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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 35. This is the beginning of the thread.
Posted by shellir on December 22, 2001, at 13:48:05
does anyone know the difference between methadone and other opiates? I switched from oxycontin to methadone because of the expense and am now down to 10mg. I have no idea if methadone is like other opiates in creating a tolerance, or if the same dose will continue to produce the same (small) effects? Any help will be greatly appreciated because I have a certain number and am trying to determine how long they will last.
Shelli
Posted by stjames on December 22, 2001, at 23:11:29
In reply to Re: methadone? No Information? (nm), posted by shellir on December 22, 2001, at 20:31:16
Perhaps a search on "methadone" at http://www.google.com could answer this question
Posted by shellir on December 23, 2001, at 10:33:42
In reply to Re: methadone? , posted by stjames on December 22, 2001, at 23:11:29
> Perhaps a search on "methadone" at http://www.google.com could answer this question
thanks, james.
I tried google first and found out lots and lots of interesting information on methadone, but so far have not found if it is habituating like other opiates. There are thousands of articles, sites on the subject, but for some reason that one question is eluding me.
I also know that using methadone for pain is different from using it for detox symptoms. Once a day is not enough for me--need it three times, just hoping that I will not need to go up on the dose.
Shelli
Posted by MB on December 23, 2001, at 10:55:01
In reply to Re: methadone? » stjames, posted by shellir on December 23, 2001, at 10:33:42
Methadone is habituating, and you can get addicted to it like any other opiate. I took it for detox and then later for maintenence (to stay off of heroin). I had to get off of it because they would only allow me one dose a day and I would go through agonizing withdrawal every night. Their answer was to increase the dose (eventually to 110mg/day) but all that did was make the withdrawal each night worse. My point is that I think the single-dose-per-day scheduling rule for addicts has more to to with bureaucratic b.s. and less to do with the way the drug may or may not react differently in addcits vs. pain sufferers. Addicts are treated like animals in this country. If you can get on a multiple dosing schedule, I think it is VERY plausible that you would never need to increase your dose. When I was allowed a multiple dosing schedule (in the hospital) I immediately dropped fro 110mg to 70mg and was fine (took less to do more). I think it is a promissing drug. It cured my OCD, depression and anxiety COMPLETELY. However, I could not put up with the red tape involved in getting a "split" dose and was required to quit the program. The downside is that getting off the stuff is MISERABLE, even with a tapering schedule.
Good luck,
MB
Posted by stjames on December 23, 2001, at 11:56:26
In reply to Re: methadone? » stjames, posted by shellir on December 23, 2001, at 10:33:42
> > Perhaps a search on "methadone" at http://www.google.com could answer this question
>
> thanks, james.
>
> I tried google first and found out lots and lots of interesting information on methadone,Cool ! Glad you are using the internet. I was not trying to be pissy, as you reposted on this so soon it seemed you needed answers now.
I went searching, did not find your answer, but I really like this page:
http://www.methadone.org/index.html
I would say that all opiates are habituating, but methadone does not produce classic addiction. You also cannot tell, through any test other than toxicology, that someone is on methadone.
j
Posted by shellir on December 23, 2001, at 13:37:32
In reply to Re: methadone?, posted by MB on December 23, 2001, at 10:55:01
> Methadone is habituating, and you can get addicted to it like any other opiate. I took it for detox and then later for maintenence (to stay off of heroin). I had to get off of it because they would only allow me one dose a day and I would go through agonizing withdrawal every night. Their answer was to increase the dose (eventually to 110mg/day) but all that did was make the withdrawal each night worse. My point is that I think the single-dose-per-day scheduling rule for addicts has more to to with bureaucratic b.s. and less to do with the way the drug may or may not react differently in addcits vs. pain sufferers. Addicts are treated like animals in this country. If you can get on a multiple dosing schedule, I think it is VERY plausible that you would never need to increase your dose. When I was allowed a multiple dosing schedule (in the hospital) I immediately dropped fro 110mg to 70mg and was fine (took less to do more). I think it is a promissing drug. It cured my OCD, depression and anxiety COMPLETELY. However, I could not put up with the red tape involved in getting a "split" dose and was required to quit the program. The downside is that getting off the stuff is MISERABLE, even with a tapering schedule.
>
> Good luck,
> MBthanks so much for the info. Not the answer I wished for, but I'd rather know the truth. I can already feel today that 10mg is not doing the trick like it did yesterday. I think unilateral ect may be the first answer for me until I can organize another plan; I am in a very deep deep depression after withdrawing from 250mg of oxycontin a day (prescribed by a psychiatrist who turned out to be a sadist).
shelli
Shelli
Posted by shellir on December 23, 2001, at 13:41:14
In reply to Re: methadone?, posted by stjames on December 23, 2001, at 11:56:26
Posted by MB on December 23, 2001, at 14:03:59
In reply to Re: methadone? » MB, posted by shellir on December 23, 2001, at 13:37:32
> thanks so much for the info. Not the answer I wished for, but I'd rather know the truth. I can already feel today that 10mg is not doing the trick like it did yesterday. I think unilateral ect may be the first answer for me until I can organize another plan; I am in a very deep deep depression after withdrawing from 250mg of oxycontin a day (prescribed by a psychiatrist who turned out to be a sadist).
>
> shelli
>
> Shelli
It's not surprising that you'd be extra depressed comming off of that much oxycontin. Are you also suffering the physical symptoms of withdrawal? Those are rough. So the methadone isn't working for you, you want to get off of it? Maybe 10 mg three times a day would work better? Good luck.
Posted by shellir on December 23, 2001, at 15:45:57
In reply to Re: methadone? » shellir, posted by MB on December 23, 2001, at 14:03:59
>
>
> It's not surprising that you'd be extra depressed comming off of that much oxycontin. Are you also suffering the physical symptoms of withdrawal? Those are rough. So the methadone isn't working for you, you want to get off of it? Maybe 10 mg three times a day would work better? Good luck.I had less physical symptoms than I anticipated. I think they gave me something like closipan (sp?) and I was locked in a hospital so I had no choice but to get through it. Also the first day (out of three) they gave me 10mg of valium every 4-6 hours and shots of something for nausea. Then they cut me completely off of the valium and I was discharged the next day.
Are you still self medicating your depression and other symptoms with opiates? I keep debating between opiates vs unilateral ect to get me back home and back to my business. I think you are taking buprenorphine, if I remember correctly. (?) I think I am going to order that and see if it helps with my depression, but that's going to be more of a future potential resolution.shelli
Posted by stjames on December 23, 2001, at 16:45:43
In reply to Re: methadone?, posted by shellir on December 23, 2001, at 15:45:57
I keep debating between opiates vs unilateral ect to get me back home and back to my business.
Would you clarify for me ? Are you trying to come off opiates or was the switch to methadone an attempt to find a better opiate as treatment for your depression ?
Posted by shellir on December 23, 2001, at 17:24:55
In reply to Re: methadone?, posted by stjames on December 23, 2001, at 16:45:43
> I keep debating between opiates vs unilateral ect to get me back home and back to my business.
>
> Would you clarify for me ? Are you trying to come off opiates or was the switch to methadone an attempt to find a better opiate as treatment for your depression ?After years of success with nardil, finally in my upper 40s, nardil lost it's effectiveness. I tried augmenting lamictal, topomax, etc. etc. , then tried parnate, no success.
Found pdoc last summer prescribed oxycontin for my depression. Worked great, although I could still feel the underlying depression each day until the opiate kicked in. I have had to go up three times and the last time it cost me out of pocket over $1,000 per month. Told pdoc couldn't afford so he switched me to high level of methadone. Didn't have the same anti-depressant effects, was also in high stress part of my business year (xmas). Became highly suicidal, forced into hospital, detoxed from over 100mg of methadone a day. Told at U of Penn that I "just" needed long term therapy and was discharged.
Terrible depression now manifesting as horrible pain in my chest (same as before I ever started nardil). Over this weekend I am taking a minimal amount of methadone (which I still have from my last pdoc who I fired) and waiting to talk to someone about unilateral ect hopefully tomorrow. Am willing to try to get out of deep hole and not worry about getting "unpopular" drugs. Live in D.C., staying at parents out of state. The methadone does take away the depression; I don't see it as a long term solution because I have no one to prescribe it and detox centers will only give it to you once a day. So I am confused, (in answer to your question).
Sorry so long, but this is what happens when you are in another city severely depressed without friends and work and have access to a computer! Do have appointment with excellent pdoc in d.c., but not for three weeks and presently unable to tolerate the severity of this depression.
Shelli
Posted by stjames on December 23, 2001, at 17:45:06
In reply to Re: methadone? » stjames, posted by shellir on December 23, 2001, at 17:24:55
Gee, i do feel for you. You have been thru the ringer.
Sounds like a longer acting opiate was the way to go. But what good is an effective treatment if it is a hassle to get it. There are other long acting opiate/opiate like meds and www.needymeds.com could supply them to you at little cost. However you would need a doc who
will be around to prescribe for you, that you can trust.For myself, I would do ECT if nothing else worked or was something I could not get a ready supply.
Posted by MB on December 23, 2001, at 20:23:47
In reply to Re: methadone?, posted by shellir on December 23, 2001, at 15:45:57
>
> >
> >
> > It's not surprising that you'd be extra depressed comming off of that much oxycontin. Are you also suffering the physical symptoms of withdrawal? Those are rough. So the methadone isn't working for you, you want to get off of it? Maybe 10 mg three times a day would work better? Good luck.
>
> I had less physical symptoms than I anticipated. I think they gave me something like closipan (sp?) and I was locked in a hospital so I had no choice but to get through it. Also the first day (out of three) they gave me 10mg of valium every 4-6 hours and shots of something for nausea. Then they cut me completely off of the valium and I was discharged the next day.
Was it Clonidine? They gave me that when I got off the methadone. It helped a little, but not that much.
> Are you still self medicating your depression and other symptoms with opiates? I keep debating between opiates vs unilateral ect to get me back home and back to my business. I think you are taking buprenorphine, if I remember correctly. (?) I think I am going to order that and see if it helps with my depression, but that's going to be more of a future potential resolution.
>
> shelliNo more self medication for me...I got myself into trouble that way (with opiates I always want more more more). Now the plan is to get on a mood stabilizer, add an SSRI and then a stimulant (rage attacks, depression, OCD, and ADD are the new diagnoses). Again, why did you decide to get off of the methadone?
Posted by shellir on December 23, 2001, at 22:18:55
In reply to Re: methadone? » shellir, posted by MB on December 23, 2001, at 20:23:47
> >
>
>
> Was it Clonidine? They gave me that when I got off the methadone. It helped a little, but not that much.
>
> yes, I think that's it. I have no idea whether it was helping or not because it's the only time I've ever detoxed --so far :-) Little white pill.
> > Are you still self medicating your depression and other symptoms with opiates?>
> No more self medication for me...I got myself into trouble that way (with opiates I always want more more more). Now the plan is to get on a mood stabilizer, add an SSRI and then a stimulant (rage attacks, depression, OCD, and ADD are the new diagnoses). Again, why did you decide to get off of the methadone?I got really messed up switching from the oxycontin to methadone. I couldn't really figure how often to take it and I was working 18 hour days (I run a small business from my house). So I was under super pressure and never should have changed meds until after Christmas.
I liked the oxycontin a lot more but unfortunately, I kept having to go up to maintain the anti-depressant effect. At least methodone is cheap. The pdoc who was giving me opiates was too crazy, mean, and sadistic for me to stay with. He made me come several times a week and wait for up to two hours for five minute appointments. He also had me on about six meds (including nardil, wellbutrin, and concerta) and nothing was working except the oxy.
It's so strange to me that I would give up a great source for opiates, but I really hated the guy. Looking back, of course, I should have played it differently. Used him for what I wanted and started looking for a new pdoc. Too late now. I only have a limited supply of methodone, so there is no option to stay on them.
Shelli
Posted by MB on December 24, 2001, at 11:13:53
In reply to Re: methadone? » MB, posted by shellir on December 23, 2001, at 22:18:55
> > >
>
> >
> >
> > Was it Clonidine? They gave me that when I got off the methadone. It helped a little, but not that much.
> >
> > yes, I think that's it. I have no idea whether it was helping or not because it's the only time I've ever detoxed --so far :-) Little white pill.
>
>
> > > Are you still self medicating your depression and other symptoms with opiates?
>
> >
> > No more self medication for me...I got myself into trouble that way (with opiates I always want more more more). Now the plan is to get on a mood stabilizer, add an SSRI and then a stimulant (rage attacks, depression, OCD, and ADD are the new diagnoses). Again, why did you decide to get off of the methadone?
>
> I got really messed up switching from the oxycontin to methadone. I couldn't really figure how often to take it and I was working 18 hour days (I run a small business from my house). So I was under super pressure and never should have changed meds until after Christmas.
>
> I liked the oxycontin a lot more but unfortunately, I kept having to go up to maintain the anti-depressant effect. At least methodone is cheap. The pdoc who was giving me opiates was too crazy, mean, and sadistic for me to stay with. He made me come several times a week and wait for up to two hours for five minute appointments. He also had me on about six meds (including nardil, wellbutrin, and concerta) and nothing was working except the oxy.
>
> It's so strange to me that I would give up a great source for opiates, but I really hated the guy. Looking back, of course, I should have played it differently. Used him for what I wanted and started looking for a new pdoc. Too late now. I only have a limited supply of methodone, so there is no option to stay on them.
>
>
> ShelliWhat about buprenex? It is an an opoid (is that the right term?) that isn't as addictive and habituating as the regular opiates. Maybe finding a doctor (who isn't sadistic) who would prescribe buprenex wouldn't be that hard. There are some people on the board who have had success with it.
Posted by shellir on December 24, 2001, at 22:49:09
In reply to Re: methadone?, posted by MB on December 24, 2001, at 11:13:53
> > It's so strange to me that I would give up a >
> What about buprenex? It is an an opoid (is that the right term?) that isn't as addictive and habituating as the regular opiates. Maybe finding a doctor (who isn't sadistic) who would prescribe buprenex wouldn't be that hard. There are some people on the board who have had success with it.I don't think it *would* be very easy for me to get in the Washington, D.C. area. (It's a partial opiate.) I've never met any pdoc yet willing to prescribe it, anyway. It is probably easier to get off the internet, and when the pills are available here, rather than injectible form only, then I may look into it again. I actually was given some in the first hospital I was in for detox and it didn't help at all. Some company does sell it to hospitals in sort of jello form. Maybe they didn't give me a large enough dose or maybe I didn't left it desolve slowly enough. I totally freaked out and left that hospital after my doctor (the sado guy) would not prescribe anything else for detox, like a benzo. At the next hospital at least they gave me benzos for the first day every few hours.
Shelli
Posted by TerriM on December 26, 2001, at 8:01:45
In reply to Re: methadone? » MB, posted by shellir on December 24, 2001, at 22:49:09
Buprenorphine is considered an opiate agonist/antagonist. Some compare it to Stadol. Buprenorphine (Buprenex) was approved by Congress last year for use as an addiction treatment medication. Private physicians are supposed to be able to prescribe the medication. Unfortunately, because there are concerns about patient diversion, our government has taken absurd precautions and added Naloxone (an opiate antagonist) to Buprenorphine, so if an individual attempts to inject it, they will go into instant, excruciating withdrawal. At this time, the FDA hasn't approved this Bup/Naloxone combo. There are some trials taking place throughout the country for those addicted to opiates. Buprenex is approved for the treatment of pain and many Drs. do prescribe it.
Methadone can be prescribed by private physicians for the treatment of pain. But, only licensed 'opiate treatment programs' (a physician can go through the tremendous hassle of becoming a 'med unit' if they desire, but few care to deal with the hassle) can prescribe methadone for the treatment of addiction. I have heard of a some psychiatrists that prescribe methadone for the treatment of depression.
Methadone is a wonderful medication with many uses. Unfortunately, because of our society's ignorance about the disease of opiate addiction, much stigma surrounds methadone because of it's association with heroin addiction. Physicians are allowed to legally prescribe methadone for the treatment of pain, but not for the treatment of addiction (unless they take the steps I mentioned above). According to federal law, Opiate Agonist Treatment Programs - Methadone Clinics - can only treat patients for opiate addiction, not for pain or mental health issues.
There is a web site called 'An Addict's View'
http://www.addict.f2s.com/medarticlemenu.html
that has several articles about treating depression with methadone.On a personal note, a good friend of mine was diagnosed as being bi-polar and his psychiatrist prescribed methadone. Methadone was the only medication that was effective for him.
> > > What about buprenex? It is an an opoid (is that the right term?) that isn't as addictive and habituating as the regular opiates. Maybe finding a doctor (who isn't sadistic) who would prescribe buprenex wouldn't be that hard. There are some people on the board who have had success with it.
>
> I don't think it *would* be very easy for me to get in the Washington, D.C. area. (It's a partial opiate.) I've never met any pdoc yet willing to prescribe it, anyway. It is probably easier to get off the internet, and when the pills are available here, rather than injectible form only, then I may look into it again. I actually was given some in the first hospital I was in for detox and it didn't help at all. Some company does sell it to hospitals in sort of jello form. Maybe they didn't give me a large enough dose or maybe I didn't left it desolve slowly enough. I totally freaked out and left that hospital after my doctor (the sado guy) would not prescribe anything else for detox, like a benzo. At the next hospital at least they gave me benzos for the first day every few hours.
>
> Shelli
Posted by shellir on December 26, 2001, at 21:52:33
In reply to Re: methadone?, posted by TerriM on December 26, 2001, at 8:01:45
Posted by Elizabeth on December 28, 2001, at 15:00:49
In reply to Re: methadone?, posted by stjames on December 23, 2001, at 11:56:26
> You also cannot tell, through any test other than toxicology, that someone is on methadone.
I'm not sure what you mean by this -- could you elaborate?
-elizabeth
Posted by Elizabeth on December 28, 2001, at 15:16:14
In reply to methadone, posted by shellir on December 22, 2001, at 13:48:05
> does anyone know the difference between methadone and other opiates?
The main difference is that methadone has a long half-life (although people taking it for pain still apparently need to take it every few hours). It's a full agonist just like morphine, etc.
People on MMT can take it once a day to block cravings and they usually reach a dose at which they remain stable (yes, they really can take it once a day, although some occasionally find they need a nighttime dose, which is hard to arrange with the government's one-size-fits-all rules about MMT dosing). That's a very different use than what you're using it for, though. People taking it for pain do need to keep increasing the dose because of tolerance, and if they stop taking it they need to taper off of it gradually in order to avoid or minimize withdrawal symptoms.
Clonidine (an adrenergic autoreceptor agonist) might have been what they gave you in the hospital. It helps a bit with some opioid withdrawal symptoms, although it doesn't help much according to most people who've tried it. I think that the best way to detox from opioids is to switch to buprenorphine and then taper gradually. Buprenorphine does cause withdrawal symptoms, but they don't last very long and are very mild compared to those of full agonists. The main tricky part, IMO, is finding the right dose to start at. If you're taking a high dose of methadone and you get switched to a low dose of buprenorphine (e.g., the 1 mL that I take), it's probably not going to do much for you.
Buprenorphine isn't really much like Stadol (butorphanol) at all, pharmacologically. Stadol is a kappa agonist/mu antagonist, while buprenorphine is a kappa antagonist/partial mu agonist. Stadol might even trigger withdrawal symptoms in a person who's dependent on opioids.
The sublingual buprenorphine tablets haven't been approved specifically for maintenance treatment, and the drug company doesn't want to try to market them until they've been approved for that use.
I hope this helps. Be well.
-elizabeth
Posted by TerriM on December 28, 2001, at 17:59:39
In reply to Re: methadone » shellir, posted by Elizabeth on December 28, 2001, at 15:16:14
It's recommended that patients be completely off methadone for at least three days before starting Buprenorphine because it will cause withdrawal (this is from several patients who were involved in Bup trials). So beware of taking methadone and then attempting to start Bup immediately afterwards.
> > does anyone know the difference between methadone and other opiates?
>
> The main difference is that methadone has a long half-life (although people taking it for pain still apparently need to take it every few hours). It's a full agonist just like morphine, etc.
>
> People on MMT can take it once a day to block cravings and they usually reach a dose at which they remain stable (yes, they really can take it once a day, although some occasionally find they need a nighttime dose, which is hard to arrange with the government's one-size-fits-all rules about MMT dosing). That's a very different use than what you're using it for, though. People taking it for pain do need to keep increasing the dose because of tolerance, and if they stop taking it they need to taper off of it gradually in order to avoid or minimize withdrawal symptoms.
>
> Clonidine (an adrenergic autoreceptor agonist) might have been what they gave you in the hospital. It helps a bit with some opioid withdrawal symptoms, although it doesn't help much according to most people who've tried it. I think that the best way to detox from opioids is to switch to buprenorphine and then taper gradually. Buprenorphine does cause withdrawal symptoms, but they don't last very long and are very mild compared to those of full agonists. The main tricky part, IMO, is finding the right dose to start at. If you're taking a high dose of methadone and you get switched to a low dose of buprenorphine (e.g., the 1 mL that I take), it's probably not going to do much for you.
>
> Buprenorphine isn't really much like Stadol (butorphanol) at all, pharmacologically. Stadol is a kappa agonist/mu antagonist, while buprenorphine is a kappa antagonist/partial mu agonist. Stadol might even trigger withdrawal symptoms in a person who's dependent on opioids.
>
> The sublingual buprenorphine tablets haven't been approved specifically for maintenance treatment, and the drug company doesn't want to try to market them until they've been approved for that use.
>
> I hope this helps. Be well.
>
> -elizabeth
Posted by shellir on December 28, 2001, at 18:59:59
In reply to Re: methadone, posted by TerriM on December 28, 2001, at 17:59:39
> It's recommended that patients be completely off methadone for at least three days before starting Buprenorphine because it will cause withdrawal (this is from several patients who were involved in Bup trials). So beware of taking methadone and then attempting to start Bup immediately afterwards.
Wow, I wonder if I can find any documentation on that; something to send the sadistic ass***e that prescribed and failed to detox me at "his" hospital.I was actually off of methadone and on oxycontin for two or three days before the detox try on buprenorphine. I went through horrible horrible detox for hours (I was sick, in pain, and felt that I wasn't able to breathe). After being told that I was acting "like a three year old", I left that hospital. I was at least given a benzo at the emergency room, and a benzo and clonodine in the next hospital.
Have you read that in studies, or is the info from people that you know who went through the trials?
Shelli
Posted by Elizabeth on December 29, 2001, at 6:32:36
In reply to Re: methadone, posted by TerriM on December 28, 2001, at 17:59:39
> It's recommended that patients be completely off methadone for at least three days before starting Buprenorphine because it will cause withdrawal (this is from several patients who were involved in Bup trials). So beware of taking methadone and then attempting to start Bup immediately afterwards.
That's something I've heard, but I've never actually found anyone who experienced it. I've known plenty of people, in contrast, who've used bupe to detox by switching directly and have been able to avoid WD symptoms completely.
Maybe it's something that happens to some people but not all, in which case the only way you can tell if you're one of the unlucky ones would be by trying it.
-elizabeth
Posted by stjames on December 29, 2001, at 14:29:04
In reply to Re: methadone? » stjames, posted by Elizabeth on December 28, 2001, at 15:00:49
> > You also cannot tell, through any test other than toxicology, that someone is on methadone.
>
> I'm not sure what you mean by this -- could you elaborate?
>
> -elizabethAccording to http://www.methadone.org/index.html
(somewhere in there) reaction time tests are not slowed while on methadone.Or to put it another way, unless one does a blood/urine test (toxicology) there is no way to
tell on is om MM.The assumption is always that methadone gets you high, and therefor impairs one just like opioids.
Posted by Elizabeth on December 30, 2001, at 17:28:33
In reply to Re: methadone?, posted by stjames on December 29, 2001, at 14:29:04
> > > You also cannot tell, through any test other than toxicology, that someone is on methadone.
> >
> > I'm not sure what you mean by this -- could you elaborate?
>
> According to http://www.methadone.org/index.html
> (somewhere in there) reaction time tests are not slowed while on methadone.
>
> Or to put it another way, unless one does a blood/urine test (toxicology) there is no way to
> tell on is om MM.I don't believe that you can necessarily draw that conclusion simply because reaction times are not slowed. Methadone affects different people differently, as do other opioids (such as codeine, morphine, oxycodone, and heroin). But anyway, you can't tell for sure that someone is on an opioid -- any opioid -- simply by observing them. Some people will get stoned and "nod," others will just be sick, some (like me) become activated, and some don't show much effect at all.
An addict who is maintained on a stable dose of an opioid (whether it's methadone, LAAM, heroin, or whatever) will generally not experience much (if any) psychotropic effect, although there may still be side effects. This is due to tolerance, *not* because of some special property of methadone.
The one outwardly visible side effect that's caused by pretty much every opioid (although it's only a hint, not a positive sign, that a person is on opioids) in pretty much everyone who takes them (including people who are tolerant, such as MMT patients) is pinpoint pupils. (Demerol is a notable exception -- it tends to cause dilated rather than constricted pupils.)
> The assumption is always that methadone gets you high, and therefor impairs one just like opioids.
Contrary to popular myth, it is possible to get high on methadone. People on MMT don't get high or impaired on it because they're tolerant to these effects at the dose that they're taking.
-elizabeth
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