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  • BDD Moderators: Keif’ Richards | negrogesic

Opioids always wondered what determines what maintenance you receive ( methadone vs bup )

Zonxx

Bluelighter
Joined
Apr 28, 2019
Messages
2,860
if dawn ever sets on me and forces me to go for maintenance at some point in life, what determines what they give you? ive never taken bup but methadone didn't really feel as great as morphine or oxy but it did the trick to keep wd at bay to say the least
 
Duration of time intended to be on opioid replacement therapy and size of opioid addiction (if both are large, then methadone may be superior).

I was on 380mg/day of methadone for a few years and have generally been able to avoid any serious opioid addiction since i tapered myself off of it years ago...

This is not that common however as doses that high are generally associated with much longer term use, but my case was not complicated by chronic pain issues. Methadone at high doses will get you high in high doses in ways that are not possible with buprenorphine, but the withdrawal is both severe and protracted, so don't get on it unless you plan on being on it for years.

Basically i got bored of being high, which might not be the case for alot of methadone recipients as most clinics will not permit doses similar to what i was taking...
 
I think that in a lot of locales, methadone maintenance is given to patients with a diagnosed chronic pain condition . . . in the US and other places where the regulation is similar, the fact that Suboxone can be handled by a GP means that if a client is seen to be not as far gone as some of the more advanced cases, Suboxone is the choice . . . I have also heard of chronic pain people who got the physical habit we all get but had coloured outside the lines a bit in some way who were given plain buprenorphine in tablets or patches as their chronic pain medication and are treated and carried on the books as a chronic pain person rather than an addict, which is true they are an iatrogenic habitué . . .

The modus operandi in a number of Continental European countries appears to be estimating the client's habit, then putting them somewhere on a scale which is usually ER tramadol tablets, ER dihydrocodeine tablets, ER morphine capsules or tablets, hydromorphone ER tablets and a polymer implant in at least two countries, and methadone and/or levomethadone is both on this continuum and used like it is elsewhere to varying extents, with Suboxone being available to the prescribing doctor to be used in any of a number of cases like methadone intolerance, severe pain, and so on . . . the fact that very few countries actually have a legal legacy of an act of Congress making it illegal to treat addicts (Harrison Narcotic Act 1914) and the government ignoring court cases which countered this, there are the case of European and Canadian doctors, amongst others, who give habitués and addicts their drug of choice or a close analogue, with hydromorphone, oxymorphone, and morphine being common. Heroin on prescription appears to be given, at least in the earliest-starting programmes, to people who relapsed severely on methadone and/or suboxone maintenance.

Certain countries also have other drugs they have tried -- I think the UK still may have dipipanone addiction clinics which use a liquid concentrate, Taiwan also has very high dose propoxyphene liquid concentrate available, and China uses another bridged oripavine derivative, dihydroetorphine, alongside buprenorphine, There have been trials of dextromoramide, piritramide, heroin, and morphine injection and/or SL tablets to deal with cravings in some country, and tramadol maintenance folks often get a pump bottle or dropper bottle of tramadol liquid. I have heard of oral tilidate, Perduretas (100 mg codeine HCl ER tablets) meptazinol, and Load/Dors & Fours (Codeine tablets plus Glutethimide tablets) used experimentally.

If some places cannot do heroin prescription because of politics and stigma, there are always nicomorphine, dibenzoylmorphine, acetylpropionoylmorphine, dipropionylmorphine, diacetyldihydromorphine, and an especally useful one if they could make 12, 15, 18, 24, 36, and 48-hour tablets and capsules, a 7-day liposome shot for the arse cheek of it in addition to plain tablets, effervescent tablets, and pre-loaded syringes -- acetylmorphone
 
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Here, at least, they always try methadone first unless there's a clinic reason not to or the patient is strongly against it. Other than that they pretty much outright ask you which you'd prefer.
I hated being on methadone, so I'd always advice Bupe. Methadone shot my tolerance right up, I gained 30+ pounds without any exercise or dietary changes and I would sweat constantly. In summer, a two minute walk would have me soaked (big sweat patches on my clothes and I could feel loads running down my face, back, neck and thighs).
 
Racaemic methadone, the form used for OST everywhere except Austria and Germany (which use levomethadone by default, and I think the Benelux and Scandinavian countries technically are able to use either and if someone in Austria or Germany insisted on methadone rather than levomethadone, they may be able to get it there too) can lead to QT interval prolongation because of the non-analgesic dextromethadone component, so people in various risk categories related to that are put on Suboxone in the US and the first line choice in a number of other places for those people is ER morphine.

Anyone worried about methadone screwing up their heart can read up on the patents and journal articles, as the pigeons on the Kärntnerstraße told me that the stereoisomer resolution is one of the simplest in organic chemistry -- well down into the range of kitchen semi-clandestine guerilla chemistry . . . actually, one would do better to try to get their DOC or Suboxone/Subutex anyways . . .
 
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In NZ they outline the choices: methadone or suboxone (they don't have subutex...) and then let you choose.

If you want to stay on it long term/forever and need something that still gets you a bit high then methadone is good (although I wish they would just give me slow release oral morphine, some injectable (dia)morphine would be nice too lol but NZ is a way off that yet).

If you wanna come off it short term, sub seems easier. Also if you want to still be able to get high shooting up H you're gonna wanna stay on bupe lol.

Last time I did smack I spent way too much money and didn't get nearly high enough for it to be worth it. Boiling down my biodone and shooting it ends up being the only IV opioid that's affordable in NZ when you have an m-done tolerance. Kinda annoying, but it makes it easy to stay away from spending my cash on MS, Homebake, Oxy etc cause it just isnt worth it for me
 
Racaemic methadone, the form used for OST everywhere except Austria and Germany (which use levomethadone by default, and I think the Benelux and Scandinavian countries technically are able to use either and if someone in Austria or Germany insisted on methadone rather than levomethadone, they may be able to get it there too) can lead to QT interval prolongation because of the non-analgesic dextromethadone component, so people in various risk categories related to that are put on Suboxone in the US and the first line choice in a number of other places for those people is ER morphine.

Anyone worried about methadone screwing up their heart can read up on the patents and journal articles, as the pigeons on the Kärntnerstraße told me that the stereoisomer resolution is one of the simplest in organic chemistry -- well down into the range of kitchen semi-clandestine guerilla chemistry . . . actually, one would do better to try to get their DOC or Suboxone/Subutex anyways . . .

What's the difference between Subutex and Suboxone? I can never remember. Is it just that Suboxone is a full opioid antagonist?
I saw on an episode of Intervention, this woman (Sandra, Rx Med addict) took Suboxone AND Opana and seemed able to get high on the Opana. Any reason this could work?
I's much rather have Morphine ER than Subs or Methadone, but they're too easy to abuse.
 
What's the difference between Subutex and Suboxone? I can never remember. Is it just that Suboxone is a full opioid antagonist?
I saw on an episode of Intervention, this woman (Sandra, Rx Med addict) took Suboxone AND Opana and seemed able to get high on the Opana. Any reason this could work?
I's much rather have Morphine ER than Subs or Methadone, but they're too easy to abuse.
Subutex is buprenorphine alone, Suboxone has naloxone added to it. Both are bupe which is a partial agonist aka mixed agonist/antagonist. The naloxone is a bloody waste of time though IMO it's just marketing (although I do think it can be potentially negative, perhaps in those sensitive to naloxone. I've heard of people having headaches etc and switching to subutex and feeling better)

So it annoys me that they only have Suboxone here

The blocking effect of buprenorphine varies between people. I was on it a for years and it never blocked much of anything for me. I think that is probably rare though but I'm sure many people can still get high just not as high ya know.

I also think they need to roll out the option of Levomethadone over here and elsewhere too. More options would be nice.
 
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Subutex is buprenorphine alone, Suboxone has naloxone added to it. Both are bupe which is a partial agonist aka mixed agonist/antagonist. The naloxone is a bloody waste of time though IMO it's just marketing (although I do think it can be potentially negative, perhaps in those sensitive to naloxone. I've heard of people having headaches etc and switching to subutex and feeling better)

So it annoys me that they only have Suboxone here

The blocking effect of buprenorphine varies between people. I was on it a for years and it never blocked much of anything for me. I think that is probably rare though but I'm sure many people can still get high just not as high ya know.

I also think they need to roll out the option of Levomethadone over here and elsewhere too. More options would be nice.

Ahh, thanks for clearing that up. We only have Subutex here, not Suboxone. A lot of people say Methadone say methadone stops them getting high, but it never made any difference to me.
 
if dawn ever sets on me and forces me to go for maintenance at some point in life, what determines what they give you? ive never taken bup but methadone didn't really feel as great as morphine or oxy but it did the trick to keep wd at bay to say the least

When they have done studies of current and former addicts, they have found that morphine made them feel the best, especially when it was delivered in the form of smack . . . the strength and long duration of effect notwithstanding, they preferred codeine to methadone as well because codeine delivered morphine too, as does nicomorphine -- morphine is apparently a unique ne plus ultra euphoriant drug. Hydromorphone, also as delivered by hydrocodone, thebacon, and acetylmorphone feels slightly different but is also practically at the same level as a euphoriant. I think that dihydromorphine is even better than morphine, which is why dihydrocodeine and nicocodeine are so great. The morphine-hydromorphone-dihydromorphine comparison in my experience is subjective to a great degree too . . . then there is oxy:

Oxycodone feels like hydro and C-Jam basically, making it unique, and it seems there are two ways oxymorphone can hit people --as a super Oxycodone, or a stronger hydromorphone.

These studies also show that methadone and codeine completely fix morphine withdrawal, whereas pethidine is noticeably partially lacking.

The oral route of administration may be part of it too -- when one drinks it or swallows tablets, there is a delay -- methadone injectable is available, and I was given methadone through an IV in hospital once, and I asked them to mix my hydroxyzine in with it, and it felt wonderful -- it sort of reminded one of Diconal but it wasn't exactly the same thing. The long duration of action cuts down on the bang of smack because the bang is the increase of narcotic action over a short period, and if methadone is already giving one a 40 per cent narcotic effect, the smack just increases it, not starts something new. Methadone also has NMDA, nociceptive, and σ receptor effects making it an excellent painkiller.

Something similar to this, but structurally different is levorphanol a long-lasting morphinan synthetic about 9-15 times stronger than morphine, the parent compound of the active metabolite of DXM. . . since they know DXM slows down tolerance growth, they could probably use a combination of racemorphan and racemethorphan, as a methadone alternative for people with chronic pain and/or severe depression along with their addiction as they are looking at both DXM and levorphanol as antidepressants too.

Suboxone actually does block receptors -- it is a κ and δ opioid antagonist and partial μ agonist which kicks out anything else hence the precipitated withdrawal. So the two are implementations of very different philosophies about detox/maintenance.
 
I don't know about you guys but I rather liked methadone...once you go over 300mg it gets pretty nice.

Once, someone called the paramedics on me when I was nodded on phenobarbital and they thought I had OD'd on opioids. I wake up, and am plenty alert, and after pleading for them to not do it the paramedics inject me with an antagonist (mind you, i was on 380mg of methadone at the time). You can imagine the pure horror of that precipitated withdrawal (spontaneously and uncontrollably shitting myself).

I was there for a few hours, in sheer horror, and was released. Of course, i go back home and consume 890mg of methadone, which I believe was the largest dose I've ever consumed, and eventually fall asleep peacefully in a bowl of cereal. Fuck those paramedics.
 
^ terrible story. Sorry mate

All the bases have pretty
Much been covered. In my state, it's a personal choice, but how you make that choice depends upon your plans, and habit.

I preferred methadone, but not going to the clinic 3-4x a week is nice
 
My clinic was a private and expensive operation that seemed to designed for the elite and famous people of los angeles. It was in an ornately furnished penthouse of a Los Angeles high rise, and patients never saw one a other due a complex system of multiple waiting rooms. The drawback was, because i was paying $1800 a month, I could demand was much methadone that my greedy self desired, which left me in a predicament when i eventually got off (which i did, slow and steady).

The big benefit was that after a few months or initiation, only went in once a month for all my bottles and bottles of pills (a whopping 1,140 10mg tablets a month), which after 6 months turned into only once every three months (ie., 3,420 every 3 months). In retrospect i probably could have sold that methadone for upwards of perhaps $10 a pill, or $11,140 a month, for a net profit of about $10k a month...however, i greedily consumed ever last pill...
 
It depends almost entirely where you live. Also, if there is an actual need for opioids. In the US, both are easily obtained but there is a huge difference between the 2. If you truly have chronic pain but have become addicted to standard opioid medications, a Pain Management doctor will offer Methadone. If MRI's, etc can prove the severity of the pain, chances are take-home Methadone won't be an issue.

If there is no pain involved and it is purely recreational; here in the US, Suboxone is going to be the route they choose usually. Since a Pain doctor won't help, you will have to go to an addiction specialist. Over time they will give you Suboxone to take home but usually you must take your dose in front of them. You can choose to go to a Methadone clinic but they are not nice places and many wish to avoid it. I cannot speak for other countries, but it truly comes down to preference. If you wish to be on Methadone, you can go to a specialist who will get you into maintenance. Insurance usually is a deciding factor between the 2 options. Many people choose the Bupe as if it is purely recreational, the doses of Methadone are relatively weak.

Definitely a slippery slope and if pain is involved Methadone wins by a mile but for maintenance Suboxone truly is an awesome medication.
 
My clinic was a private and expensive operation that seemed to designed for the elite and famous people of los angeles. It was in an ornately furnished penthouse of a Los Angeles high rise, and patients never saw one a other due a complex system of multiple waiting rooms. The drawback was, because i was paying $1800 a month, I could demand was much methadone that my greedy self desired, which left me in a predicament when i eventually got off (which i did, slow and steady).

The big benefit was that after a few months or initiation, only went in once a month for all my bottles and bottles of pills (a whopping 1,140 10mg tablets a month), which after 6 months turned into only once every three months (ie., 3,420 every 3 months). In retrospect i probably could have sold that methadone for upwards of perhaps $10 a pill, or $11,140 a month, for a net profit of about $10k a month...however, i greedily consumed ever last pill...
Everytime I hear you talk about this clinic I am amazed. I'm not surprised that a place like that exists though.

In NZ you start off going to the clinic regardless of whether you go with mdone or sub. You gotta pick up daily even with sub until you've been going a while, although when I was being inducted on sub they gave me 2 mgs extra to take home in case I still felt WDs, which I promptly wheel filtered and injected.

I always find it strange how in the states, you go in and get a months worth of sub at a time. They would never do that here.

On another note, I wouldn't say methadone stops you getting high, it just pushes your tolerance up to the point where it's unaffordable. After all mdone is 3-4 times (ish) the potency of morphine along with a far better oral BA
 
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What's the difference between Subutex and Suboxone? I can never remember. Is it just that Suboxone is a full opioid antagonist?
I saw on an episode of Intervention, this woman (Sandra, Rx Med addict) took Suboxone AND Opana and seemed able to get high on the Opana. Any reason this could work?
I's much rather have Morphine ER than Subs or Methadone, but they're too easy to abuse.

The Naloxone in Suboxone is added to make it impossible to abuse the med by snorting or shooting: Naltrexone has a very low oral bioavalability, so it's basically not working that way but if you try and snort or shoot here come the precipitated WDs.
So if that woman just swallowed the Opana and Suboxone she would have gotten high alright.
 
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Everytime I hear you talk about this clinic I am amazed. I'm not surprised that a place like that exists though.

In NZ you start off going to the clinic regardless of whether you go with mdone or sub. You gotta pick up daily even with sub until you've been going a while, although when I was being inducted on sub they gave me 2 mgs extra to take home in case I still felt WDs, which I promptly wheel filtered and injected.

I always find it strange how in the states, you go in and get a months worth of sub at a time. They would never do that here.

On another note, I wouldn't say methadone stops you getting high, it just pushes your tolerance up to the point where it's unaffordable. After all mdone is 3-4 times (ish) the potency of morphine along with a far better oral BA

The benefit of American capitalism my friend...he who pays, receives...

When i moved to Australia for 6 months, i brought a 3 month supply (had only planned on 3 months). So i had to go to an Australian methadone clinic, for which they made big pomp and circumstances for allowing me 180mg a day. Is that really that high in Australia?

I was sick as a dog. I remember doing codeine CWE extractions on the plane on the way home, im surprised no one thought i was making a bomb given the coffee filters i had taken from the stewardess and the multiple extraction. Funny note (the plane was empty) so i layed in the backrow where i found a medical oxygen tank that i huffed under a blanket the whole way home...
 
The Naltrexone in Suboxone is added to make it impossible to abuse the med by snorting or shooting: Naltrexone has a very low oral bioavalability, so it's basically not working that way but if you try and snort or shoot here come the precipitated WDs.
So if that woman just swallowed the Opana and Suboxone she would have gotten high alright.
Naloxone not naltrexone.

Shooting suboxone will not put you into withdrawal (unless you're dependent on full agonists of course) . That's the idea but it's a bit of a con job, buprenorphine's binding affinity prevents naloxone (and other opioids) from binding to opioid receptors. I have injected bupe/nal many times when I was on suboxone maintenance. Never had precipitated withdrawals.

You can believe otherwise of course, but I feel very confident in this.
 
Naloxone not naltrexone.

Shooting suboxone will not put you into withdrawal (unless you're dependent on full agonists of course) . That's the idea but it's a bit of a con job, buprenorphine's binding affinity prevents naloxone (and other opioids) from binding to opioid receptors. I have injected bupe/nal many times when I was on suboxone maintenance. Never had precipitated withdrawals.

You can believe otherwise of course, but I feel very confident in this.

Would that change increasing the IV dose, ie 2 pills instead of one, or 2 instead of 4?
Is there a point at which the Naloxone overpowers the Buprenorphine?
 
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