Methadone: A Flicker Of Light In The Dark

Methadone: A Flicker Of Light In The Dark

To provide a better understanding of the very important role methadone plays in the treatment of addiction.
 
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 help me whats a right dose?

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churchgirl77



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PostSubject: help me whats a right dose?   Thu Apr 14, 2011 12:33 pm

hello evry1 thanx 4 such a warm welcum! iv reasonly startd going 2 a methadone clinic & iv got a lota thoughts & concerns i need help wit i really hope u guys help me 2 understand.... im curntly on a really low dose & im still getn dope sic BAD!!!! Im wondering will this low dose start 2 work & is it better 2 stay on a low dose?????
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Digmon

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PostSubject: Re: help me whats a right dose?   Thu Apr 14, 2011 12:36 pm



Hello, and welcome churchgirl.

If you want to get the maximum benefit from methadone treatment, then you have to be at the right dose.


Tha preferred term is a “therapeutic dose.”

Studies show that most methadone patients have better treatment outcomes at higher doses.  In other words, tha therapeutic dose is likely to be found at the high end of the dosing range rather than the low end.


Think about what the dose needs to accomplish.

At a therapeutic dose you should not experience any significant symptoms of withdrawal.  Any drug cravings should feel manageable.  And your dose should be high enough to block most of the effects of other opiates.

For an opiate dependent person who has been using a significant amount of opiates over an extended period of time, it takes a significant amount of methadone to achieve these effects.


The same stigma-driven thinking that puts pressure on methadone patients to terminate treatment prematurely, also puts pressure on methadone patients to accept a less than therapeutic dose of methadone.

Methadone patients often feel pressure, including internal pressure, to “get by” on the lowest methadone dose possible.

The feeling is, “I/You shouldn’t be on methadone at all, but if I/you must be on methadone then i/you should be taking as little methadone as possible.”

But the goal is to enjoy the best treatment outcomes.  The goal is to be abstinent from illicit opiates.  The goal is to feel well and feel normal.  The goal is to have a stable home, work and social life.  The goal is to be at less risk for HIV, hepatitis C, incarceration and drug overdose.

We know from research, and the experience of thousands of methadone patients, that this kind of success is not likely to be achieved by placing the opiate receptor sites in your brain on a starvation diet.

So, don’t let anyone make you feel like you are “med seeking” or engaging in “addict behavior” just because you are asking for an increase in your methadone dose.  You and your methadone doctor should be working together to find the right dose for you.

If you are experiencing withdrawal symptoms, you should talk to your doctor about increasing your methadone dose.

If you are experiencing powerful drug cravings that you aren’t able to manage, you should talk to your doctor about increasing your methadone dose.

It often takes a higher dose to eliminate cravings than it takes to eliminate withdrawal symptoms, so it is likely that you will find your therapeutic dose by finding the dose at which you no longer have cravings.

A higher dose is also more likely to block the effects of other opiates, making it less tempting to use other opiates.

Part of the fear some people have about methadone in general, and higher doses of methadone in particular, is that the medication will cause euphoria (a feeling of being high) or sedation (especially to the point that it causes nodding off).

Certainly, methadone can cause euphoria if taken by a person who has not built up a physical tolerance to opiates.  But methadone is a slow-acting opiate, so it still wouldn’t cause the rush of euphoria associated with fast acting opiates like heroin or oxycontin (especially injected heroin or oxycontin).

Contrast this with the effect of methadone on a patient participating in methadone maintenance treatment.

The methadone patient begins treatment at a methadone dose that is low enough to allow the person to go into some level of opiate withdrawal (often 30 or 40 milligrams per day for someone with a significant tolerance to opiates).  Usually, this dose isn’t enough to even make the patient feel well, to say nothing of high.

From this point, the dose is raised (often every day or every few days at first) until the person is at a dose where they are no longer experiencing symptoms of withdrawal, and are not feeling cravings (often 60 to 120 milligrams per day, but sometimes significantly more or less).

Once the patient arrives at a therapeutic dosing level, the patient stays at this dose for an extended period of time.

Over time, the medication builds up in the patients body in a good way, so that the medication is always available to the opiate receptor sites in the brain.  The body becomes accustomed  to this dose of methadone.

A methadone patient may experience periods of sedation after taking their methadone dose during the period of increasing doses.  But once the patient is taking the same dose every day, they are unlikely to experience significant euphoria or sedation.

A methadone patient at a stable therapeutic dose is able to function normally.  They have normal motor skills and cognitive skills.  They can do anything that other people can do, including drive.

A methadone patient who is not at a stable and appropriate dose may feel drowsy, and may not be safe to drive.  Use common sense.  If you aren’t able to function normally, then you aren’t at the right dose.  Talk to your doctor about lowering your dose.

A methadone patient at a stable and appropriate dose feels well because all of the opiate receptor sites in their brain constantly remain occupied and satisfied.  And they function well because they are not high, not sick, not craving and not sedated.  They just feel normal.

Feeling normal, means you can get on with the rest of your life.
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lilgirllost
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PostSubject: Re: help me whats a right dose?   Thu Apr 14, 2011 9:39 pm

Hello churchgirl. I am so glad that you have joined our forum!

We can't tell you if you should ask for the increase or not, but we can give you the info to help you decide what is best for you.

You haven't said what dose you are on and/or how long you have been on your current dose, but i will try to answer your question the best way I can.

Methadone works differently on the body than other medications. It lasts much longer in the body and has what is called a "half life". This is what makes it such a good medication for treating opiate addiction (and even as a pain medication) What "half life" means is that when you take your dose of methdone, 24hrs later half of it should still be active in your body. (everyone metabolizes differently, but in the average patient, this is how methadone works) Working in this manner, it may take several days taking a certain dose before you will be able to see if this is the dose is going to be a theraputic dose for you.

on the flip side, iif you have been taking the same dose for several days and you are still having withdrawals and/or cravings, then the dose is probably not going to be theraputic for you and you should consider putting in a request for an increase.

So, In answer to your question, depending on how long you have been on your current dose and how bady your withdrawals symptoms are, you may want to give it a few more days and see if things change, or you may want to go ahead and put in for the increase.

Either way, you definately should speak to your clinic and make sure they note in your chart that you are having withdrawals. You want this info to be in your record (even if you aren't currently asking for an increase) because they need to know you are having issues with your dose and then later on if you decide to ask for an increase, they have documentation that you have been stuggling with your dose.

Do not let outside factors influence what you "think" a normal dose should be. Again, each person metabolizes methadone differently. I have known someone on 35 mg and they were just fine on that dose but I've also known others who were on 300mg or more and that is what was theraputic for them.

A theraputic dose means that you should not be having withdrawals or cravings (this indicates a dose that is too low) amd you shouldn't be nodding off, getting any kind of buzz or having issues with drowsiness (this indicates a dose that is too high). Again, it usually takes several days up to a week to see if the current dose you are on is going to be theraputic for you or not.

Take care and keep us posted on how thing go for you and again, I am glad to have you as part of our group!


RuthAnn
aka lilgirllost

We are not bad people trying to become good, we are sick people trying to become well.

Methadone; A Flicker Of Light In The Dark
www.medicalassistedtreatment.org
www.suboxoneassistedtreatment.org
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boogy.pc



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PostSubject: Re: help me whats a right dose?   Fri Apr 15, 2011 8:35 pm




churchgirl77 wrote:
hello evry1 thanx 4 such a warm welcum! iv reasonly startd going 2 a methadone clinic & iv got a lota thoughts & concerns i need help wit i really hope u guys help me 2 understand.... im curntly on a really low dose & im still getn dope sic BAD!!!! Im wondering will this low dose start 2 work & is it better 2 stay on a low dose?????
cheers


churchgirl77,just keep positive outlook ,you will know wen stable .you want feel sick or crave. stay strong
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boogy.pc



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PostSubject: Re: help me whats a right dose?   Fri Apr 15, 2011 8:54 pm

churhgirl77 dont get discouraged ,youll know when you get to the right dose .You want feel sick an all cravings will be gone.Keep a positive outlook an dont give up.
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upriser7



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PostSubject: Re: help me whats a right dose?   Mon Sep 17, 2012 6:37 pm

Thank you; that information was helpful to me also.
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