Originally Posted by Sublimaze
just got onto a methadone
program. He has some questions about it and was hoping the fine folks at dp could help him out.
swim was shooting about a half gram of pure dope a day. Things got tight and he finally decided to give into the methadone system. They started him on 20mg which is a joke, and he continued to use anyway. Now he is at 35 mg after 4 days of being on 20mg. He still doesn't know what methadone feels like, but notices that in the mornings he isn't very sick. He is going to keep raising it because this dose doesn't give him his normal levels of energy.
His question is that if they raise his dose only by 15 every 3-4 days, wont he be able to raise his dose indefinitely because of how long of a wait it is before he gets to raise the dose?
Swim wants to actually feel what it feels like to be stoned off methadone, at least for a day... Because of how how swims tolerance is, will swim ever get to feel this, at the rate they are slowly raising it at? If this (taking away of withdrawals, but not restoring energy levels to using level) is all swim will ever feel, should he even raise the dose?
Swim is going to be honest and say that he just wants to nod out for at least a week off of methadone. Is this possible at the rate that they are raising the dose?
The doctors say its possible to taper down off methadone without feeling discomfort, but in DF's experience, is this really possible?
Swim doesn't want to be on methadone forever!! Also, is it possible that in say 6 months down the road, swim buys an half ounce of dope and stops taking methadone and just does the dope for a month. Then can swim just detox off the dope and not have to go through horrible methadone withdrawals because swim had only been on dope for the past month?
When people say that methadone just makes them feel normal, do they mean mildly high? Does methadone give users who are "stabalized" a buzz?
Thank you so much DF!! I don't know who els I could ask that is so knowledgeable !!
Here in Ontario Canada, MMT(Methadone Maintenance Treatment) works like this:
Blood tests are done to ascertain blood chemistry and Hepatitis and HIV status and a urine specimen is collected to prove opiate
use. These blood tyests take 2 weeks usually so there is a wait before Methadone is actually dispensed to you.
Methadone is dispensed as an oral liquid at a concentration of 10mg/mL, so 20mg is 2mL of methadone solution. You take a small plastic cup and pour in some juice which is orange Tang, you slide this cup to the Pharmacist and he/she adds your dose to that cup. You take the cup and drink the contents, then I take teh same cup, refill with Tang and drink to wash the Methadone down. The Pharmacist usually engages you in slight conversation to ensure you have swallowed your dose. This procedure is called a "witnessed dose".
The clinic is visted on Tuesday and Friday or Monday and Thursday. Urine samples are taken twice weekly on those days, these samples are screened with dipstick panel tests before you leave the waiting room and enter the MD's interviewing room, so the MD knows if your urine is dirty or not(at least for the most common substances). Occasionally a sample must be given in the prescence of a Nurse. She/he joins you in the bathroom and witnesses you urinate into the cup. Each sterile urine cup has a thermometer strip on the side which reads from 32ºC to 39ºC.
Every so often a urine sample is sent out to a lab for an intensive screen for most known substances of abuse. These samples are the same ones that are taken on your Mon/Thurs. or Tues./Friday normal visits so the patient doesnt know when the samples are "labbed".
Methadone is dispensed daily at the pharmacy and all dispensing is via "witnessed dosing".
Your dose starts at 20mg or 25mg if there is evidence of IV drug
use. Your dose is increased by 10mg/week until 50mg is attained, then 5mg/week until 75 mg if needed, raised by 5 mg every 2 weeks until opiate use other than Methadone ceases. There comes a point where using other opiates
is simply a waste of money as the opiate receptors are already filled by the Methadone molecules. SWIM noticed this blockage beginning at around 30 mg/day with full blockage occuring at 55 mg/day. Over 55mg/day a single I.V. Oxycodone
(Oxycontin 4x80mg pills=320mg) dose could not even be felt, whatsoever. Same story for for a single 7,200 microgram or 7.2 milligram IV dose of Fentanyl
citrate. (1 complete 100mcg/hr Fentanyl patch). With the Fentanyl shot, no feeling of euphoria
, just a slight feeling of dysphoria and lsight nausea. SWIM continued to increase the Methadone dose until 70mg/day was reached and absolute comfort was attained while reying soley on Methadone. There was a great sense of ease as no longer was there a need to chase drug dealers, and for $5 a day, normalcy returned to life.
After 6 consecutive months of "clean" urine samples one qualifies for "carries" or the ability to take methadone doses home with you. If your urine samples are positive for THC (marijuana
, hash oil
) you can still obtain "carries" but you must have 12 months of urine samples that contain only methadone and THC and their metabolites. Any dirty samples force the patient to attain another 6/12 month time period before carries will be given.
At our clinic the twice weekly "non-carry" patients are seen downstairs, while the patients who are eligible for "carries" are now seen "upstairs" at a clinic that is called the "private clinic". This "private clinic" is staffed by a different MD and different washroom facility. In this washroom, there are 3 cameras. 1 that is at waist height directly next to you on the left side and is aimed at your pubic area. This camera is designed to ensure that urine is actually streaming from your penis into the cup. The 2nd camera is in front of you(if standing at the toilet), it is also aimed at your pubic area and ensures that no other container is used to tamper the sample. The 3rd camera is aimed at the toilet seat from a high angle from in front of the toilet. This camera ensures that if a male sits down on the toilet to provide his sample that no tampering goes unrecorded.
The same urine cups that have the 32º-39º stick on temperature strip are used in the "private" clinic. You must at least 1/2 fill the cup and screw on the top. You exit the bathroom and hand your sample to the nurse who proceeds to screen your sample with various "dip-stick" panel urine testers. Once the "dipstick" results are known, the actual dipstick and a piece of paper are given to the MD and a few monets later your name is called and you enter the MD's interview room. He asks you if you have used, you answer.(he allready knows your dipstick screen results as they are sitting right in front of him. This tests the honesty of the patient. he asks if you are comfortable and if you have any questions. You are in the actual interview room for no more than 3-4 minutes, sometimes less or more if you have questions.
Once "upstairs" in the "private clinic" you must bring in a "locked box" this is any metal or similar box that either has a key or combination padlock or self contained locking mechanism. This is to keep children or others out of your carries that are in the "locked box" that is in the fridge. After the box has been seen by the private clinc MD, you fill out paperwork in which you contract that only you will consume the methadone and that you understand that your dose can easily kill a child or an adult, and that you wont sell or trade your methadone. You also sign a waiver that allows you to be recorded via closed circuit TV while in the bathroom. Your times and days which you visist the "upstairs/private clinic" also change. You now MUST visit every Monday and Friday, between 8-11am or 1pm-3:30pm. He usually takes patients before 8am as well in case you have to be at work at 8am, but the pharmacy doesnt open til 8am so carries must be picked up later if you see the MD between 7:30-8am. It's really great that he sees patients early, he doesnt have to.
Once you are "upstairs" you are given one carry for the weekend, it's up to you if you want it on Saturday or Sunday. If you want to sleep in on Saturday, you do you "witness dose" on Friday and are given a "carry dose" to be consumed on Saturday. If you want to sleep in on Sunday, you do your "witness dose" on Friday. Then when you come in on Saturday between 8am-10am, you do your "witness dose" and are given a "carry-dose" to be consumed on Sunday.
After 1 month of clean urine samples (3 months if testing positive for THC products) you are eligible for more "carries". After 6 months of entering the "private clinic upstairs" (no THC use) you are given five "carries". You perform your "witnessed dose" on Fridayyou see the MD and leave a urine sample and get "carries" for Saturday and Sunday. Then see the MD on Monday, give a urine sample perform a "witnessed dose" and then receive "carries" for Tuesday, Wednesday and Thursday. Then the cycle repeats.
After another 6 months of "clean" urine tests and no THC use(12 months after entering the upstairs/private clinic) you are eligible for 6 carries per week. You choose your MD visit day for either Monday or Friday, then onthat day, you provide your urine sample, are seen by the MD, then go to the pharmacy and perform your "witnessed dose" and recieve your 6 carries.
Once you are at the point of seeing the MD once per week and providing a urine sample once per week, you have the opportunity for a "holiday" from the clinic. This "holiday" can be used anytime, but must be setup weeks in advance and is only valid once per year. This "holiday" allows you to obtain 13 "carries" or 13 take home bottles/doses of methadone. This "holiday: affords the opportunity to travel to places to which previously would be impossible because you had to be at the clinic every Friday or Monday. It is a priority to keep your clutch of 13 "bottles/carries" cold for every moment since you pick them up from the pharmacy until you consume the last dose on day 13. The Methadone/Tang solution mixed at 10mg/mL is placed in the same 100mL brown plastic medicine bottle, then is topped off to the 100mL level with more orange Tang juice. The resulting solutrion in the medicine bottle is NOT sterile, so if not kept cool, by day 7 through day 13 the Metyhdaone/Tang solution will start to ferment. Keeping the solution as cold as possible is a must. This sounds easy, but considering that if visiting friends/family who do not know that you are on MMT, providing cold temperatures covertly can be problematic. Sometimes you can't simply slam your Methadone bottles in your wife's parents refridgerator without raising some questions. You must be seen by the MD and provide urine sample on the same day you receive your 13 "carries" and on the 14th day when you would do your "witnessed dose".
Eventually you will progress to the point of seeing the MD and providing a urine sample every 2 weeks and then eventually providing a urine sample and seeing the MD once per month. Even though you only see the MD and provide a urine sample every 2 weeks or once per month, you will still only be provided 6 carries per week. Everytime you pick up your carries(once per week) you MUST perform the "witnessed dose". Urine samples that test positive for use of THC containing products delays progression through the process. Testing only for Mthadone and Methadone metabolites ensures the quickest progression to full "carries", this is the method to which SWIM subscribed.
Any "dirty" urine test results in the patient falling backwards a step in the process, and multiple "dirty" urine tests accompanied by the patient denying drug use (lying) will result in the patient losing their "carries" and being sent back downstairs into the "regular" MMT clinic and having to perform "witnessed dosing" every day.
Medical procedures in which certain medications are used for pain control or anesthesia will require the MMT patient having the surgeon/anesthetist writing a note of all medications used during the procedure and for any medications prescibed for use after the procedure.
There are 3 distinct levels in the local MMT programs.
1)Titration-levels of Methadone are increased until other intake of non-Methadone opiates cease and the patient can function with no symptoms of withdrawal
2)Maintenance-the patient can work, go to school live a life free of drugs
3)Taper- methadone dosage is slowly reduced at whatever rate the patient requires until the patient requires no methadone supplementation.
Reducing the dose by 5mg/per month until reaching 20mg/day, then slowing the taper to 2-3mg/day until 5mg/day then reducing the daily dose by 1mg/month until no methadone is taken. Friends SWIM knows have done this and reported absolutley zero withdrawl symptoms.
Treatment is what people make it, if folks follow the system, it does work. People who want to get better and live opiate free can benefit from MMT, but people who cant stay away from opiates can also lead full and productive lives if they have to stay on MMT indefinitley. Everyone is different.
If SWIY wants to feel an opiate buzz from methadone, get your "carries" and simply "double-dose" one day. But SWIY will never be able to "nod" off on Methadone for a week, it's half life is too long. "Double-dosing" more often than once a week leads to wasted methadone as it's takes so long for the methadone blood levels to stabilize at baseline.