Questions on methadone maintenance.

[Jaydeexo]

Hey guys! I'm new to this site and have no idea how it really works but I was just trying to get as much advice as I could about MMT as I just started dosing last week. I have been a heroin user for 4 years, IVing about a gram or a little more a day. So I've decide to kick the habit. Unfortunately the only way I've been able to not use is by starting a completely new habit with methadone, but it is working and I am grateful. My only problem is I'm still waking up sick. I dose everyday at 35mls around 9am. By around 10pm I'm already starting to feel crappy. Then by the time I wake up around 7 am I'm in full blown wds. Is this normal? Does this mean I have to go to a higher dose? I was trying to keep my dose as low as possible so that I could taper down eventually and it not be as hard as it would be if I was on let's say 120mls. But I was also under the impression that it lasts for 24 hrs and that definitely is not the case IME. Any advice on this subject would be greatly appreciated!

 

[Jabberwocky]

It sounds like you haven't stabilized on the medication yet. There are two ways you can do this. The first is harder and requires you to stick out the low dose until your body gets used to it. I do not recommend that. You are probably better off slowly increasing your dose 5mg a week until your dose holds you a full 24hrs.

It is best to stay as low as possible, but the right dose for you is the right dose for you. You cannot judge what is the right dose for you by what other people are dosing at, only by whether it keeps you from getting sick for 24hrs or relapsing. Generally people benefit from a dose of 60-80mg who have a habit as significant as yours, so 35mg is still fairly conservative.

Once you have stabilized and are feeling comfortable again you can, if you are ready, begin to slowly decrease your dose back down to 20-40mg as it feels appropriate so that when the time comes to get off the stuff, if that is what you want, it is easier to handle. But a high dose isn't necessarily any harder to get off than a lower dose, it just requires a longer time commitment in order to taper properly.

Methadone is a big commitment. Congrats on making this healthy, positive step in your recovery! It won't be easy, but as you have already begun to find methadone can be so very helpful in catalyzing the recovery process.

 

[d3athadone]

stay low man. your gonna feel like crap for a couple of weeks or wahtever from now but its worth it. U can go up if u just dont care, but if u wanna get off at some point u might as well stay low.

 

[Jabberwocky]

If the OP feels he is in danger of using opioids or other substances on top of his dose if he doesn't increase it, then increasing it temporarily, with the intention of going back down as soon as he has stabilized, is the more skillful decision than toughing it out and risking relapse or another habit.

 

[d3athadone]

Yeah being on methadone and junk sucks. I remember when I first got on methadone I met a bunch of junkie friends and we all used together for years. We would meet up for some dope and just yak and yak. I guess part of it was nice thats why we did it but in retrospect those people were not my friends at all. It wasn't any everyday thing. Just like here and there. Its a waste of time. After that I got serious with my methadone and just cut out the dope and got used to going down. Come to think about it. I was at like 70 or 90mg when this shit was going on. Anyway I went down to 1 mg and was at like 1mg for a month or two before i jumped off. I went down super slowly at the end. It sucked, but a lot of the time it was fine. It took me 4 years to get off that shit. Don't make the same mistake I did. Make sure your life is in a really good place when you get off. Even if its just 1mg. That 1mg is keeping you sane. Get life together to a lvl of reasonable normalcy then get off. Cuz I relapsed when I got off it. I was just being stupid. Then dope took another 4-5 months of my life and I'm just now 2 weeks clean.

 

[cj]

You need to keep raising your dose until you can go 48 hours without getting sick. The reason I say that is because you will eventually miss a day of dosing from waking up late, traffick, car trouble ect. When it happens you don't want to be sick and scrambling to get your DOC. I had a similar habit to yours and didn't stabilize until I got too 100mg. That had the added bonus of being a blocking dose so I couldn't get high even if I wanted too.

 

[Jabberwocky]

That is exactly the point. Methadone is a huge commitment, and if not used properly it can cause a lot of pain. But when used properly it is probably the best treatment for opioid use disorders in America right now. Granted, it is really hard to use it properly given all the clinic bullshit, but it can be done. I mean, if I can do it more or less right, anyone can.

Getting the dose right so that it satisfies your cravings is key. So is finding the psychosocial support necessary to promoting an atmosphere of recovery in your life. For some that may be 12 step communities, though I find them really oppressive and alienating for people utilizing ORT. Other organizations like Against the Stream and Refuge Recovery, as well as local community institutions like the Mindful Awareness Research Center in Los Angeles that are more accepting and supportive I find infinitely more helpful. And finding a good therapist you feel safe enough to get vulnerable with is crucial to a meaningful recovery.

 

[cj]

Methadone maintenance has absolutely saved my life. I was addicted to H for 8 years and tried every other kind of treatment offered in the US with little success. I haven't used H in 17 months thanks to methadone. The clinic certainly has its bullshit but its nothing compared to the bullshit of buying H illicitly. I always say that its all good as long as I don't have to wait in a ghetto ass parking lot for hours waiting on my dose.

My advice is too continue raising your dose until your not waking up sick or having cravings. Start taking miralax everyday to soften your stool and stay regular. Then evaluate how you feel in 6 months. If you still don't like it at that point then get back on heroin. The thing to remember is that heroin isn't going anywhere. But if you can make this work your life will drastically improve.

 

[Jaydeexo]

Thank you so much for all the advice you guys. As of right now I did go up on my dose. I'm currently dosing at 45mls and I definitely see a difference in the time it takes for me to start feeling sick again. I've also noticed that when I do start getting sick it isn't as intense as it was before. I haven't used heroin in 9 days now which is amazing. But the cravings are still there. So far dosing has been a life saver for me. I am a 5'2 130 lb female and hoped that factoring that in would also help me keep my dose as low as possible but I see now that it seems the amount I was using has more of a factor than weight and height. I've come to terms on going as high as I need to take away cravings and sickness. I just know that I do not want to be on maintenance for the rest of my life. But I do know at the same time that if I wasn't on it I wouldn't have stopped using in the first place. It's a very touchy subject as well in my outpatient treatment center that I enrolled myself in. They see it as I'm not actually clean and that is ok. As long as I know that it is saving my life I guess that is all that matters right now.

 

[d3athadone]

^ At the end of the day you are still on an opiate. So I see that argument, but It saved my life at one time too.

 

[cj]

Thank you so much for all the advice you guys. As of right now I did go up on my dose. I'm currently dosing at 45mls and I definitely see a difference in the time it takes for me to start feeling sick again. I've also noticed that when I do start getting sick it isn't as intense as it was before. I haven't used heroin in 9 days now which is amazing. But the cravings are still there. So far dosing has been a life saver for me. I am a 5'2 130 lb female and hoped that factoring that in would also help me keep my dose as low as possible but I see now that it seems the amount I was using has more of a factor than weight and height. I've come to terms on going as high as I need to take away cravings and sickness. I just know that I do not want to be on maintenance for the rest of my life. But I do know at the same time that if I wasn't on it I wouldn't have stopped using in the first place. It's a very touchy subject as well in my outpatient treatment center that I enrolled myself in. They see it as I'm not actually clean and that is ok. As long as I know that it is saving my life I guess that is all that matters right now.

That's great news! Don't let the outpatient place talk you into anything your not comfortable with. At the end of the day those places are more married to there own program then they are to you staying alive. This is life and death after all. Statistically people who stay on methadone for two years have a better outcome then people who stay on it for less then 2 years. Once you get your life stabilized and want to come off you can start a nice slow taper to accomplish that. The fear of getting stuck on methadone for life is more propaganda then reality from what I have seen.

 

[My3sons]

Besides, I'd rather be "stuck" on methadone the rest of my life than to ever go back to active heroin addiction. I literally wiped out my entire retirement account from that garbage "over 100,000," stopped paying bills, temporarily lost custody of my kids.... the list goes on... I will be on methadone one year next month, caught up with all my bills, aside from the money I owe the IRS from early retirement account withdrawal, have my kids back, and live a 100% normal life now. In my opinion comparing a life on dope or methadone is like comparing oranges with rotten apples!

 

[Jabberwocky]

Well said.