Got questions on Heroin Addiction, suboxone, methedone and doctors

[Sweetmosses]

Swim and his girl have been on dope for about a year and some change on and off. They've been snorting it just untill about a month ago. They started shooting it, alot less cheaper and alot better feeling WOW.

Anyway swim hasn't been fully addicted to this yet, on the other hand she is very addicted. Swim has stopped doing it now just so he can pay and support for her. They are both tired of this life and need change. They are both unsure on how much is in each bag. She has to do about 4-5 bags a day.

She doesn't have any health insurance. Swiw has insurance. He was thinking of going to a doctor and saying he is addicted to dope and needs to start a plan for Suboxone. Then he would give the pills to her.

Swim is very unaware of the procedure that is taken to get a plan, like where to go. Swim is under the insurance plan witih his parents. He doesn't want any of the prescription details to reach his parents.

Swim was told that he could go to his family physician. But he is afraid about any information reaching his parents such as approvals or anything. He is 19yrs old so he figured that he is an adult and everything is confidentially between his doctor and him.

Swim is not sure if the doctor he always went to will be able to presribe suboxone. Swim thinks that he still goes to a pediatrician. He has no idea about his own doctors which is sad. If they dont prescribe it, then he is just going to have to go to another doctor right?

He called a doctor today and was told that he would have to pay 250 for the first visit and then 150 for each other visit. Is there anyway insurance can pay for this.

Also, does everyone think that swims girl might need methadone? He has heard that this is like a worse drug, it can be very dangerous.

Another option he has is that he knows an officer that he has known for years, he has no idea swim does anything but knows his girl does. He was telling swim that he could setup something that she can be brought into the hospital and she can be deteoxed. I guess swim should ask the officer but he is just going to ask the readers, who would pay for the detox insurance normally? She doesnt have nsurance, so she would have to pay cash they assume.

Any help is welcomed. Thank you very much and sorry for the long post

[Solinari]

Damn US health system sucks, $250 for the first visit.

First off, coming off smack need 100% determination, otherwise one will detox, perhaps remain drug free for a while, and then start using again. Getting off smack is not the hard part although it can be difficult and very unpleasant, the real challenge is staying off it.

For methadone, it would definitely have to be the person them self that goes to the doctor and/or methadone clinic. From what i have heard, methadone programs in the US are even more strictly controlled in my own country, the UK. So i really doubt one would be able to get methadone prescribed for ones own use, and then be able to give it to someone else. Even if this were possible, i would advise against it, too many risks and could easily end badly (legally, personally, or medically).

For detox, the only thing really is Subutex (Buprenorphine or whatever brand name it may come under). Again, i imagine the person involved would have to do this them self. I am unfamiliar with Buprenorphine and how it is given out in my own country, so i have no idea how it would work in someone else's. Never the less, i imagine it would be difficult and could involve the same risks as i mentioned earlier.

There are other options such as tapering off oneself but this can be difficult when using street heroin. It would involve something like going from 3 bags a day, to 2 bags, to 1 bag, then cut down maybe 3/4 of a bag, 1/2 a bag, etc. and you would probably need Valium or Xanax for the latter stages that will involve some withdrawal.

Trying to taper off with heroin itself is probably a bad idea, it is very difficult to do and will take 101% determination and will power. Tapering off oneself with something else, something you know the purity of would be better but still very difficult. Perhaps Oxycodone or Morphine and Valium or Xanax. One has to be very careful though, and one must not take them to get high and one must know what they can handle.

DIY detox with illicit drugs is very hard and can be dangerous especially when substitute drugs are used, such as opiates for opiates. Going cold turkey with nothing but will power and something like Valium can be done, but WILL most definitely involve at least 3 days of very unpleasant withdrawal, but one can do it, and can get through it.

[Solinari]

I must stress though, that one must be prepared to stay clean after the detox, or it will all be for nothing.

If one feels they couldn't do this, then methadone maintenance is probably the only alternative to illicit drug use. It's long term though, will involve difficulty, especially at the start, and could end up lasting years (as the case for myself).

[Solinari]

Does no one have anything add to this, or perhaps a follow up response from Sweetmosses?

I would like to know what you made of the post, good or bad, i would welcome some feedback, can be from anyone come to think of it.

[rocksmokinmachine]

If it is anything like the European system, SWIY will not be able to pick up the tablets and give it to his partner, over here it is all supervised consumption. I don't know if it is the same in the US it's just to stop people selling thier medication on.

SWIY says his partner is using 4-5 bags a day. If I am not mistaken that is around 0.5g in the US. That is too high a level of use to switch to buprenorphine. SWIY's partner should just get some health insurance and get on a methadone program. She should probably start on around 50/60mg of methadone, this can be reduced by 5mg a week at the most. This is considered quite rapid.

SWIY is right by sayin methadone is a worse drug, the withdrawals are far worse and last up to a month. People need to be really determined, as SWIM has seen people use 100mg/ml of methadone a day plus 1g+ of heroin a day.

[Solinari]

Completely agree on the determination.

Bottom line is, if someone is not serious about quitting then the user will just go back to using again. Often a user will not only delude others about wanting to stop, but they will be deluding themselves and deep down they will know it.

Without 100% determination, the detox will be for nothing. A maintenance program on either Subutex or Methadone can help a lot, it can and does reduce illicit drug use to virtually nil. That said it does take some time getting used to living without illicit drugs, living the life of a junkie is a habit in itself, so getting used to that can be hard.

Even although i barely use at all, and have been relatively "stable" on 90mg of methadone, sometimes i still feel like i am an addict rather than a recovering or recovered addict (which is still a way off yet).

Anyway, it will look like the person involved will have to do it them self. Trying to control your own habit (who ever that may be) is hard enough, but trying to control some one else's is pretty much impossible and will lead to relationship problems.

[Solinari]

Getting off of drugs is not the hard part, it's staying off them.

[rocksmokinmachine]

Solinari, does SWIY find that UK doctors often prescribe addicts more methadone than they actually need?

What are others experiences with this?

[Solinari]

Originally Posted by rocksmokinmachine

Solinari, does SWIY find that UK doctors often prescribe addicts more methadone than they actually need?

What are others experiences with this?

I wouldn't say that, my experience of methadone prescriptions seems to be, through a local drug service, the user will be put on 25ml (1mg/ml) no matter how big a habit that user claims they have. Then from there it will be increased. This is how i started but it was a few years ago now, close to 4 years probably.

Thankfully i no longer have to deal with the local drug service and i deal directly with my own GP who is a very decent person and doctor (that doesn't mean he gives me anything i want, far from it). Some people i know have to deal with the drug service, and from what i have been told about it, i am so glad i don't. Currently i am on 90ml of methadone per day (again 1mg/ml ie 90mg) but it wasn't always the case. For probably 60 - 70% of the time that i have taken methadone (close to 4 years on and off), i was on relatively low doses, from 25mg - 45mg.

Then after advice (of sorts) from a doctor who heads up methadone maintenance in my county, (from what i gathered he was basically saying that metabolic rate is a more important factor in determining dosage than the size of the users habit), i visited my own doctor and told him about this. He gradually put up my dose over 3 or 4 months, until i was on 80ml for a few months then put up once again to 90ml (current dose). Since then, close to a year, i have been doing far far better than i had ever done before. My illicit drug use is very occasional, maybe 2 or 3 times a month (at most), and it's just out of sheer boredom and frustration, possibly anxiety and/or depression that makes me want to score. (of course i get anti depressants, mirtazapine it's called).

From the people i know on methadone, i wouldn't say they get an unnecessarily high methadone dose, but i imagine some will. Even so i don't think it's over prescribed, in terms of an individuals dose (over prescribed generally is debatable i suppose).

Wow, i can edit, i am a Silver Member!! Well thanks to those that made this possible, whoever you are.

Regards.

[JaWill88]

when swims habbit was at its worst he was slamming 1 gram at a time (black tar of course), 3 times a day. thats quite a decent amount of heroin. oh yes and with cocaine whenever possible which was pretty frequently. last year the day after christmas swim got on suboxone (buprenorphine/naloxone mixture) at 16mg and he was fine. no withdrawal. swim is greatful for suboxone. with suboxone a patient usually takes home 30 days worth at a time. that may be in swisweets best interest. but on the other hand it is very expensive without insurance, more than methadone swim is pretty sure. but as said above, swiy really needs to be sure swiy and swiys girl want to quit before doing anything otherwise its a waste. good luck.

[madpad]

GPs used to hand it out pretty easily in the UK but then they started all these drug services before that many people without habits got themselves one after getting scripts.
As to over prescribing it seems to vary widely. Some under prescribe and others over prescribe. As to the dose someone actually needs lot of it is down to will power as swim has gone from habits in the low g's a day dose straight to around 50mg without any real problems.

Getting off methadone is another problem as it's nothing like the week or so in bed from H. After almost twenty years taking it, or substitutes, every day, well maybe a few weeks of days without in total, swim knows.
Luckily swim hasn't really had to put up with the hassle of daily dispensed or take on premises scripts.

I'd try to avoid the methadone route if possible and try to stop with the sharps as it only takes one slip to end up catching something that could well kill swiy.

[Solinari]

The days of daily dispensed have been over for me for over a year now. Frankly i couldn't put up with the daily trips to the chemist, i couldn't go back to it.

After saying that i didn't think it was over prescribed, i may have to change my mind on that. My friend was recently put on methadone, and after just a few weeks he is taking the same as me. It took me months and months to get up to 90ml, but it seems it only took him weeks.

The way they do it now, through the drug services, i am so glad i don't have to deal with them. With their weekly meetings on a Friday to get a prescription, i have heard it's nothing but a junkie convention. I would be put off by that alone.

My doctor doesn't over prescribe methadone, at least not in my experience, but it may well be true for the drug services that are now giving it out.

[rocksmokinmachine]

Originally Posted by Solinari

After saying that i didn't think it was over prescribed, i may have to change my mind on that. My friend was recently put on methadone, and after just a few weeks he is taking the same as me. It took me months and months to get up to 90ml

The outpatient clinic SWIM was in prescribed 20ml (1mg/ml) for every 'bag' the user claimed they were using. The prescriptions were written out way to easily and there was no real way to determine the levels of use, just a quick urine sample beforehand and a positive test for opiates was all that was required. Afterwards the user was sent to see the doctor. "How much are you using". He asked SWIM. "5 bags a day". Replied SWIM. "OK, 100ml of methadone". Said the doctor.

As easy as that

[Solinari]

Well, i was on about 45ml, maybe 50ml max, for ages. Then my mother it was, went to some conference thing and heard a doctor speak. From what i could gather, this doctor heads up methadone maintenance program in my area and according to him, metabolic rate is more important than how much the user is using in terms of bags per day.

Maybe a lot of them do say 20ml for each bag, but that seems too random for my liking. one bag will be different from the next not just in size, but in purity as well probably. Anyway, since i went on to 90ml (put up over a couple of months though), it has been much easier for me. I still use occasionally and admit as much to my doctor but he doesn't instantly want to put the dose up, and nor do i.

[jerbles]

swij has been addicted to this substance for a long time now (since he was 15). He had to (forcably) go cold turkey several times (locked up), but this only made him more eager to use when he got out. During these periods of time without use (2 months was the longest), he found himself feeling very empty and that life seemed to be meaningless.

The 5-7 days of withdrawals are definately the hardest part, but keeping off it is very, very hard as well, especially when most of your friends (and some family) do the shit. Rehab is shit. Swij spent a month in one when 17, and while there only thought about using (even dreamed about it).

Swij also started slamming to conserve dope (not to mention the lovely high), but now IV is also a factor (mental addiction). He loves sticking himself, even though most of his veins are gone, when that plunger goes down everything seems worth it. As happy as heroin can make you, this lifestyle definately isn't fun or even tolerable at times. Swij has real financial issues, but every time he gets a dollar it goes straight to dope, and he really can't help himself.

For some reason, H just seems to make swij happy and content with anything. These days, he's perfectly happy just sitting at home not doing shit, as long as he's high (or not sick). A while back swij went to his doctor for help, but was only recommended to a rehab and prescribed anti-diareah and nerve pills. Swij's tried using everything from cocaine to valium to dxm to deal with withdrawals and nothing does shite for him.

The nearest methadone clinic is unfortunately an hour away from swij, and he can't drive there everyday for his dose. Suboxone sounds pretty good, but swij doesn't like the whole nalaxone thing.

Anyways, once someone crosses that line into heroin addiction, the doors close and lock, and they're there the rest of there lives. I applause the people that have successfully recovered, but swij is definitely not one of them, and I don't consider methadone to be a successful recover, as it's still obviously an addiction.

And as for Sweetmosses, how is it that swiy didn't get addicted while his girl did?

[rocksmokinmachine]

In Europe Buprenorphine/naltrexone properations do not exist.

It seems sillly really as Buprenorphine is a mixed agonist/antagonist

[Sweetmosses]

Originally Posted by jerbles

And as for Sweetmosses, how is it that swiy didn't get addicted while his girl did?

I dont know. strong mind i guess. But i know i cant let that fool me. I kno that if I forget about the consequences i could fall in that dark hole.

Still i am i'ving and being able to control it

There was one day actually recent, that i could not sleep i think it was the H knocking at my door. i tried takeing nyquill with some other stuff and smoking some green. That just resulted in the bigget headache ever, but i was able to pass out and get by to the next day.

[Solinari]

When you take buprenorphine then use heroin, do you get withdrawal symptoms?

[djesus]

Swim has kicked dope before and is familiar with suboxone and methadone in the US.

First off as everyone else said it cant be stressed enough the she has to truely want to stop using and be totally determined.

Suboxone in the US is given as take home perscriptions usually 2 weeks or a months worth at a time. Suboxone is a good drug a worked weel for swim but it is very expensive unless you have insurance.

I would advise her to try to get insurance by any means possible if this cant be done then she should apply for medicaid. Either one of these is goin to help alot in getting help kicking.

Swim's not sure how common it is for medicaid to cover suboxone treatment so i would go for insurance but Swim understand insurance is not that easy to get so if she cant get insurance she should apply for medicaid then call around to see if you can find any doctor that can perscribe suboxone that will take her medicaid

If the suboxone doesnt work out its not the end of the world. She still has options. She could try an Emergency Room detox. Swim lives in NY and here there are several hospital in which you can walk into the emergency room tell them you are withdrawing from heroin and be detoxed right away. When Swim went to detox in a hospital he walked in and explained his situation and within 2 hours was in a very comfortable room with a dose of methadone it was a low dose but it stopped the withdrawls for sure. He was given a dose of methadone every 4 hours for four days and then observed without medication for a 5th day. By doing this she get through the worst of her withdrawls relatively comfortablelly and she will not gain a methadone addiction as if she where to go on a methadone maintenance program. Swim's experience with the emergency room detox was very good. Swim had insurance at the time of his detox but Swim's sure because she will be goin through the emergency room medicaid will cover it or the state in some form will. The only thing is that she'll deffinately need more treatment after this the detox will get her through being sick but will not keep her clean i would suggest some counseling or outpatient service.

Also if it is neccesary the methadone maintenance program is an option. While everyone one is right when they tell you how dangerous and addicting methadone can be it is not a total death trap. Swim as well as many people Swim knows have used the methadone program successfully and come off of it. If she follows the instructions of the program and does not abuse the medication she can use it as a very helpful tool to help her get off the dope and then slowly stop using the methadone the method will aslo make withdrawls pretty much non existing. Suboxone and the emergency room methadone will also pretty much kill withdrawls as well ( at least in Swim's experience), But Methadone Maintenance programs are almost ALWAYS covered fully by medicaid. Swim know many programs where all they require to accept you is proof of employment even if you have no medicaid or insurance.

Detox is not the end though altough she must detox first to get any further in her recovery so deffinately go out and get that done by any means. But once you accomplish that i would recommend outpatiend but the best tool for recovery out there ( at least in swim and most people swim knows who have gone through this) is Narcotics Anonymous that programs saved Swim's and many others lives and it is toally free. It may be hard to go or want to go at first as it was for swim but once swim did he fell in love with it and im sure swiy and her will.

Swim as some one who has experienced what she i goin through first hand is willing to help in any way and knows how hard this is for Swiy and her. Fell free to ask me any questions or send me a PM with any questions or if i can help in any way.

Good Luck Swiy and his girl will be in my prayers please keep swim posted. I wish Swiy and her strenght and luck

[rocksmokinmachine]

Originally Posted by Solinari

When you take buprenorphine then use heroin, do you get withdrawal symptoms?

From experience, yes

[djesus]

If u use subs then use heroin within 24 hours of the subs you wont get sick but u wont feel the heroin.

If u use heroin and then use subs u will get sick if you didnt wait 24 hours from your last heroin usage to take the subs. If you wait 24 hours from your last fix to take subs you should not get sick, but the subs should eliminate any sickness you might have from the heroin withdrawl.

swim keep noticing people saying the subs made them sick. may swim ask how long before you took the sub was you last heroin use? because from swims understanding of how suboxone works as well as personal experience how swim explained above is how it should work

[jerbles]

Swim knows first hand that outpatient and counseling doesn't work (at least not for him).
Never tried NA, I've heard good things about it, but the whole idea just seems depressing as hell to me, and would probably just make swim want to use more.

If you're forced into inpatient or something (like I was for probation), then that will definitely help you get through your withdrawals. Yeah, swim was fucking miserable for about 2 weeks in there (and pretty much the other 2 weeks as well), but there was no possible way to leave. 28 days may seem long as hell when one is dopesick, but it's really not that long at all, and just think about it as 28 days free of having to cop and ingest that poison.

Swim managed not to use for about 2 weeks after rehab, but was offered to snort some and of course he did. It didn't do anything for him, so he decided to take out that needle again, and it all came back to him. At first the withdrawals were mild, and he could even sleep through them, but then they got stronger and stronger up until this point. Swim started feeling them at 9PM last night, and knew he wouldn't get a hit till about 8am, so he drank half a bottle of nyquil, at 20mg ambien and sat at the computer waiting for the drowsiness to set in.

It never did, all the nyquil and ambien just added greatly to the nausea and gave swim hot flashes, and here swim is, 2pm, only recently had his fix and tired as hell, but knows he needs to stay awake to score again. If only swim had a fucking bottle of subs or dones, he would be fine.

[djesus]

Swim also did a 28 day inpatient rehab and it was great but he had to detox at the hospital ER because the rehab said they did have the resources needed to deal with a severe opiate withdrawl. They had darvocet on hand to help people going through minor withdrawl symptoms but had nothing to help with a more serious withdrawl so seim went to the hospital for a 5 day methadone detox and then went into rehab where he didnt require any medication. Rehab , however, was one of the best experiences of his life. He learned so much there, meet some really great people, never laughed so hard, had a blast, and the foo was great

[madpad]

You shouldn't get wds from taking H after buprenorph but if you have a decent H habit taking buprenorph will put you into wds for a short while. Swims had that before when swim couldn't score H and ended up trying some bup but swim was able to work the next morning.

Swim managed to kick a H habit before without too much discomfort but a methadone habit is something else entirely, which is why swim wouldn't advise taking it for any length of time. At least not years (swims been prescribed on and off, mostly on, for around 18 years now and just can't manage to stop.)

[Solinari]

I did know that taking buprenorphine after taking heroin or any opiate/opioid agonist would or could cause withdrawal.

I just wasn't sure what would happen the other way around, taking something while on buprenorphine.