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The way the OP phrased the question bothers swim a little, "going out with a bang"? Initially I read this to mean wanting to have one last go at getting high before committing to a methadone programme, but it could be read as a self-harm/ suicide reference. In which case, sorry, but this type of discussion goes beyond the scope of the forum, which focuses on drug use and harm reduction.
However, I am gonna give it the benefit of the doubt for now, and leave the following info for you about using tramadol whilst on methadone:
Swim was recently prescribed tramadol for post-op pain relief, on top of her methadone script. She wrote about the experience in the Tramadol Experiences Thread:
Originally Posted by Helene
Swim has been prescribed tramadol for the past week or so due to post-operative bone pain. Swim is an IV heroin addict, has been for the past five years. Prior to that, she was a regular user of heroin for another two years.
Swim is currently taking 50mg of methadone a day, as well as using about a half gram of heroin for maybe two days a week. This is pretty much the lowest her habit has ever been, at its highest she was doing about 3g of heroin a day.
Swim was prescribed tramadol because the codeine she was initially prescribed was not touching the sides, no matter how high the dosage. Over last weekend, swim was using sevredol (morphine sulfate) to control the pain. Then on Monday morning, she went to her GP and he suggested a tramadol script. She's been prescribed 100mg of tramadol, 3 or 4 times a day (up to a maximum of 400mg per day).
Swim was sceptical whether a weak opiate like tramadol would work, considering her high opiate tolerance, and long history of using heroin, a much stronger opiate. But in terms of pain control, it has worked. In fact, it seems like it's worked better than the sevredol was, certainly it's lasting longer, with only a small amount of pain at the end of each six hour dose period.
In terms of recreational/ pleasurable/ euphoric effects, swim has felt nothing what so ever. This is probably due to her high opiate tolerance, and the continuous baseline methadone dose. It's hard to say if on the first day taking it she noticed any stimulant, mood-uplifting effects, she certainly felt a lot better than she had for the past few days, but swim's fairly certain that this was just due to her not be in pain, she'd spent the whole weekend battling against horrible, intense pain all along her jawbone, causing terrible ear-ache as well. So I guess finally finding something that stops it would cause her to perk up a little. Thereafter, no noticeable upper-type feeling, in fact, nothing in terms of effects at all, save for the painkilling qualities.
Swim has noticed that her methadone has not been as effective since she's been taking tramadol. It seems that a recognised and documented side-effect of tramadol is its liability to reduce the efficacy of methadone, swim didn't know this when she started taking it, but luckily was in a position to be able to up her methadone intake a bit, to counter this. Swim's methadone prescriber has told her that when she stops the tramadol, she main need to up her methadone a little more, to make up for the loss of the opiate intake which the tramadol was responsible for. Swim isn't sure about this, she doesn't imagine she'll need to be taking tramadol for more than another week or two, but we'll see how things are after she stops.
So all in all, from an already highly opiate-dependent perspective, tramadol, in these therapeutic (but high) dosages works to relieve post-op bone pain, but gives no noticeable pleasurable/ narcotic effects.
Originally Posted by Helene
Swim started taking tramadol on the 7th December, at the maximum dosage of 400mg per day. This just about worked to control her pain, she'd been using a combination of codeine and morphine for a couple of days prior to that, but was rather surprised at how well the tramadol worked. See her previous post here for more details.
So, fast forward to the present day, she's no longer in that much pain, so has stopped taking the tramadol - she doesn't wanna be taking any unnecessary meds, not on top of everything else. She had her last dose yesterday morning. She'd slowed her dosage, from 400mg per day down to 200mg per day over the past week or so, without any problems. Basically, she wasn't experiencing pain as often or as intensely, so wasn't taking as much as frequently. Yesterday was the first day she didn't need to take any at all. She's had a few twinges of pain yesterday and today, but 50mg diclofenac has sorted that out no problems.
Anyway (slowly getting to the point...) so swim has been taking tramadol at the described dosages for seventeen days, on top of (the very low, for swim) dosage of 50mg methadone per day. On stopping the tramadol, fuck me has she felt ill. I mean withdrawal ill, rattling. The tramadol fucked up the methadone anyway, started interfering with it in very odd ways, but swim managed to kinda get round that, by a combination of taking the meth at times as far away from her tramadol dosages as possible, and by using a bit of gear on top. But she hasn't had any gear for the past few days (she doesn't use daily anymore anyway, hasn't done for a couple of months now, and never has any problems WD-wise with adjusting back to her methadone after a day using), and since stopping the tramadol, 50mg of methadone just has not been holding her for 24 hours at all. Luckily, she's got enough methadone to be able to take more, as necessary, and tried taking 60mg yesterday, which sort of seemed to work, but she woke up ill this morning again. She isn't gonna up the meth dosage any more than this (refuses to - she's done too damn well to get it down so low, not gonna go up past 60mg).
She's not feeling that awful at all, just was a little irritated to be waking up rattling two days in a row. Her doctor did warn her that she might need to up her methadone dose a bit when she stopped taking the tramadols, to compensate for it, so she doesn't know why she was at all surprised that this turned out to be the case. I guess it's just that she got literally no narcotic, euphoric effects from tramadol, only painkilling ones, so (wrongly) didn't really associate that with, or expect any withdrawals. I know swim's existing opiate tolerance/ dependency has a lot to do with the lack of any effects from (the relatively weak, short acting) tramadol, but somehow in the same way she figured the (much stronger, and longer acting) meth would cover up any withdrawal effects from halting the trams. Seems not though!
Point swim's making is this - even drugs that give literally nil narcotic, pleasurable effects can send you into withdrawal when you stop taking them. This may seem obvious, but even people who like to think they are rather experience and well-versed in the ins and outs of opiates can get caught out every now and again!
Hope that helps answer your question, and please do come back to clarify your above post, and put our minds at rest.
Last edited by Helene; 15-01-2010 at 11:36.
Reason: adding in more info
That's the way I read it, the OP is trying to get clean, but wonders if he can have a final blow-out with the trams... in case he didn't get this from my above post, the answer to that is no - tramadol on top of methadone will not get you high, in all likelihood the only effects you're gonna get are some pain relief and maybe a reduction in the efficacy of your methadone, causing you to start withdrawing. They really aren't recommended to be used concurrently, for that very reason.
The Cat strongly recommend to go into the very informative File/Document Section for a Read!
Tramadol and Methadone are a bad combination, this is what the Cat remember
but not why!
Maybe Tramadol is in/ decreasing the Blood plasma level of Methadone
or something similar happen,
or something happen inside of the synaptic cleft,
not remember exactly!
Tramadol is not considered an opioid, but in fact, it is.
It is simply that it does not depend solely on its opioid quality for its pain relieving ability.
As a result of its action, it effects methadone levels as a mixed agonist-antagonist.
It should be avoided by those using methadone.
tramadol isnt a very good drug to mix with anything jsut because it seems pointless. first time swim tried tramadol he took 4 and it felt like a tab 5, did it the next day and just felt sweaty and ill. methadone also has the potential to make you nauseus (sp?) so i wouldnt reccommend mixing them. swim says just take the methadone to help get off the smack. swims never done smack but hes done methadone and can see how it could possibly help you, just hope you dont get hooked.
Tramadol and Methadone are a bad combination, this is what the Cat remember
but not why!
Yes, this is correct. As stated in swim's above post, tramadol lessens the effect of methadone, meaning that it is very possible that you will wake up in withdrawal, even after taking your normal methadone dosage. This is even more important for someone who is just starting methadone treatment, and has not yet stabilised on it.
Originally Posted by kpinhead
swims never done smack but hes done methadone and can see how it could possibly help you, just hope you dont get hooked.
If someone with a physically addiction to heroin is put on a methadone script of course they're "hooked" - methadone just substitutes the heroin they used to use daily, and stops withdrawal occurring. A heroin addict can't just swap from heroin to methadone, then quit the methadone straight off without experiencing any withdrawal. One would need to slowly taper down, reducing their methadone dosage by small increments in order to avoid extreme physical withdrawal.
Last edited by Helene; 16-01-2010 at 10:07.
Reason: removing some code that sneaked in...
While SWIM was in prison people were getting into debt for these tablets and 400mg was the recommended dose for a "buzz"
The problem with tramadol is that it doesn't really behave as a straight forward opiate. Someone who is addicted to something like heroin or methadone will have a high tolerance to opiates, and they could take a relatively large amount of something like oral morphine sulphate without any serious negative effects (as long as the dose was within reason, carefully calculated and based upon their current tolerance/ habit). But this sort of logic cannot be applied to tramadol - the maximum safe oral dosage is 400mg per day, and this is regardless of tolerance or habit size. The higher the dose, the greater the likelihood is that a seizure will occur. The reason for this is its tendency to trigger seizures, and the fact that this effect does not decrease with opiate tolerance. If you have never taken tramadol before and never experienced a fit, it is impossible to know how low/high your seizure threshold is, or if tramadol is likely to trigger a fit. To be safe, anyone with any history of fits or seizures should avoid tramadol entirely, and everyone else should avoid taking more than 400mg of tramadol in any 24 hour period.
I guess I should have specified. SWIM is not planning on hurting himself, but on the contrary, he wants to become healthier and happier. He's on day 5 of his withdrawals and has been taking suboxone as he needs and sees fit. He decided not to go with the done since he heard it was as addictive as heroin, and he really didn't wanna start up a new addiction (the cigarettes are enough..). And, he didn't go through with the trams either. He wanted to get nice and high one last time but said screw it and has been doin well since. He knows it's only day 5 and it's not much of an accomplishment but hey, it's a start, right?