people on methadone or buprenorphine maintenance

[JaWill88]

swim is on buprenorphine (suboxone) maintenance. he felt opioid effects when he began but faded after a month. now he feels absolutely nothing from it. swim knows people are not supposed to be high on it but when swim feels some effects it keeps him from wanting to do heroin and cocaine. swim is wondering if people on methadone feel opioid effects? any at all? swim takes his suboxone and there is no "come up, peak, and comedown". he feels NOTHING. swim wants to know if methadone may be what swim is looking for. btw swim knows all about the notorious withdrawals and all that stuff thats bad about it. thats not what swim wants to hear about. he knows how to get off of bup or meth relatively easy. but anyway, can anyone give swim some advice? he thinks this may help with his problem.

[kborodinski]

Iam on methadone for 4 years now, I went from 185mg down to 135mg in the last year now. I think methadone is great, you begin to feel normal and able to do your daily task at hand. One big problem with it is you SWEAT like shit, its like your body cant regulate its own temp. And its the hardest of all opioids to get off of. In terms of its half-life I went 48hours without getting sick. This is the way I get it methadone hcl dissolved in 100ml of tang. But seen it come in clear liquid 10mg/1ml like water but a little bit thicker. I tried to bang some, but did not feel anything. Someone said to me that powder methadone would give you a rush. Anyways good luck in your affairs.

[sweetsugar]

swims partner is on a methadone maitenence, he's been on it for a while now, and started at a dose that held him from w/d'ing but his dose was put up repeatedly until he felt the effects. once at a dose that he felt comfortable with, after a while he has stopped feeling the slight high as he is addicted to the dose he takes (or perhaps built a tolerence), therefor feeling 'normal'.. in swims partners case he likes to get high almost every day(wherever it'll be smoking a spliff, popping a benzo, having a drink etc ~ swiy gets the drift), doesnt have a prob with reality but considers life that more enjoyable with a little something - if that makes sence. therefor his cravings for herion are more intense.. something swim thinks is something a recovering herion addict has to deal with...

[madpad]

SWIM has never needed high doses, even coming from a substantial opioid habit. As long as it takes the edge off and stops WDs. If swim can go for much more than a bit over a day or has any sweating problems or drowsiness swim knows the dose is higher than necessary.

[Orchid_Suspiria]

Methadone definitely has some effects,much more than buprenorphine.The thing about methadone is it seems as tolerance builds its long half life seems to decrease.This means where when you start methadone it might take you 48 hours to go without it before getting sick but later on it may only take 24.Buprenorphine seems to have a much longer half life

[moda00]

Well suboxone (buprenorphine) is a partial agonist whereas methadone hcl is a full agonist, so in theory the opiate effects of methadone are more powerful.. although before becoming an addict, swim would use both recreationally on occasion and found that the bups had a much more intense/stronger effect. Bups are generally stronger milligram for milligram, so perhaps this was so because swim wasn't doing equivalent doses- she could take a quarter of a pill (2mg of an 8mg pill) of buprenorphine/Suboxoneand and be wasted for an entire day.. this was also the only opioid type drug she's ever blacked out on, on its own (memory loss).

However, now that swim has an opiate dependence from regular/daily injection heroin use, her body responds a bit differently than it did when she was still using pharmaceuticals recreationally. She found that once she developed a tolerance and physical dependence, buprenorphine would not get her high, although she did have occasional opiate effects when she first started on it- occasional itching, occasional drowsiness, etc., nothing too strong. This dissipated over time, but she was also unable to stay sober when she first started trying to kick, with outpatient/inpatient treatment programs and suboxone/bup maintenance.

Buprenorphine has a ceiling effect, meaning the dose-response relationship is not linear, and the response plateaus once a certain dose is reached (between 32-40 mg from what I've read). Methadone, as a full agonist without significant "ceiling," will continue increasing in effects as the dose is increased- making it a good option for those with very high tolerance, for whom the highest doses of suboxone do not alleviate withdrawal symptoms.

However, now having been on methadone for around two years, swim can tell you that you do not get any "higher" on methadone maintenance. Maintenance dosing is defined as a stable dose to which the patient is completely tolerant as far as euphoria, analgesia, and respitory depression. So while both buprenorphine and methadone are synthetic opioid type drugs and can produce opiate effects, especially when first started, one cannot continue to experience those effects indefinitely without tolerance and ever-increasing doses- which is the opposite of being stabilized or moving towards sobriety.

In swiy's specific situation as described, I don't think methadone is the right choice, but of course tis a very personal decision. Sure swiy could probably feel some opiate effects for awhile, but eventually one would have to stop going up and stabilize at a dosing level, and these effects fade completely as they do with suboxone. As swiy described with his suboxone, so this swim feels with her methadone- there is no come up or come down, no high or opioid effects felt from dosing- it is a stable state while awake and normal sleep.

It just worries me that swiy seems to seek those opiate effects in a maintenance program. Of course we opiate addicts will want to seek the opiate effects; in addition, drug addicts in general crave the intense rushes of using, which are inevitably followed by come downs or crashes- this is the nature of addiction, and one of the reasons why it can be so detrimental. I know swiy is early in his recovery- but I can tell you that one of the most important parts of recovery is to move away from the desire or expectation of those chemically induced ups and downs, and learn to be okay with sobriety and the more "normal"/natural and subtle ups and downs in life. It is worth doing, at least for now- remember, swiy can always go back to using, but please give sobriety a shot- real sobriety, which I personally believe can be achieved through the help of maintenance opioid therapy, but only if it is done with the intent of stabilization- stabilization of both the opioid dose needed, and of the patient's moods and mind states. Now, swiy craves because he is new to sobriety- it can take a few months before those acute cravings leave for many people. But seeking another opiate to give swiy these feelings will prolong his struggle IMHO.

Especially since (and correct me if I make an inaccurate assumption, please) swiy is adequately maintained on the suboxone in that he is free of the immediate physical withdrawal symptoms, and is able to feel relatively stable during the day and sleep through the night. Swim would suggest that if this is the case, ride it out with the suboxone- methadone has been a lifesaver for swim, but it has its downsides. She personally feels it should be used as a last resort, when other treatments are not appropriate for whatever reason, and/or have been tried and failed. It does restrict one- having to go to the clinic to dose daily for the first 3-6 months, for example, and is a much longer term solution in most cases than suboxone, plus takes longer to come off, and is generally expensive compared to suboxone (which is covered by most health insurance; unlike most methadone programs). Swim advises that if suboxone is wearing off too quickly or not alleviating withdrawal symptoms, that this should be addressed- perhaps try a split dosing schedule, or increasing one's dose. If this fails to help, then of course explore all swiy's options, including methadone. But if one can achieve relative stability on suboxone without having to switch to methadone, and/or if one's only motive for switching to methadone would be to recapture the opioid effects one craves- please think long and hard about it, and give it a bit more time.

Best of luck! I'd be happy to point swiy to resources, or answer any questions about my experiences with methadone if that is the route swiy decides to go, or about my experienced with suboxone prior to starting methadone.