You’ve got to work it out for yourselves
Hello my name is adam waynestock i’ve been a drug and alcohol specialist now for almost 20 years and and i kind of thought about how many gallons of this stuff i prescribed over the years to people with heroine dependence and it made me realize that even 20 years i might carry on having the same conversation with people who are on some form of opiate substitution
All the time and i guess i just wanted to put it down on video so i don’t have to say it so many times about how i think people can work out what the right dose is for them because i know a lot of people who are on methadone hate methadone i understand people think this is liquid handcuffs people think this rots their teeth it doesn’t want your teeth this gives
You a dry mouth it makes you crave carbohydrates a bit like aaron it also numbs the pain from dental abscesses and unfortunate dental accesses is not very good for many people that’s what’s bad for your teeth there isn’t sugar in here that doesn’t want your teeth but i think one of the biggest issues is that so many people don’t use methadone in the correct way
Now that’s sometimes because the people who are prescribing it or dispensing it aren’t giving the best advice and at the moment in the uk we’re caught up in the recovery agenda which is suggesting to people that what they need to do is come off what i would suggest you is that you can recover from your opioid drug dependence and if you maintain yourself on a happy
Dose of methadone or buprenorphine if that’s what recovery means for you if you to return to sort of life you want i’m free from having to score drugs use drugs commit cry and be away from your family being stable on maintenance therapy gives you the recovery you want then don’t let anyone tell you that you need to come off that’s a choice that you make it’s the
Minutes at the right time for you i digress i’m going to tell you how i think you should work out if you’re on the right dose of methadone the right dose of methadone that any person is not a magic number it is the dose of methadone but one keeps you free from withdrawal at least 28 hours a day why 28 hours because i don’t think people should wake up every morning
And just before they get their dose they start feeling your knees sweaty and achy and having to be at the chemist or their clinic you know on the dot at nine o’clock that’s not a life maybe you need to take your kid to school maybe you need to go and meet someone first you should be on a dose that keeps you comfortable so you need to be dosed once a day but you’re
Not tied to the clock and so when i mean keep you comfortable 24 hours 28 hours a day i mean absolutely 100% comfortable before you get your dose you should feel almost identical to how you feel after you get your dose if before you get you those here a bit achy or a bit your knee you’re starting to feel weak why heavy late then i’d suggest to you that you’re not
On enough and actually going up might let you feel a bit more comfortable not going up much maybe 5 or 10 milligrams but if you’re going to be on this drug get the most out of it the second thing that can give you a clue to whether you’re on the right dose is whether or not you’re still using if you’re still using on top you ain’t on the right dose the whole idea of
This thing is that you’re on a big enough dose to build up tolerance to the effects of heroin so that when you use heroin it’s a waste of time now you might be on a dose of 30 or 40 milligrams a day and you might say you know what that keeps me pretty comfortable the 24 hours a day i get withdrawal but i’m still using 2 or 3 bags a day you’re not enough what i’d
Say too is that you feel those 2 or 3 bags a day if you dose went up to 60 or 70 or 80 or whatever it was you wouldn’t feel any pleasure from those 10-pound bags and then you might stop now i know that some people will go i don’t want to stop using heroin and actually i want to keep my dose low because i want to carry on using and you know what that’s your right
But what i would ask you is you need to weigh out how much extra pleasure you’re getting from those extra couple of bags this is what’s that that’s costing you both financially but emotionally personally if it means you’re continuing to commit crime or putting yourself at risk of overdose blood-borne viruses of you if you inject and the right dose of methadone can
Suppress people using heroin and actually the bigger the dose iran the less people use and it’s not just because you feel less effect when you use on top of the bigger dose but bigger doses of methadone are also associated with reduced craving so the final thing is if you find you’re still thinking about heroin or craving even if you’re not using and actually going
Increasing your dose might help and but if you’re continuing to use on top and you’re feeling that heroin increase your dose and just see what the effect is so you know i see lots of people who might be on 60 or 70 milligrams they’re using two or three times a week and what i would say to them go up ten or fifteen milligrams and then in a couple weeks time let’s
See what happens and you know what if you use has disappeared you’ve saved yourself a hundred quid and you haven’t used and you’re more comfy that’s great then of course you can gradually reduce your dose down the other thing that’s really important is of course your dose can be too high and if you feel sleepy or sedated or stoned in the two or three hours after
Your dose that could mean you’re on to higher dose and you need to tell staff around that because sometimes what happens is people end up hanging asleep in the afternoon after their dose and actually that then affects how well they sleep at night and the other thing we don’t talk about this very much it’s it actually as people get older particularly is their
Lungs or their livers start working less well a dose of methadone that they’ve been stable on for years can actually start becoming too high and if you start noticing that actually you’re getting more tired after your dose you’re a bit more sleepy talk to people about coming down finally what i’d say to people is whatever you do with your dose whether you go up
Whether you go down treat it as an experiment it’s about working out what works best you you know a safe rate of increasing your dose for most people is about five milligrams every fourth dose and if you’re still using a lot people might go up a little bit more quickly what doctors will always be paranoid about is increasing you dose so quickly that actually you
Start overdosing and that’s obviously something we want to avoid at all cost and you know the same rules apply for a foo preneur thing but before i mention that the final bit is don’t become obsessed by a magic number i’d say to yourself i’m not going to go above 60 milligrams the right dose for you is the one that keeps you free from withdrawal stops using stops
Your craving and lets you get on with your life and whether that’s 30 milligrams 90 milligrams 150 milligrams it doesn’t matter doses above 100 milligrams get yourself an ecg that’s useful and i know some of you are going to be saying but the bigger the dose is the longer it’s going to take me to come off and of course that’s true but i would say that i’ve seen
Hundreds of patients who over decades of their life have kept their methadone dose at a low level that means they’ve always continued to use heroin and what they’ll say to me is methadone doesn’t work and what i’d say is no you’ve never gone on big enough dose to actually allow methadone to work so if you really want to give yourself a bit of freedom from having
To score and use that try and pop your dose up and see how it works and the buprenorphine pretty much the same thing obviously the big difference is that you dissolve this tablet under your tongue and while therapeutic doses for methadone would be 60 80 100 milligrams the buprenorphine you get full receptor blockade at around 16 milligrams of buprenorphine and you
Know equal doses of buprenorphine don’t make you feel more stoned they just last longer and that’s something a lot of people don’t realize and you know if you’re stable on a dose of 12 milligrams of buprenorphine a day and by stable i mean you’re free from withdrawal you’re not using you’re not craving if you doubled you dose actually you’d only have to be dosed
Every other day and which potentially could be a good thing but they gain and get obsessed by a magic number we’re all different it’s the right dose for the right driver at the right time for you and don’t let anybody else tell you what the right dose is be in charge of your own treatment
Transcribed from video
Methadone & bup: Getting your dose right By Global Drug Survey
