Heroin Starting methadone on monday and need advice!

[LucidSDreamr]

This is way off topic but I just wanted to ask since you mentioned u used black tar.

Before I ask though congrats on your decision. You will have money energy and time...and eventually you'll find you can get pretty fucking high off methadone if you ask for dose increases at a fraction of the monetary health and spiritual cost of heroin....if you still want to feel that nod for some reason.


So back to the black tar thing. What geographic area do you use it in? I'm assuming it was being acquired from the street...if not just disregard this entire question. Amd did you feel like it had a legit amount of real heroin in it or was just all fent like powdered H is now days.

 

[birdup.snaildown]

Every medical professional I have talked to actually suggest staying on maintenance indefinitely because your the risk of relapse and OD/death is less.

Well from a health perspective, that makes sense. It's what the data indicates had the best health outcomes.

From a health perspective, it makes sense to leave people on methadone "indefinitely"?

EDIT: btw if anyone's interested I can dig up some data.

Yes, I'd like to see it. I'm not challenging whether or not the data is untrue, but I suspect I will have a different interpretation of it than you.

Medical professionals don't care if you stop taking methadone, because they don't want you to get better. Psychiatrists leave people on anti-depressants for years for the same reason. They don't care.

 

[JessFR]

From a health perspective, it makes sense to leave people on methadone "indefinitely"?



Yes, I'd like to see it. I'm not challenging whether or not the data is untrue, but I suspect I will have a different interpretation of it than you.

Medical professionals don't care if you stop taking methadone, because they don't want you to get better. Psychiatrists leave people on anti-depressants for years for the same reason. They don't care.

Yes, that's exactly what I'm saying. From a medical perspective it makes sense.

And frankly, to say no doctors or psychiatrists anywhere care about their patients is so over the top I don't care to argue it.

I'll dig up some data in a little bit, but I don't see much point. Sounds like your objection is a fundamental philosophical belief based on iunno, mistrust of pharmaceutical companies and healthcare in general would be my bet?

In which case this I can't argue that with evidence any better than I've already given.

 

[birdup.snaildown]

I'm sure there are doctors that genuinely do care, but (from my experience) they are far and few between... that is not, however, how I established my opinion about this.

I'm not going to take for granted that it makes sense for everyone who goes on methadone to consume opiates every day of their life. Frankly, that's an extraordinary statement. I'd have to look at the numbers. If you don't want to present the data, that's fine. You offered.

I'm sure indefinitely consuming methadone prevents some death from OD, but what % of people is it saving and at what cost?

The whole anti-lockdown argument is the same. Some folks are arguing that it is better for society to take away our rights. Less people will die, yes, but - in the meantime - how many people suffer?

The internet is overflowing with people claiming "the science" supports their argument. This is rarely true in either direction. Whatever data you present will not take into account the damage that remaining on methadone indefinitely does to individuals, because it's too difficult to measure.

Same thing, with the lockdown debate. You can measure deaths from COVID and case numbers but you can't measure the enormous psychological and spiritual impact these restrictions have had on individuals.

According to the same logic - from a health perspective - it makes sense for us to remain in lockdown indefinitely.

 

[JessFR]

Fuck it, I'll dig up quick answers now.

A comparison of abstinence-oriented and indefinite methadone maintenance treatment - PubMed

Advantage was taken of a natural experiment to compare the outcome of abstinence-oriented and indefinite methadone maintenance. Subjects assigned to an abstinence-oriented program were significantly more likely than those assigned to indefinite maintenance to use heroin (OR 1.3) and amphetamines...

pubmed.ncbi.nlm.nih.gov

Subjects assigned to an abstinence-oriented program were significantly more likely than those assigned to indefinite maintenance to use heroin (OR 1.3) and amphetamines (OR 2.8) during the first 2 years of methadone treatment but less likely to use benzodiazepines (OR 0.7). Subjects discharged from the abstinence-oriented program were significantly more likely to relapse and return to maintenance treatment (RR, first 6 months, 4.2). The abstinence-oriented program was also less able to attract heroin addicts into maintenance treatment.

Retention in methadone maintenance and heroin addicts' risk of death - PubMed

A long-term follow-up was made of a cohort of 307 heroin addicts admitted into a high-dose, Australian methadone maintenance programme in the early 1970s. Using data from clinic records, official death records and methadone treatment histories, it was found that subjects were nearly three times...

pubmed.ncbi.nlm.nih.gov

A long-term follow-up was made of a cohort of 307 heroin addicts admitted into a high-dose, Australian methadone maintenance programme in the early 1970s. Using data from clinic records, official death records and methadone treatment histories, it was found that subjects were nearly three times as likely to die outside of methadone maintenance as in it (95% CI RR 1.45 to 5.61)

Study highlights effectiveness of methadone and buprenorphine | NIDA Archives

In a comparative effectiveness study of 6 approaches to treatment for opioid use disorders, only treatment with buprenorphine or methadone was associated with reduced risk of overdose and serious opioid-related acute care use.

www.drugabuse.gov

A team of investigators reviewed insurance claims of more than 40,000 people age 16 and older diagnosed with OUD. They looked at data for six different treatment pathways, including (1) no treatment, (2) the medications buprenorphine or methadone, (3) the medication naltrexone, (4) inpatient detoxification or residential services, (5) intensive behavioral health, including intensive outpatient counseling or partial hospitalization, and (6) nonintensive behavioral health, which included outpatient counseling. Scientists then reviewed follow up records of the patients receiving treatment at 3 and 12 months and compared their outcomes to those of people who received no treatment.

Only treatment with buprenorphine or methadone was associated with reduced risk of overdose at both time points. Indeed, treatment with either of these medications was associated with a 76% reduction in overdose at 3 months and a 59% reduction at 12 months. Compared with no treatment, buprenorphine or methadone treatment was also associated with a 32% and 26% relative reduction in serious opioid-related acute care use at 3 and 12 months, respectively. Serious opioid-related acute care use was defined as an emergency hospitalization with a primary opioid diagnosis code.

Thing is, I doubt any of this is gonna change your mind, because it sounds like your position has nothing to do with harm reduction, or minimizing health risks. Only that you see the goal as getting off drugs and living without opioids, and methadone isn't in line with that goal.

Personally, I'm following the approach that's the whole principle of bluelight, harm reduction. And methadone has been extensively studies along with buprenorphine and shown very good results at keeping people from overdosing, getting HIV, ending up in jail, etc, and that trend continues over time.

I'll see if I can find some more data to show. It's difficult to track down the studies specifically comparing methadone to say, abstinence or rehab. Most are about methadone vs continued use of heroin.

 

[birdup.snaildown]

Subjects assigned to an abstinence-oriented program were significantly more likely than those assigned to indefinite maintenance to use heroin (OR 1.3) and amphetamines (OR 2.8) during the first 2 years of methadone treatment but less likely to use benzodiazepines (OR 0.7).

So people are more likely to use heroin if they aren't using methadone, but less likely to use benzos. That former doesn't surprise me at all. As for the latter, I'd need to see data measuring the negative impact that benzo use has on methadone users.

Subjects discharged from the abstinence-oriented program were significantly more likely to relapse and return to maintenance treatment (RR, first 6 months, 4.2). The abstinence-oriented program was also less able to attract heroin addicts into maintenance treatment.

This doesn't surprise me either. People are less likely to quit cold turkey than they are to accept free opiates from the government. Makes sense. Users are more likely to relapse if they don't go down the maintenance path. That makes sense too. I don't disagree with anything so far.

A long-term follow-up was made of a cohort of 307 heroin addicts admitted into a high-dose, Australian methadone maintenance programme in the early 1970s. Using data from clinic records, official death records and methadone treatment histories, it was found that subjects were nearly three times as likely to die outside of methadone maintenance as in it (95% CI RR 1.45 to 5.61)

What is the death rate?

You have to balance risks and reward.

The problem we have with this discussion is (if I understand you correctly) you don't think there are any negatives staying on methadone for years... So weighing risks and rewards - for you - is impossible.

Harm goes beyond a simple death toll.

The final quote is repeating the same thing about overdoses increasing when people don't consume methadone and instead continue injecting street drugs. I still don't know how many people are actually dying. How many people does it save per year? How many people (who stay on methadone indefinitely) doesn't it save?

Something like 50,000 people in Australia are on opioid maintenance programs. You can't compare that number to total overdoses. You'd have to compare it to the number of people who overdose while trying to quit without maintenance programs.

The data you have presented is (currently) incomplete.

I doubt any of this is gonna change your mind, because it sounds like your position has nothing to do with harm reduction, or minimizing health risks.

If you're going to engage in discussion with me, I'd appreciate it if you give me the benefit of the doubt. I am open minded. You have (in the past) repeatedly accused me of being stubbornly opinionated despite having admitted I was wrong and changed my mind numerous times during our interactions.

 

[JessFR]

The internet is overflowing with people claiming "the science" supports their argument. This is rarely true in either direction. Whatever data you present will not take into account the damage that remaining on methadone indefinitely does to individuals, because it's too difficult to measure.

I'm still waiting for you to actually explain this damage, I don't recall that you have. I'm not seeing any that can compare to the kind of damage heroin addiction does. And abstinence would have to be effective for it to mitigate that damage.


EDIT: I can't seem to link to this one, getting the browser error message thing.

Methadone maintenance treatment has been one of the best researched treatments for
opioid dependence (Cooper et al., 1983; Gerstein & Harwood, 1990; Hargreaves, 1983;
Mattick & Hall, 1993; Ward et al., 1992b). It is the only treatment for opioid dependence
which has been clearly demonstrated to reduce illicit opiate use more than either
no-treatment (Dole et al., 1969; Yancovitz et al., 1991), drug-free treatment (Gunne
Grönbladh, 1981), placebo medication (Newman & Whitehill, 1979; Strain et al., 1993a;
Strain et al., 1993b), and detoxification (Vanichseni et al., 1991) in clinical controlled
trials. These trials have been conducted by different research groups, in markedly
differing cultural settings, yet have converged to provide similar results.

Like a lot of discussions with you, this one is confusing me a bit. I never told you that you should have quit. You said there was no alternative. There is always an alternative, IMO... In another thread you said prostitution was inevitable in certain situations with heroin addicts.

I'm not passing judgement on people any more than you were in the abortion thread by stating your opinion. This whole idea of opinions implying judgement bothers me. People should be able to state their opinions.

I don't like Islam. That's not a personal judgement on any individual. I just disagree with the ideology of Islam and it's important (I think) for people to be able to speak their mind.

Does the data indicate people are more likely to quit using opiates if they take methadone? I'm not sure what data you're talking about. I'm always a bit sceptical with stats, but I'm happy to have a look.

I'm sure it does improve quality of life if you're totally strung out and have very little prospect of maintaining sobriety. I mean of course it does, because it's a way to avoid getting clean while also avoiding the pitfalls of street drugs.

Methadone is basically legal heroin.

My advice is: don't take it if you want to kick.

Alright since I'm on the computer I'll answer this one too while I have a real keyboard.

First, I suspect what I said was more that prostitution is very likely in female heroin addicts, at least to some degree, over their using life. It's a lot higher than the norm in men as well, but for probably pretty obvious reasons women are at much greater risk.

That, or what I said was that being propositioned as a female beggar in the street is inevitable, which it is if you do it for any kind of length of time. I can't really comment on what the likelihood is for men. Again for obvious reasons. And that if you're a heroin addict, it's also very likely a large number of those people (but not all) will end up taking that option, at least once, at some point.

That sounds a lot more like something I'd have said.

As for the abortion thread comparison. We aren't an abortion forum. I might not agree with abortion, but if I were on a pregnancy forum or something, I would be MUUUCH more careful with my choice of words and to not come across as judging people. Because these are vulnerable people and it's an area where they are likely to be in higher numbers.

I don't really have a problem with you expressing your view here (as much as I understand it), just these judgey comments about how methadone isn't a treatment and implying it's not worth doing.

Does the data indicate people are more likely to quit using opiates if they take methadone? I'm not sure what data you're talking about. I'm always a bit sceptical with stats, but I'm happy to have a look.

Well, excluding the actual opioid that is methadone and subuxone, yes. I mean, there isn't really a "quit" here. You can be clean 40 years and relapse. You've never "quit" until you're dead and someone can look back and say "you didn't use again after that". All we can evaluate is if people have relapsed over a predefined number of years.

In THAT sense, yes, methadone from the studies I've seen (and I think some of the ones I just put up or referred too) is more effective than most other strategies as keeping people from using heroin or other illicitly obtained opioids over a given timespan.

I'm sure it does improve quality of life if you're totally strung out and have very little prospect of maintaining sobriety. I mean of course it does, because it's a way to avoid getting clean while also avoiding the pitfalls of street drugs.
Right, exactly, that's why I got on it.

And not everyone is ready to get clean, but so long as they know the risks, they should have the option to avoid the dangers of heroin using maintenance until they are, if they one day are.

My advice is: don't take it if you want to kick.

I would probably 80% agree with this. I only disagree in the sense that I haven't really seen in detail the data regarding fast tapers with subuxone and methadone vs cold turkey withdrawal vs medication assisted withdrawal (comfort meds) and such. I don't know that either are more effective than CT withdrawal or comfort med aided withdrawal, so I'm reluctant to assume that they're not. I've heard of people having success and failure with all 3, but I'd rather have more than experience alone to go on.

 

[JessFR]

@Mantha520 btw we've kinda gone off on a tangent here in your thread, if you like I'm sure we could ask the mods to split off this debate into its own thread and return your thread to just your issues.

 

[birdup.snaildown]

I haven't made a single "judgey" comment in this thread. It is irrelevant whether or not this is an abortion forum or a drug forum. I am posting my opinions based on my experience with methadone and observations of friends/family who've been stuck on it. Me saying I don't like methadone isn't a personal judgement.

I'm still waiting for you to actually explain this damage,

I'm not sure what you'd like me to explain.

Do you think there is no negative taking methadone for years?

 

[JessFR]

I haven't made a single "judgey" comment in this thread. It is irrelevant whether or not this is an abortion forum or a drug forum. I am posting my opinions based on my experience with methadone and observations of friends/family who've been stuck on it. Me saying I don't like methadone isn't a personal judgement.



I'm not sure what you'd like me to explain.

Do you think there is no negative taking methadone for years?

Well there are some negatives because of its regulatory framework, but you said side effects. Implying directly a result of methadone.

Methadone does have side effects, But not everyone gets them, and a the ones that exist are often quite manageable.

And I don't think they are even remotely in the same league as the dangers of continued heroin use. Or even the dangers of repeated relapses trying to stay abstinent (which is very common).

And no, saying you don't like methadone isn't a personal judgement, saying it's not a real treatment or implying that you're still just an addict as if you've gained nothing, and saying it like it were just a fact, really strike me as potentially harmful.

Which brings me to the final point, your audience matters.

Just cause it's appropriate to say something in one place doesn't make it ok in every place.

This is a drug support forum first and foremost, and more specifically a harm reduction focused one (exactly what methadone is, harm reduction). So making these kinds of arguments, said in this kind of way, is far more potentially harmful than if you said them somewhere else, or even if you said them but didn't imply your opinions are facts.

 

[birdup.snaildown]

You're confusing me with @Just a little pinprick

(I never said anything about side effects.)

 

[birdup.snaildown]

And no, saying you don't like methadone isn't a personal judgement, saying it's not a real treatment or implying that you're still just an addict as if you've gained nothing, and saying it like it were just a fact, really strike me as potentially harmful.

Which brings me to the final point, your audience matters.

Just cause it's appropriate to say something in one place doesn't make it ok in every place.

This is a drug support forum first and foremost, and more specifically a harm reduction focused one (exactly what methadone is, harm reduction). So making these kinds of arguments, said in this kind of way, is far more potentially harmful than if you said them somewhere else, or even if you said them but didn't imply your opinions are facts.

Methadone addicts are addicts. I didn't state my opinion in a negative way. My tone is neutral. You have a certain experience with methadone. So do I. I don't believe it's helpful for people to only hear one perspective.

If I'm breaching the BLUA, please let me know. Otherwise, let's just stick to the topic rather than making personal comments. I'm not judging you here. You're judging me. In future, please do it via private message.

 

[darvocet21]

Every medical professional I have talked to actually suggest staying on maintenance indefinitely because your the risk of relapse and OD/death is less.

I'm not sure about relapses but it certainly makes it harder to OD when stabilized on a sufficient dose of methadone. However until one matures out of addiction, which does happen and is probably the number one indicator that one is ready to taper off, drug abuse by MMT patients, especially with benzodiazepines and stimulants, is common and tested for by clinics.

But it takes a very high dose of another opioid to overwhelm methadone's blocking effect. People waste a lot of money trying, still chasing the memory of long past euphorias. However the risks associated with picking up fentanyl or one of its geometrically more powerful analogs thinking it's heroin now means people who take methadone need to be as careful to avoid a fatal overdose as opioid-naive individuals, if not more so since they invariably take larger doses.

Remember: an amount of Fentanyl equivalent to a couple grains of salt can cause a fatal overdose. Most of what is advertised as heroin is actually adulterated with or substituted by Fentanyl or Fentanyl analogs. Don't die like a dog

 

[JessFR]

Methadone addicts are addicts. I didn't state my opinion in a negative way. My tone is neutral. You have a certain experience with methadone. So do I. I don't believe it's helpful for people to only hear one perspective.

If I'm breaching the BLUA, please let me know. Otherwise, let's just stick to the topic rather than making personal comments. I'm not judging you here. You're judging me. In future, please do it via private message.

Not for me to say it you're breaking any rules.

Personally, and this is pretty nitpicky so if you don't agree you don't agree, it's not something I care enough about to argue, but I wouldn't call myself a methadone addict.

Id call myself an opioid addict or perhaps a heroin addict. I'm dependant on opioids, and I'm addicted to opioids. I'd argue that while methadone does nothing about the dependency, it is very effective at treating the symptoms of the addiction.

The symptoms of my addiction is doing shitty things for drugs, lying to people, doing shit that's harmful to me in various ways, committing crimes and stealing. That's what methadone treats, and the health risks related to those symptoms. And it has done so with extremely effectively.

Some people don't like the disease model, but I think that's another silly misuse of the term disease. Depression is a disease. It's a disease of abnormal functioning in the brain, as is addiction.

You can't just decide you're no longer depressed and you can't just decide you're not an addict anymore.

 

[MyrandaK]

It's illegal here. I'm sure some people find ways to get it. But I've never used it and I've never seen it.

Guess it's just not worth it to break the law to get something like kratom.

This is very true

 

[Iceman1216]

Hellllooo!



Alrighty, you definitely can use heroin while also on methadone, it's risky, as all this stuff always is. But yes it will work.

The main issue I can think of is drug testing. Rules are different in different places for whether you have to be giving clean urines to stay on methadone, So the main issue I'd be concerned about is if there were any issue if you came up positive in a later drug test. It prooobably would be ok, it's just that the rules vary, I know what the rules are like where I live, and here I don't think it'd be a problem, but if you're using tar, you definitely don't live where I live.

It also varies how fast they will increase your methadone dose, as well as what they will start you on. Here if you're a heavy user they generally start you on 30-40mg.

You might well have some withdrawal in the first few days, but if you get your methadone early in the morning (as a lot of people who have jobs to get to need to) then it probably won't be too bad.

It takes a few days for the methadone to build up, regardless of what dose you start on, so by day 3 30mg will be more effective than day 1, but it's likely you'll keep increasing up till when you tell them you're comfortable, and not sick when you wake up. For me I'm on 80mg.

Main thing is to be able to get through that first week, it shouldn't take too long to get up to a dose where you're feeling a lot better, probably inside of the first couple weeks. But you gotta keep going for those couple weeks, cause if you miss multiple doses in a row they often won't give you your full dose, which then of course increases the risk of you continuing to use.

I was definitely still using though for the first week or so when I got on methadone. Actually I've been inducted into a methadone program I think 3 times and was using the first weeks each time. First 2 times didn't really stick, but I was very serious by the 3rd and got stable.

The heroin will most likely still work and be euphoric (or about as euphoric as normal) in the first few days since you'll likely not be on that much (for your tolerance anyway) and it'll be building up in your system, but eventually once you're on enough, it's likely you won't feel the need for heroin and will probably feel like you can tell that it wouldn't be very good if you had it (at least that's how it felt to me). I'd be cautious to not get on too much more than you need to though cause it can be quite sedating, particularly in the first few months. You wanna feel well pretty much all the time, but still functional.

I wish you luck
If you have any other questions please feel free to ask.

Girl you are the best, great post to a newcomer

 

[Ganjcat]

Ok so I am scheduled to start my intake tomorrow morning and I an totally ready to be off the dope its been on and off for years now but im to the point where I'm really done this time! I just have to be able to make it thru my work week without being sick. Once I'm to the point where I'm not sick in the morning and on a stable dose I don't want to ever touch dope again! I'm not looking to use it to get high or manipulate the system at all. Thank you all for the feed back! I just have one question? When I go for my I take and first dose I don't have to be in withdrawl like for subs right? I plan on going at 6 am so can I get well in the morning b4 I go or do they need to see me in withdrawl before they dose me?

no you don't have to be in withdrawal you just have to give a piss test congrats btw this is a big step your taking just remember to be patient

 

[JessFR]

I'd like to emphasize again though, your first few days on methadone will be the hardest. The methadone has to build up, so even if 30mg doesn't seem to be doing much in the first day, it'll likely have a lot more effect by day 3.

 

[Biggdogg88]

You’ll be OK buddy I’m on my third year I was really bad had to go was of the youngest people at the methadone clinic My dose was as high as 350 mg now I’m all the way down to 130 Just try not to use much in the beginning and go up as fast as possibleThe more you use in the beginning the longer it’s gonna take you for you to feel good

What do u mean the more u take, the longer it will take for u to feel good?

 

[negrogesic]

What do u mean the more u take, the longer it will take for u to feel good?

I think he means it takes a while to stabilize and to not increase ones dose too quickly