![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 35. Go back in thread:
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
Posted by shelliR on December 30, 2001, at 20:01:08
In reply to Re: methadone? » stjames, posted by Elizabeth on December 30, 2001, at 17:28:33
> 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.)
Hi Elizabeth,
Keep the information coming, it's great.
As for my pupils, (on methadone 15mg tid) my pupils look pretty normal size--just checked :-)
>
> > 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.
I always felt a high through my body (sometimes very slight; sometimes, especially at the beginning, more) with oxycontin, generally about an hour after ingestion, along with the lifting of what feels like deep pain and heaviness in my chest. With methadone, I have not felt the same feeling going through my body; I can't feel the "kick-in" time, although it takes about the same time for the depression to lift from my chest after the first dose in the morning.
Shelli
Posted by spike4848 on December 30, 2001, at 21:13:27
In reply to Re: methadone? » Elizabeth, posted by shelliR on December 30, 2001, at 20:01:08
> > 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.)This is true. In the emergency room, you can look at patients pupil size if you suspect opiate use/abuse. Many opiate users have pinpoint pupils, also called myosis. From what I remember some people on methodone maintenance had myosis, about two-thirds. But many of them were takening additional opiates with their methadone. Some patient's pupils sizes were normal.
And methadone does not come up in standard urine drug screen. It must be added to the routine tests .... and often comes back a day later. And watch out for naltrexone ..... the opiate antagonist. A couple shot of that stuff will totally reverse any opiate effect.
Spike
Posted by leonard60 on December 30, 2001, at 21:40:14
In reply to methadone, posted by shellir on December 22, 2001, at 13:48:05
methadone is like other opiates and ou will weed to increase the does with time becuase you will build a tolerance. I would have staye on the oxycontin they are much less painfill to get
of of them.
Posted by stjames on December 31, 2001, at 17:05:56
In reply to Re: methadone? » stjames, posted by Elizabeth on December 30, 2001, at 17:28:33
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
Keep in mind I am talking about heroin addicts converted over to MMT. Tolerance has something to do with it, but the advantage with methadone is that it occupies receptors far longer than heroin.
This means one is not having to seek a fix every 6 hours and go thru a cycle of significant impairment (on the nod) to less impairment. Then withdrawal and more drug seaking behavior.I live in the heroin center of the US, we have more per capita deaths and addicts here than anywhere else. The people I know who are on MMT
say they are not impaired by methadone. If you look at the context, I would have to agree. Going from living on the street, chasing a fix to having a job and place to live is a big jump in functioning ! Not to mention being on a med that is less likely to cause an OD, is of a pure and known strength, avoiding unsafe IV injection, ect.So I find the question of if one is high or not on methadone pointless. At least in the context of MMT and addicts.
james
Posted by stjames on December 31, 2001, at 17:11:43
In reply to Re: methadone? » Elizabeth, posted by shelliR on December 30, 2001, at 20:01:08
> I always felt a high through my body (sometimes very slight; sometimes, especially at the beginning, more) with oxycontin, generally about an hour after ingestion, along with the lifting of what feels like deep pain and heaviness in my chest. With methadone, I have not felt the same feeling going through my body; I can't feel the "kick-in" time, although it takes about the same time for the depression to lift from my chest after the first dose in the morning.
I would say this has much to do with length of action; oxycontin is far shorter acting than methadone so levels rise quickly (you feel high) and drop quickly (you withdraw). Methadone can act for days, levels rise and drop very slowly.
Posted by shellir on January 1, 2002, at 22:31:13
In reply to Re: methadone?, posted by stjames on December 31, 2001, at 17:05:56
> Keep in mind I am talking about heroin addicts converted over to MMT. Tolerance has something to do with it, but the advantage with methadone is that it occupies receptors far longer than heroin.
The thing that I don't get is why methadone works for some people with the once a day dose, and for others, not. I've never been on heroin, so maybe that has something to do with preparing your body to accept once a day dosing. I was relieved to read MB's post that she went through withdrawal every evening when getting methadone once a day because I think I would have a similar experience. I'm not sure about withdrawal, but I do know that it's antidepressant effects last for me for about six hours and that my worst time in early morning, when I have not had a dose for at least eight hours.
I am surprised that when I started replacing my third dose of methadone (15mg) with 7.5mg of vicodin, I did not experience any drop in mood. I know that when I switched from oxycontin to methadone, my dose was halfed. So I am confused why then 1/2 dose of hydrocodone would have the same effects on me.
I think at some point I ran across a dosing chart for opiates; I'll have to try to find it again. Meanwhile, does anyone know if I am off track in thinking that that the same amount of methadone is stronger than say vicodin (hydrocodone)?
On a positive note, I recently received an e-mail from a person I mailed from a methadone advocate program, who said that it actually may be possible to be given more than one dose at some clinics. He also gave me a contact person for my state, hwich apparently has very liberal laws regarding the "best medicine" guidelines that went into effect last March. Not that I have any idea what that means, but it seemed encourging :-)
> This means one is not having to seek a fix > I live in the heroin center of the US.
I thought I picked up somewhere in your posts that you lived in New Mexico? Where is the drug capital of the US, anyway?
Shelli
Posted by shellir on January 4, 2002, at 10:33:06
In reply to Re: methadone, posted by TerriM on December 28, 2001, at 17:59:39
Posted by Elizabeth on January 5, 2002, at 3:48:19
In reply to Re: methadone?, posted by stjames on December 31, 2001, at 17:05:56
> The assumption is always that methadone gets you high, and therefor impairs one just like opioids.
Well, first of all, methadone *is* an opioid. But anyway, that's not "always" the assumption. I've encountered people who believe (perhaps because they heard comments such as yours somewhere) that methadone has some special property that makes it different from other opioids (such as heroin, morphine, oxycodone, etc.) that prevents it from causing euphoria, motor impairment, etc. People will develop tolerance to these effects from taking any opioid on a regular basis. This isn't a pharmacological property of methadone; it's a property of how methadone is used in MMT. It's used to prevent withdrawal in people dependent on opioids. Any opioid can do that.
> Keep in mind I am talking about heroin addicts converted over to MMT.
I'm not sure why one should have assumed that, since this thread is not about MMT.
> Tolerance has something to do with it, but the advantage with methadone is that it occupies receptors far longer than heroin.
> This means one is not having to seek a fix every 6 hours and go thru a cycle of significant impairment (on the nod) to less impairment. Then withdrawal and more drug seaking behavior.Sure, that's an advantage of methadone, and it's one of the reasons methadone was chosen as the drug to use for treatment of heroin addiction. Today we have other long-acting opioids (such as LAAM) and slow-release formulations (such as MS Contin), too, and these could also be used (indeed, buprenorphine and LAAM are in use in some places for treating opioid dependence).
> I live in the heroin center of the US, we have more per capita deaths and addicts here than anywhere else.
Does that attract tourists? :-)
> The people I know who are on MMT say they are not impaired by methadone.
I never said they were (I'm very much in favor of MMT and I agree that it's a safe and effective way to help people get and stay off heroin). But that's not because methadone has fewer side effects than other opioids; it's because people on MMT are tolerant to those side effects.
> So I find the question of if one is high or not on methadone pointless. At least in the context of MMT and addicts.
Once again, I'm not sure why you bring up MMT -- the discussion here is about a different use of methadone, in nonaddicts. The question of whether one can get high on methadone is very important if one is concerned about the possibility of becoming addicted to it, for example. If people are led to believe that methadone won't get them high or addicted or cause motor impairment, they are liable to exercise less caution about the way they use it. I think it's important that people not be misinformed about drugs that they might be taking.
-elizabeth
Posted by stjames on January 5, 2002, at 20:53:06
In reply to Re: methadone? » stjames, posted by Elizabeth on January 5, 2002, at 3:48:19
If people are led to believe that methadone won't get them high or addicted or cause motor impairment, they are liable to exercise less caution about the way they use it. I think it's important that people not be misinformed about drugs that they might be taking.
You might want to look at some studies
"The insensitivity of these tests of skill performance to the acute effect of methadone on the clients within the methadone maintenance program indicate that these clients should not be considered as impaired in their ability to perform complex tasks such as driving a motor vehicle."
http://www.google.com/search?q=cache:KAnhFvX-WUcC:www.druglibrary.org/Schaffer/MISC/driving/ddimp.htm+motor+impairment+and+methadone&hl=enMMT is what I know, that is why I mention it. I have never thought that is was not addicting.
These reaction tests indicate to me that once stable on a dose one is not impaired.I don't see a connection to high and dependance, ie, just because you don't get high from something does not mean dependance will not happen.
A quick check of the archive will show that many
do think if one takes an opioid for a mental illness they are getting high so they feel better, that this is all that is happening, and it is bad. Many where I live feel the same about
MMT, they are still just getting high and nothing has changed.Warning: I have ADD, expect tangents !
james
Posted by Elizabeth on January 6, 2002, at 22:33:30
In reply to Re: methadone?, posted by stjames on January 5, 2002, at 20:53:06
> > If people are led to believe that methadone won't get them high or addicted or cause motor impairment, they are liable to exercise less caution about the way they use it. I think it's important that people not be misinformed about drugs that they might be taking.
>
> You might want to look at some studiesI'm sorry -- I must not be communicating my point very well. You're saying things about methadone which apply only to its specific use in MMT programs, but which might be taken (mistakenly) as applying to methadone in general. I understand that what you have to say about methadone is true in the case of MMT, but that's a special case. This thread wasn't about MMT at all; as such, making claims about MMT as though they applied to methadone in general seems like a bad idea. For an opioid-naive person to take methadone under the assumption that it won't get them high or addicted, or cause motor impairment, would be potentially dangerous, since in nontolerant persons, methadone has the potential to cause any or all of these effects.
> MMT is what I know, that is why I mention it.
Then you should know that what you know about MMT does not apply to other ways that methadone is used.
> These reaction tests indicate to me that once stable on a dose one is not impaired.
You're assuming that a person taking methadone for some other purpose (such as depression or nociceptive pain) will reach a stable dose. It's not clear what happens when people take opioids for depression (it seems that some are able to reach a stable dose but others develop tolerance and must therefore keep increasing the dose), but people taking methadone for pain do become tolerant, as do patients taking other opioids for pain. Methadone causes tolerance (or doesn't cause it) in the same way that other opioids do. It does not have some novel pharmacological property that makes it safer.
> I don't see a connection to high and dependance, ie, just because you don't get high from something does not mean dependance will not happen.
I didn't say dependence; I said addiction. Pharmacologic dependence happens with many drugs (such as corticosteroids, antidepressants, and antihypertensives) that don't get people high, but that's not addiction (which, confusingly, is called "substance dependence" in DSM-IV).
> A quick check of the archive will show that many
> do think if one takes an opioid for a mental illness they are getting high so they feel better, that this is all that is happening, and it is bad. Many where I live feel the same about
> MMT, they are still just getting high and nothing has changed.That's true, but many people also have the reverse belief, that methadone is "okay" to give to addicts because it's "different" from other opioids. There are lots of misconceptions out there about methadone.
> Warning: I have ADD, expect tangents !
Expect the same on my end. :-) Seriously: tangents are cool, but it's important to let your readers know that your comments refer to the use of methadone in MMT, and not necessarily in other situations.
-elizabeth
This is the end of the thread.
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