Opioids New Methadone Mega Thread and FAQ v 3.0

[kleinerkiffer]

v1.0
v2.0

From sixpartseven:

I decided to make this FAQ to be a companion to the buprenorphine FAQ phrozen created. With these two FAQ's, anyone considering some for of opioid maintenance will have two resources to use to compare and contrast the differences of the two drugs, helping them come to a decision of which drug would be better for them.

Some of the information contained in the FAQ was not authored by me. I have listed all the sources used at the bottom of the post.


Methadone FAQ

What is it?

Merck methadone information

Methadone is a full mu-opioid agonist. Methadone also binds to the glutamatergic NMDA (N-methyl-D-aspartate) receptor, and thus acts as a receptor antagonist against glutamate [1]. NMDA antagonists such as dextromethorphan, ketamine, and ibogaine are being studied for their role in decreasing the development of tolerance to opioids and as possible for eliminating addiction/tolerance/withdrawal, possibly by disrupting memory circuitry. Acting as an NMDA antagonist may be one mechanism by which methadone decreases craving for opioids and tolerance [2].

Methadone, a long-acting synthetic narcotic analgesic, was first used in the maintenance treatment of drug addiction in the mid-1960s by Drs. Vincent Dole and Marie Nyswander of Rockefeller University. There are now 115,000 methadone maintenance patients in the United States, 40,000 of whom are in New York State and about half that many are in California [3].


What is a normal dose?

There really is no normal dose. The dose required for maintenance therapy is highly dependent upon the dose of whatever other opiate you were using before getting on methadone. However, most clinics normally start you at a dose between 40mg and 60mg, and increase by 5mg or 10mg every day or two until you get to the required dose.

The most common and traditional dosing regimens, however, tend to fall far short of providing optimum or even sufficient results for a number of patients. This is due to the ceilings many clinics place on dose levels [4].


What are the withdrawals like?

The withdrawals from methadone are similar to every other opiate, although they have been reported to be much more severe if the dose is too high when the patient cuts off usage. Physical symptoms include nausea, sneezing, vomiting, diarrhea, sweats, chills, joint pain, elevated blood pressure, fever, runny nose, and increased tear production.

The psychological symptoms can include depression, anxiety, paranoia, panic disorders, delusions, decreased sex drive, prolonged insomnia, and fatigue or exhaustion.


Is there a ceiling dose?

No. Your dose of methadone can be increased as high as it needs to go. One thing to consider when that starts to happen is maybe entering a detox program to get your dose back down and possibly even taper off of it completely.


What is methadones bioavailability?

The bioavailability is between 40 - 80%, with a half life of 24 - 36 hours [5]. The Wikipedia article has it listed as 40 - 90%, and more than one other source, including Bluelights own thread on bioavailability, have put it closer to 80 - 90%.


Other Notes:

Methadone is Schedule II in the US.
It is metabolized by the enzymes CYP3A4, CYP2B6 and CYP2D6 [6]
Half-life: 24 - 36 hours
Drug Test: Not detected in standard 5-panel test, but can be tested for.


I took the FAQ portion of phrozen's buprenorphine FAQ and copied it, adjusting it to pertain to methadone, so credit goes to phrozen for the layout, questions, and some answers that went unchanged.

Q: How long after my last methadone dose can I take an opiate and feel its effects?
A: With methadone, the higher the dose, the more heroin it can block. It also depends on how long you have been taking the methadone. Wait at least 24 - 36 hours before trying to dose another opiate if you want to be sure you feel the full effects from it.

Q: Is methadone a good replacement for buprenorphine?
A: Maybe. Some people with a high enough opiate tolerance may not be held by bupe at any level, even at the highest(ceiling) possible dose. Methadone does not have a ceiling dose, so your dose can be raised as high as it needs to be raised to make up for tolerance. You should research both before deciding what to go on, as they both have different positives and negatives in regards to their use.

Q: I'm thinking about switching from bupe to methadone. At what bupe dose should I be when I switch?
A: Switching from bupe to methadone is MUCH easier than switching from methadone to bupe. The latter means you would have to taper your dose of methadone down to around 30 - 40mg before making the jump. Going bupe to methadone, you dont have to get your bupe dose down, because again, methadone does not have a ceiling and the dose can be taken as high is it needs to be taken to compensate for tolerance.

Q: Will I still have cravings on methadone?
A: Its possible, but since methadone is a potent mu-receptor agonist, generally the cravings will be well taken care of. But, if your dose isnt at the exact place it needs to be (too low), you may experience some cravings.

Q: Is methadone good for depression/anxiety?
A: Just like any other full-agonist, it can cause depression. And again, like other full-agonists, it will help ease anxiety.

Q: Is it safe to shoot methadone?
A: No. It can cause many of the same complications as shooting other pills. The best advice is to use a micron filter if you absolutely must try to shoot. If you get liquid methadone from the clinic, you should most definitely not shoot it. The sucrose and syrup contained with-in are horrible for your veins.

Q: Is methadone recreational?
A: Yes. It is a full mu-receptor agonist. Someone using methadone for maintenance purposes may not be able to get high from it unless they take a very high dose, but for someone who is not on maintenance and has a somewhat low tolerance, it is perfectly recreational.

Q: Can you overdose on methadone?
A: Yes you can. Methadone is very potent and very easy to overdose on. Be careful and always start small.

Q: Can I still get high on other opiates if I'm on methadone?
A: Yes. You can "shoot through" your dose of methadone with a larger amount of your prefered opiate than normal, but the risk of OD is huge in this scenario. Its best to wait 24 - 36 hours, that way you can feel the full effects of the opiate without risking a massive OD.

 

[natalie71]

Hi i am new here..and i am in NEED OF ADVICE, please!!
Background: i have used opiates for about 20 yrs-im ashamed of that timeframe.
But anyhow I started with vicodin, percs, norco, advanced to old oxys, H-smoked & iv'd, also went on a speedball binge for a cpl yrs, iv demerol, iv morphine, dilaudid iv/pills, roxys, and for the last 4.5 yrs i was on roxy blues 4x day & started at 80 mg methadone scripted by my pm doc.
I have severe migraines to which i have used to the hilt to get lots of great meds..only problem is that in the last year or so, as you know, the damn FDA & DEA have scared the crap out of my pm doc & 95% of other docs to severely drop patient dosages of opiates or even just cut them off!! Soulless creeps!!!
I would lauch into some great curse words for them all, but im new here, so i'll try to maintain. But of course u all know what i mean.
So LONG STORY LONGER...I AM HERE SUFFERING & NEED INPUT PLEASE!!!
Last thurs, 5/19/2016, i got my methadone dose down to 20mg/day & last took it late morning..
Then bc everyone knows done w/d's are EVIL, i smartly thought i'd take a short acting opiate for 5 days then switch to the 5 Subutex 8mg pills & 2 suboxone strips (8mg) I got to ride out the remainder w/d's & jump after that so i'd avoid most of the rest of the w/d's w/o getting used to the subs.
So here i am almost a whole 7 days later since my last methadone dose & i feel horrible!!
But it wasnt supposed to go this way...bc when i stopped the done, i took 9 8mg dilaudid pills a day for 5 days, waited in hell for about 27 hrs till i was a score of 28 on the COWS scale then started taking the subutex...i broke up 2 pills into 2mg pieces bc i wanted to take the lowest dose possible. So far ive taken about 14mgs & im still hurting bad.
Im also taking kolonpin-ive taken it for cpl yrs & Xanax-I've been on 4mg/day of that for 10 years...both are barely making me feel sleepy...oh & I'm taking 600mg ibuprofen-I've taken four. Those are from my elderly mom..boy i feel great all around!!

PLEASE SOMEONE HELP ME OUT. Do i need to take some more Subutex? Maybe i need an induction of 16mgs or more?
I only have limited resources for the subs, so i want to be able to conserve. It sounds silly, but i haven't thought about my amount of drug use in a long time, and typing it here makes me feel pretty lousy. I've wasted alot of time high & chasing my high..
Oh boy here comes the depression too!!
*SIGH*

 

[crzydiamond]

Well, I had tried in your other thread to strongly suggest further tapering the methadone before attempting this (as when done slowly is not painful). But that's water under the bridge now as you've been off methadone for 7 days. There is no point in going back , so going forward ...

It may take a day or two for your body to fully adjust to the buprenorphine. It's not always an instant relief, although with a high score on the COWS scale one would expect some relief. Are you really sick Or are you not sick but not feeling great? I mean, subs are only a partial agonist so it's not going to feel all warm and fuzzy.

The thing is, you have already taken plenty of bupe. So now you're going to have to stick to that route. Honestly, I would say you probably still had some methadone in your system. Plus you're not figuring the oxy into your tolerance. So I think you didn't stay on a short term agonist long enough (only 5!days) after switching from methadone. So now it's going to be a waiting game---waiting until the bupe is able to hold you. So you're going to have some shitty hours of feeling like dirt.

But hang in there. Soon as your tolerance drops to the level bupe can sustain you'll feel better. It's usually only a day or two. Keep taking bupe--i would suggest 4 mg am and 4 mg pm---for the next few days. Once you feel better, start dropping the bupe dosage. Once you're stable, a bupe dose can last up to 3 days so near the end of taper you can go to every other day to conserve


I know it's easier said than done, but at this point you have to just hang in there. But if there's ever a next time, listen to the people who've been there who try and give you pointers on slow tapers! In your other thread the one poster gave you a long detailed plan that would've avoided all this...

You should feel somewhat better tomorrow

 

[natalie71]

crzydiamond-thank you so much for the post & your other great post, i know i know i didn't listen, but darn it i wanted off that damn methadone SO badly.
It put weight on me, made me sweaty and worst of all was the constipation!! Good Lord!!

For now i am hanging in there, i cant go back..i just wont. I am over it!!
I kicked many things in younger days, but being the age i am, i am still young enough to (hopefully) avoid many long term health problems and i am blessed to have a decent life.

I have had a difficult cpl years: my mom went into assisted living, and i have no other family. I luckily have some awesome friends and a bf who truly cares for me and wants to move forward in life together. But i know i cannot move forward chained to that methadone crap!

I did call my pm doc and he's going to call in a clonidine script tmrw, which i know will def help me out. So i am being less stubborn and heeding advice.
These w/d's are really bad...that drug should be banned. It is obviously a lifetime commitment when u get on it, which my old pm doc never truly explained to me.
As i have said, these docs have no clue about the crap they prescribe. My pm doc now had told me he could taper me in a week & i should take warm baths and drink milk!! wth?!!
It should be mandatory for all med school students to go thru opiate w/d's..ha ha...then they will have real knowledge, respect and compassion towards their patients!

I'll keep posting, esp when the "fog" and pain start to really clear.
Take Care!

 

[natalie71]

So i guess im alot more angry of a person & inpatient..i am too lethargic to do anything & too awake to sleep...ughh...
Music has always helped me to chill, so i downloaded a bunch of songs & i was shocked that i figured out how to sync them from my Ipad to Iphone...my brain feels fried!!


Anyways, my bf who was very supportive of my quitting this crap..even tho he smokes dope himself...yes, yes i know that is NOT good for me now..but it is what it is. Actually he's all pissy bc he was late to pick up & his connect blew him off & wont take his calls-hahaha
I told him thats a sign for him to stop too. But of course, since mine is a pill habit-which he thinks is worse bc im living off savings & he works w/out any problem...ya for the last year or so.
We all know how that'll work out

Its an ungodly hour when i used to be blissfully calm & sleeping away...this just sucks.
I know that i'm gonna need some sort of pain meds for my migraines, i cant take drugs like Imitrex or any other triptan migraine drugs. I tried three, felt like i was having a heart attack. I have a bad family history of heart issues-my dad died at just 60 from an attack & so did 2 of my aunts on my dads side.
So i've been stuck trying all sorts of other meds to control them, God they are awful. They have me in bed for 2-3 days, BUT @ least i felt good then

 

[natalie71]

Well...another 3 hours of sleep last nite, woke hot as heck & with a headache..
I called my pm doc & left an urgent msg. for him to call me, and said I needed a script for clonidine..geez Im seeing him next Friday.. But the office staff said they put a note & he'd call me at 5-6pm tonite...he has a cpl question. For God sakes, I'm not asking for 100 morphine, just damn clonidine!!

Well here it is about 6:45 on a fricken holiday weekend!!
I know the doc & staff locked the doors @ 5pm exactly & got the hell outta dodge!!! Grrrrrr...assholes.
Oh and besides the Monday holiday, the office is always closed on Tuesday..so I'm not getting any clonidine!! DAMMIT!!

Gee thanks my caring pm doc!! But i suppose AGAIN its my fault..I shoulda called on Mon/Tues..
Shoulda/Woulda/Coulda

 

[natalie71]

Now thanks to pm doc feelgood/dont give a f**k..i have swim looking high & low for clonidine..
So far its been easier to find speed, dope, & some coke...

This is ridiculous!!!!

 

[Bliss26]

Hang in there Natalie, you're doing great!

I'm on day 2 on a quick taper.
Have you ever tried Lyrica and T4 for WD? They as a combo take away 100% of WD symptoms.

There is always some asshat here who points out T4= Codeine =opiate so ofcourse it works. But, you can halve your dose and still get relief, and codeine is perfect for a quick taper because it's 1) easy to get and 2) takes away WD but no fuzzy feeling so no incentive to take more than needed

 

[Bliss26]

Even if you can only get one of T4 (codeine) or lyrica, it'll take at least half your WD away and be easy to quick taper.
And I'm coming off 200mg oxy or 5x 30mg dilaudid a day

 

[natalie71]

Bliss 26: thank you so much for your input...i appreciate every bit of info i can get.
swim was able to finally chase down five 0.2 clonidine at about 11pm last nite..when i got them, i immediately took a whole one & in about an hour, i felt SO weighted down & weird.

So i climbed onto my couch, fell asleep for about 4 hrs & woke achy & thirsty as heck-no biggie there, i just drank a bottle of water..
Anyhow now its a little b4 8am & i took a half of another clonidine BUT now i cant sleep..i just feel super lethargic & i have pains all over, you know how it is..

I was trying to find info about Subutex bc I've now been taking it since early Thursday in my feeble attempt to take it for like maybe 5 days to get over the worst part of the methadone wds..what a frigging mess!!
So Ive taken almost three 8mg subutex since early thurs., & now its early sat...why in the heck do i still feel wds??

I was in an inpatient detox & they gave me suboxone for a short time to come off hydros/& occasional H. It MUST be the fact that was yrs ago, and this time i was on methadone for 4.5 yrs...dammit im so angry at my old pm doc for starting methadone- i had done all the opiates except fentanyl, and i would kick for 5-7 days & yes it sucked, but not like this!!!

I SO SO badly want to stay off that crap...i gained 30 lbs, was constipated horribly (i know opiates all do that, but w/others, i never went for longer than a cpl days..with the methadone poison, i suffered for up to a week & then went thru hell w/enemas etc-SORRY TMI there) but it is what it is..
The last week i took that garbage, i honestly felt like i was taking poison each time-I WAS ACTUALLY!!

Sorry for the rant, I am just hoping & praying that when i stop the sub in a day or two, i will feel ok w/some more clonidine & vitamins etc.Maybe i approached this all wrong..but my pm doc is an idiot-said he could taper me to 0mg in a week!!! Wtf??!!
And to add to my misery, ive had awful insomnia since my dad passed when i was 22, so i take xanax already, so thats not helping plus my new shrink is a dick-whole other story..

I just dont wanna end up totally losing it 5150 style. Nor do i want to upset my elderly mom, who already said that it looks like im headed back to detox/rehab
Im not old, but not a 25 yr old either...
This just sucks...hopefully today will be better.

 

[jayjaysleepyhead]

Sorry im new not being selfish but i am going through a spell of staying in bed especially last 3 days getting up to do the toilet and occasional snack some tv still on my bed could this be methadone related or could it be my very slow diazepam dettox kicking in now ive went from 20 mg to 4 mg doing 2 mg reduction every month its taken 7 months with no real withdrawls had a 25 yr habit i wonder is this bed ridden mood and sweats got anything to do with that or is it the 45 mls of methadone just making me lazy i dont work have little money luckily everything is free in britain if you are on the sick pay as its called here its too easy really hence the fact half of eastern europe lives here. Thanks

 

[jayjaysleepyhead]

Hi crazy diamond please take it from someone who almost died forget about the real drugs you really got to watch your iburofen intake i tell you why as quick as i can i basically was given them paracetomol and an antibiotic to take daily afer losing two teeth i ended up in hospital after taking 12 iburofen in 24 hrs plus my paracetomol and antis i had this untakeable pain in my stomach and back ended up in A&E got a ct scan was told due to too many iburofen i had a massive hole in my stomach and would need proper surgery asap that night i was under the knife for 3 hours asleep thank god they repaired me as i was internally bleeding i got lucky all due too a few too many bloody iburofen it took me 2 weeks hospitalized to recover it scared the living hell out a me and i dont scare easily as ive seen it all so please dont underestimate the power of those horrible painkillers

 

[Ignio]

How long can a methadone solution for oral intake keep its potency?

The only thing I know is that it is conserved wit 0,11% Caliumsorbat.

Do we speak months? Years?

 

[kleinerkiffer]

....

 

[CfZrx]

Methadone improved my quality of life by 10,000%. Mixed with weed and kratom it has killed my severe pain.

 

[ElabR8]

Question why you are using and why you relapse?Withdrawals are mind over matter,you have to be in control.

 

[MMT]

Question why you are using and why you relapse?Withdrawals are mind over matter,you have to be in control.

And you know this how ?

 

[Ignio]

Nothing about how long liqiud methadone can be preserved without loosing potency?

 

[adder]

It isn't a reactive compound so it should stay good in a syrup for a long time if it's kept in a dark place.

 

[Ignio]

Okat thank you adder