Opioids Methadone metabolism

[thebasaliva]

Hello.

I've been in harm-reductive methadone treatment for eight months now.
For the first half the titrated dose felt appropriate and I had no withdrawal symptons during the day.
After four months I started experiencing withdrawal symptons at night and the dose was titrated 5 mg up.
It helped and I can now sleep a few hours longer, but still I do experience strong withdrawal symptoms during the night before morning and always wake up because of them.

I asked for another dose titration and it was approved by my previous care provider.
Then I moved to another city.

My dose is nearly 100 mg per day but I guess and feel it should be 100 to be enough for the whole day and night, and keep the withdrawal symptoms off until the next dose is provided.
The new doctor wants me to give blood samples to check the situation because he may think I'm just wanting to get high or something, which is definitely not the case and was well examined by the previous care provider in closed facility conditions.

Because I'm very concerned about the new doctor thinking the levels he will see in my blood (plasma?) indicate I'm 'high' (which isn't the case!),
I want to get some advice how to make sure my methadone metabolization is as fast as possible.

So the question is simply: how to speed up my methadone metabolization and what kind of variables affect it?
Diet? Work out? Nicotine? Other medications and how do they affect? Should I quit using benzodiazepines if they may the hinder the process of methadone break-down in my system?

Thanks!

 

[JessFR]

I'm sorry but I think this question might run afoul of the forums rule against asking how to beat drug tests.

Just to be clear, I'm not a moderator for this part of the site, so such a judgement is not mine to make. I'm just trying to alert you that it's possible this thread might wind up closed for this reason. I don't know, it's just something I thought I should mention.

While it's open though, honestly I can understand why your doctor might be a little suspicious. I'm certainly not saying I don't believe you that you're experiencing this problem. I'm just surprised that you're experiencing any withdrawal on 100mg of methadone a day.

I'm on 80mg a day myself and I had a pretty large heroin habit before that, and generally don't have any withdrawal provided I get the full 80mg once a day.

In my experience, doctors are usually inclined to let you increase your methadone pretty liberally, because they've been trained that staying on the program and being comfortable on it is key to long term improvements. So your doctor might not do anything anyway.

It seems more likely to me that your doctor wants to blood test you because he may be concerned that you might be somehow selling your methadone and that that's why you're experiencing withdrawal. And he or she wants to test you to check that the full amount is in your system. And that there aren't other opioids in your system.

If that's the case (that the full amount is in your system and you're not on other unprescribed opioids), you may be best off doing nothing. If he finds that the full dose is in your system and you're still complaining of withdrawal, in my experience with the methadone program, I would expect most doctors would increase your dose at that point. Not worry about you getting high. They're usually trained to let you continue increasing your dose provided you're taking it consistently and still say you're uncomfortable or feeling cravings for opioids.

That said, this is all based on my experience with my doctors and other users on methadone that I know of, in my part of the country. So of course your experience may vary.

I hope anything I've said is of help. Good luck.

 

[thebasaliva]

I can't be selling my methadone because I have to drink it in in a clinic in front of a nurse every once a day. Also they do take urine tests and there has never been any indication of wrongfully using other opioids during the treatment. This particular doctor really isn't as liberal as the others I have seen, and he also comes from a country where there is no opioid treatments and very harsh laws againts drug (ab)use and completed his education and got a license there.

I really don't think that being interested in the metabolization of a prescribed drug I'm taking in a controlled environment can be againts those rules, and really do hope it isn't. I also do have a common interest in the metabozilation of the drug in question, and what might affect it in a way or another. The question could be formulated in a very different way to get the same answer and not give an impression of foul play againts any rules, but I don't think that's needed. This is not about beating a drug test - you can't beat this kind of testing including urine and blood sampling.

I just want to make sure there is the minimum amount of the drug in my system by living normal life which includes gym and other types of work out, hobbies, nutrition and also want to know whether benzos. smoking or other drugs and medications do affect the metabolization process.

If there is any kind of abnormal accumulation my game and life is lost, because even now the current ration isn't adequate and does not make my life quality really better because I do experience anyway the clear withdrawal symptoms every night many hours before the next dose is provided, and that really cumulates in time if you can't ever sleep a good night and has to go to the clinic sick every morning.

I was already cleared for the dose titration to 100 mg by the previous care provider, but moved to another city before it became official in papers. I was on 95 mg and it was lowered to 90 mg when moving because they do not serve 'halves' in here, only 90 +- 10, and so on.

 

[JessFR]

I have no authority in this area of the site, so it won't me for me to interpret if any of this is against the rules or not. Or what if anything should be done about it. I just wanted to give you a heads up since I could imagine it being interpreted that way. Since it's asking how to influence the results of a drug test. Even if it's not the kind of drug test the rule is usually focused on.

Would it be possible to ask for a different doctor? I too have experienced on occasion more judgemental doctors, so I can understand your concern. Unfortunately if that's the case it may be better to try and get a different one. At least if your current one winds up taking actions that are against your best interests.

People have managed to smuggle out methadone in spite of supervised dosing. Usually when you get a supervised dose (especially if you're a new patient) they'll prompt you to say something after you get your dose specifically to make it harder to potentially keep the dose in your mouth and smuggle it out.

My point is just that it's a possible reason I can think of for you to be blood tested in the situation you describe. As I said in my experience, most doctors I've met will generally allow you to continue increasing your dose if you still feel cravings or are uncomfortable, provided you're not missing doses.

But as you said, some doctors are just judgemental assholes.

As for your metabolism question specifically. I'm unclear if your goal is to increase the amount in your system or decrease it. But a faster metabolism would imply decreasing it. Either way though, I'm honestly unsure how you might go about doing that in any event. There are common substances, one widely known one is grapefruit juice, that can decrease the breakdown speed of other substances. Resulting in increased blood levels. But I'm not aware of any that do the reverse. And taking such substances carry their own risks and can influence the effects of all sorts of other substances.

 

[thebasaliva]

Only way to get a different doctor is to relocate and as I bought this apartment I really won't be relocating and moving to another city in a while, despite whatever happens about the treatment. I can always get back on the streets if the doctor wants to keep me sick. My goal is to have a minimal accumulation and so minimal 'normal' amount of the drug in blood when the samples are taken, a few hours between them.