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I was always under the impresssion Methadone and Morphine were 1:1 when IV'ed but Done lasts longer and maybe morphine is a better highpain relief? Both are very body buzzy - never shot Morphine however. Now I know Metrhadone oral would be like twice as strong as it's BA is twice so I understand.
What I thought was OxyContin was 1.5x stronger than Morphine but not Diamorphine. OC's BA is similer to H/if not higher. If someone was on 80mg of Methadone every 12 hr - would an 80mg of OXycontin (uncrushed) every 12hr match it or be stronger?
Not only that but most Methadone is racemic and only half ithe mg you take works.
60mg OC oral for a non-tolerent person would make 'em sick probs (20-30 usualy) but 60mg would clearly be deadly with done?
+ Methadone vs Heroin (both street and pharma). I know theres alot of crap about so people believe 'done is better as it's always pure but what about pharm amps of heroin.
I mean STRONG in terms of how much to overdose, depession, etc
I also know that fairly mod-high doses of done have a good binding affinity so this might lead people to believing Heroin, OC, etc isn't as strong.
Another thing is (if I aint onfused you enough) where does bupe match up?
As TBBW rightly points out, comparison of opiates when it comes to 'strength' is usually used in a pain management setting and will vary according to the individual.
One other thing that is often overlooked is incomplete cross-tolerance. People who use opiates do build a tolerance of course, but its not complete and uniform. So, the tolerance they build to their current opiate won't extend completely to the other opioids, and the estimated difference between any two opioids can vary pretty widely.
This is why there is a very real danger when converting doses in reading a straight equianalgesic table and thinking 'oh, x amount of morphine equals x amount of methadone' or whatever...it will vary according to things such as age, prior side effects, RoA, liver function, etc.
Many medical professionals recommend reducing the dose of the new opiate by around 30 - 50% to account for the incomplete cross-tolerance, and titrating or building up from there.
An example would be if somebody was receiving 200mg oral morphine (chronic, daily) and was switching to oral hydromorphone, they should be advised to start at 25mg to 35mg per day - this would be a 33 to 50% reduction in dose when compared to the calculated 50mg that an equianalgesic calculator would give you...a big difference!
Whenever anyone asks for comparative doses with pharma opiates, I calculate in the reduction for incomplete cross-tolerance (and note it in the post) as I think its really important thing to be aware of. Tables and calculators are a good rough guide, but many don't take this into account.
I don't know if that adds to or clarifies some of the confusion, lol, but I just wanted to throw that out there as I think its a good thing to know
ref: Pasternak, G., (2001), the pharmacology of mu analgesics: from patients to genes, Neuroscientist, 7(3).
Last edited by catseye; 04-03-2012 at 21:00.
Tony, Methadone, as well as any other opioid, is very sedative , and there is a reason for why the "weaker" opiates/opoids exist, it is not to kill an opiate-naive person with an OD.
Quit citing comparisons of the strength of opiates, they don't work that way. it is not like TNT is ten times stronger than Dynamite. Opiate pharmacology is much much more complicated than saying a porsche goes two times as fast as a toyota...
By the way, who do you want to kill with an OD?
don't take offence. but your question above sounds a bit in that way..
here is what everone so far is missing, methadone is so dangerous because of its "half life" the drug stay in your system much longer than the effect. meaning you may take more because your pain comes back , but because of the half life your body has not gotten rid of what you have already taken and therefor you OD. or potentially.
The fact of long half life wasn't missed, the OP only was told that the way He posted the question makes no sense. I can't give you an answer about how your car accelerates if you ask me how much gas it needs, if you catch my drift.
BTW, the OP has asked several such questions about "strength" of opiates and how to compare doses ( what does not work in a medical setting and less still in a recreational one) all over the Opiates sections.
The op seems to think it goes like one apple has as much calories as how many bananas, and that is not how it works, half life included or not.
This is about better educating the OP that he has asked unanswerable questions and why this is so.
And No, Half- life is not the contrary of LD50. (Even when the rig is half full or half empty)
I am mainly refering to the sedation, nod - danger. Maybe its because it's up there with the strongest and used recrationally (2hr to peak, etc) it's the danger of people with lower tolerences getting ahold of it I guess.
Orally its alot more BA than heroin, morphine so thats to take into account.
Could someone please clarify the bit about "racemic" methadone? I seen little bits and pieces of information about there being "two kinds" of methadone in the 70 mgs or mls that the clinic gives me in the form of their evil pink juice, which is never a satisfying dose, but when I get ahold of tablets I find that 25-35mg is "enough". I've thought about taking my Sunday take-home right after dosing at the window on Saturday, to see if 140 would do it for me.... I've been enrolled at the clinic for over a month and am still having night sweats, insomnia, anhedonia, unless I find extra material outside of the clinic.
Firstly, I would strongly urge you NOT to just take your Sunday take home straight after your Saturday! Doubling your dose from 70ml to 140ml could quite easily overdose you and put you in the ER..or in a box in the ground
Increases are usually in 5 to 10ml steps...please be very careful, ok?
With regard to your question though - as far as I know, you will only ever be offered the racemic version of methadone in the US (a combination of levo- and dextro-methadone in equal parts). I think only Germany offers patients levo-methadone, which is twice as strong as the racemic mixture.
So the tablets and the liquid you are scripted are both racemic, and afaik the tablets/liquid/wafers of racemic should all be the same, dose-for-dose
I know there are a couple threads around which debate the efficacy of liquid vs. tablets - people prefer one or the other, but if 25mg tablets are holding you and 70ml liquid isn't, then I'd suggest talking to your treatment worker or a supervisor at the clinic and asking about switching to the tablets all of the time perhaps?
Personally, I think that 70ml is a slightly low therapeutic amount...from what I've read, 80-120ml seems to be a general guideline for comfortable maintenance - obviously, the lower the better, and remembering that the point is to not withdraw rather than to feel high When you say that your current dose is "not satisfying enough" I'm assuming you mean you are getting wd's.
Have you reported the night sweats, etc to the clinic, and have they worked with you at all to increase dose? They obviously will be following the "start low, and go slow" approach to keep you comfortable, but if 70ml is truly not holding you then something needs to be done.
I've read a few times lately at DF that the therapeutic dose of methadone (that keeps you stabilised the best) is between 80mls-120 mls. I'm not sure about this for two reasons, the first is cuz the dose of methadone you need is determined by the amount of heroin you were using to begin with as not everyone uses the same amount of heroin, and potency differs area by area, and secondly (as I've said before) the people that picked up at the same pharmacy as I did were on doses ranging from 55 mls-70 mls, I never met anyone who was on a higher dose than that, and over the time I was picking up (years) I met nearly all of the clients that used that particular pharmacy. We'd stand chatting whilst we waited for the pharmacy to open.
I was on 120mls simply cuz my dose had to cover a chronic pain problem as well as my addiction, and when I got to (I believe it was) 110mls the pharmacist said he'd had to order larger bottles specifically for my take homes cuz they'd never had anyone on that dose before, and didn't have any suitably large bottles. That says to me that no one had been on that dose for a while or else they'd have had the right sized bottles for me. Most of the other addicts I spoke to were quite surprised that I was on such a high dose, and they asked me why it didn't knock me out.
I spoke to my GP (who was my prescriber) and asked him what dose he thought I would need and he told me it was all up to me. If I felt comfortable then that was the dose I needed. He also mentioned that some doctors prefer to allow their patients to use extremely high doses that virtually had them on their back, simply cuz while they were high, as opposed to comfortable/stable, they would have no desire to use heroin. He told me that the higher doses started at around 110 mls increasing to 190mls, in some cases, more.
Please don't think that I'm saying any of this to be argumentative, I'm just trying to understand how such a therapeutic dose can be arrived at when, in my experience, most people take nothing like that dose.
Originally Posted by missparkles;1164781
He also mentioned that some doctors prefer to allow their patients to use extremely high doses that virtually had them on their back, simply cuz while they were high, as opposed to comfortable/stable, they would have no desire to use [AUTOLINK
heroin[/AUTOLINK]. He told me that the higher doses started at around 110 mls increasing to 190mls, in some cases, more.
I think that bit about some doctors keeping people on high doses is important to note, and it no doubt is the case with some. I know that the ideal therapeutic dosage was devised in the '60's (Dole et al, 1966), but this has continuously been challenged through the years by others and the results seem to come out pretty much the same.
By" ideal therapeutic" I mean based on serum methadone levels (determined by blood), and the minimising of the 'peaks' and 'troughs' between doses.
I totally agree that every person is different, and research can be far different than real life - but as far as what the actual amounts are based on, it's one of those things that has been established and kinda worked its way into the guidelines of most prescribing manuals, etc. Methadone has a huge amount of research behind it and whether it's correct or not, the prevailing wisdom has been "As with antibiotics, the prudent policy is to give enough medication to ensure success” (Dole 1988)
I'm sure it has a lot to do with the motivation and desires of the individual...I mean, how motivated are they to come off street gear and get stable? How do they cope with not feeling high? etc
It's a real individual balancing act, isn't it?
I can't speak from personal experience as you can, so I'm only going on what I've heard from others - and while I do know of plenty of people stabilised and doing well on lower doses (50ml, 70ml, etc) I also know of many people who are on higher doses (say 100+ml) who are not managing...not necessarily chasing a high, but just not feeling well. It is very complicated isn't it?
Now I'm assuming when the OP says that his dose isn't "satisfying" that there are objective (directly observable) withdrawal symptoms occurring (rather than subjective ones which don't really count for a lot, clinically speaking).
It's an interesting observation, missparkles, and I agree that there is a huge difference between what seems to be the pervasive theory and what works in practice
Hey Catseye, I didn't want you to think I was being argumentative, of course there's a lot of research behind that optimum dose of methadone, I'm just wondering why, if its been so well researched, so many addicts are on no way near that dose. A lot, in fact, are kept at half that dose, or less. I just didn't want the OP to think that they had to be on 120mls to feel ok, that's all. You're quite right though, we are all different with our bodies metabolising various substances at very different rates. As you pointed out the most important aspect of this whole thread is that the OP, and the fact that he's not stable on his dose. That's really what needs to be addressed isn't it?
Obviously the correct dose (aside to what the statstics say) depends on what the substtuted patient sees as "sufficient dosed".
In the first five years of MMT I clearly was chasing a high, and didn't feel content when the Nod lacked me. To me at that time meant 110mg of rac-methadone.
With me getting a different view of what I want in my life and the changed drug-intake behaviour that followed these thoughts I now find myself in the situation to feel comfortable with a much lower dose, steadily reducing slooowly and (fingers crossed) with no unwanted side effects from evtl. too low a dose.
I am sure that a reduction of the drug without the change of mindset is bound to fail and that patients who feel comfortable only when the effects of the drug are perceptible should be given as high a dose as is needed.
Feeling incontent and unstable is the enemy of maintenance therapy, changes in mindset take time.