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Re: methadone shellir

Posted by Elizabeth on December 28, 2001, at 15:16:14

In reply to methadone, posted by shellir on December 22, 2001, at 13:48:05

> does anyone know the difference between methadone and other opiates?

The main difference is that methadone has a long half-life (although people taking it for pain still apparently need to take it every few hours). It's a full agonist just like morphine, etc.

People on MMT can take it once a day to block cravings and they usually reach a dose at which they remain stable (yes, they really can take it once a day, although some occasionally find they need a nighttime dose, which is hard to arrange with the government's one-size-fits-all rules about MMT dosing). That's a very different use than what you're using it for, though. People taking it for pain do need to keep increasing the dose because of tolerance, and if they stop taking it they need to taper off of it gradually in order to avoid or minimize withdrawal symptoms.

Clonidine (an adrenergic autoreceptor agonist) might have been what they gave you in the hospital. It helps a bit with some opioid withdrawal symptoms, although it doesn't help much according to most people who've tried it. I think that the best way to detox from opioids is to switch to buprenorphine and then taper gradually. Buprenorphine does cause withdrawal symptoms, but they don't last very long and are very mild compared to those of full agonists. The main tricky part, IMO, is finding the right dose to start at. If you're taking a high dose of methadone and you get switched to a low dose of buprenorphine (e.g., the 1 mL that I take), it's probably not going to do much for you.

Buprenorphine isn't really much like Stadol (butorphanol) at all, pharmacologically. Stadol is a kappa agonist/mu antagonist, while buprenorphine is a kappa antagonist/partial mu agonist. Stadol might even trigger withdrawal symptoms in a person who's dependent on opioids.

The sublingual buprenorphine tablets haven't been approved specifically for maintenance treatment, and the drug company doesn't want to try to market them until they've been approved for that use.

I hope this helps. Be well.





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