Opioids Morphine ER for opioide maintainance

[nasir~]

I have been on methadone for about 5 years now and while it is indeed helping with craving, pain and other stuff, there are far too many sideeffects I'm sick of.

So since a couple of months there is a new maintainance medication called “Substitol“ here in Germany.
It's basically ER morphine.

My doc is willing to switch me over if I want to. They say the dose equivalence is like methadone 1:6-1-8 to morphine.
Sounds reasonable to me.

So what i'm asking:
What Do you guys think about it? Should I give it a chance?

With methadone there has always been somewhat of a high for me, which I liked.
This should be the case with morphine too, right?%)

In the end I hope to achieve a better quality of life, by getting less craving, more anxiolytic action (which they claim it has, significantly) and fewer sideeffects.

I will definitly try it, but I got high hopes for this which I hope won't be dissapointed...

 

[Hodor]

ER morphine has been the opiate of the "detoxing" masses for years now here in Austria. I put "detoxing" in quotation marks because one of the main reasons it's so popular is that it's abuseable as fuck, for a number of reasons:

* morphine has a low oral BA (approx. 25% ), and it is dosed accordingly. That means that by slamming it you get four times as much bang for your buck. Now, Substitol is mainly prescribed around the Vienna/Nether Austria area (other states tend to favor methadone), so by driving to the next state over (which, in Austria, isn't a particularly long drive) you could sell your morphine for a considerable sum (even if it's a ...ugh... "G'spuckte", a "spitter"), drive back to Vienna, and get yourself some smack.
* ...which brings me to next point: Heroin gets metabolized into morphine. It's only a few hours after shooting up that you can tell somebody's been taking heroin instead of their prescribed morphine by testing for the intermediary metabolite 6-MAM.

So I'm actually kind of baffled they'd start offering Substitol in Germany, as doctors in Austria are increasingly being pressured to prescribe Subutex/Suboxone, Methadone or Polamidone (L-Methadone, which lacks many of the side-effects of racemic methadone). That said, I guess the level of Substitol abuse isn't quite as high as it used to be once the pharmacists (who are the ones dispensing the Substis/bupe/'done here) wised up to the enormous resale potential and simply opened up the capsules and poured the beads onto a spoon for the patients to swallow.

 

[Ligaturd]

It's harm reduction and it works. It doesn't have to be methadone or buprenorphine as many people will be on them for life and it would benefit some to just have morphine or diacetylmorphine. I don't see a problem as it still mitigates the risks of having an unreliable supply of drugs and the risks and criminal behaviors that can come with that. Also removing the users from low quality or fake drugs also lowers the risk of death in the case of heroin or morphine maintenance. I don't think it is a bad thing at all if that's what you want to do, I personally want to get sober so I am utilizing buprenorphine as of right now and morphine or heroin would go against my goals.

 

[nasir~]

ER morphine has been the opiate of the "detoxing" masses for years now here in Austria. I put "detoxing" in quotation marks because one of the main reasons it's so popular is that it's abuseable as fuck, for a number of reasons:

* morphine has a low oral BA (approx. 25% ), and it is dosed accordingly. That means that by slamming it you get four times as much bang for your buck. Now, Substitol is mainly prescribed around the Vienna/Nether Austria area (other states tend to favor methadone), so by driving to the next state over (which, in Austria, isn't a particularly long drive) you could sell your morphine for a considerable sum (even if it's a ...ugh... "G'spuckte", a "spitter"), drive back to Vienna, and get yourself some smack.
* ...which brings me to next point: Heroin gets metabolized into morphine. It's only a few hours after shooting up that you can tell somebody's been taking heroin instead of their prescribed morphine by testing for the intermediary metabolite 6-MAM.

So I'm actually kind of baffled they'd start offering Substitol in Germany, as doctors in Austria are increasingly being pressured to prescribe Subutex/Suboxone, Methadone or Polamidone (L-Methadone, which lacks many of the side-effects of racemic methadone). That said, I guess the level of Substitol abuse isn't quite as high as it used to be once the pharmacists (who are the ones dispensing the Substis/bupe/'done here) wised up to the enormous resale potential and simply opened up the capsules and poured the beads onto a spoon for the patients to swallow.

Thanks for your thougts on this. While I really appreciate your care (and reservations) I already knew all that.
I mean the bioavailability thing, the (IV) abuse potential and also the other concerns many people have with morphine.

All this shouldn't be an issue for me, though.

What I really care about is if this an adequate maintainance medication for someone who uses it just as prescribed.
If it kills cravings more efficiantly than methadone, how long (meaning, hours a day) do you feel the effects with the ER mechanism, etc.

Don't get me wrong. As I said, I appreciate your apprehension but it doesn't really apply to my requirements.

It's harm reduction and it works. It doesn't have to be methadone or buprenorphine as many people will be on them for life and it would benefit some to just have morphine or diacetylmorphine. I don't see a problem as it still mitigates the risks of having an unreliable supply of drugs and the risks and criminal behaviors that can come with that. Also removing the users from low quality or fake drugs also lowers the risk of death in the case of heroin or morphine maintenance. I don't think it is a bad thing at all if that's what you want to do, I personally want to get sober so I am utilizing buprenorphine as of right now and morphine or heroin would go against my goals.

Thank you too.
Nice to hear opinions from well educated and intelligent people. I don't say this to kiss ass, seriously! XD

 

[Hodor]

It's harm reduction and it works. It doesn't have to be methadone or buprenorphine as many people will be on them for life and it would benefit some to just have morphine or diacetylmorphine. I don't see a problem as it still mitigates the risks of having an unreliable supply of drugs and the risks and criminal behaviors that can come with that. Also removing the users from low quality or fake drugs also lowers the risk of death in the case of heroin or morphine maintenance. I don't think it is a bad thing at all if that's what you want to do, I personally want to get sober so I am utilizing buprenorphine as of right now and morphine or heroin would go against my goals.

They're not giving people straight up IR morphine sulfate powder designed to be injected though, they're giving them ER oral morphine and hoping the users are going to take it as directed.
Now, if they actually do take it orally, it's a good solution. If they don't, though, it's arguably far less harm-reducing than bupe or methadone:
* several hundred mgs of morphine taken as an ER capsule are effective at controlling somebody's withdrawals throughout the day. Several hundred mgs of morphine injected (thus releasing it all at once and, what's more, quadrupling(!) the bioavailability) are a recipe for an OD
* plenty of Austrian junkies have lost fingers, limbs or lives from failing to properly remove the binders in the ER beads before injecting Substitol
* as stated before, there is a huge black market for Substitol in the surrounding states. Users may be enticed to sell their Substitol (becoming not just users but dealers), then use that money to buy street heroin in Vienna

 

[nasir~]

So from your experience/observations: Does it “only“ control withdrawal, or do you actually “feel“ it working?
- which has always been the case for me on methadone
Of course we're talking about taking it as prescribed.

 

[cjh1221]

Don't know about the particular brand but my morphine ER has always been a pill of packed "beads" made of wax with the morphine inside making it nearly if not entirely impossible to ever be able to safely IV it. Very hard to abuse them. Maybe you will have better luck with it there but for us Stateside, it's basically crap. One would think they would make it as difficult to abuse as possible making the diversion problem a little less likely to occur...who knows.
I did read somewhere that the time-release could be broken with hot water. If you melt the pill in very hot water and dip your finger in and out of it repeatedly once it cools, you can gather the wax on your finger in layers, releasing the morphine into the water....then drink. I wouldn't trust it for IV though, way too high of a possibility of not getting all of the wax out and then you still have binders/fillers to worry about. Hopefully it is just not that hard for you guys there but I cannot imagine they would make diversion/abuse so easy.

Edit: it never really mattered how much I did, 3 or 4 times my normal dose didn't even give me a high...I never felt it at all, it just kept me from getting sick for the most part. Chewed it, ground it up, never mattered. It was like maintanence for me pretty much. Like Subs. No high, just not sick. Well, sometimes if I took 4xs my normal dose it made me puke for like 24 hrs. straight but I only made that mistake once....ok, maybe twice. But I still didn't "feel" it.

 

[average extreme]

i know someone who switched to substitol from methadone and i plan that too.
he finds it better but he also said that the switch wasn't that easy for him at first. i will wait a little longer before i try it, i want to hear some more experiences first.
i heared that, compared to methadone, you don't sweat as much on substitol/morphine, is that true?

 

[nasir~]

i know someone who switched to substitol from methadone and i plan that too.
he finds it better but he also said that the switch wasn't that easy for him at first. i will wait a little longer before i try it, i want to hear some more experiences first.
i heared that, compared to methadone, you don't sweat as much on substitol/morphine, is that true?

The sweating thing is really an issue for me on methadone.
I never used to sweat a lot. Even when doing sports much less than most people.

But on methadone I sweat like crazy. Seriously I just have to do some house cleaning and my shirt is almost completly wet.
When I do sports (boxing and other stuff usually) the sweat is literally dropping from my body.
Also I have slight heart problems, from IVing/smoking cocaine probably.

The sweating is supposed to be much less of an issue with morphine. Morphine seems to be quite forgiving on the heart compared to methadone.

Regarding “l-polamidon“(levomethadone): It has fewer sideeffects than methadone but only marginally.

This bigoted society...
Questions regarding healthcare(which opioide maintainance IS) are not determined by logic, evidence and common sense, but rather hysteria, prejudices and politics.

It really sucks.

We (as a society) need a new approach to drugs and their users.

 

[d1ahp]

The sweating thing is really an issue for me on methadone.
I never used to sweat a lot. Even when doing sports much less than most people.

But on methadone I sweat like crazy. Seriously I just have to do some house cleaning and my shirt is almost completly wet.
When I do sports (boxing and other stuff usually) the sweat is literally dropping from my body.
Also I have slight heart problems, from IVing/smoking cocaine probably.

The sweating is supposed to be much less of an issue with morphine. Morphine seems to be quite forgiving on the heart compared to methadone.

Regarding “l-polamidon“(levomethadone): It has fewer sideeffects than methadone but only marginally.

This bigoted society...
Questions regarding healthcare(which opioide maintainance IS) are not determined by logic, evidence and common sense, but rather hysteria, prejudices and politics.

It really sucks.

We (as a society) need a new approach to drugs and their users.

IV Morphine is actually used for chest pains in a hospital setting.

Morphine does have a pretty notable histamine release action. I can see that not feeling too great long term. Though, it obviously can be countered with some antihistamines.

The only noticeable Methadone side effects to me are sweating and the heavy feeling after the "buzz" is gone. The sweating can aided by Cinnamon supplements and the heavy feeling with coffee, for me at least.

 

[Keif' Richards]

I have very little knowledge regarding modern Morphine Maintenance programs, but from the little I've read, it would seem that Morphine is superior to Methadone in a lot of ways. I would immediately hop on if possible. Methadone is a great tool and has served me well, but if Morphine works better, then HR would probably dictate to go with the latter.

 

[d1ahp]

I have very little knowledge regarding modern Morphine Maintenance programs, but from the little I've read, it would seem that Morphine is superior to Methadone in a lot of ways. I would immediately hop on if possible. Methadone is a great tool and has served me well, but if Morphine works better, then HR would probably dictate to go with the latter.

It's not available in the US as far as I know, correct?

 

[clsteele]

Its one of the 4 options i know of in the UK i.e. methadone, subutex, suboxone and morphine however its rarely used now in favour of subutex [bupe] due to [as mentioned above] it does nothing more than at best stabalise your addiction most addicts cant be trusted with it, especially as the ER ones used in the UK are VERY easy to defeat the extended release mechanism. But if you're strong enough not to abuse it its not bad from what i hear, most seem to prefer subutex though.

 

[clsteele]

never heard of it only nalaxone, subutex, suboxone and methadone.

 

[d1ahp]

So what does it look like? Someone gives you a 500MG(dependant on tolerance) Extended Release Morphine pill, you take it in front of the dispense nurse?

Can someone who has done this elaborate on how the process work?

 

[nasir~]

Isn't there some kind of diacetylmorphine/Heroin program in the UK?

I 've been in the diamorphine program here in Germany.
That was actually perfect. Unfortunately I had to move, so I had to go back on the methadone.

So what does it look like? Someone gives you a 500MG(dependant on tolerance) Extended Release Morphine pill, you take it in front of the dispense nurse?

Can someone who has done this elaborate on how the process work?

Yes, it's supposed to work that way.
When you 've proven that you can be trusted, they might consider to give you one week “take home“.

 

[mokele]

In Austria, mainly vienna, this is the preferred substitute. you go to apothecary and take it there, weekend take home. if you work, weekly take homes.max dose is1,600mg(these are ER!)

 

[OntarioGuy]

They do this in Canada as well, though it's not an organized program like the methadone and suboxone clinics are. Here it's not uncommon for a family doctor to maintain a patient on ER morphine, ER Hydromorphone and I've even seen transdermal fentanyl maintenance.

I myself was forced onto a morphine maintenance several years ago for breaking methadone clinic rules.
My doctor gave me a 10:1 dose when switching to morphine from methadone. I was cut off cold Turkey from 120 mgs of methadone per day. My family doctor then prescribed me 1200 mgs of oral morphine per day, in the form of 2 x 200 mg MS Contin 3x daily.

It probably would have worked, but I began to IV the tablets. I imagine if taken properly morphine would definitely work as a maintenance med. Or any opioid for that matter granted it's taken orally in a time released formulation

 

[kleinerkiffer]

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