Trying to split dose

[Badly Drawn Girl]

I've been on mmt for 4 months now and I'm still not making it more than 12 hours without getting sick. The problem is that I'm great during the day. I wanted to get a trough done so that I could make a push for split dosing but I was informed that a) my clinic currently has no one available to do that and b) the doctor doesn't recommend troughs until a person hits 120 mgs. I've explained that I don't see the point in upping my dose when I'm quite comfortable for 12 hours and then suddenly I'm a mess. All the higher doses are doing is making me feel higher during the day, but they aren't lasting a minute longer.

I've had two dirty ua's in a row (they were actually almost two months apart) but I'm doing really well in my opinion. I usually have one day a week where I'll break down and take about 40 mgs of Oxy at night because I'm just too miserable to cope. That's a far cry from 400 mgs a day, but of course all the clinic sees is a dirty ua. I was told that they are hiring someone who can do a trough but it will be a couple of weeks.

On the plus side, I've been completely clean since I went up to 90 mgs. That's a first since started at the clinic. Even though I don't feel better at night, for some reason the voice in my head that says "Just take something and you'll feel better" has shut up.


My question is... should I continue to up my dose in the meantime (which is what was recommended to me) or should I just hang on until I can get the test? I'm at 90 mgs now, and like I mentioned, they like you to hit 120 before doing the test. But I'm actually getting sleepy a few hours in to my day so I feel like my dose is really on the cusp of being too much for me. Thoughts?

[Seedy]

I can't help you but this is interesting reading as I've been considering 'done myself recently. reading that your dose won't hold you more than 12 hours is pretty discouraging as I know I have a very fast metabolism so it would most likely be the same for me. How are you in the mornings? like do you wake up way to early in withdrawals on a regular basis? That, I would find very hard to handle.

[Duckfeet]

Your question is a good one, but just to let you know: the opinions are *radically* different, even opposed, with one side saying that if you go *up* in dose, you will get better, that these symptoms that might appear to be "doing too *much*, i.e., sleepy during the day, etc., will get better w/increase...that there are people on hundreds of mgs or mdone, who are doing fine...

I'm the other side, more or less "old school" w/this. My attitude was always to just do enough to "get well'--around 40-50mg, for any heroin habit I had, and enough to where "heroin" just can't make a dent, what is called a "blocking" dose, which is 80-100mg, so most addicts I know, being who we are, get on, get well around fifty, and continue on up, for the blocking...or just cuz we always want more anyway, tho it's dimishing returns...

My favorite dose? ... anround 50, because I always "feel" it, in the morning, because I'm in slight withdrawal when I take it, so about an hr after dosing, I get a "lift..."

But unlike the high dose aficionadoes, I always know i'm going to want off this, at some date, so I did what I always did, which is to get on around fifty, and then keep'em going up every day, until I hit 100mg...then I realized what I was doing, and turned around and worked my way back down again...I'm at 9mg daily haha, and I don't feel shit, nor should I ....

Split dosing, all that, well, all the clinics are different, but unless you have takehomes--and you can do what you want w/yer dose--the clinics hate it, as it's such a hassle for them and slows everything down...

Gonna have to sort this one out for yourself, as we'll be all over the place with it....

best wishes...


I've been on mmt for 4 months now and I'm still not making it more than 12 hours without getting sick. The problem is that I'm great during the day. I wanted to get a trough done so that I could make a push for split dosing but I was informed that a) my clinic currently has no one available to do that and b) the doctor doesn't recommend troughs until a person hits 120 mgs. I've explained that I don't see the point in upping my dose when I'm quite comfortable for 12 hours and then suddenly I'm a mess. All the higher doses are doing is making me feel higher during the day, but they aren't lasting a minute longer.

I've had two dirty ua's in a row (they were actually almost two months apart) but I'm doing really well in my opinion. I usually have one day a week where I'll break down and take about 40 mgs of Oxy at night because I'm just too miserable to cope. That's a far cry from 400 mgs a day, but of course all the clinic sees is a dirty ua. I was told that they are hiring someone who can do a trough but it will be a couple of weeks.

On the plus side, I've been completely clean since I went up to 90 mgs. That's a first since started at the clinic. Even though I don't feel better at night, for some reason the voice in my head that says "Just take something and you'll feel better" has shut up.


My question is... should I continue to up my dose in the meantime (which is what was recommended to me) or should I just hang on until I can get the test? I'm at 90 mgs now, and like I mentioned, they like you to hit 120 before doing the test. But I'm actually getting sleepy a few hours in to my day so I feel like my dose is really on the cusp of being too much for me. Thoughts?

[lolleedee]

I was on MMT for 2 years...I've been off for almost 2 1/2. I was up to 90mgs. a day and was in withdrawl every morning. I told the staff, who made me an appointment with the clinic doctor. Instead of me taking a take home, I dosed at the clinic and then came in early the next morning to see the doctor in complete withdrawl...the didn't do a trough because it was plain for him to see how much I was hurting and they saw me dose the day before so I guess they figured goo enough!! My dose was split to 45/45 and after that I felt like a million bucks!!!

[Narkotikon]

I'll tell you what happened to me. I started at the clinic I was at in Dec. 2005, and progressed until I got to around 90mg, and was still craving / thinking about opiates all the time, and would ALWAYS be so damned tired. So, of course the doctor kept telling me to up the dose. They were particularly interested in knowing if I got tired a few hours after I dosed, or if I got tired later in the day / early evening, and I was honest and told them I got tired at around 2:00 or 3:00 PM in the afternoon, and I dosed at about anywhere from 8:00-9:00 in the morning usually, sometimes 9:00-9:30 in the beginning. They were saying that the dose was wearing off, and that's why I was getting tired and still craving. Apparently to them if you get tired an hour or two after you dose, that means you're getting too much, but if you get tired like 5 or six hours (or more I assume) that means that you're metabolizing the methadone too quickly and not getting enough. In other words, it's not holding you all day. That's what I was told. So, according to that theory, I followed the doctor's advice and was led to believe that I just needed a higher dose, and that all would be fine. Well, I got up to 100mg, and things still hadn't gotten better, and at that point, the clinic required a trough to go beyond 100mg, so I paid the $25 and had the trough done. The trough results said my blood serum methadone levels were a 180, and that it should be between 350 and 450, and that meant that I was metabolizing it too quickly, and that I still needed more, which made sense to me, because that's what the test showed. So, I allowed them to up my dose, but I just kept getting sleepier and sleepier during the afternoon, to the point where the doctor prescribed Provigil 200mg bid to help with that, but even it really didn't work better than coffee.

So, I finally get to 140mg a day, and I'm just so sleepy and so amotivational / not functioning that all I'm doing is dosing, going home to watch tv for about four hours, then literally passing out until 2:00AM or something like that, then having to stay up all night because 1.) I'm not tired after having slept so much, and 2.) having to stay up to make sure I could make it to the clinic in the morning, because I was afraid that if I did go to sleep, I'd sleep through the alarm and miss the clinic and not get my dose. No one there at any point mentioned anything about split dosing. They just kept telling me I needed more and more methadone to hold me, to the point where my family (who was paying for it) finally got tired of me not working and sleeping all day, and realizing that the methadone wasn't going what it was supposed to do (they didn't want me to go there anyway) and was actually making things worse, that they stopped paying and I got administratively detoxed from 140mg to 0mg in two and a half weeks. It was hell.

So, the point is, I feel like 1.) that was WAY too much methadone for me, at one dose, and 2.) split dosing would have been the way to go, because I could have stayed at a lower dose, say 100mg, taking 50mg at the clinic in the morning, and 50mg at home in the evening, and I would have been more compliant. I did test dirty for opiates and coke the first three and a half months I was there, first opiates, then coke, but the reason I never got take homes after that, even though I was totally clean, is because every other week I'd skip a day, just so I didn't have to dose, because I was SO over medicated. And the policy there was you had to be compliant for 90 consecutive days to get one take home, which I didn't do because I couldn't go 90 days without missing.

So, if you're not holding through out the day, which it sounds like you're not, and you don't want to go higher, then I really would try to get that trough done (it will show your accurate levels, and that should be proof enough) and push push push for split dosing. I mean, you could maybe go a little higher if you wanted to, but if it starts to make ANYTHING worse, it's just going to be bad in the long run, because you're at a higher dose than you probably need when you could take less and split dose, and you're probably going to get more side effects like I did at higher doses. I'm just saying, if you feel split dosing is the way to go, then try your hardest to push for that. Don't let the clinic boss you around. I was ignorant when I started MMT. I mean, I knew what it was and the basic info and stuff, but I totally believed the clinic and thought I really did need more. And that was totally my fault. Educate yourself as much as you can about this. Methadone is such a horrible drug to detox from, especially when you're forced to do it quickly, and it's even dangerous we all know. If you can take as less as possible and split dose, I'd say do that before taking one really big dose to hold you through the day just because they don't want to split your dose. That's terrible and totally unnecessary. A MMT client / patient should remain at the lowest possible dose that works, and they should never be over medicated. I think it's unethical of clinics to force people into taking one huge dose each day just because they don't want to split their doses. I think it causes more problems than it solves, and I also think it can be a great way for Methadone Clinics to get people overly medicated so they're somewhat chained to the clinic (i.e., the clinic can get as much money out of you as possible).

[Duckfeet]

Again: I agree. And I finally had to leave another site, even tho I had really good friends there, because the predominant theory was that most of these symptoms were *not* caused by too *much* methadone, but by too little, and some of the stories are very convincing, tying in w/EDS and other theories, and generally go under the more--seemingly--benign theory, that you "just need the *right* dose" and you'll be alright, and then come testimonials--and anecdotes--about/from people on doses *much* higher than I'm even *thinking* about...and to any troubled newbie to mmt, these theories are very convincing, seductive even, because the reality is that: anytime you get to feeling "bad" again, you just "up the dose," until you are alright, and if that is 300--for now--that is fine...until you feel bad again, then you maybe need *400*, etc. Sure, fine..but what if they *aren't* right, and that maybe people like me are?

Well, then, you got a *long* way to come down, you can't just say "oops". Because if yer still falling asleep whenever you sit, generally lethargic, watching t.v. and eating ice cream at say, 200mg, what do you do then? Well, you keep going up, until you get the "rite" dose, since getting *off* this shit seems farther and farther away: you have invested your own life in a theory which almost self-fulfilling: I mean, you aren't going to say at 300mg "I was *wrong* are you?

And that's why it's so diabolical to me, to treat typical longterm opiate side effects as something to be overcome by more opiates....not for me....and I've been at this a lifetime, and am staking my life on being right, on this one. If not I'd be *well* over a 100mg daily, by now.

And of course--the web being what it is-you can find powerful evidence all over the damn place, going back to Niswander and other pro-methadone pioneers, to tell this junky what he secretly wants to hear anyway: I just need *more*: that's my *real* problem...

So for me--just me--I had to get kind of seriously honest with myself, and say....*Nope*, I'm sleepy *because* of this damned methadone, not because "I haven't reached the rite dose, yet," and I'm lethargic *because* of the methadone, not because "I haven't reached the rite dose, yet," and I sit around and watch t.v. and eat ice cream, and life goes by, not becase "I haven't reached the rite dose yet..." but simply because of the methadone itself...

The real danger of the "going up no matter how high you have to go, you have EDS!, and yer endorphins just need to get rite, then you can very very gradually, over a few *years* time, get off it!" is that deep in my gut I don't buy it, and going up is just way too handy in controlling old junkys like me, and keeping methadone clinics in happy, profitable business. Kind of interesting to me, that they didn't really "discover and promote" EDS until *private for-profit* methadone clinics came along, and they love it. Too self-serving for me.

Why I went to Canada, and have corresponded so avidly w/Nick? Because if I'm going to be on an *opiate* I want honest heroin, and quit jacking around, rather than a synthetic substitute. I go to methadone vets group once a month, and most of these guys are around my age--fifties, some sixties even--and I'm telling you, the longterm methadone "clients" look terrible, to put it bluntly, they are all bent over, several of them use canes to walk, and we seem to get a death a month... I look good, compared to these broke down old fucks...was it methadone? No, I don't think so, but to a man, once they got on methadone--years ago--all most of'em have done is sit around and watch t.v....hell, I was paragliding and bodysurfing huge waves while these guys have been channel-surfing and fighting constipation...fuck that....I've been there last two years, and I try to be nice, but it was a form of purgatory I hope I never return to....

So sure, methadone's always in the cards for lifetime opiate addicts like me, and I know that, I don't "pretend..." but I try like hell to put it off as long as I Possibly can, and *when* I can: get the fuck off it, as I know what it's like to look out over a bluff on Big Sur, and *not* need any dope, and be just alrright w/the whole damned life carnival: endorphins be damned....

So I say go no higher than fifty mg, get yer shit together, get off...and funny thing, lower I get, less sleepy I am during the day, better my diet is, my t.v. was disconnected months ago, and I'm much more physically active...interesting, because I too was told I needed to "go higher"...and I know there's a few who think, yeah, you just wait, yer only at...'x' mg, wait until *zero*, fucker...hardest thing--and for me, most necessary--is just to shake off the 'junky mentality' and I got that in *spades!*...but I'm getting better....

7mg daily, down from 100mg ...no sweat, so far...I'm sure hell is waiting, just around the corner hahahaha ;)


I'll tell you what happened to me.

<snip, snip>

I think it causes more problems than it solves, and I also think it can be a great way for Methadone Clinics to get people overly medicated so they're somewhat chained to the clinic (i.e., the clinic can get as much money out of you as possible).

[OxyContinuously]

i found that with meth clinics,, they are almost too happy to increase your dose to crazy amounts...

150mg is commonplace, and i know dudes that take 250mg and better per day of the juice..

I mean I don't care how voracious your dope habit was, a quarter gram of methadone??!!?

to me that seems like not only overkill, but a money-making scheme b/c who in their right mind would kick that much done? and obviously, if u keep going, u keep paying (in most cases-- iknow there are free ones, and DF, you were telling us that veterans like yourself can sometimes get it provided at no cost, which is good)

first off, a cold turkey off of 250mg may very well KILL someone....i'm being serious, here...at the very least, it'll be seizure-city,, and the part i don't like is that the counselors, and the people at the clinic know darn well that if a patient goes up that high, they have little to NO chance of kicking it successfully, although they'll always tell u otherwise...i mean how long, realistically, would a taper to zero from 250mg take for someone to do? Months and months if not yrs...

Also, every clinic I know about touts methadone in the sense that it's lauded as a cure-all for opiate addiction,, and the counselors actually tell the patients that meth is easier to kick than heroin cuz it lasts so darn long---they use that as a major selling point for methadone, and i think that's wrong to mislead people that are trying to get their lives in order....

don't get me wrong, methadone can be a lifesaver,, and me? well, as some of you know, I am in the process of thinking it over...i visited my clinic (a private pay clinic as the free one is just not for me--i'm not a dick or anything but the people that go to the free one are, how shall we say?--the "bottom shelf" of society...no thanks!) got the info, talked to the counselor, and I may do it...I don't know yet...

but yeah, all this talk about done got me thinking so i wanted to share that with everyone

[Duckfeet]

Yeah: I' ve been thinking about this a lot, since my post above, u know: did I want to get that old battle going again, etc?., but I figured it was just important if somebody *was* wrestling with it, to know that not *everybody* agrees w/that theory: opiate addiction=EDS=methadone is good!

Again, I have really good friends, who give really good explanations of why they are finally happy and at peace at higher doses, and that's o.k: I just figure it's important to--every once in a while--voice the other view of this: and I'm *on* methadone, I'm *glad* methadone is available, when I needed it, but I see it the way I posted above, and both methadone *and* subs are to be treated w/extreme caution, not to be taken lightly, because bottom line: they are much easier to get on, than they are to get off...

Enough.

[SurfRat]

No methadone here.


But I would like to comment doctors are not as a rule real too good at thinkin' on the hoof.

ie. A lot. Not all. Of doctors read info and remember and recall info really good, because that's how you get through med school and a lot of doctoring does involve punching in the equation and adhering to the *answer*.

HG Wells in Food of the Gods, made reference to doctors as being "revolving book cases."



Meaning, if you can, of course you should try splitting your dose

[Badly Drawn Girl]

How are you in the mornings? like do you wake up way to early in withdrawals on a regular basis? That, I would find very hard to handle.

I want to thank everyone for their responses! Nark, I get tired about 6 hours after dosing, so I appreciate your experience. That makes sense that it correlates with the 'done leaving my system since I'm not sleepy soon after dosing.

As for your question Seedy, I dose around 9 am every day. By 9-10 pm I suddenly feel like someone has sucked every drop of the methadone out of my body. I get terrible muscle aches, more burning than pain, and I have to constantly stretch my muscles. I have a hard time getting comfortable. I also alternate between sweats and chills. It isn't as bad as normal wd's. I have little desire to use for one thing. And I can easily sleep, something I cannot do during wds. (Although I do wake up every few hours in terrible pain, I'm able to go right back to sleep) When I wake up in the morning, I look like death warmed over. I'm shaky, agitated, and I hurt like I got hit by a truck. One hour after my dose I feel wonderful. I definitely "feel" my dose while it's working. I get a warm, happy glow, all my pain fades away, my attitude immediately improves and it's like nothing bad happened. Until 12 hours later when I'm suddenly a mess again.

My push for split dosing is because I'll never earn my takehomes at this rate... I keep having dirty ua's. I get ONE takehome a week and I do split it. My weekends are glorious things because of that. So I know it will work but in the meantime, I have to play the game. I haven't upped my dose yet. I've been at 90 for a week and I haven't used which is a first. (I've been using once a week)

And I'm not worried about getting off the 'done eventually, this is a lifelong route for me. My health will only get worse so there is no light at the end of the tunnel. I don't want to build up to a huge dose though if a smaller dose, broken in half would work better. I want to be able to up my dose as needed when my pain gets worse. I'm scared I'm going to end up with no options.