dopetalk
Core Topics => Health Issues and Medical => Topic started by: Dopeless Hopefiend on November 21, 2016, 03:26:58 PM
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So, I'm hoping one (or more) of you fine people might be able to help me find some credible info that I can share with my doctor around what the true Morphine equivalent dose of methadone is.
Some of you may remember that I was on longterm MMT until about 6 months ago. Tapered down to 30mg then jumped off & my doctor started prescribing me suboxone. The subs were great for helping me get off of the clinic, but didn't do a thing for me as far as keeping my chronic pain at a manageable level, so as of about 6 or 7 weeks ago I stopped taking them (with the support of my doctor). She has proven willing to treat me for chronic pain, and she did put in a referral to my clinic's pain mgmt department, but the wait for an appointment could be as long as a year.
In the meantime, she's willing to continue prescribing but she will only prescribe opiates following the new CDC prescribing guidelines. So, after converting everything to Morphine Equivalent Doses she'd prefer to keep me to about 50 MEDs a day and has been clear that while there is some leeway she will never go above 90 MEDs a day. I'm Ok with that, I'm not trying to get some ungodly amount of pills from her.
The issue I'm having trouble with is around converting methadone to MEDs. She started me out on a low dose of ms-Contin, but it didn't work well for me & I have a histamine reaction to Morphine. So I suggested a low dose of methadone, because for everything I hated about the clinic I have to admit that the MD really did control my pain well. The problem is that according to her opiate calculator 20mg of methadone is equivalent to 80mg of morphine. I don't believe that. I always understood that it was pretty much 1:1, but that it can be hard to convert due to the extremely long half-life of MD & the fact that it builds up in your system over time. Based on her calculations there wouldn't be any room to go up if I needed to, or to have any short acting meds for b/t pain.
I have been looking for some credible information that I can bring her that explains this better. She's a great doctor, but she just doesn't have experience using MD for chronic pain. In the meantime she switched me to OxyContin 10mg q 12hrs,with ir oxycodone for breakthrough pain. She's much more comfortable prescribing that than methadone. I'm a little surprised because oxy has such a higher abuse potential than MD, but it is what it is.
Anyone got any links that might be helpful?
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I have wondered this too and I believe that 1:1 is correct but only for the half-life of Morphine.
Morphine's half life is short and is reported to be between 1.5 to 7 hours so you need much more morphine.
See http://www.nhtsa.gov/people/injury/research/job185drugs/morphine.htm
It also depends on the formulation.
She is sort of right because I would want at least 2-4 times as much morphine.
At least with Methadone you don't have to re-dose all the time but then again, it's always not as smooth as Morphine.
If you want to try M then go for the Extended Release and ask for twice the amount of M. for the same dose as 'done.
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I don't want Morphine, she was giving it to me. It really doesn't do much for me, at least not at the doses she's willing to prescribe. I was talking to her about prescribing me methadone for pain, which she was willing to do after consulting with her team. The problem is these new damn guidelines from the CDC. You have to convert all other opis into Morphine equivalent doses & based on that she thinks 20mg methadone a day is equal to 80mg Morphine a day. I don't think it's such a straightforward 4:1 conversion, but me not thinking so isn't good enough for her lol.
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It seems to me that it isn't a straight forward conversion. There is a big difference between a one time methadone dose and chronic dosing. I doubt it is one to one. Opiate naive folks can take a 60mg pill of morphine and live, but I would never risk giving them 60mg of methadone.
This seems closer to my experience: https://www.compassionandsupport.org/pdfs/professionals/pain/methadone_dose_conversion_guideline.pdf The sliding scale makes more sense then a straight conversion.
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wow. yeah, sorry there's NO fucking WAY Morphine to Methadone is 1:1, I think that's wishful thinking on your part.
If I had to guess, she's probaly fairly close with 4 to 1, maybe that's a LITTLE low, but shit, nfw it's 1:1.
I'll reserve my "I told you so" for some other time. But really, had you stayed at the clinic you'd have 2x monthly pickups right now. it'd be almost like being on a Dr. script of done except you wouldn't have all that red tape around quantities, you'd be able to name your own dose.
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Yeah, I know 1:1 is wishful thinking. I was hoping it was at least maybe 2:1 lol.
@dizzle, I'm chuckling right now because as a was writing this post, one of my first thoughts was Dizzle is gonna say I told you so. 😂 I remember your advice when I was getting off the clinic & I totally get where you're coming from. That said, I still don't regret getting off the clinic. I'm not sure what the clinics are like where you are, but here they fucking suck. I had 2 weeks of takeouts at a time for years, then they dropped me down to weeklies and were going to continue dropping them all the way back to daily dosing. Because I have a prescription for lorazepam. I've been prescribed it for close to a decade, my pcp had the psychiatric nurse practitioner take over prescribing it to appease the clinic, but they decided that wasn't good enough. The have a zero tolerance policy for benzos, prescribed or not. I wasn't willing to give up my script.
Honestly, I still feel like it's the best decision I've made in a long time. I've lost 30 lbs, I'm sleeping better, not sweating all the time. I'm Ok on the oxy my doc is prescribing. It gives me good enough pain relief, I just am not sure I won't take more than I'm supposed to & run out early, so I thought a low dose of methadone might be a better option for me.
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i was in the same discussion with my doctor bc my state passed a law saying all non cancer patients had to be below 100mg morphine equivalent dosing. i was told 20mg of methadone is equal to 80mg morphine. my pharmacist said the same thing.
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@Dopeless Hopefiend
wow. that SUCKS. No, in chicago it's weird some clinics are gay AF, like they have all those lame ass rules and pull shit like that. Most of those are like $40-50/week. Mine, however is the most expensive in the city, I believe, at $60/week (big whoop, $10/week more) and they basically let you name ur dose, and as soon as you meet the federal minimums for carries, you get them. They don't have weekly meetings or stupid shit like that, literally I have to have "monthly contact" with my consouler but that is literally a phone call or like when I'm there I see her in the hallway or at the checkin desk and I'm like "whatup?" she like "everything cool?" and I'm like "yep", that's considered a "monthly contact"
I'll give you an example of how awesome my clinic is:
I got high a few weeks ago, and I got dropped at the clinic (didn't think I was going to) so I just filled up the cup with water, lol. I figured I'd rather say I just drank a shitload of coffee or something than getting a positive test. So, about a week later I get a call from my counselor, she say "what the fuck was that you gave me last week?" I was like "yeah, that shit was water", she goes "I know I saw it when I was sending out the samples to the lab, I pulled yours so you didn't get a hot drop in the system, what the fuck you doing giving me water?" I said "well I got high and didn't want to give a hot piss" she said "you dumbass, next time it's like that just pull me to the side and let me know, I ain't trying to get you caught up, whatever you do don't do shit like that again, if I wasn't the one packing the samples, you'd have been popped and there'd be nothing I could do about it"
literally that was the convo that took place. I guess you could say I have it sweet. Also, one of the nurses steals methadone that is extra used to calibrate the machines, and sells it to me. For awhile I was getting like 1500mgs a week or two for like $100. It was a nice lick. Now there's a new head nurse and my girl ain't able to do it like she was so that's pretty well over with, but it still happens sometimes when she can pull it off...
So, yeah, it's pretty awesome.
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Oh shit @dizzle, that sounds like a dream clinic. Here if you're private pay it's about 15 bucks a day, so right around $100 a week. Not only did my clinic have the zero benzos policy, there is also a no weed policy, even if you have a medical card, and even though it's been legal recreationally for 2 years in my state. You have to do 2 groups a Week and meet with your counselor weekly until you get up to an m4 status. Which means 4 takeout s a week, and at minimum that would take someone 8 months to accomplish. Realistically more like a year. After that you drop down to one group a week until you're on weekly take homes when you can finally do one group/2 one on ones a month.
If things were like your clinic I would've stayed there forever probably.
As far as my original question, I guess I have to accept that it really is a 4:1 ratio. Oh well, I should just be grateful my doctor is willing to prescribe opiates for chronic pain at all.
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Yeah, everything i see gives it anywhere from 2.5 - 5 times stronger than oral morphine.
Id say ur only real chance at getting enough opiates in you per day, would be to get scripted something of the morphine family, where oral bioavailability sucks and sniffed is better and iv is like ten times stronger. Either morphine, dilaudid (hydromorphone), or opana (generic oxymorphone er is still crushable just like the original stop signs were)
Opanas were such a lucritive script back when the op's came out because of its bioavailability. Orally only 10% got absorbed, which made them have to give such large amounts. They are about 4 times as strong when sniffed and ten times as strong when iv'ed. If you got an equivalent oral dose(or anything close even) you could sniff some to make it stronger to keep up with your tolerance.
At ten times stronger iv over oral, thatd make 4mg iv equivalent to 80 mg oxycodone orally. A 40mg opana would have ten iv doses equivalent to 80mg oxycodone oral, so that one opana40 could be equal to 800 mg oxy c. Probly a little less than 800, as some would be lost making it iv'able singe they arent instant release.
Opiates like oxycodone and hydrocodone are actually better absorbed orally, and are actually less when sniffed. Thats why you cant get "extra" out of those scripts and taken as scripted is actually best
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It really "grinds my gears" when im
with someone that sniffs heroin and
wont try it the "right way" so they
dont need so much for the same
result. I ended up with a friend
last week cause my guys were both busy so i went to his guy. I only had 40 bucks, and needed at least 2 shots out of it to get me thru the day. Well we get it, and its not very fat. So i broke off about a third and did it. Got a nice rush from it. So i then had to get this dude at least something for goin to his guy for me. I know he couldve done the whole 40 in one line if he could, so the best i could do is break him a third of my bag.
Basically, get as much out of opiates as you can. Strung out on 50$ lines twice a day is the same as 2 - 15-20$ shots. Dopesick is dopesick imo/ime. If you can get dillys/opanas, as long as you know youre sniffing 10mg each time, theres almost zero overdose risk and is the same as swallowing 40mg instant release. Just be smart and keep up a strict dose the same each time. Thats ur best bet with this doc that wont write much.
Fyi that 90mg morphine is the same as 30mg opana per day, and 30mg oxymorphone sniffed per day is a pretty hefty dose. I had some bad wd's when i quit off of 40mg per day(2 20mg lines per day) thatd be ur best bet to get a max of 2 15mg lines per day (less if you dont even need that much)
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Man, that doesn't sound right about the morphine to opana. I might just have fucked my tolerance up a lot more than I realized since I last got opana. It seemed like shooting ten mgs of opana seemed like 120 mgs of morphine.i guess it was longer in between than I remember and my tolly was going up the whole time. Who knows
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@Thoms, the opiate calculators all say opana to morphine is 3:1, so going by that dog food would be right. That said, I think that different drugs just work differently so it isn't always that straightforward. I've never had opana myself, but from what I gather it is some strong ass shit.
As far as what you were saying @Dog Food, I'm just about positive that my doc wouldn't even consider oxymorphone. She is my pcp, not a pain specialist so I think that would be way out of her comfort zone. Besides that, I'm not looking to start IVing anything. It's been almost a decade since I last shot dope and I hope I never go there again. Plus, my veins are fucked so it would be a mess. Honestly, I'm just trying to get adequate pain control, and a little opiate glow is just a bonus.
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Route makes a difference too. I dont think Opana is very active orally, but it sure is active IV or sniffed.
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Ya with oxymorphone or dilaudid, you wouldnt have to iv it. Simply sniffing a portion of the pil would be stronger than taking the whole thing orally. A way to get up to 4 times as much meds by just sniffimg a line instead. Obviously iv would make it almost ten times as much meds but not necessary if 4 times as much is good enough to hold you.
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I just switched from a 300+mg a day morphine IV habit to methadone maintenance (oral) and honestly 30mg was keeping me from getting sick after like 3 days, I was surprised how little done I needed. I'm at 60mg now but only because the clinic keeps upping my dose against my wishes.
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Ya with oxymorphone or dilaudid, you wouldnt have to iv it. Simply sniffing a portion of the pil would be stronger than taking the whole thing orally. A way to get up to 4 times as much meds by just sniffimg a line instead. Obviously iv would make it almost ten times as much meds but not necessary if 4 times as much is good enough to hold you.
I haven't looked it up recently but I'm pretty damn sure that isn't true for Dilaudid. Ive never sniffed pills hate putting drugs up my nose but it's airways been my under standing that opana and Roxy are good intranasally but Dilaudid isnt (waste to do it any way but IV, really low BA orally and intranasally)
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Ya with oxymorphone or dilaudid, you wouldnt have to iv it. Simply sniffing a portion of the pil would be stronger than taking the whole thing orally. A way to get up to 4 times as much meds by just sniffimg a line instead. Obviously iv would make it almost ten times as much meds but not necessary if 4 times as much is good enough to hold you.
I haven't looked it up recently but I'm pretty damn sure that isn't true for Dilaudid. Ive never sniffed pills hate putting drugs up my nose but it's airways been my under standing that opana and Roxy are good intranasally but Dilaudid isnt (waste to do it any way but IV, really low BA orally and intranasally)
I've honestly only snorted roxi like twice in my life, but I didn't think it was much different than just swallowing them. I mean, I felt it quicker but as far as the effect the difference was miniscule.
Now, dilaudid IV on the other hand. I was in the hospital years ago & they were giving me 8mg oral dilaudid every 3-4 hours. I also had a picc line in so had very easy access. I cheeked those fuckers & booted them just about every time. Without a picc or a central line in it wouldn't even be worth my time anymore though. My veins gave up a long time ago lol.
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I just switched from a 300+mg a day morphine IV habit to methadone maintenance (oral) and honestly 30mg was keeping me from getting sick after like 3 days, I was surprised how little done I needed. I'm at 60mg now but only because the clinic keeps upping my dose against my wishes.
Its surprising how much stronger methadone is. All of that redosing in a 24 hour period makes a huge difference.
For pain management I think most docs do a smaller dose more often. It isnt a straight division though so you might get a bit more medication. Maybe its psychological and docs just prefer to write 30mg 3xdaily instead of 90mg.
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I just switched from a 300+mg a day morphine IV habit to methadone maintenance (oral) and honestly 30mg was keeping me from getting sick after like 3 days, I was surprised how little done I needed. I'm at 60mg now but only because the clinic keeps upping my dose against my wishes.
Seriously? The clinic puts your dose up against your wishes and despite being stable ? Why would they do that? I have never heard of that happening ... it makes no sense whatsoever ! I thought that abstinence was the end game and pulling that shit is counterintuitive.
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I just switched from a 300+mg a day morphine IV habit to methadone maintenance (oral) and honestly 30mg was keeping me from getting sick after like 3 days, I was surprised how little done I needed. I'm at 60mg now but only because the clinic keeps upping my dose against my wishes.
Seriously? The clinic puts your dose up against your wishes and despite being stable ? Why would they do that? I have never heard of that happening ... it makes no sense whatsoever ! I thought that abstinence was the end game and pulling that shit is counterintuitive.
I only just started so they have it set to raise every 3 days until I get to 90, but I had to see a counselor yo ask them to stop and the request I guess hasn't been processed. Other ppl I've talked to said they tend to push really high doses on people and they can be dicks about going down (if it's what they perceive yo be too quickly)
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That clinic policy is absurd and is akin to the drug dealer mentality.
You are doing the right thing because the side effects of Methadone and the likelihood of suffering more at the end of your dose, all increase when the dose goes up. High doses of Methadone make me miserable.
I always recommend that patients keep decreasing their dose so there is room to use other opiates to be used sporadically and to never get too comfortable with their clinic.
I can't help but be cynical and state that the private clinics want your money and often care little about your dependency.
Morphine ER, twice a day, is a far better option than Methadone, IMO.
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Just picked the first chart i found. Click on one of the first posts, its blue i believe.
https://www.reddit.com/r/opiates/comments/3ucu69/opiate_bioavailability_chart_very_useful/
Dilaudid is at 35% oral and a lil over 50% insufflated( sniffed)
Not THAT drastic, but still worth it imo over oral
And you know Roxys are just instant release oxycodone right? Oxycodone is at about 90% oral and 50% insufflated, which sounds just about right for what i remember from years ago when i did oxy daily.
Opana has a huge difference, from 15% oral to 45% sniffed
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Everyone knows the only right way to do roxy is to snoke it on foil. G÷t irnr #
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Everyone knows the only right way to do roxy is to snoke it on foil. G÷t irnr #
You know, I actually tried doing that once, but it did not work out at all. I broke it into quarters, then put a piece of it on the foil. All that happened is that the pill got all fucking burnt. It didn't roll down the foil like h at all. I just ended up eating the burnt piece along with the rest of it lol. 😂
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It used to get said a lot on the phile. It's a pretty useless thing because you would be better off just eating it. Sort of like you did I guess 8) They showed it on an intervention episode at one point. I never really got into oxy for some reason. Dilaudid or morphine were the big ones in my scene and when I saw oxy I was already on H. My tolerance was too high to make the prices worthwhile.
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These CDC guidelines are scaring the fuck out of me. Every doctor is reading them way too literal and I have a feeling they're all gonna just RX everybody 2 x 30mg MScontins a day with maybe a percocet for B/T pain and leave it at that because they're not gonna want to or know how to convert everything to MMEs.
I also read that the CDC doctors that helped write those guidelines meant those doses as max STARTING doses for pain mgmt. and not the be all, end all end of the fucking spectrum for folks that develop tolerances over years/decades and not meant for folks that have already been well above the guidelines for a long time.
Some state was trying to pass a law regarding these fucking guidelines and one of the CDC doctors that helped write the guidelines had to come out against the bill 'cause they said it'd lead to unnecessary quick tapering and/or folks getting cut off completely.