LOL

100 mg methadone is probably a good standard dose in terms of prevention. Clinics of course want to prescribe as little as possible but there is not any sense behind it. It takes minimum 60, preferably 100 to archieve the required tolerance. 150 is a moderate to high dose which is often necessary to curb any remaining drug problems. Higher doses are often prescribed for special reasons. You cannot demand that users should be put on a standard dose since methadone is highly metabolised and thus variable in effect and duration. 60 mg in one user may be identical to 150 in another. The guideline is max. 100 mg if you want to drive without doctors permit here.

I would say that being on methadone or buprenorphine(or any other opiate) for the rest of your life is a small price to pay to get out of such a tragic situation(did I mention that it would be better to avoid it in the first place?). But you only have to take it as long as you're in risk of relapsing, as protection. If you manage to put a decent life together with perhaps a girlfriend and kids, you can easily taper it down(it may take up to 18 months for a full methadone dose though). Then you can go on naltrexone for a few months to get as normal as possible. Just remember that it's rather unsafe to do that since you may relapse if your new life falls apart for some reason. Say your girlfriend is unfaithful and you try to 'comfort' yourself. Things like that happen easily. Alternatively you could try and move somewhere where you can't access it so easily but it's hard since there are train stations, red light districts and addicts almost everywhere in the world. Even if you're an average person like me(that is, not doing narcotics) you can always walk up and offer a homeless 10-20 dollars to find the local dealer. You don't even have to be or act like a junkie or even look like one, it's everywhere, where will you hide? Maybe one of the poles?

It's ironic that the best treatment currently proven to work for the majority of heroin abusers is actually heroin itself. It was developed to fight morphine abuse btw. IMHO, fentanyl analogues would probably be better, cleaner to administrate and ridiculously cheaper but they didn't use that in the trials(so far).

Buprenorphine is probably the best alternative if you cannot tolerate the side effects of methadone such as sweating, weight gain etc. or want to progress to a new life. It has also the unique benefit of making you feel fairly normal, as you weren't on an opiate. In that case, you just take like it is your insulin except you do it sublingually.

It cannot replace methadone as treatment for the average user because its receptor blocking only only last for a day or two. Many users switch to buprenorphine in order to be able to take other opiates(of abuse, such as H) several times weekly. It doesn't help with other types of drugs of abuse, it can even exacerbate the problems associated with benzodiazepine abuse that is typical among such people.

Introducing buprenorphine as an extra option is a step in the right direction because it makes users feel better and more normal. But the only true solution to make people stop taking drugs is to make them feel so well in their everyday life that they don't feel compelled to take drugs in order to tolerate life in the first place. In the US, it has been a common way of thinking to look at addicts as morally infected(and capable of infecting others) and that they need to 'suffer' and 'purge', like a sort of catharsis that will 'cleanse' their bodies of this moral disease and bring them back as whole new people. The 'rehab' and 'detox' phenomena come from this flawed way of thinking. When they invariably fail(and they do, unless considering 'getting them off the street' a success, they are perceived as morally evil. Thus comes the bizarre idea of putting people in jail for drug abuse and/or related crimes. In the american mindset, a person that again and again goes out and smokes heroin instead of taking care of his family, such a person is no better than someone who axes his neighbour just for the hell of it. The average american will probably be more inclined to pardon the axe murder than the addict, given the choice.

Very few drug users are in reality evil in the biblical sense. The primary reason for taking drugs is to feel good here and now, quenching the physical and psychological pain, boredom, despair etc., rather than a desire to be wicked. According to another flawed theory, 'the accessibility theory' exposure to drug accessibility will create drug users by itself. If that was true, we would all be alcoholics, smoke cannabis and generally be polyabusers of street drugs because very few people in the world today are restricted from getting them.

Sometimes we forget that most people, a large majority of the population don't *need* psychoactive drugs to get through life and these people don't take them even presented with the accessibility. Even though almost every person today can get many illegal drugs quickly and easily, few people take them and much fewer end up taking them chronically. The reason is most likely that these people have a healthy body and nervous system and also high circulating amounts of the endogenous substances that make them feel good, motivated and relaxed by baseline, plus their body and brain retains sensitivity to these substances.

The only way to bring people in risk of addiction up to this baseline is to change their genetic makeup already before birth _and_ remove a large amount of the social problems that exist today. The last part is probably the hardest but can probably be compensated for by genetics since a significant part of the population still don't like taking drugs even when placed under high stress.

Such people don't need drugs and generally don't understand why others take them. But ignorance is no protection and they too can quickly find themselves in the same situation due to the flawed moral of society. The classic is the otherwise healthy patient who develops a chronic pain problem such as back or leg pain. As he has faith in the authority of doctors(and authorities generally) he rigidly follows his doctors advice and takes the prescribed pills at the correct time of day. The pills may be strong narcotics(his medical record is straight so why not) but he is confident that he will never become addicted since he is prescribed it for a legitimate pain problem and he is under the care of a competent doctor. Besides he would never take his meds to get 'high and he cannot even think of himself as an addict. In fact he thinks they are scum and should all go jail. He votes for old testament politicians and thinks criminals and drug abusers are treated too soft.

Now, this patient doesn't know that the primary risk factor for developing dependency and addiction to opiates is not the desire to get high but the dose and the time(months, years) he takes it. This is the solid statistical risk factor. Whether you take it for pain or pleasure makes no difference at all to the receptors in your body, contrary to the reassuring myth you get from many doctors as a pain patient. In fact chronic pain may be worse in that matter because you may have to take it 24 hours a day rather than in 'pulses'. Like is the case with other receptor agonists, limited but constant binding to the receptors cause more downregulation than high but temporary binding. Another disadvantage that the pain patient has is that he cannot tolerable off time well since his already troublesome pain will be amplified('rebound pain'.

Opiates are notorious for developing tolerance and will eventually require dose increases to cover the same amount of pain(unless the pain gets better). Only very few patients will be able stay on the same doses for many years, most require regular adjustments, typically up. And dependence is invetiable for all who take an opiate for extended perioids of time. Some good doctors understand this logical consequence(dependence and tolerance doesn't necessarily make an abuser) and are willing to go all the way but most doctors will call in the hounds once he discovers his patient in that situation. With these doctors, it would be better to not take the meds in the first place because there is nothing as bad for pain as withdrawal.

After some time(typically more than year), the faithful patient will have had to have some dose increases(thoroughly discussed with his doctor of course) and that has made him a little worried. He thought he would be taking the same dose all the time. He don't like asking for dose increases but he cannot function when he's aching. What is even more worrying is that the meds don't work so well as they did, in fact even the higher dose doesn't work so good as the ones he got in the start of the treatment despite being smaller. It's like the dose is never sufficient for some reason. Once the receptors are downregulated to a certain point, the end-of-dose premature withdrawal symptom shows up. At this state he will probably start to realise that he is in trouble but he tries to hide it from his doctor hoping it at least won't get any worse with time. But it does and then he starts to run out of meds before getting the new prescription. He get a full blown WD the last few days before he can get it filled. The pharmacist notices his runny nose but doesn't say anything(what would it help anyway).

Finally the inevitable happens. He gets in legal and financial trouble(already happening of course) because he tries to manipulate his prescriptions. He goes to several doctors, tries to fill them early, maybe even try to scam a pharmacists or buy some street 'oxy' on the wide black market. He may have more pay more than 1$ per milligram from black pharmacies or even his local drug dealer but at this point he doesn't care anymore. It's no longer a question of getting proper pain relief but of barely staying normal. As the irony reaches its high point, he is arrested as the scum he is. The doctor can of course not prescribe anything to him more. He is sympathetic but reminds him that's it his own fault he turned into an 'abuser'. "If I had known you would abuse your medication I would never have prescribed it" the doctor says.

Now this patient is worse off than before. He hasn't got enough money, he can't hold down a job, he can't get hired, he is going through heavy WD and his pain is much, much worse now which is the logical consequence of opiate receptor downregulation. The best he can do now is line up for MMT and accept his new life as a junkie. He better try to learn the slang such as "dope" instead of medicine and exchange his suit for a stereotypical junkie uniform(hoody and white sneakers). Very cliche but what can one do.

Bottom line: you don't have to act like an addict to become one.

PS: Agonists reduce receptor density, antagonists increase it. The more receptors you have the more sensitive you are. Sensitivity is somewhat more important than the amount of drug, producing a stronger reaction. Increasing sensitivity works most often better than increasing the dose but it's of course harder to accomplish.

While I certainly have to commend you for your ability to type very long opinion pieces regarding the use of methadone or Suboxone, I think it is important to once again point out the facts involved in these treatment approaches.
Tapering methadone of course makes sense. That is how many, many people have discontinued their treatment at methadone clinics and managed to stay clean.
The theory of "very few opiate receptors left in your body" is exactly opposite the clinical facts. If you are asserting that an addict must continue to fill in some imaginary gap with drugs for the rest of their life because of a lack of opiate receptors in the body, I think you have missed the point entirely.
The only thing the addict will be chronically deprived of after discontinuing methadone is their original drug of choice. Which is, after all, the point of all of this.
When people present these misguided theories about opiate addiction, especially ones that sound like a life long imprisonment with liquid handcuffs, I'm afraid that active abusers might see no useful point in approaching recovery from this angle and just keep using until they die.
On the other hand, if your tactic is to make potential addiction sound like hell on Earth forever, then maybe someone will see the light regardless of the facts.
You sound like an intelligent person who has had considerable experience with drug abuse and are in active recovery. Congratulations on that achievement and best wishes for your future.

Weeeeeeell it looks like we have to disagree on at least four counts

One. please do not try to turn me into an addict too(LOL). Because I’ve been close to one and experienced the consequences doesn’t necessarily make me one. I don’t have problems with chronic pain either anymore. But that is off-topic personal info I only discuss over PMs.

2.
There is nothing theoretical about receptor downregulation. It happens with many kinds of drugs especially ones related to hormones, for instance with insulin. Note that there are several ways the desensitizing happens, reduced receptor density and binding is just some of the mechanisms but often the most significant. Strong binding to receptors can reduce their numbers within hours. The body continuesly create and break down receptors, when an agonist or antagonist is present, the balance is merely shifted one way or the other

This explains it very short and efficiently in the case of insulin.
http://en.wikipedia.org/wiki/Downregulation_and_upregulation
And the mu receptor itself
http://en.wikipedia.org/wiki/Mu_Opioid_receptor

Here is some about mu receptor downregulation, the process behind opiate tolerance and addiction.

Mu opiate receptor down-regulation by morphine and up-regulation by naloxone in SH-SY5Y human neuroblastoma cells
http://jpet.aspetjournals.org/cgi/content/abstract/265/1/254

"The human neuroblastoma cell line SH-SY5Y was used to demonstrate morphine-induced down-regulation and naloxone-induced up-regulation of opiate receptors in a mu receptor containing neuronally derived preparation capable of desensitization to morphine. Chronic exposure to morphine decreased the number but not the affinity of mu opiate receptors in SH-SY5Y cells."

Here it is shown that baclofen reduces withdrawal and(interestingly enough) restores the restores mu receptor levels which had previously been decreased with morphine(receptor density)
http://www3.interscience.wiley.com/journal/109580729/abstract?CRETRY=1&SRETRY=0

Here it is shown with etorphine which is an incredibly potent mu agonist.
mu-Opioid receptor downregulation contributes to opioid tolerance in vivo.
http://www.ncbi.nlm.nih.gov/pubmed/11420091

3. The evidence on relapse rates is against you. The relapse rate is very high. Even the most dedicated ones(and they are naturally the minority) that make it through 5 years of heroin abstinence still suffer a 25% relapse rate.
http://www.highbeam.com/doc/1G1-77875249.html
There is no basis for your claim that they can merely 'stop' using. Again, if you could see inside you would not have said that.

4 My only tactic is to merely point out the grim facts. There is nothing here I say that cannot be found with just a few keystrokes on Google. Facts saves lives. It is first and foremost the ignorance of facts(by the western world in particular) that does all the damage and the deaths.

When you understand the changes that opiates(and other drugs) make to your body, it makes it easier to judge when to use them, how to use them and which ones to use or to avoid. This is especially important if you have to order them online from places that may dissappear any minute.

Upon reflection (and reading your profile), I'm thinking that you and I probably have a lot of interests in common when contributing posts to this drugbuyers.com discussion board even though we are on different continents and are familiar with possibly different drug treatment modalities.

Rather than continuing to debate the clinical differences between cell surface down-regulation vs. opiate receptor site growth which would take this discussion even further off-topic, I'll just stress one point that we seem to disagree on.

There is a considerable factual basis for my claim that substance abusers can (I never said "merely") quit using. I did. I have files of hundreds of other people who did and have successfully remained clean. While it is certainly true that relapse rates are dismal, they are not 100%. To even suggest that a drug abuser is somehow sentenced to a life of taking some drug to fill up a hole is a disservice to the thousands of people who work tirelessly as professionals in recovery programs and to the millions of people struggling every day to remain drug free.

Maybe the relapse rate is much worse in Europe and that is the basis for your assertion. In that case, possibly the structure of your treatment programs needs to be re-evaluated. But I seriously doubt that the introduction of medical grade heroin is the ultimate solution, however.

If anything I've said was construed by you as trying to turn you into an addict, I apologize. There are enough already without any effort by me to add to the ranks.

martind, I have to say I agree with you on so many points.

I don't know where to start and don't wish to type a book, but I do know that taking opiates increases the receptors, not decreases. I also know that it's disturbing for anyone to come to a site that has many many chronic pain patients, patients who are terminally ill, bed ridden, etc. and give them no hope for a better life. _99, obviously you are in Europe yes? Here in the US there are so many different opiates for so many different conditions that I don't think they'll ever have a pharma grade Heroin to use, not when we have methadone and subutex/suboxone to get off of any of the other opiates or Heroin or cocaine/crack, etc. Here, they also use low dose blood pressure medicine and low dose anti-anxiety medicines mixed with the lowering of the opiate so that the person isn't as likely to relapse.

Anyone can google, and I believe you won't find a better group of google users than on this site. Anyone who has to deal with chronic pain googles their condition, ways to treat it, the medicines they are on (I've googled ever medicine ever prescribed in the last 12 years or so, and that includes EVERYTHING, not just opiates or scheduled medicines).

I feel like you are either trying to take away hope from people who are trying to stop opiates now that their pain is gone, or you're trying to scare people into never starting. This may be the wrong site, as most people only find their way here after googling their conditions or medicines, which leads them to this site.

There is a misconception that even chronic pain patients can go without medicine if they really wanted to, which is what we try so hard to fight everyday here.

Two examples I've seen recently, even though one is fiction.

First - Let's take the show House for example. Very popular in the US, and since the lead actor is British, I have to assume he's popular in the UK also. Anyway, although the show is on about the 7th season, the storyline for the last year or so has been that he's an addict because he was taking 8 vicoden a day, even though his injury was horrendous and even his doctor friends agreed he would have pain forever. But suddenly at the end of the season last year they started to make it look like it was such a horrible thing, when we have significantly stronger medicines in the US than Vicoden ES and with his injury he probably should have been on them. The end of the season has him checking into Rehab. Well, what do you know! The new season starts and all of the sudden he's not in pain anymore. Now it's just "sore but manageable". Rehab has set him free! Do you know how that makes all the chronic pain patients in the US feel? To see a show where they know the main character is portraying someone with a permanent serious injury and now all of the sudden, because of Rehab, he isn't in pain, and is only in pain when he gets BORED? I love the show, but was sorely disappointed at the direction the writers went. They may have been feeling heat from somewhere about the fact that the main character was openly taking opiates to deal with a horrible injury and are now backpedaling to make it seem like anyone can deal with any horrible injury if they just keep busy and don't think about it.

How about all the people who can't even sleep at night because there is no such thing as a comfortable position? People who night after night are lucky if they can make it until 1:00 am or 2:00 am because of the pain and then they give up and get up? Do you know what THAT does to the inside of the body after a while? Try going several weeks with 2 hours of sleep a night and tell us how well you would function, when taking a pain pill before bed would alleviate that problem and help that person sleep so that they didn't always feel like they couldn't function?

Second example. There's a show in the US; a reality show about people who are or were famous and are addicted to something, whether it be alcohol, cocaine, prescription medicine, etc. The show shows them as they go through the process of Rehab. There was one particular man on the show, Jeff, who was obviously permanently disabled. He'd had more than a dozen surgeries, spent most of his time in a wheelchair or flat out on a bed, and they were trying to get him off of all opiates. They tried the first season but he "relapsed" (actually he'd had two more surgeries and all his medicine was prescribed by his doctor/surgeon). So they have him on the 2nd season and again they are trying to take all his pain medicine away and seem occasionally bewildered when he would lash out at people, or would refuse to go outside and sit around in the sun with everyone. He's a case of someone who is growing older, has severe pain, many surgeries and is the absolute strongest candidate for "give the man the medicine he needs and just shut up about it" that I have ever seen. And yet....you see the Rehab doctor going to his house and trying to get him to stop all opiates after his next surgery *sigh*. Geesh. Some people will be in pain for the rest of their lives and I can promise you they didn't want to be. Any chronic pain patient would tell you they'd rather be who they were before the pain started than pop a darn pill anyday.

I used to jog every single day, and had 2 hobbies that took up my entire day. Now, I just want to make it through the day without too much pain. I just want to be able to wash clothes the kids need, keep the house clean and keep myself clean without too much pain. I don't succeed but try never to cry in front of my family.

I've stumbled upon many of your posts in your very short time here _99, and there is a running theme to them. I'm sorry, but I don't think opiates are evil, I don't believe everyone who has to take them for a year or two and then stop because the pain is gone can't stop, and your scare tactics bother me.

It's a case of being in other's shoes. How many of us here have said "If the DEA could be in our shoes for a week they might leave us alone?" or "if our doctor could be in our shoes....etc.?". I wish you could be in our shoes for just a couple of days and see that even standing long enough to shower, brush your teeth, do your hair, etc. is enough to ruin your entire day before it even starts.

Case in point: Recently I watched a documentary about a doctor who was in an accident. He was used to telling his patients "this will sting a little" when he gave them a shot (I don't remember what type of shot). When he became the patient himself and had to deal with the shots daily until he got out of the hospital, he had a whole new respect and he said now he tells his patients straight up "This is going to hurt a lot".

If only everyone were empathetic to others instead of judgemental about what is going on inside our bodies, because obviously we haven't figured it out for ourselves, Life would be a better place. We wouldn't feel ostracized, we wouldn't be subjected to monthly urine screens, urine screens that are wrong that get people ejected from pain clinics monthly, etc. I hate pain clinics as they are out to get all the money they can from shots, nerve burnings, etc., but at least they would give some medicine to help you through the month. But if you have constant urine screens for years and then one comes up weird, you are thrown out, instead of being given another test. My test said I was taking Restoril when I was on Ambien CR. Have never seen Restoril and can't imagine it would work any better than Ambien so why would I need it when I got Ambien CR every month? And yet I was ejected. In fact, my urine screen looked like 4 different people's urine all mixed up! It wasn't fair to judge me then, by the same people who had been taking care of me for 4 years and I had never had a urine screen come up so wonky. Yet I wasn't even given the opportunity to have another urine test. I was simply ejected.

Life isn't fair, and gets even less fair when people in constant pain, with all the tests to prove it, are being scared to death with your rhetoric.

And sorry if I offended you, but that's my honest opinion after running across many of your posts in the last 2 days.

You are going to be put on ignore because I don't think you are being helpful to the community and you have pulled me and Martind way off topic. (and you've pulled other people off topic in other posts) So this may get deleted or added to the flame wars at the bottom of the page, but maybe you'll see this before you keep on with your campaign agenda...whatever it may be.

Wow Lynx...bravo!

I enjoyed your post and heartily agree, especially with your statements about "House". I'm surprised I haven't seen more posts here about it b/c it bothers me...a lot.

I also think that _99 often brings threads off topic and diverts your and martind's useful and informative advice. Unfirtunately I am doing the same with this post, so I'll leave it at that.

That is exactly why I described the induction, daily and weekly increase RANGES for you.

What was that about spectacles? And not reading posts?

LOL

Doses of course are dependent on how much the user currently uses. There cannot be a real standard number.