Opioids Using other drugs while on maintenance? Safest way to go about it?

[trevic]

So, in a couple of weeks I'm going to be starting maintenance therapy. It's either going to be buprenorphine or methadone. I was also offered "buvidal" which I had never heard of before but is slow release buprenorphine as a weekly or monthly injection — this kind of scares me though, and I've never known anyone on it, so I think I won't go for that . I need to speak to the doctor and should be getting started on something that day. By the sounds of it I can choose which one I want to go for though the doctor may recommend something specific as I have existing liver damage, though they took my blood and my liver function is still normal, so all options should be available to me.

Anyway, I never expected to end up on maintenance, but at this point I think it's the right move for me for several reasons. The thing is though, in addition to my heroin habit I rather like GBL and pregablin. I don't do either with regularity, I did pick up a tiny dependence on GBL cause i was using it every day to try to get off the gear, but that failed. I tapered down over a few days since it was just a tiny dependency and now use once a week or so and experience no withdrawal or anything. I get scared combining downers, so currently when I do them, I smoke just enough heroin to push back withdrawal for a bit but not get me high (not that I can really get a proper high from smoking at this point anyway) and then three or so hours later I use, starting with a very small dose — 300 pregab/as low as .25ml G, then work my way up.

With meth or bupe though it's in my system for ages right? Would it be possible to still use these substances? Like let's say I go on methadone which is what I'm leaning towards, if I had the meth first thing when the pharmacy opens (luckily I live round the corner from one and can collect from there) I understand meth in the beginning can have a bit of a high. If I then used late at night, more than 12 hours after the meth or bupe, and was careful about my dose, would this be overly dangerous? Would bupe be a safer option to go with if I want to continue using these two things occasionally, particularly the pregab since I know it's only a partial agonist?

Should I wait until I get take home and take a lower dose that day since the pregab/GBL helps me ignore mild w/d? Does anyone else do this and have any input on how to go about this the safest way?

Thanks for any help with this.

 

[OpiumWhisperer]

Bupe is going to be the safest compared to methadone as its respiratory depression is substantially less. After a few months of being on bupe, the danger of combining with gaba drugs will lessen as your body adapts to the bupe. (That’s not to say you can throw caution to the wind)

Also in the US they only give you a few days of methadone each visit vs bupe you can get your entire month from one visit. I thought about doing methadone instead of bupe when I cleaned up my act and I’m glad I ended up going on it. Methadone withdrawal sounds horrendous compared to bupe.

Whichever you end up on I highly recommend getting your liver enzymes checked regularly. I’m a healthy young dude and after 4 years of bupe my liver is showing signs of minor distress.

 

[trevic]

Bupe is going to be the safest compared to methadone as its respiratory depression is substantially less. After a few months of being on bupe, the danger of combining with gaba drugs will lessen as your body adapts to the bupe. (That’s not to say you can throw caution to the wind)

Also in the US they only give you a few days of methadone each visit vs bupe you can get your entire month from one visit. I thought about doing methadone instead of bupe when I cleaned up my act and I’m glad I ended up going on it. Methadone withdrawal sounds horrendous compared to bupe.

Whichever you end up on I highly recommend getting your liver enzymes checked regularly. I’m a healthy young dude and after 4 years of bupe my liver is showing signs of minor distress.

Thanks for getting back to me! Yeah I guess I'm leaning towards the bupe then for that reason. When I spoke to my drug worker we talked more about methadone because that's what I was thinking I wanted to go for then, and she said at best I'd get twice weekly takehome and that would take awhile.

One thing that concerns me, and you might have insight on since you're on it yourself. With the methadone she said they'd start me on 10mg and increase by 10 each day until I'm in a good spot. She flat out acknowledged that I'd probably use on top of the low doses, as they likely wouldn't do much to even lessen my withdrawal. With bupe though, how is the process of titrating the dose up? Am I just gonna have to endure feeling like shit for a few days while they slowly raise it?

Yeah, I think both meth and subs won't be ideal for me to take with my liver damage, but I'm sure they're a lesser evil in that regard than heroin. The other two I'm not really too concerned about in terms of my liver health, as I know pregab isn't processed in the liver, and I couldn't really find evidence of GHB/GBL causing liver damage outside of chronic use and overdose.

Once I re-engage with the support I'm supposed to have for my liver, I'll be getting my liver function checked regularly anyway. My habit isn't massive though, so I don't imagine I'll need a huge dose, and I'm hopeful to stabilise for a bit and then begin titrating down and hopefully get off it relatively fast -- we'll see how that pans out in reality, though.

I'm guessing I'd be safer going for the daily bupe if I want to do this as well, right? So I can leave time between bupe dose and pregab/gbl? The injection, once I looked into it a bit, seems appealing in terms of not having to go to the pharmacy all the time even if it's close, but I wouldn't be able to leave a timegap with that would I, since it's constantly releasing slowly into my system. Maybe I could move to the injection down the road once my body has adapted to the bupe or something?

 

[ovo1024]

Lemme just say regarding the methadone, no they won't start you on only 10mg. By law, every patient must start on 30mg and now some clinics are starting patients at 50mg because so many new patients are Fentynal users. And they need a higher dose to have any chance of reducing withdrawal symptoms.

 

[trevic]

Lemme just say regarding the methadone, no they won't start you on only 10mg. By law, every patient must start on 30mg and now some clinics are starting patients at 50mg because so many new patients are Fentynal users. And they need a higher dose to have any chance of reducing withdrawal symptoms.

I dunno, maybe she was wrong, maybe we’re in different countries. She said tho that the doctor would say at the appointment that they think x dose would do the job and then I’d go up 10mg at a time with her checking in once I got close to the recommended dose to make sure I wasn’t overly sedated. She used a recommendation of 40mg as an example, perhaps if the doctor felt I needed more they’d start on a higher dose, I dunno.

This is in the uk, and was according to my key worker, not the doctor themself. Also don’t know if this is general procedure in the UK, or just this place — it’s one of the few drug places that’s still NHS tho so it’s probably the same across the NHS ones.

 

[OpiumWhisperer]

Thanks for getting back to me! Yeah I guess I'm leaning towards the bupe then for that reason. When I spoke to my drug worker we talked more about methadone because that's what I was thinking I wanted to go for then, and she said at best I'd get twice weekly takehome and that would take awhile.

One thing that concerns me, and you might have insight on since you're on it yourself. With the methadone she said they'd start me on 10mg and increase by 10 each day until I'm in a good spot. She flat out acknowledged that I'd probably use on top of the low doses, as they likely wouldn't do much to even lessen my withdrawal. With bupe though, how is the process of titrating the dose up? Am I just gonna have to endure feeling like shit for a few days while they slowly raise it?

Yeah, I think both meth and subs won't be ideal for me to take with my liver damage, but I'm sure they're a lesser evil in that regard than heroin. The other two I'm not really too concerned about in terms of my liver health, as I know pregab isn't processed in the liver, and I couldn't really find evidence of GHB/GBL causing liver damage outside of chronic use and overdose.

Once I re-engage with the support I'm supposed to have for my liver, I'll be getting my liver function checked regularly anyway. My habit isn't massive though, so I don't imagine I'll need a huge dose, and I'm hopeful to stabilise for a bit and then begin titrating down and hopefully get off it relatively fast -- we'll see how that pans out in reality, though.

I'm guessing I'd be safer going for the daily bupe if I want to do this as well, right? So I can leave time between bupe dose and pregab/gbl? The injection, once I looked into it a bit, seems appealing in terms of not having to go to the pharmacy all the time even if it's close, but I wouldn't be able to leave a timegap with that would I, since it's constantly releasing slowly into my system. Maybe I could move to the injection down the road once my body has adapted to the bupe or something?

Thanks for getting back to me! Yeah I guess I'm leaning towards the bupe then for that reason. When I spoke to my drug worker we talked more about methadone because that's what I was thinking I wanted to go for then, and she said at best I'd get twice weekly takehome and that would take awhile.

One thing that concerns me, and you might have insight on since you're on it yourself. With the methadone she said they'd start me on 10mg and increase by 10 each day until I'm in a good spot. She flat out acknowledged that I'd probably use on top of the low doses, as they likely wouldn't do much to even lessen my withdrawal. With bupe though, how is the process of titrating the dose up? Am I just gonna have to endure feeling like shit for a few days while they slowly raise it?

Yeah, I think both meth and subs won't be ideal for me to take with my liver damage, but I'm sure they're a lesser evil in that regard than heroin. The other two I'm not really too concerned about in terms of my liver health, as I know pregab isn't processed in the liver, and I couldn't really find evidence of GHB/GBL causing liver damage outside of chronic use and overdose.

Once I re-engage with the support I'm supposed to have for my liver, I'll be getting my liver function checked regularly anyway. My habit isn't massive though, so I don't imagine I'll need a huge dose, and I'm hopeful to stabilise for a bit and then begin titrating down and hopefully get off it relatively fast -- we'll see how that pans out in reality, though.

I'm guessing I'd be safer going for the daily bupe if I want to do this as well, right? So I can leave time between bupe dose and pregab/gbl? The injection, once I looked into it a bit, seems appealing in terms of not having to go to the pharmacy all the time even if it's close, but I wouldn't be able to leave a timegap with that would I, since it's constantly releasing slowly into my system. Maybe I could move to the injection down the road once my body has adapted to the bupe or something?

When you start the bupe you’ll have to wait about 24 hours after your last dose of full agonist opiates. This ensures you won’t end up in precipitated withdrawal from the Buprenorphine’s high affinity for the opioid receptors (it will rip off any full agonists opiates and insert itself to the receptor causing a horrendous acute withdrawal). Just use common sense and you’ll be fine.

Once you’re in the clear you can take as much bupe as needed. If you’ve been doing fentanyl you’ll likely need around 16+ mg’s per day. After about a week or two you’ll be smooth sailing.

As for using PreGab and GBL, your safest bet is daily bupe, not the shot. Once you’re ready for the shot (and not using GBL anymore), you can easily wean off the bupe.

I highly recommend looking into Ibogaine for when you’re ready to shut the door for good.