Just to clarify, I never said he was taking too much. Of course you didn't say I did, but just to be clear, I never said, or even implied that.
I was talking to Welderman. I wouldn't presume to tell someone they're dose without at least having all available info. But nor would I encourage them to just indiscriminately increase they're dose.
What irritated me is that the OP made it very clear that he already is/was getting a buzz from his dose. So clearly his first response shouldn't be "just up the dose". However, it is sounding like he may very well have to consider that. But first, he needs to attack this problem from every angle.
Clearly the dose must be high enough, and as I mentioned in the Methadone Megathread, for MMT particularly, the maintanence dose MUST BE HIGH, regardless of tolerance.
OP, if you have any sort of interest in pharmacology, or if you are a fast learner, check out the Methadone Mega Thread, and read my last post. Not only does it help explain the pharmacological profile of the high-dose methadone used in MMT, but it may be relevant to your particular problem, possibly explaining(partially) how you initially get a "buzz" from your dose, but then subsequently feel like shit.
Just a couple questions though:
1. Did you only get a buzz when taking the cimetidine? And if so, what dose of cimetidine were you taking?
2. Do you feel fine initially? And then later feel like shit? If so, what is the duration? 6hr? 12hr????
But please, DO NOT RAISE YOUR DOSE, not yet. YOU WILL REGRET IT. Believe me, when I was in MMT I my tolerance got insanely high, and it took years to fix it. Not to mention that the WD is simply unbearable from high dose methadone; not only is it worse than coming off of a street dope habit, but it never fucking ends. At least for me, it didn't. It would have been impossible to go cold turkey from that, I would have killed myself if I had to through weeks of that hell.
Of course, sone people don't have a choice; they're tolerance is so high that they have to take that risk.
But yours isn't. So don't irreversibly alter multiple brain systems fur the hell of it. They're is an explanation for your problem, and we shall find it.
And for everyone saying "who cares if your tolerance is low, take as much as you want", that is sorry advice. It takes several days for methadone to reach steady state, so at least wait for that before telling him to flood his brain with an extremely powerful, long lasting opioid. Also keep in mind that the bioavailability of methadone is generally high, but also highly variable, ranging anywhere from 40-90%.
In addition, methadone is extremely sensitive to PH. So much so that even the half-life is PH dependent. As crazy as it sounds, a modest increase in urine PH doubles methadone half-life. And increasing stomach PH will maximize the oral bioavailability, and in some cases makes the BA 1.5-2x higher.
Methadone metabolism is complex, and also fascinating, and they're are countless ways you can manipulate it. All are viable options to try, before upping the dose, when you admittedly have a low tolerance.
Not to sound Korny, but methadone saves lives. However it can occasionally do more harm than good, and rarely, it even destroys them. So unless they are fully educated about every aspect of methadone, and MMT in particular, people shouldn't be giving advice about it. I don't go consoling people at Gambler's Anonymous meetings, ya know....
