from the standpoint of helping addicts...but one would be wrong.

https://www.npr.org/2025/01/29/nx-s1-5276898/rfk-drugs-addiction-overdose-hhs-confirmation-trump

 

[notsmokeymcpot42088]

We can only hope that at some point TH-030418 will become the medicine used to treat dependent opioid users. They made thienorphine which is a partial agonist that was clearly intended to replace buprenorphine, but I think this newer compound is tacit admission that for some, a full agonist (or even superagonist) is the more appropriate treatment, initially at least.

Apparently it can be given every 3-4 days. I imagine it's affinity is so high that it would blunt the effects of any street drug (even fentanyl).

Sounds kind of nightmarish to me. A 3-4 day partial agonist that fent can't cut through (Thienorphine that is) -- would the w/d not last a damn long time and be pretty brutal? (Just going off of transferative property of high binding affinity long duration)

I think a full agonist would be better treatment really. But than they would have to concede addicts something "fun" --- Morphine replacement always felt like the way Id go if I was stocked up and legal.

Chippermonk -- wait are you telling me a politician is a hypocrite? One in the Trump administration. Someone so considerate to people with things like autism. (ok ill stop)

 

[Them Witches]

Its a business

Yes indeed. Daily the US government "grosses" $2.63 million from 400,000 MAT Methadone patients @ an average $50.00 a week per patient. Of course some patients have insurance, that is why the figure is "gross income" Back in 2004, the Methadone clinics charged $50.00 per week out of pocket.

Yearly at $50.00 per week comes up to $960,000,000 yearly just for Methadone. Add in the Suboxone the number go up.

Out of pocket for 120# Mallinckrodt Methadone 10mg IR is $44.23 per month OR $0.36 per tablet. This is what I pay for it at my pharmacy and the out of pocket figure doesn't increase until the monthly count goes to 240# at $58.96 per month. At the clinic they are charging 4-4.5 (400-450% mark up) times this to either the out of pocket patient or the patient's insurance.

Fun fact -- In 1842, the First Opium War was won by the British because they paid India to grow poppy and harvest the raw opium to be smuggled into China. This tactic was a pre-war weapon to weaken 4,000,000 fighting age men into opium addicts. We do not have 4,000,000 document opioid addicts in 2025. This how the British took over and controlled China's main strong-holds, like Hong Kong and other major populated areas of China.

 

[notsmokeymcpot42088]

I will keep it a buck -- small town, sub clinic travels through town and only accepts cash. About 30 ppl in there every hour or two -- Hell one time they jerked me around awhile and I was the last person to leave but the staff and I had a smoke in the parking lot and quickly realized they were not about to leave that building till I pulled out. I waited an extra 20 minutes as they wasted my time that day. Would not be a bad take and it is probably insured. But crime is bad.

 

[daturetard]

I will keep it a buck -- small town, sub clinic travels through town and only accepts cash. About 30 ppl in there every hour or two -- Hell one time they jerked me around awhile and I was the last person to leave but the staff and I had a smoke in the parking lot and quickly realized they were not about to leave that building till I pulled out. I waited an extra 20 minutes as they wasted my time that day. Would not be a bad take and it is probably insured. But crime is bad.

Were you tryna hit a lick on the bupe clinic

 

[Them Witches]

On the show : The Crime of the Century" a pain patient was offered a deal with the biggest Oxycotin rep of Florida that she would pay for the Rx if they could document him to show the drug was safe. He was prescribed 22-25qty Oxycotin 160mg every 12hrs for lower back pain. The guy saved the pill bottle to reference it later down the road,

I believe since Purdue was sponsoring the trial and the sales rep was bringing him the pills instead of filling at a pharmacy, that many of the OC 160mg pills were a placebo. If they were real that is 8,000mg of OC Oxycotin. That is a 12,000 MME daily. That man's liver, kidneys, stomach, and intestines would have shut-down. The man would have had severe bradycardia and he would have died from a pulse of 15-20bpm. No way that man was crushing a 12,000 MME with a body weight of 190lbs.

A 5 digit MME is out of this world crazy. 12,000 MME equals wearing 66qty Fentanyl 100mcg patches at one time.