Opioids Sick While Starting Methadone - Oxycodone vs Fentanyl vs Stop Being a Pussy

[Oxy8_8]

Hi.
I'm on day 2 of methadone (day clinic) treatment for a 300mg/day (on average) oxycodone habit. Forced into treatment as I was caught out by my doctor on Monday, started at the treatment on Tuesday by order and refusal to continue an opiate prescription (ie this or cold turkey). I have acute pancreatitis, which is medically classed as being on an equal to, or greater than pain level than childbirth. So I can't live without a lot of painkillers. Yesterday I got given 35mg in (10,15,10) increments throughout the day (9am-4pm) after WD assessment (physical - sweating, vomiting/intestinal cramping, lacrimation, rhinorrhea, pupil size, BP). I told them I don't drink. They breathalyzed me. 0.00. I told them I'd test positive for opiates and benzo's. They made me do a piss test. I tested positive for opiates and benzos. I felt a little sick, cold and sweaty all evening and night but nothing too horrible. I took 1mg of alprazolam at night to sleep. I told them this morning so they knew to take into account my blood pressure might be lower even if I'm WDing.

Today I got 35mg methadone at 10am. 10mg at 2pm and 0mg at 5pm (despite telling them I felt pukey and anxious). Tonight I feel very sick, have diarrhea and generally shitty mood. And I'm not getting methadone for a minimum of 15 hours (more like 16) when I get there tomorrow.

I really want to have a small dose of opiate to stop the suffering but don't wanna fuck up and end up getting less methadone tomorrow (although if I have anything tonight, I WILL tell them what, when and how much). Small doses as I have methadone in my system. Would 20mg of insufflated OxyContin still be in my system and make a difference in 15 hours? OR a fentanyl (1.5mg/ml, 10ml in 140 sprays) nasal spray? Or should I REALLY just try hard and bear through it until tomorrow? Maybe take some benzos to sleep but no opiates?

Help a guy out? We all know how hard withdrawal/detox etc can be.

 

[Doody OD]

If you take anything tonight it will be in your system tomorrow. I don't know how they titrate doses in the UK but in clinics here they start people on 20-30mg and generally increase by it by 10mg per day. A person here is not expected to stay away from opiates until their dose of methadone stabilises them, if a person used the previous day they would not get a reduced dose the following day because of it.

Whilst any drug you take tonight will show up tomorrow, it will not be still active, so I can't see why the would give you less . However, you never know what strange rules some clinics have. It is over 20 years since I got methadone in the UK, so maybe someone else can give you more info. However, I would not spend the evening sick if I had opiates there, but that is me.

Best of luck with it.

 

[Oxy8_8]

If you take anything tonight it will be in your system tomorrow. I don't know how they titrate doses in the UK but in clinics here they start people on 20-30mg and generally increase by it by 10mg per day. A person here is not expected to stay away from opiates until their dose of methadone stabilises them, if a person used the previous day they would not get a reduced dose the following day because of it.

Whilst any drug you take tonight will show up tomorrow, it will not be still active, so I can't see why the would give you less . However, you never know what strange rules some clinics have. It is over 20 years since I got methadone in the UK, so maybe someone else can give you more info. However, I would not spend the evening sick if I had opiates there, but that is me.

Best of luck with it.

Thanks
Basically, they gave me 10mg first time first day but I got 35mg that day.
I got that 35 immediately today and added 10 later on so sounds the same as yours.
I get that 45 immediately tomorrow then get assessed every 2-3 hours to see if I need 5 or 10mg added.

They won't not give it to me, but if having "extras" keep me from withdrawing into tomorrow, I'll get less methadone in the afternoon due to the other opiates making me okay, so I'll be stumped on 45 again, whereas if I didn't have other opiates I'd be on 55 :/.
I could always exaggerate lol. I'll see how it goes. If I actually vomit or get cramping I'll take 20 or 40mg oxy. I'll tell them, though. I think they'll the mildly annoyed but understand.

 

[Mr.Scagnattie]

Methadone clinics are usually pretty understanding of patients continuing to use in the beginning to fight being sick until they are brought up to a high enough dose to eliminate withdrawal. The main thing to tell them is that you are still getting sick and need to be upped so you don't feel the need to use anymore, otherwise the entire thing is pointless.

 

[Doody OD]

You actually spend the whole day in the clinic, getting assessed at stage to see if you are in W/D? Is that correct? As Mr S stated most clinics understand you will use until you get a dose of methadone that stabilises you.

Is this a normal NHS clinic? I find that interesting. Here you will be see that day, given you dose and not come back til the following day when a person will be assessed again.

It can take months to stabilise, some never stabilise at all.

What dose do you think you will need?

 

[Oxy8_8]

You actually spend the whole day in the clinic, getting assessed at stage to see if you are in W/D? Is that correct? As Mr S stated most clinics understand you will use until you get a dose of methadone that stabilises you.

Is this a normal NHS clinic? I find that interesting. Here you will be see that day, given you dose and not come back til the following day when a person will be assessed again.

It can take months to stabilise, some never stabilise at all.

What dose do you think you will need?

I live in the UK and it's free so I'm positive it's NHS.

I go at 9am and get assessed usually at 10, 10:30 if they're running later. I get given the entirety of what I took the previous day (for example, I had 35 yesterday and then 10 later so I'll get 45 tomorrow morning). They check you every few hours (you can ask, if you feel really shitty, but they make you wait at LEAST 2-3 hours between doses) and add 10mg if you have a high enough "score". By score I mean they check how much you're sweating, pupil dilation, rhinnhorea, blood pressure, ask you to report any vomiting (you have to actually show them) and tell them any diarrhea or cramping.
Depending on you're score, they either give you 10mg or don't.

It's normally roughly 9 or 10am to 4 or 5pm.

They ask in the morning if you took anything overnight. They seem very neutral if you tell them yes. I was hoping for them to add more then 10mg a day. I was on 300+mg (up to 600) oxycodone every day so like 30 and 40mg methadone is waaaayy low for me. I'm gonna feel shit for a good 5 days or so more if they titrate that slowly.

I'm pretty tiny at 5"6 and barely 110lb (definitely under 8 stone) so they assumed like 50/60mg but I have a habit of up to 600mg of oxycontin a day WITH 0.5mg xanax 3 times a day and 1-2mg xanax at night. So people tell me I'm hardcore. From tjat I think I'll probably need like 90 or 100mg? I'm really not good at methadone conversion. I can convert any literally opiate to any other opiate by memory but can't seem to get a clear grasp on methadone.
I know it's stronger than oxy. But not whether it's 1.5 times as stong, twice as strong, 4 times? I dunno. Neither do the staff I guess or they'd just give me the correct dose from day 1.

 

[Doody OD]

Sadly most official recommendations suggest a max of 10mg a day, I know of individual docs who will go higher, but that's the official line as far as I know.

That sounds like a waste of time to me, it appears that you have enough of your own opiates to get by for a few days, is that correct? If so, I would just take them in the evening after you get your afternoon increase, until you get up to a dose that holds you.

Is there a max dose limit or anything like that there?

 

[Lightning-Nl]

I'd say get some loperamide to combat the withdrawal for today - then, once they get your methadone up to the right dose, get off of it. Loperamide is an over the counter opiate that is used for treatment of diarrhea, it can be bought almost anywhere.