Opioids After 2 years, I still can't figure out what's going on with my methadone dosing...

[Bomb319]

I am on a high dose of 220 mg which I take every day as maintenance. One of the reasons it's so high is because I had some surgery and medical issues way back that also greatly increased my tolerance...but I digress

My issue is that my daily dose has wildly different effects from one day to the next. These are definitely not psychological because I have objective symptoms of withdrawal on occasion as early as 18-24 hours after my last dose! Huge pupils and even the late-withdrawal symptom of sneezing fits are a good example. Yawning is always the first sign, and that can come infrequently as early as 10 hours after dosing. I'm always trying to use potentiation methods to help with this. I take high-dose Zantac several times daily to minimize stomach acidity, since that has a powerful effect on efficacy. I always take my dose on a stomach as empty as possible, and I take Diphenhydramine along with it; this is one of the more mysterious effects. Diph. doesn't just potentiate it by making me feel drowsier and enhancing subjective effects. I don't know how, but it appears to actually modulate the intensity of methadone itself - meaning that right before it kicks in, I can feel a sudden increase of purely opioid effects before the drowsiness kicks in. I also take clonidine, and quite a lot of it (up to 0.5 mg per day and sometimes more) mostly to help with the early withdrawal I often get because I metabolize methadone so quickly.

Even if I do all these things consistently from one day to the next, effects can vary dramatically. For example, the other day, I used these various measures as usual. Yet I could barely feel it kicking in after dosing. For the rest of the day, I felt as though I hadn't even taken anything (except withdrawals would of course been much worse if I hadn't). Yesterday, far from having the same experience, I was probably affected by it more than I have been any other time in the past year. I was actually high from it - coming on in strong waves all day as though I'd taken heroin. No joke. And that was without increasing my dose at all. I DID drink grapefruit juice the day before, but only a couple glasses of it and it was just from concentrate. If that was a factor, I could never have imagined it could produce such a powerful effect. At any rate, this wild fluctuation of effect happens constantly when I DON'T have GFJ or any other change in my routine.

If anyone can PLEASE provide insight here, I've been trying to figure out the answer and solution to this for literally years now. This is certainly the best place to ask, and everyone here is always really friendly and helpful! If possible, I would also REALLY love to know what the regimens are of other MMT users and which practices they have perfected to optimize their dosing. Thanks a lot!

 

[Bomb319]

OK, this is completely unprecedented. The end of the day is nearing and I haven't dosed since yesterday. Yet not only do I still feel completely fine, I'm still definitely feeling the methadone, and quite strongly, too! There have been days where I would have chills and nausea by now. I really need to know exactly what it is that's affecting this so much. Like I said before, I had quite a bit (one liter or two pints) of white grapefruit juice - but it was from concentrate and I drank it more than 2 days ago! It wouldn't cause such a strong effect over that length of time, would it???

 

[crzydiamond]

I would eliminate all of the potentiators, all the extras. I'm on methadone too. I have been on it before and successfully tapered. I have discovered that I have mild wd upon waking whether I dose higher or lower.

If you eliminate all the potentiators (except the stomach acid reducers as methadone is very affected by pH ), you will be better able to see what is the methadones effects. You can always add potentiators in at a later time, although honestly I wouldn't. Just take your dose. All that other stuff may be causing the fluctuations

Have you had peak/trough plasma level tests? Usually the peak is done around 3-4 hours after dosing and the trough is prior to dose. If you have a major swing you may be abnormally fast metabolizedr. There shouldn't be giant swings. I personally found that the higher my dose the bigger the difference between the peak and the trough and thus the worse I felt in the morning.

Everyone is different. But all the people I know who are stable just come in, drink their dose, and be on their way(or drink their tale homes at home), but they don't bother with all that manipulating and potentiating. Incidentally you can make your dose hit harder and faster but may wear off quicker. Or vice versa. I'd try to go back to baseline then go from there

 

[Bomb319]

I would eliminate all of the potentiators, all the extras. I'm on methadone too. I have been on it before and successfully tapered. I have discovered that I have mild wd upon waking whether I dose higher or lower.

If you eliminate all the potentiators (except the stomach acid reducers as methadone is very affected by pH ), you will be better able to see what is the methadones effects. You can always add potentiators in at a later time, although honestly I wouldn't. Just take your dose. All that other stuff may be causing the fluctuations

Have you had peak/trough plasma level tests? Usually the peak is done around 3-4 hours after dosing and the trough is prior to dose. If you have a major swing you may be abnormally fast metabolizedr. There shouldn't be giant swings. I personally found that the higher my dose the bigger the difference between the peak and the trough and thus the worse I felt in the morning.

Everyone is different. But all the people I know who are stable just come in, drink their dose, and be on their way(or drink their tale homes at home), but they don't bother with all that manipulating and potentiating. Incidentally you can make your dose hit harder and faster but may wear off quicker. Or vice versa. I'd try to go back to baseline then go from there

Thank you very much for your reply; I really appreciate it! I agree with you, and your advice is highly sound. The only problem is that once you get used to using these methods of potentiation, they are inexorably tied to the effect of the methadone itself - often to such a degree that withdrawal will occur. It happens especially hard with me, as I'm positive I'm a fast metabolizer. It's very interesting that you believe high doses are more likely to cause this problem, as I have thought this myself several times as well. However, when I DO succeed in fixing this, it's invaluable for work, socializing etc. and saves me a ton of problems. As I mentioned in my OP, I HAVE tried quitting those methods several times, but even after allowing time for my body to adjust, it just doesn't work nearly as well for me. Another issue is that there really aren't many things I even do regularly to potentiate - for example, the GFJ trick I only did one time (recently), although there is no doubt whatsoever that it was extremely effective. I can completely rule out placebo since I get physical w/d without doing anything, but this time it actually lasted nearly THREE TIMES as long!

Thanks again. I know there are lots of MMT users here, and I would really appreciate any other advice or sharing of experiences. Please. Thank you!

 

[crzydiamond]

You're quite welcome. I don't have any exact answers, just what my experience is.

Some things, like the GFJ, may work that well because you don't do it regularly

You always see the half life of methadone given as a very wide range (8-59 hours). Some of this is the individual persons chemistry and whether or not they have methadone built up in their system. However, much of it is due to methadone being very dependent on the body's pH. Have you done any research about methadone and pH? There is interesting reading there. pH drops overnight while sleeping, another reason I feel I always feel yucky when I wake up.

Your best bets for having methadone last longer and hit harder is to keep your body more alkaline. Also, inhibiting certain enzymes can help the half life last longer. You just don't want to mess up and have the methadone hit faster and harder but get "used up" sooner

Hope you are able to achieve a balance. Like I said, you should aim for not using potentiators but if you must, eliminate as many as possible so you can better see what the effect is.

 

[Bomb319]

Yes, I know about pH except I always just figured it referred mostly to stomach acid content when swallowing the drug. For this reason, I take a lot of antacids multiple times a day - usually Zantac since it's the strongest available, but is also subject to development of rapid tolerance (tachyphylaxis) after six weeks for unknown reasons. I still take it, and Tums when I can as well - lots and lots of them (hope I don't have problems from ingesting so much calcium).

I'm very intrigued over how exactly I can increase my "body" pH more generally. If anyone can PLEASE tell me how to do this, that may solve the problem once and for all because acid control does seem to both intensify my normal daily dose as well as making it last much longer. Only taking it on an empty stomach and possible the GFJ trick come even close. I still can get so sick, I REALLY need to know this please!! I know that another option is to take drugs that are PGP substrates, but I have no idea which ones or the dose and effects of such. I'm always hearing about how well Cimetidine (Tagamet) works, but as that is prescription only in Canada (right?), it will be literally impossible to get. Even if I could find a doctor to fill it (not the hard part), any pharmacist would warn me of a dangerous interaction and not fill it. In BC, we have a provincial program called Pharmanet, where every single pharmacy no matter what chain or company has a central database of every single person who has ever had a prescription drug, exactly what they had and which dates they were filled, etc. Anyone putting through a Tagamet Rx would almost certainly get an automated, red highlighted warning of a dangerous interaction. I would need powerful OTC PGP substrate drugs, the only one I know of being Imodium. It would be worth it only if I didn't need to take very many of them. At any rate, doing it this way is far more dangerous than subtly changing pH - especially while taking such a high dose of methadone. So once again, if ANYONE can please tell me the best, most efficient and cost-effective way to achieve a significantly higher pH, I would really be forever grateful!! Thank you Thanks again for your replies and help, crzydiamond!

 

[My3sons]

220 mgs is the highest dose I have heard of so far. Do you work? I cant imagine that you can be sick 10 hours after dosing. Your halfway point is the average full dose most people take. Maybe you are just taking too much. You need to have bloodwork done. Stop trying to potentiate, stop obsessing over every little ache, pain, twinge you feel, keep yourself busy and move on with life and trying to be clean from illicit drugs. it sounds like you spend your time analyzing every twinge and obsessing over how good you can feel off methadone. Remember you are supposed to feel normal not high.