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Thread: Using Heroin when on Methadone Maintenance

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    #26
    Bluelighter rachamim's Avatar
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    Crankinit: "Plenty of people" are still a very small minority. Any substance with a metabolic ceiling will always have only limited value. The people gaining benefit from Bupe could just as easily gain the same benefit from methadone. The advantage is not in the substance (unless the user has a history of overdosing on methadone, due to bupe's higher safety profile). I am glad that bupe is available because it allows people a choice, indeed, DHC and heroin itself should also be allowed more widely. Tell me, what benefit do you personally gain from bupe that you could not gain from methadone?
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    #27
    The bupe ceiling is high enough for heaps of people. I would say for the majority of opiate addicts in Australia, it would be sufficient (yes, I'm guessing)

    Even people using tons of good heroin, or hundreds of milligrams of oxycodone multiple times a day have been able to transition to bupe easily, without even having to use the maximum dose. That doesn't mean it's for everyone, but I think it's far more effective than you think.

    Benefits of bupe -

    Less fatigue than methadone.
    Doesn't seem as hard on the body (I don't have any links to back that up)
    Blocks receptors so if you want to use, you'll likely have to wait three days for the bupe to clear.
    Gave me energy when I had my dose in the morning. Other people have noticed this also. (more so than methadone)
    It's further away in it's actions from regular opiates, whereas methadone is a full agonist like heroin/morphine/oxy
    It's believed to be easier to come off (this hasn't really been proven yet I don't think)
    Overdose is almost a non-issue.
    In some countries you can get a month of take aways at once. (like in the US, however....it costs much more than methadone there)



    I'm sure I could think of more but just got off a night shift and my brain is a bit slow I'm sure others will list some other benefits.

    For people that aren't set on giving up opiates, maybe bupe isn't as effective. If you still want to get high, than methadone is a pretty good option...and once you're on a decent dose of methadone is can be almost impossible for some people to switch to bupe.

    Quote Originally Posted by rachamim View Post
    Crankinit: "Plenty of people" are still a very small minority. Any substance with a metabolic ceiling will always have only limited value.
    Technically true but I think you'd have to be a doctor treating lots of patients with bupe to get a good idea of who it works for it, and who it doesn't. Maybe looking at rates of bupe vs. methadone patients in the last few years would give a better idea of whether it's a very small minority of opiate dependant people or a larger amount.
    Last edited by Christ!; 15-03-2012 at 01:35.
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    #28
    ^ I'd be interested in seeing those numbers myself.

    Crankinit: "Plenty of people" are still a very small minority. Any substance with a metabolic ceiling will always have only limited value. The people gaining benefit from Bupe could just as easily gain the same benefit from methadone. The advantage is not in the substance (unless the user has a history of overdosing on methadone, due to bupe's higher safety profile). I am glad that bupe is available because it allows people a choice, indeed, DHC and heroin itself should also be allowed more widely. Tell me, what benefit do you personally gain from bupe that you could not gain from methadone?
    For one, it has a fraction of the side effects. Dental issues, weight gain, fatigue, mood problems, etc. all of these are regularly reported in methadone patients at a far greater rate than bupe or full agonist opioids.

    Considering that, and the fact that methadone is much harder to detox off, why would I use methadone if bupe works for me without a problem? It tickles my opioid receptors and kills my back pain enough to keep me happy and functional and kill cravings, and I have a not-inconsiderable opiate tolerance. And this is only anecdotal, but tolerance doesn't seem to climb up the way it does with full agonists, it's just as effective now as it was 4 months ago when I started taking it.

    That's not to mention that, where I live at least, bupe is far more accessible than methadone. In SA, methadone requires you to go to a clinic, which (quite aside from being a long travel time from my house and being full with no waiting lists) means being subjected to urine tests, looked down on and treated with suspicion by doctors and having to subject myself to the crowds that hang out there. With bupe all I have to do is see my usual doctor once a month and rock up for my dose.
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    #29
    Bluelighter SpiritFolk's Avatar
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    Yeh I found Bupe to suit me better. Things I like -

    I could get back in the workforce. I couldn't on methdone from either having minor w/d every morning which were small but I definitley needed to leave where I was and make it to the clinic straight away.

    I also had more energy and motivation as Christ! and also looked less wasted.

    Could resist the urge to shoot pointless shots of H, as where on methadone I still tried to get high and waste $$.

    Also being able to poo again was nice too. yay.
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    #30
    Also being able to poo again was nice too. yay.
    L0l. This too. It's less frequent, but not problematic, unlike full agonists.

    You know you're a junky when you can have a discussion about bowel movements Though it's not as bad as 'who has the worst veins.'
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    #31
    Bluelighter SpiritFolk's Avatar
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    ^^ Haha yeh totally, I rememer thinking that too... but the who has the worst veins discussion takes the cake. 'I've got mad caves in my arms man...' lol
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    #32
    What is the best dose to switch from methadone to bupe? I've heard some people say 40mg, others 30 and one said 20. I know this is something to talk to my doctor about, but I thought I'd put it out there and ask for suggestions who've actually "been there, done that".

    It's not that I didn't want to go on bupe in the first place, it just didn't hold me because of my tolerance. The take aways seem much easier to get, and the most important factor for me is apparently it's easier to taper off. Maybe this deserved it's own thread, but fuck it. Hope you mods don't mind. It is still relevant to the original question, if you don't look too hard
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    #33
    Bluelighter rachamim's Avatar
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    Christ: Everyone of the benefits (of bupe) that you listed were either old wives tales or else can be gained with methadone. A month of "take homes" is available even in the US IF the client is in compliance. Being easier to get off of? That is a psychological issue because in physical terms it really isnt anyy different at al. Hard on the body? Wive tale. Blocks for three days? Methadone almost always blocks at least eight days. Energy in the morning? Psychological and you can see the same thing with any drug of choice. You are correct that bupe has a higher safety profile but I had noted that. Still, IF you take methadone as directed you are in no greater danger. That single, tangible benefit only avails itself to those who will use other substances with methadone...something noone should do.

    If most Aussie addicts would be sufficiently dosed with 60mg of methadone then yes, as you claim, most would be fine with bupe. Of course in reality it has never been like that. If bupe were that suitable you would see it pushed more by the powers that be...leaa diversion, greater safety profile...it just doesnt do the trick unfortunately.
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    #34
    Bluelighter rachamim's Avatar
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    Crankinit: Methadone ruins teeth? Look, if you educate yourself on Old Wives Tales you will never get anywhere. That is one that iscabsolutely false. It is true than many methadone clients have horrid teeth but this is due to the fact that no addict will see a dentist while active in their addiction. After a decade or two they get on methadone and eventually gain enough stability to worry about their dental hygiene. Having only noticed their horrid teeth while on methadone they deduct that it is the methadone.
    Weight gain? Most junkies arent hitting up the buffet as they run the streets. With stability those neglected facets are in the forefront. Mood swings? What addict does NOT have them? As for your question about why you wouldnt take bupe IF bupe works for you...that is entirely subjective.
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    #35
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    If you really want to stop using then don't subject yourself to years of methadone addiction. I came to herion addiction the opposite way. I was addicted to methadone by way of endless supply of pyseptone. My first IV was a 10mg pyseptone. You will never have that feeling again.

    Methadone is so hard to beat. My withdrawal didn't peak till about 5 days after stopping, although I wouldn't know if it could have got worse.Using herion to beat methadone then about 5 days to beat herion addiction it seems backward to gjve more additive drugs to get off less additive drugs.
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    #36
    Quote Originally Posted by SpiritFolk View Post
    Also being able to poo again was nice too. yay.
    Yeah that's definitely one of the advantages , bupe doesn't seem to have nearly as strong a constipating effect as other opiates.

    Another would be that it doesn't seem to kill libido as much as other full agonists. Seems like some people on methadone have their sex drives entirely wiped out.

    Bupe will wreck your teeth just as bad as methadone I think. It's caused by reduced saliva in the mouth, bad bacteria moves in pretty quick without saliva....I've always countered this as best I can with brushing my teeth three times a day and chewing gum.

    What is the best dose to switch from methadone to bupe? I've heard some people say 40mg, others 30 and one said 20. I know this is something to talk to my doctor about, but I thought I'd put it out there and ask for suggestions who've actually "been there, done that".
    Sorry that I can't speak from personal experience! 30mg is recommend as the max dose you want to be on when changing to bupe, but you want to shoot for as low as you can get. The transition isn't easy but if you do a really slow taper on the methadone you can barely notice it (apparently) - switching to the bupe and getting used to it after methadone can be a bit tricky, and might take a few weeks to adjust properly. If you search around a bit on google you'll find reports of people who switched successfully and explain their experiences with it.

    rachamim -

    From wikipedia - http://en.wikipedia.org/wiki/Bupreno...rsus_methadone

    In terms of efficacy (i.e., treatment retention, mostly negative urine samples), high-dose buprenorphine (such as that commonly found with Subutex/Suboxone treatment; 816 mg typically) has been found to be superior to 2040 mg of methadone per day (low dose) and equatable anywhere between 5070 mg (moderate dose),[21] to up to 100 mg (high dose)[22] of methadone a day. In all cases, high-dose buprenorphine has been found to be far superior to placebo and an effective treatment for opioid addiction, with retention rates of 50% as a minimum.[21][22][23][24] It is also worth noting that while methadone's effectiveness is generally thought to increase with dose, buprenorphine has a ceiling effect at 32 mg.[25] That is, while a methadone dose of 80 mg will likely be more effective than a methadone dose of 60 mg (see Methadone dosage), a buprenorphine dose of 40 mg will not be more effective than a buprenorphine dose of 32 mg.
    Unfortunately some of those references are to sources that I don't have access to
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    #37
    Bluelighter rachamim's Avatar
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    Christ: I dont want to sound as if I am ragging on everything you say but Wikipedia is entirely worthless. It is entirely consumer generated content and although it did finally implement an editorial process as such, it does not consist of even rudimenrary fact checking. Any site that tells you Black Tar is acetylated opium needs to be laughed out the door...but...Jimmy Wales, the site co-founder, warns his readers NOT to use the site as an academic reference so that it is difficult to heavily criticise a site that states clearly it is not to be taken seriously, as opposed to the scores of readers who take it upon themselves to do so.

    That said, its secondary hyper-links can be worthwhile if patiently researched. I will discuss the particular secondary source in which bupe is said to exhibit superior client retention...if you actually follow the hyper-link you will see an interesting example that focuses on a meta-analysis of 13 clinical trials involving methadone in France. France by the way, is the only nation where bupe outpaces methadone...and is only because the state pushes it. In fact the analysis showed a HIGHER drop out rate. It also showed that bupe users tamper with their medication, on average, two years after induction, showing that the metabolic ceiling is insufficient for most bupe clients. I need to add, the metabolic celing is equigesically 60mgs of methadone so that unless a client is sufficiently sated with 60mgs of methadone- a sub-therapeutic dosage- bupe is pretty much useless vis a vis Opioid Substitution Therapy.
    Last edited by rachamim; 16-03-2012 at 18:41. Reason: spelling
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    #38
    Bluelight Crew Tommyboy's Avatar
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    Quote Originally Posted by rachamim View Post
    Crankinit: Methadone ruins teeth? Look, if you educate yourself on Old Wives Tales you will never get anywhere. That is one that iscabsolutely false. It is true than many methadone clients have horrid teeth but this is due to the fact that no addict will see a dentist while active in their addiction. After a decade or two they get on methadone and eventually gain enough stability to worry about their dental hygiene. Having only noticed their horrid teeth while on methadone they deduct that it is the methadone.
    Weight gain? Most junkies arent hitting up the buffet as they run the streets. With stability those neglected facets are in the forefront. Mood swings? What addict does NOT have them? As for your question about why you wouldnt take bupe IF bupe works for you...that is entirely subjective.
    The horrid teeth from methadone is also because a lot of people crave sweets while on methadone, which are bad for teeth. If weight gain is only from having a more stable life, then that would mean that people on suboxone would experience this as well. I wonder how the two groups of patients would compare if data was taken to see if weight gain was more prominent in one group than the other. My suboxone constipation was pretty horrible, so I would say they are both about the same in that aspect, with the severity being dose dependent of course.

    IME bupe is the easier of the two to get off of, but this isn't the thread for such an argument.
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    #39
    I don't buy your argument that bupe is useless if you tolerance exceeds the level where you would be put on 60mg of methadone. I know mine certainly does, but bupe has been a lifesaver for me. It kills cravings, keeps my mood up and makes my back pain controllable and non-debilitating. So if that's the case, what the hell does methadone offer that bupe doesn't?

    I'm not suggesting that people should be forced to use bupe over methadone, and honestly don't understand why you're so defensive (except that people get like that about their drugs), but I do dispute your claim that bupe is insufficient for proper maintenance, or that it only works for those with a low tolerance, because I'm living proof that that isn't true.

    In an ideal world, patients would be able to pick their opioid of choice and receive the dose they require every day, but the reality is that bupe and methadone are the only two options right now (outside of certain clinics in Europe). If one works for someone, why push them to use the other? If a patient is perfectly happy with bupe, what do they have to gain by using methadone instead?

    And unless you have the numbers to back it up, I don't buy that the those happy with bupe consist of a 'very small minority.'

    In my experience (admittedly limited, I don't know a lot of other people on maintenance), a lot of the anti-bupe crowd are those who go onto maintenance expecting to get high and nod off all day. They know bupe won't do this, so they swap to methadone hoping that a full agonist will. Except of course their tolerance goes up and within a few weeks they're back to staying well with a bit of analgesia and heightened mood, which is exactly where they would have been if they stayed on bupe. They convince themselves that it will automatically be inferior because it's 'less' of an opioid than methadone, when in the context of maintenance, they achieve largely the same effect and result.
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    #40
    Quote Originally Posted by rachamim View Post
    Christ: I dont want to sound as if I am ragging on everything you say but Wikipedia is entirely worthless. It is entirely consumer generated content and although it did finally implement an editorial process as such, it does not consist of even rudimenrary fact checking. Any site that tells you Black Tar is acetylated opium needs to be laughed out the door...but...Jimmy Wales, the site co-founder, watns his readers NOT to use the site as an academic reference so that it is difficult to heavily a site that states clearly it is not to be tKen seriously.
    .
    Wikipedia is pretty worthwhile I think...but you're right, you do need to check the references and keep in mind what limitations it has. I sometimes forget to keep this in mind and take wiki on face value - not a very wise thing to do I'll do some proper reading up when I have a bit of time, because I find this kind of thing interesting.

    Quote Originally Posted by rachamim View Post
    Christ: I dont want to sound as if I am ragging on everything you say but Wikipedia is entirely worthless.
    I don't take it personally you have far more personal experience than me, and have probably read a lot more on the subject.

    There's so many variables when trying to assess how effective an opiate maintenance drug is. A girl I know was on bupe for about a year, was going well with it, ended up tapering off it for 6 months before relapsing with heroin - when she tried to get back on the bupe it didn't 'hold' her like it did before, she stuck with it for a few weeks before deciding to ask her doctor for methadone, and it ended up working very well for her....the odd thing was her dose was only 35mg, far short of the 60mg that would match up with the bupe ceiling. Maybe she just became accustomed to full opiate agonists? and since bupe was a partial it wasn't doing the trick anymore?

    I don't think you can rule out bupe completely at this point as 'almost useless except for people that have very low tolerance, which is a very small percentage of opiate dependant people' (paraphrasing)

    I'm not saying methadone is bad or anything. It's changed HEAPS of peoples lives for the better. For some people bupe is a better choice, and for others methadone will be the better option. I think lots of people underestimate how powerful bupe can be, but I can't really prove this... It'll take many more years to make any definite judgements on its efficacy IMO, and more studies done to get an accurate picture.

    I guess the best advice to people considering either bupe or methadone treatment - if you're in a stable enough environment, and take it as directed...give bupe a go first. The transition from bupe-methadone is much easier...and at least you'll know if it's right for you or not.
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    #41

    I guess the best advice to people considering either bupe or methadone treatment - if you're in a stable enough environment, and take it as directed...give bupe a go first. The transition from bupe-methadone is much easier...and at least you'll know if it's right for you or not.
    That seems logical to me. Start with bupe, if it doesn't work for you then swap to methadone. Hell of a lot easier than going the other way.
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    #42
    ^ I agree, a lot of doctors are woefully ignorant about a lot of things.

    You have to remember that a lot of medical training is just rote memorization, a lot of that gets forgotten in the ensuing years when they spend their time just laying back and handing out scripts, and a lot of people go into medicine for the money and prestige without any real care for the subject or the patients.

    On top of that, with the wide area of knowledge they're expected to have, they usually end up with a knowledge base that's broad, but not deep. Which is why while a doctor would still know more about medicine and the human body in general, anyone who's made the effort to learn about a particular aspect of medicine or condition (in this case, addiction, drug abuse, narcotics etc) can outstrip a doctor in that particular area. I'd say the average BL regular probably knows more about drugs than 90% of doctors.

    The sad reality is that for all they like to portray themselves as knowledgeable and infallible, most of them are just regular people making a living and not much more invested in what they do than someone at an office job. And the other sad reality is almost all of them refuse to admit it.

    In your particular example, I'm sure most doctors working at clinics see it as a cushy job. They just sit in an office, ask a few questions, order blood tests, write scripts and look down their nose at the 'dirty druggies.'
    Last edited by Crankinit; 16-03-2012 at 10:48.
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    #43
    Bluelighter rachamim's Avatar
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    Tommyboy: Studies have been done showing methadone does not lead to weight gain so it may just be a matter of perception. As for craving sweets, supposedly all opiates/opioids cause this but that is another myth.

    Crankinit: I am defencive because that is how people like me get about our substances? Im still smiling ten minutes after reading that. Not that I want to seem even more defencive, but I have been off of Methadone Maintenance for nearly half a decade. I maintain on morphine, there is no methadone in the Philippines. Now, IF this assumption of yours is so baseless, and it is, imagine what other things you have incorrectly put stock in. What I DO get defencive about is incorrect information on a Harm Reduction site. Harm Reduction is a subject near and dear to my heart. Selling baseless information about the "horrors" of methadone could easily lead to addicys in need from looking at the substance as a viable option. Since bupe only holds limited utility, that can easily translate into an addict forgoing treatment and thereby spending their life in prison, or, even their death. I dont "defend" methadone, nor do I prosteylyse...I simply allow interested people to make up their minds based on facts, not opinion.
    Last edited by rachamim; 16-03-2012 at 18:59. Reason: spelling..I hate English
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    #44
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    ^ hey man, nobody's having a go at you. i am really enjoying this conversation - and it is nice to see some familiar cats from other parts of the forum stray into the australian drug discussion...it just seems like a bit of healthy debate to me. disagreement isn't necessarily disrespect!

    "facts" are a great thing to work with, but in a world so muddied with opinion, myth and bullshit as opiate addiction (and its various treatments) is, all we have to go on is what we have experienced, what we've read, and what we've seen. nearly every 'truth' is hotly debated by someone - there aren't many absolutes that i can see. again, as Christ! said, i'm not as experienced as some folk - but we all form opinions based on what we see as fact.

    but a lot of this does fall back to opinion - which isn't always a bad thing. when it is a matter of ignorance in the medical profession, then yes it's a shitty situation - but i think it just goes to show that even the appointed 'experts' are in the dark about many of the complexities of maintenance treatment.
    by that i mean that the textbook cases they are informed by, and the realities of the situation as they present themselves, are often very different.
    a basic example of this would be all the myth and misinformation about the naloxone in suboxone - just one of many things the medical fraternity seems to simplify and miss the point with.

    i like to think that there is not one truth - but many truths. bupe might not work for every addict, but the more treatment choices people have, the better - right?
    opiate addiction is a complicated thing - much like the human organism.

    not everybody ends up with a gorilla several-grams-of-smack-a-day habit - but the people hooked on various other opioids, or varying doses aren't any less addicted or in need of treatment. a junkie in a town with really weak smack is going to be in just as dire a position as someone with access to pure, undiluted stuff. their withdrawal experiences may vary, but they're both stuck without a fix.
    i think both bupe and 'done have their pros and cons - in an ideal situation, they would only be a couple of the treatment options available to people.
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    #45
    Bluelighter rachamim's Avatar
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    Spacejunk: There is always room for opinion. When a person misstates their opinion as fact, that can easily veer from ignorance into dangerousness. That needs to be addressed. As for their being "many truths," in a Philosophy 101 class, MAYBE, but with issues like greatment retention, adverse side effects of treatment, and receptor affinity, there is only evergoing to be one truth.
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    #46
    Bluelighter Miss Kirsty's Avatar
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    My two cents as someone who has been on Subutex, Bupe and currently on MMT is that personally i wish i had never started MMT....I used subutex many many years ago when it first came out and imo that one is the best...I felt great while taking that...I stayed clean 7 years after my first detox...Then i used again....and got myself another habbit pretty quickly...This time i went on Soboxone as in my area subutex was no longer available....I was on 16 mg per day...I found i could use if i skipped a dose, but it wasnt the same...I changed to methadone as i knew people who were taking it and they were still using gear also...sooo without investigating i asked my dr to put me on MMT...I havent been able to use since i stabilised on 115mg....I am going down slowly and am now on 95mg....While on 115mg i used a full box of 80mg oxy and didnt feel a thing...I prob near died that night when i went to bed!.. I really havent managed to get clean yet but i swapped to MMt about 8 mnths ago and hate it!!
    Worst thing i ever did i think...If i had my choice again id be on soboxone for sure....
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    #47
    Bluelight Crew Tommyboy's Avatar
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    Quote Originally Posted by rachamim View Post
    Tommyboy: Studies have been done showing methadone does not lead to weight gain so it may just be a matter of perception. As for craving sweets, supposedly all opiates/opioids cause this but that is another myth.
    The craving of sweets is one of the few side effects of methadone that I have seen a lot of people on it agree on. There are plenty of threads on this in Drug Culture where many people that are pro MMT discuss how they never craved sweets at all until they started MMT. If a bunch of people that are on MMT experienced this, I don't see how it can be dismissed as a myth.
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    #48
    Bluelighter Miss Kirsty's Avatar
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    Quote Originally Posted by opi8 View Post
    I'm down to 65mg of methadone now. I shot a gram for the first time in a couple of weeks, not expecting anything special but this time I felt a nice rush AND the "feeling" lasted a good hour or so. I was motivated to clean, work, do everything just like the good 'ole days before my addiction got out of control. It's the same gear that I've been using in the past, so that's not the reason. Of course it's nothing like shooting without being on MMT, but at least I don't feel like it's a complete waste of money any more. It's given me a bigger incentive to reduce my dose too.


    I am still on 95!!!!


    Wish i was on 30mg!!!!
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    #49
    ^ The best advice I can give is to start tapering. The literature says it's not too uncomfortable to reduce your dose by 10% per fortnight. I would give it a trial run, but get a script that says you can dose between 85 - 95mg, that way if you don't think you can cope with the reduction, you are not forced through agony and can go back up to your regular dose.
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    #50
    Crankinit: I am defencive because that is how people like me get about our substances? Im still smiling ten minutes after reading that. Not that I want to seem even more defencive, but I have been off of Methadone Maintenance for nearly half a decade. I maintain on morphine, there is no methadone in the Philippines. Now, IF this assumption of yours is so baseless, and it is, imagine what other things you have incorrectly put stock in. What I DO get defencive about is incorrect information on a Harm Reduction site. Harm Reduction is a subject near and dear to my heart. Selling baseless information about the "horrors" of methadone could easily lead to addicys in need from looking at the substance as a viable option. Since bupe only holds limited utility, that can easily translate into an addict forgoing treatment and thereby spending their life in prison, or, even their death. I dont "defend" methadone, nor do I prosteylyse...I simply allow interested people to make up their minds based on facts, not opinion.
    I didn't say 'people like you,' I just said 'people.' Which is true, people 'do' get defensive about their drug use, past and present, and their opinions about it. Claiming otherwise is just being intentionally obtuse from someone with as large a presence on these boards as yourself. Stating that one substance has a wider side effect profile than the other, that every one reacts differently to drugs and that a lot of people do find bupe to be an amazing, life changing drug, is hardly preaching about the 'horrors' of methadone.

    I find it interesting that you rant on about being all for making 'informed decisions' but then insist that bupe is useless and methadone is superior in every way, because the evidence just doesn't back you up. Even ignoring the side effects and taking the two chemicals at their face value, you're obstinately refusing to acknowledge that bupe has a place in opioid maintenance and works for a good number of people with all kinds of addiction histories.

    I'm well aware that bupe doesn't meet the needs of some addicts, but I don't think those are an overwhelming majority and I do think that it has more to do with the psychological profile of the individual, their motivations for getting on maintenance and the manner in which they react to the drug than it does whether they have more than a small tolerance.
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