New Methadone MMT patient - desperate for your advice, please :-)

[_freebird_]

New Methadone MMT patient Australia - desperate for your advice, please

Dear bluelighters, I am a long time lurker/always reading threads here as a valuable source of harm minimization (checking how much is safe with what etc) I hope I am posting in the right area with an appropriate question.


I am 26 and female and starting MMT on Tuesday once I pick up scripts etc. The permit has been applied for. The doctor tells me the permit will not affect me, future jobs etc but is this true? Has this come back to haunt anyone?


In all truth I feel very guilty about my current predicament and unsure whether my decision to go ahead with MMT is a good one or not. I would love to hear from anyone with the knowledge and experience to offer me advice.


For 1-2 years I have used heroin/whatever opiate I can get my hands on. I do not, and have not injected. Route of administration is snorting or smoking. Withdrawal symptoms seriously vary depending on what (#3 or #4 - close to pure or heavily cut) I have taken and for how long. The last 6 months - 1 year I've not gone without heroin or other opiates for longer than 4-5 days and that's extremely rare. Usually less than that say 1-2 days in between large binges.


In the last 3-6 months I have started taking methadone for "in between days" - I work and cannot afford to miss days due to withdrawal. My first few times taking it (unscripted) knocked me around at 30-35mg (assuming it is uncut) enough to feel "high" for at least 12hours. Now, at a higher dose of 50-70mg (still unscripted) I pretty well just feel normal or maybe a little drowsy and seldom euphoric.


My main questions are: Is methadone possibly too "strong" of an opiate to consider as treatment in my situation? I realize my unscripted use has caused me to be addicted to it as well as heroin but I am still very concerned about the long withdrawal - my withdrawals previously have been every symptom apart from diarrhoea and vomiting - does this mean I am not "addicted" enough to opiates in general to be considered for MMT? (Yes I was honest with my doctor about all usage however he has not taken any drug tests etc to "make sure" of what I am telling him)


How does one go about getting a dose increase? If my current source is undiluted etc (pretty confident it is safe) I already know my starting dose of 20mg is not enough to "hold" me - sure I won't be in terrible withdrawal but I will certainly be feeling uncomfortable along with severe cravings like my dose is wearing off before it should. Also, as mentioned I have a job - I am starting MMT to keep it and to prevent myself injecting - I'm sure if I keep going the way I am it would be the next step.


How long does it take for a doctor to give takeaways if I am doing everything right?

Thank you

Much respect
_freebird_

 

[Crankinit]

I am 26 and female and starting MMT on Tuesday once I pick up scripts etc. The permit has been applied for. The doctor tells me the permit will not affect me, future jobs etc but is this true? Has this come back to haunt anyone?

I'm not on methadone but I am on suboxone, and the major issue I've faced with it is stigma from doctors when I tell them I'm on it. Not all doctors have a negative reaction, but a lot of them do to some degree or another, I've had anything from just a bit of rudeness to judgmental and condescending rants, to prying into my drug history when it isn't relevant to assuming I'm trying to get drugs out them. Doctors who know will also be far less inclined - generally bordering impossible - to give you certain types of medication, namely opiates and benzos, should you need them in the future.

That said, doctors don't automatically know you're on ORT. There's no universal database for them to access, so they won't know unless you tell them, or your prescribing doctor does, or you allow them access to the records from your prescribing doctor's practice. I almost always tell doctors, both in the interest of full disclosure in case my drug history is somehow relevant to what I'm seeing them for, and because it gives a chance to assess the doctor and their attitude. But there's nothing which obligates you to do so.

As far as employment goes, I can't see it being a problem unless you work in healthcare, in which case it might be possible for employers or coworkers to access medical records (I'm not sure exactly how it ties into medicare and prescription authorities, and how much access certain officials in the healthcare industry would have to that info), or something like law enforcement or certain fields of government work where I imagine you'd be obliged to disclose it. There's no other way for an employer to find out you're on maintenance that I know of unless you tell them or they find out by accident, there's no database they can access like a criminal record.

In all truth I feel very guilty about my current predicament and unsure whether my decision to go ahead with MMT is a good one or not. I would love to hear from anyone with the knowledge and experience to offer me advice. For 1-2 years I have used heroin/whatever opiate I can get my hands on. I do not, and have not injected. Route of administration is snorting or smoking. Withdrawal symptoms seriously vary depending on what (#3 or #4 - close to pure or heavily cut) I have taken and for how long. The last 6 months - 1 year I've not gone without heroin or other opiates for longer than 4-5 days and that's extremely rare. Usually less than that say 1-2 days in between large binges. In the last 3-6 months I have started taking methadone for "in between days" - I work and cannot afford to miss days due to withdrawal. My first few times taking it (unscripted) knocked me around (not sure if I can say exact amounts or not?) enough to feel "high" for at least 12hours. Now, at a higher dose (still unscripted) I pretty well just feel normal or maybe a little drowsy and seldom euphoric.

...

- my withdrawals previously have been every symptom apart from diarrhoea and vomiting - does this mean I am not "addicted" enough to opiates in general to be considered for MMT? (Yes I was honest with my doctor about all usage however he has not taken any drug tests etc to "make sure" of what I am telling him)

You shouldn't feel guilty - addiction isn't something people choose, and if maintenance is what you might need to give you breathing room to get your life in a place where you don't need opiates to function, then I don't see anything wrong with at least trying it.

Your useage pattern is very similar to what mine was, and that of almost all of the other opiate users I knew back in the day (binging for a few days/weeks till the supply or money ran out, then getting sick or filling the gap with methadone/suboxone, then getting on again when more money/opiates were available, and rinse/repeat).

The image of the opiate addict who shoots up multiple times a day for months on end isn't an accurate representation of most opiate addicts, at least not now in Australia - you aren't somehow less of an addict because you aren't running around on the street homeless committing crime to stop yourself from going into withdrawal, and the whole purpose of ORT is to prevent your life devolving into that state.

IMO you sound like the kind of person most likely to benefit from ORT - you've developed a problem, you've recognized it as such, but it hasn't reached such a level that it's completely destroyed your finances and relationships and career and support systems (although I'm sure it's taken a toll).

I will post amounts in mg if I am asked/allowed.

You are Just not prices.

My main questions are: Is methadone possibly too "strong" of an opiate to consider as treatment in my situation?

Only you can answer that - of course strength is pretty relative, you just have to find a dose which makes you feel stable (kills the cravings and discomfort without making you feel sedated or buzzed). You've said you've already taken methadone, so you should have a good idea of the effects.

An alternative to consider if you haven't already is suboxone, it's a bit milder, it has a ceiling dose so you don't have to worry about constantly escalating your dose like some methadone patients do, has weaker side effects, it completely blocks other opiates, making it considerably harder to give in to spur of the minute cravings, and by all accounts it's easier to come off of than methadone. You could talk to your doctor about it or do some research online.

I realize my unscripted use has caused me to be addicted to it as well as heroin but I am still very concerned about the long withdrawal

The long withdrawal is a shitty aspect of ORT, absolutely, but it can be mitigated to a large degree by slowly tapering down once you've got your life in a better place, especially if you don't allow yourself to escalate the dose too much. Tapering isn't the cakewalk some people portray it as (I'm currently tapering off suboxone and finding it less than comfortable, and I know methadone is supposed to be worse), but it isn't debilitating either, you just have to take it at your own pace. It's certainly no worse than constantly chasing opiates while your life falls apart and going into withdrawal when you run out.

The biggest thing which causes people to end up "trapped" on methadone is dose escalation - patients who keep raising their dose until they end up in the 60 - 120mg range because each time they raise it they catch a bit of a buzz for a few weeks before stabilizing (the way you described getting "high" the first few times you took it, but now no longer getting that effect even on higher doses). If you avoid that and just sit on the lowest dose which kills your cravings and keeps you well, you'll have a much easier time of it.

How does one go about getting a dose increase?

...

If my current source is undiluted etc (pretty confident it is safe) I already know my starting dose of 20mg is not enough to "hold" me - sure I won't be in terrible withdrawal but I will certainly be feeling uncomfortable along with severe cravings like my dose is wearing off before it should.

That's between you and your prescribing doctor. It's probably something you want to discuss with them before you actually start the program - how flexible they're willing to be on dose and what kind of dose you're going to start with. Are you getting your prescription from a private doctor or a methadone clinic? I've heard a lot of awful stories from people about how clinic doctor's treat their patients in terms of controlling their dose and so forth, whereas in my experience and from what friends have told me about their own experience, private doctors tend to be much more flexible and understanding.

Also, as mentioned I have a job - I am starting MMT to keep it and to prevent myself injecting - I'm sure if I keep going the way I am it would be the next step. How long does it take for a doctor to give takeaways if I am doing everything right?

This varies from state to state, you should be able to find out online. I just hit up google and found this for Victoria:

Methadone Take-Away Doses
For the first two months of treatment, clients must attend each day for their dose. After this, if the client is considered stable, some take-away doses may be prescribed, see below for further details: ​

after two months of continuous treatment and considered stable (on the correct dose and not missing doses) – eligible for up to 2 take away doses per week

after six months of continuous treatment and considered stable (on the correct dose and not missing doses) – eligible for up to 5 take away doses per week

http://hrvic.org.au/pharmacotherapy/pharmocatherapy-available/methadone/

Again, depending on state, doctors are sometimes allowed a degree of discretion with TA's, if it interferes excessively with your life.

TBH I think a lot of these questions are things you should be having a frank discussion with the prescribing doctor about. They're the only one who can give you solid answers and having the conversation with them will give you a feel for how they'll treat you as a patient.

Good luck, whatever decision you make.

 

[spacemonkey]

methadone gets stronger each time you take it due its long half life. 50-70mg of methadone is quite a high dose.

I quit methadone about 9 months ago, and still get some RLS bullshit, I found methadone to be a lot worse for me then heroin except for the price, due to being overly depressed, still in withdrawals, heroin for me was an energetic high while methadone was a depressing one. Also I packed on a fuckload of weight craved sweets like a tub arse, gained unusual lumps in my tits, pretty sure it messed with my hormones, I literally lost all interest in sex.

methadone withdrawal was pretty fucked I didn't sleep right for around 4 months, but I did jump off @ 20mg because I had the shits with slight withdrawals from tapering.

All I'm saying is be careful and keep your dose as low as possible also try suboxone as an option in QLD you get more takeaways with subs then methadone.

All the best with it and just realize the Drs will say it will stop your cravings this is not true, you will get a dose that will make you stable for a limited time while you sort out your life, then the dosage will have to be raised to stave of withdrawals.

 

[chugs]

In all truth I feel very guilty about my current predicament and unsure whether my decision to go ahead with MMT is a good one or not. I would love to hear from anyone with the knowledge and experience to offer me advice.
_freebird_

Hi FreeBird

You really need to understand that what your going through is completely and utterly misunderstood. Even by the so-called experts. I would heartily recommend that you have a read of a post I made on this subject. I also explain a bit more over here

Essentialy what we call opiate "withdrawals" is not withdrawals at all. Its really hard to explain but basically the heroin/opiate that you take is simultanously making you high and is giving you what one could call "dope sickness". When you have your last shot the stuff that makes you high is metablised faster then then the stuff that makes you dope sick. Thus when the stuff that make you high (which is hiding the effect of the dope sickness) goes you're suddenly left with dope sick.....or what people call "withdrawals". Think of it this way. Heroin actually has two drugs inside it. One that makes you really high and one that makes you really sick. If Heroin didn't have the good shit in it and you shot it up you'd basically become dope sick immediately.

That's why its incorrect to call dope sick withdrawals. Why the focus on withdrawals is that dope sickness is the number one reason why we relapse, why we keep using and why we used in the first place.

This mechanism appears to be very sensitive in drug users i.e. we're always suffering from a low level of dope sick but we just don't know it because its a subjective experience thing...like if you saw the world in black and white you wouldn't really understand what colour is. That's why you have had an affinity to opiates. When in the womb/little baby your mother was subjected to a lot of stress which created a stress hormone which in turn changed how your brain developed....that's why calling drug use a choice is a fucking evil banality.

So stop feeling guilty for being sick. If you suffered from MS, or another disease would you feel bad because you were seeking to treat it? Our society pushes us into a wall when it comes to treating one's afflictions. Doctors and society think we're just lazy and want to get high. However outside of having a bit of fun I know that for myself and most opiate users most days are just about being normal and getting on with life.

Sure I want to get high on a friday night and kick back. But no I don't want to be high 24/7. Just dope sickness will fuck my shit up if I don't keep using.

I know you've just inducted onto methadone but I would strongly strongly recommend, if the methadone doesn't work out for you to consider asking your doctor to move you to suboxone/subutex. Its far more subtler/safer/better option to be on and using in my view.

Could you clarify one thing, what state are you in Freebird. Its quite unusual that you're already dosing at a chemist/takeways just after going onto the program.

 

[SixBuckets]

As far as employment goes, I can't see it being a problem unless you work in healthcare, in which case it might be possible for employers or coworkers to access medical records (I'm not sure exactly how it ties into medicare and prescription authorities, and how much access certain officials in the healthcare industry would have to that info), or something like law enforcement or certain fields of government work where I imagine you'd be obliged to disclose it. There's no other way for an employer to find out you're on maintenance that I know of unless you tell them or they find out by accident, there's no database they can access like a criminal record.

It's illegal and also against health department policy for any health staff member to look up the medical records of anyone when it's not directly related to their work. That includes coworkers, employers and HR. It definitely happens, but people can be fired and fined for accessing health records inappropriately.

Government and not-for-profit employers will often ask job applicants to complete a health declaration where you disclose any ongoing health conditions, historical health conditions that may impact your job performance, and treatment that you're taking, but it's not a legal requirement for you to disclose every medication you're taking. They say they take disciplinary action if you don't disclose a health condition, but I would say they'd be on very shaky ground legally if they tried to do so for something that had no impact on your ability to do your job. I'm not sure if commercial sector employers also have these health declarations as part of job applications.

The main situation I can see where you'd have to disclose during a job application is if the job involves driving or operating machinery - but the OP probably wouldn't be applying for them anyway as they tend to involve frequent drug tests. If you do work for an employer who does drug tests, they can't fire you for taking legally prescribed methadone, but they do test for it and will find out you're on it if you complete a drug test.

 

[Crankinit]

It's illegal and also against health department policy for any health staff member to look up the medical records of anyone when it's not directly related to their work. That includes coworkers, employers and HR. It definitely happens, but people can be fired and fined for accessing health records inappropriately.

Key words I've heard stories more than once from family members working in the medical field.