Talk:Methadone

Added warning about injecting pills with talc

I just added it yesterday, I thought it should be mentioned since there are some who still try and inject the pills. They usually do a tedious filtration thinking it will remove any harmful ingredients but it WILL NOT. It will only disperse the particles at most. The same goes for any other pills containing talcum, from ritalin to oxycodone. Injecting the liquid methadone is usally safer but it's still *not* a good idea because of the high volumen of liquid required, plus the various soluble additives. There is really(or should not be) not much motivation for injection since the bioavailiability is around 60% orally. There is actually a rush yes but it disappears(or rather, is greatly reduced) after a few months of use. It is possible to get 'high' from methadone in the start but it doesn't take long before it's gone for good. Larger doses may get you feeling 'wasted' but the euphoria will be gone. The number one problem with methadone is something else: the number of deaths/suicides involving combinations of other drugs and methadone.

The problem with the section on injecting methadone is that it contains a variety of misinformation, and I don't see an easy way to fix it without substantial changes. Those changes require a choice between adding information that could be dangerous, or removing information that can be dangerous if not known. Still, the outright misinformation could be lead to fatal misunderstandings and needs to be corrected somehow. The primary risk from injection of pills are the insoluble components (due to lung issues, blood clots, basically having solid chunks of junk in your blood). Talc is one example of an insoluble component, other brands of methadone pills contain other insoluble components. Talc can certainly be filtered out with a filter that is fine enough. Also the fact that chemical means can be used to purify the pills for injection seems relevant. Perhaps the best solution is to mention that there are methods to safely prepare commercially available methadone for injection, but most injection users do not follow these methods. And further to mention that due to high oral bioavailability, lack of a rush, the lack of a eurphoric high, onset that is no faster, there is simply no reason to inject methadone other than to satisfy an addiction to injection. Jqrt (talk) 21:46, 19 June 2009 (UTC)

Besides that, methadone is a good drug for both maintance and pain relief provided it's used correctly. It's one of the few opiates that will not require endlessly higher and higher doses, possible due to its NMDA receptor antagonism. It will not completely prevent concurrent abuse of other drugs but it will *greatly* reduce it. Many junkies on methadone still do occasionally heroin as a side abuse when they have the money. But it's nothing compared to the daily hunt they used to do everyday before. Remember that there is no permanent treatment of opiate addiction so far, only harm reduction, This is what methadone does. By the way, it's not really harder to get off methadone than other opiates although it must be done in a different way. However it takes more TIME because one has to take into account the long half life of methadone. This means it takes much much longer to taper off than short acting opiates. You can only reduce the daily dose with 5-10% every month even when you're down to one pill of 20 mg. Personally I think we will have a real cure(possibly an ibogaine analog) for opiate addiction within 15-20 years. M99 87.59.103.3 (talk) —Preceding undated comment added 19:27, 25 May 2009 (UTC).

It's important to mention that methadone itself is a tremendous addiction - unfortunately, it's a lot of work to find "proper" sources for this. I even found educational material for doctors indicating that it is not addicting. Partially this is because they use a definition of "addiction" that includes the need for increasing doses (tolerance). This is pretty important to mention as well. I don't agree that it's not "harder" to get off methadone than opiates - although because it must be done so slowly, some people may find it easier overall. Methadone must be tapered at the extremely slow rate you mention, with the addict at risk of severe many-week-long withdrawal if access is cut off. Other opiods can be quit with only two days of incapacitating withdrawals - making it a simple matter of desire to quit. For example, consider the user who wishes to quit, but must go to work on a normal schedule. All other opiods allow for a detox involving a rapid week-long taper (during which they will be greatly uncomfortable but not incapacitated - still able to work), two days of incapacitating withdrawals (unable to leave the house or work), and a week to two of greatly unpleasant but not incapacitating symptoms. Other opiods can be quit basically immediately once the decision to do so has really been made. Two days of incapacitating withdrawal symptoms does not cause most people to lose their job - they can time it with the weekend. These important factors can really not be ignored. People are being put on methadone without accurate information from doctors and methadone clinics. The correct information is available. It's even on this page in a disjointed manner. But clearly more citations for this are needed, as the methadone industry is a powerful and profitable one and even rearranging this page slightly seems like it might start a revert war. Jqrt (talk) 21:46, 19 June 2009 (UTC)

"Controversy"

I noticed the "controversy" section has some unsourced statements, particularly the first sentence. Can this be deleted, or is that a violation of protocol? —Preceding unsigned comment added by 68.80.193.90 (talk) 10:26, 31 May 2009 (UTC)

Feel free to remove it, just be sure to explain what you're doing in the edit summary box so that the users watching recent changes don't assume you're doing something malicious like blanking vandalising. I think all of that so-called "controversy" section could be removed as unsourced and unnecessary. This article is really poor, IMHO, and really needs some TLC so please feel free to work on it if you feel inclined. Sarah 11:21, 31 May 2009 (UTC)

Price clarity

The statement, "In late 2004, the cost of a one-month supply of methadone was $120" is unclear as no specific dose amount is given or associated with that time interval. Cost depends on dose and dose depends on patient need. 500 mg/day would obviously incur a greater cost per month than say 5 mg/day. —Preceding unsigned comment added by 76.180.195.34 (talk) 14:09, 3 June 2009 (UTC)

The British National Formulary (BNF 57, latest edition, online at http://www.bnf.org/bnf/bnf/current/3534.htm) gives the prices as:

• Oral solution 1 mg/mL, methadone HCl 1 mg/mL:
  • 20 mL = 29p
  • 30 mL = 60p
  • 40 mL = 58p
  • 50 mL = £1.03
  • 60 mL = 87p
  • 100 mL = £1.45
  • 500 mL = £9.60

• Oral solution 5 mg/mL, methadone HCl 5 mg/mL:
  • 20 mL = £1.47
  • 1 litre = £73.33

• Injection, methadone HCl:
  • 25 mg/mL, 2-mL amp = £2.05
  • 50 mg/mL, 1-mL amp = £2.05

• Methadose® (Rosemont) - oral concentrate, methadone HCl:
  • 10 mg/mL (blue), 150 mL = £12.01
  • 20 mg/mL (brown), 150 mL = £24.02

• Tablets, methadone HCl 5 mg:
  • 50 = £2.97

• Injection, methadone HCl, 10 mg/mL:
  • 1-mL amp = 93p
  • 2-mL amp = £1.61
  • 3.5-mL amp = £1.98
  • 5-mL amp = £2.14

Ben (talk) 14:30, 3 June 2009 (UTC)

It also varies greatly depending on what country, state, region you're talking about. I personally think it would be better to not include a price, or perhaps to include prices from several places just as examples but they would need to be from different countries and not all American at the risk of being US-centric (which all the substance abuse related articles tend to be). Sarah 03:26, 4 June 2009 (UTC)

Yes, I foolishly began a post towards the end of the talk page. I had a co-worker who was faced with a bill of $240.00/week from a clinic in the Maryland and Washington D.C. area. However, upon release of a hospital stay, with a prescription to last a month, she was told that "the price of the RX was so low, the pharmacy didn't feel comfortable charging her the $5.00 co-pay on her welfare-sponsored insurance. Asked what the price would have been for a month of taking 155 mg./day, she was told it cost the pharmacy about $.03/day. Suffice it to say, the difference is huge, however at the clinic she attends, the clients are told that each person pays the same amount of money.--Leahtwosaints (talk) 00:36, 8 September 2009 (UTC)

Maybe it would be a good idea to improve the side effects section regarding acute vs. chronic use

For instance, with short term use methadone is stimulating, euphoric and invigorating(which, along with the intense euphoria, is what get people addicted). Like other opiates such as morphine it has a doping effect when used in sport. But with chronic use(say >3 months), the opposite happens with tendency to weight gain, sleepiness, chronic fatigue and possibly depression. Methadone in terms of unpleasant side effects is certainly the most physically taxing of the opiates, with the exception of LAAM. One of the most hated side effects with chronic methadone use besides the fatigue is sweating and heat intolerance. Some doctors prescribe anticholinergics to ease this side effect but it's my impression that it doesn't help much except perhaps reduce the sweating a little. It will not stop the hot flashes and the intense vasodilation that makes users sweat and suffer during the summer. When someone looks at the side effects, it may be a bit confusing since the side effect profile is very different(like most other opiates) with acute vs. chronic use. The solution could be to arrange the side effects in a table instead of a list. M99 87.59.79.24 (talk) —Preceding undated comment added 19:02, 3 June 2009 (UTC).

Origin of urban legend regarding "Dolophine" source.

William Burroughs, in his 1954 book "Junkie" states that, about 1950 whilst an inmate of the government treatment facility at Lexington Kentucky, he was given "Dolophine, a synthetic horror, appropriately named after Adolph Hitler" . This, the first mention in literature of this common fallacy, leads me to think that Mr Burroughs is the source of this myth.

118.92.223.205 (talk) 00:41, 5 June 2009 (UTC)

It is an englishism that Adolph is even spelt "Adolph", in German and in how he spelt his own name, was "Adolf". 24.20.185.166 (talk) 08:08, 3 August 2010 (UTC)

The first german trade name was (and still is) "Polamidon". --FK1954 (talk) 17:33, 26 July 2012 (UTC)

Elimination Half-Life

A 22 hour mean terminal elimination half life doesn't seem right to me. Most sources/studies report longer. Some values on the web:

http://www.medscape.com/viewarticle/441934_3  : Mean = 31.8

Google Books: Principles and Practice of Anesthesiology  : Mean = approx. 35

www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2042854  : Range = 33-46 (small sample)

Some one should look up some articles and compile a good average. Right now I'm changing the mean to "approx. 32 hrs" —Preceding unsigned comment added by 24.196.111.104 (talk) 08:23, 10 June 2009 (UTC)

honestly i wonder who they use to determine these halflives. are they reasonably naive, or are they people who are on a stable dose of various levels ?

i mention this because from experience i dont think it could be as high as 35hrs. and that upper range of 46hrs is perplexing. i also wonder if they were careful to control the sample for any liver pathway abnormalities. i dont think im so unusual in feeling that as the vast majority need dosing everyday the claim of 33hrs is even too high. im fairly confident that the many people ive talked to have the experience that methadone does not have as long a halflife as buprenorphine. —Preceding unsigned comment added by 220.101.91.57 (talk) 13:03, 2 February 2010 (UTC)

History

In the history section there's a somewhat confusing run-on sentence referencing two people named "Laura Clyde" and "Dr. Dickson". What's the relevance of this? Neither of these names is linked to another article and neither is mentioned in the History section prior to this sentence. I don't want to unilaterally delete it because I know very little about the topic, but I do think it would be a good idea for someone who does know about it to either explain or delete the sentence (actually, the sentence makes perfect sense both grammatically and logically up to the the comma following "World War II" and only drifts off into incoherence following that point). —Preceding unsigned comment added by 68.107.60.161 (talk) 17:39, 2 July 2009 (UTC)

History

The History section contains the following paragraph:

In the United States, methadone maintenance treatment emerged from trials in New York City in 1964 in response to the dramatic and continuing increase of heroin abuse and addiction following World War II, Laura Clyde dismissed these findings as false but obviously Dr Dickson was right.

This is not logical. What findings were dismissed by Laura Clyde? Probably some previous editing operation left this paragraph in an unfinished state?

Jpalme (talk) 18:53, 25 July 2009 (UTC)

Side effects

How can a drug cause both anorexia AND weight gain? —Preceding unsigned comment added by 98.213.120.190 (talk) 04:07, 8 August 2009 (UTC)

A drug can cause both anorexia AND weight gain. Just not on the same person. Any drug, not just methadone, react differently to different people..(Commonsense4 (talk) 06:27, 11 April 2012 (UTC)){comment added by Commonsense4 ).

Abuse of Methadone?

I have heard that methadone can be abused? I can't find very much as far as references, but I've heard about this in an unpublished research study on rural lifestyles. Rhetth (talk) 19:40, 9 August 2009 (UTC)

Of course. Any mood-altering substance can be abused. With methadone, it is often sold illicitly on the street, or people with "carries" (take-home doses) may save them up and take more than is prescribed to them in order to get high.

Are you thinking about incorporating into the article a more detailed section about "Abuse of methadone"? If so I'm pretty sure medical journal references can be found. -- œ^™ 22:56, 9 August 2009 (UTC)

Looks like an invitation for a huge distraction by causing a debate as to the definition of drug "abuse". It is probably best to state the facts and let the "Drug abuse" article have this complexity. There's not much room for a debate about the drug's effects itself, just about what is considered abuse. Methadone's euphoric-to-analgesic ratio is lower than other opiods. But it has the ability to stop withdrawal symptoms at a comparatively low dose, and not require an increasing dose over time. Does it being prescribed make a difference? (and if so does this depend on the jurisdiction?) Does the existence of actual pain make a difference? In what category do you place chronic pain patients who lie about another addiction so that a methadone clinic will prescribe them methadone for legitimate pain? It is tremendously common for people to take methadone in order to prevent withdrawal when taking other opioids regularly. Do we categorize these people differently depending on whether it is prescribed by a doctor for pain or by a methadone clinic due to heroin addiction? Consider that it's common for people to lie in both directions, depending on the behavior of medical professionals in their area - to either claim an addiction when they are in crippling pain, or to claim crippling pain when they want to satisfy an addiction. What if they are on methadone maintenance but still take other drugs? It seems the definition of drug "abuse" is going to be wrapped up in semantic and jurisdictional issues, and isn't too useful compared to taking the effort to describe how it is actually used. - Jqrt (talk) 23:00, 18 August 2009 (UTC)

This article makes methadone look like it has no recreational potential, which is untrue. It should still have a "recreational use" section like other drugs pages. —Preceding unsigned comment added by 92.25.34.168 (talk) 16:08, 23 March 2010 (UTC)

Two points.

1) Article contradicts itself; who made it first, Mallinkrodt or Eli Lily?

2)Amidom name mentioned with no explanation

Cost

There really should be more coverage of the actual cost of Methadone, as compared to seriously inflated costs by treatment programs who are astute enough to find that they can inflate costs to at the least, 5 times it's actual cost. The difference between a person filling a prescription at a licensed pharmacy, for a monthly cost of $30.00 USD and a clinic that might charge as much as $240.00/week is huge.--Leahtwosaints (talk) 00:23, 8 September 2009 (UTC)

Under the Analgesic section, I added a bunch of references to it being preferred for pain patients due to lower cost. However, I had quite a hard time finding any specific costs. The only way to get specific cost data seems to be calling pharmacies directly to ask what they would charge, which wouldn't exactly be citeable. If there was a study that did this research, it would be nice to find - to cite wholesale cost, cost at pharmacies, and cost at clinics, and presumably including regional differences. Jqrt (talk) 00:06, 8 February 2010 (UTC)

Inaccurate referencing in "Mortality" secion

References [26] and [27] do not really show what is claimed in the text. In [26], methadone was compared against slow release morphine, with no control group, and was found to be SAFER, yet it is claimed that "Methadone treatment can impair driving" in the wiki section. I don't see any evidence for that in the reference. The statement

"Patients are demonstrated to have extremely high involvement in serious crashes, as a study by Queensland University showed that 220 patients had been involved in crashes killing 17 people between them versus a control group of other patients randomly selected having no involvement in fatal crashes."

implies that these are patients on methadone, but in [27] they are opiate addicts. How does this relate directly to methadone? [27] also relates to driving history, not driving while on opiates specifically. There could be many reasons for correlation that do not imply causality. —Preceding unsigned comment added by 220.244.164.109 (talk) 04:10, 30 October 2009 (UTC)

Methadrone

Methadrone redirects to Methadone, but I am pretty sure it should not
The name is appearing in UK media as that of a new 'legal high' sold as fertiliser
Laurel Bush (talk) 15:41, 7 January 2010 (UTC)

I have found this - Use of legal, cheap drug on rise, fears councillor, Press and Journal website, 29 December 2009 - and Methadrone is no longer a redirect
Laurel Bush (talk) 13:10, 8 January 2010 (UTC)

New Dosage Reduction section

I added the Dosage Reduction section. I believe my addition is consistent with Wikipedia rules but would like some verification of this. There are several leading paragraphs that do not have citations embedded. This text is my summary of this issue from the articles in the six citations I added. The citations follow the introductory paragraphs because there are four quotes that I believe fall within Wikipedia's fair use guidelines - each the minimal amount of text to make the point, and a tiny portion of the overall article, and with the citation immediately nearby. Two other articles are cited at the end of the section, however they did not contain the relevant text in an bite-sized portion that I believe is useful and consistent with the fair use guidelines. So my three questions are: Is the leading text in my own words appropriate, given that it contains no citations, considering that it is backed by citations that follow immediately after. Also, is the small amount of text I quoted appropriate per the fair use guidelines. And finally, most of the articles I cite contain their own large list of citations - if I included some of these and more quotes from those articles, I believe I'd be creating an unnecessarily long section without adding any information. So I want to be sure that this is not necessary..

I realize also that I've duplicated some information under the Dosage section (anywhere else?). Overall the article hasn't ever had a good flow, and although I didn't improve it, at least the additional information and citations can be used in a rewrite/reorg that improves it...

Perhaps separate sections on initial dosage for new patients (including titration from another opiod), vs dosage reduction to taper down to nothing, vs dosage titration to move to another opiod (for which there is minimal literature that I could find, as most is aimed at moving towards methadone, however it must exist as this practice is not uncommon), would be a step towards improving the flow of the article, and provide places to move some text that is a bit out of place. I don't want to make this kind of change without some opinions.

(I realize the citations themselves that I added need some improvement as well, I wasn't going to clean this up until making sure I didn't do anything grossly improper and after checking the citations under the existing Dosage section as well) Jqrt (talk) 04:04, 6 February 2010 (UTC)

The artical actualy contradicts itself. Early in the article it talks about tapering or what is commonly called 'detoxing' at a fairly slow rate where someone whould be off 100mg in 18 to 24 months. Theat should work out to a 2.5 % reduction in doase per week give or take. However in the above commented section they are referencing a 10% per week reduction. Personal experience as an addiction Cert. MD I'll chime in that i've seen the majority of people fall at 5% with a span between 2.5 and 10% some even tolerating faster some needing WAY slower. The metabolism is increadably variable as stated all over the place. Tapers are very variable what someone will tolerate.

MAD, MD ASAM cert. —Preceding unsigned comment added by 72.37.171.156 (talk) 18:49, 28 February 2011 (UTC)

help with figuring out methadone replacement dosage for black tar heroin

I'm kicking a year long black tar habit of 5 - 7 grams per day. I am about to begin using methadone tablets (10mg) to replace the heroin. I hate dope sickness and if im not toally comfortable and free of withdrawal symptoms I will likely relapse to heroin use. What is an "equivalent" dose of methadone per day to a quarter ounce daily heroin habit? I am guessing so far about 80mg per day but this might be totally inadequate as Im no nurse or doctor but just a scumbag fucking junkie, right? Anyways, please help me get my life back from this fucking putrid, black, mexican murder cartel spawned ball of darkness. Is this the stuff that blackholes shit out? Anyhow, I've had enough of it and would rather go back to having Corona be my number one Mexican import. Help a brother out oh knowledgable one.....David, Seattle

Unfortunately, Wikipedia is unable to provide medical advice. Go see your doctor or your local drug rehabilitation center for this kind of advice. Astronaut (talk) 05:37, 10 March 2010 (UTC)

Legality

On April 16, 2010, it was deemed as class B in the UK, making consumption and distribution illegal. More info needed. —Preceding unsigned comment added by 78.33.162.218 (talk) 11:09, 16 April 2010 (UTC)

Side Effects & Deaths

It should be stated in here some where that it is fatal to children. I have heard of a few cases of infants dieing from ingesting methadone and one of those cases hit close to home. A friend of mine was on methadone and his 16 month old daughter ended up getting a hold of it and drinking it. Both of her parents did not realize that it could be harmful to her. So they didn't not seek medical help and it ended up killing her. And now they are getting criminal charges against them. I think ALL parents that are taking this should be told that it can be fatal to children. —Preceding unsigned comment added by 206.163.233.171 (talk) 01:41, 24 April 2010 (UTC)

That doesn't sound speciifc to methadone at all. Any drug can be fatal to children (or often anyone, really) if taken incorrectly. A child is just particularly likely to find something interesting and ingest it--16-month-olds are particularly unlikely to read proper dosing instructions and other warnings. It's terrible when it happens. It's not uncommon or specific to any drug (parents are constantly reminded to keep all drugs, cleaning supplies, etc, away from children!), no reason for additional scare-warnings on this particular one. DMacks (talk) 15:40, 24 April 2010 (UTC)

The problem is wider than that. Some people die after taking the drug as prescribed.

One source is a newspaper in West Virginia, which has published The Killer Cure, a series about methadone. Maurreen (talk) 17:08, 24 April 2010 (UTC)

There's a section in the article about mortality, but it's based on a 2004 FDA study of the data available for deaths and dosing instructions used at that time. In late 2006 (the WVGazette series is cited in footnote #27) they revised the dosing instructions in light of the new data, but our article doesn't seem to incorporate changed dosing or risks of the former standard dosing (which isn't much higher than the new standard?) or importance of starting at very low dose until tolerance is known. Definitely need to update the article (with FDA cite for current standards, so it's on-par with previous cite). DMacks (talk) 17:31, 24 April 2010 (UTC)

OK, thanks. Just to clarify, do you mean the dosing standard should be cited directly to the FDA? Maurreen (talk) 17:46, 24 April 2010 (UTC)

I'm not sure exactly how to work it in, but need to make it clear that the FDA apparently recognized the problem and changed its recommendations. Without that, it sounds like it's WVG's word against FDA's (either WVG's coming across anecdotal vs actual scientific study, or else big bad gov't/pharma ignoring a real problem--neither of which are true obviously). DMacks (talk) 18:25, 24 April 2010 (UTC)

Got it, thanks, that makes sense. Maurreen (talk) 18:33, 24 April 2010 (UTC)

So far, I've found this, also from the Charleston paper. It includes: "The old package insert gave a “usual adult dose” of 2.5 to 10 milligrams “every three or four hours as necessary.” That could lead a patient to think 80 milligrams a day is safe, even though studies have found that 50 milligrams or less can kill patients who aren’t used to strong painkillers, the Gazette-Mail found. The FDA deleted that “usual adult dose” from the new patient information."

I'll follow up more later, unless someone else gets to it first. Maurreen (talk) 18:45, 24 April 2010 (UTC)

External Links??

I would LOVE to know who removed the link to my org's website....that has been on these pages for about the last 5 years. There is tons of good info and support for people on Medication Assisted Treatment....including our Methadone Pregnancy page which is so important. Thanks.....Carol (Chava (talk) 00:01, 3 May 2010 (UTC))

It might have been me. I deleted some broken and misdirected links last month. What is the website name? Sandcherry (talk) 02:14, 3 May 2010 (UTC)

Hi, Sandcherry....it's "Methadone Support Org." and some know us as "Methadone Anonymous" (MA) as we're the worldwide resource for MA as well. Thanks!.....Carol (Chava (talk) 09:51, 16 May 2010 (UTC))

Carol, my apology. The link was deleted inadverdently. I replaced it today.Sandcherry (talk) 18:33, 16 May 2010 (UTC)

Insurance carrier coverage

Methadone clinics in the U.S. charge anywhere from $50–300 per week, which may be covered by private insurance or Medicaid. However, the many "cash-only" clinics do not accept insurance, forcing patients to pay up front and then seek reimbursement from their carrier, a process which is fraught with difficulty and a long history of denied claims.

I removed the statement that it is difficult to file methadone claims with insurance carriers, and that there is a "long history of denied claims". No citation was placed to substantiate this claim, and I could not find any evidence to support this statement. Furthermore, these statements are harmful. This information should not be re-added unless citations can be presented. —Preceding unsigned comment added by P07r0457 (talk • contribs) 03:56, 7 May 2010 (UTC)

Pain associated with NMDA antagonist withdrawal/use (methadone is a partial NMDA antagonist/dissociative anesthetic)

I found this paragraph on the ketamine page to underline an assumption I've had behind the more severe withdrawal of methadone above and beyond the longer half-life (the colloquial "it gets in your bones" folk-myth about "kicking" methadone) of other opioids and an idea of its other mode of action unique to it aside from the mu receptor agonism of the morphine class drugs:

..."Many long term users report "K-pains" or "ketamine cramps". The exact cause of these pains are unknown. The Ketamine induced abdominal pain is primarily limited to users injecting a gram or more of ketamine a day. It has been suggested that the amino acid Tyrosine may help alleviate the pain."...

This may relate to NMDA antagonism as a source of pain when the dissociate anesthetic effects are accounting for in a wide inventory of users subjective effects upon its subjects. Ketamine itself isn't as widely used nor have as large of a subject pool as does those upon methadone maintenance. Nagelfar (talk) 08:06, 3 August 2010 (UTC)

Confusion over the half-life in case of Methadone

As you can read in the article (in the Chembox in the upper-left corner) it says that the half-life of Methadone is 24-36 hours (and below under Metabolism section that it can actually range from "... as few as 4 hours to as many as 130 hours"). But this is not the main point of my post.

You see, in this section there's nothing mentioned about one certain specialty of Methadone, which is that the actual level of the drug in blood (SML - Serum Methadone Level) is increasing for the 4-5 days until the level of Methadone in blood becomes "stable" (i.e. it's not increasing anymore). I mean, after the initial doze is taken, then after 24 hours when a patient takes another doze, he/she still has half of the previous day's doze in his/her blood serum, therefore the half-life on the 1st day is not the same as on 2nd day (and so on until 5th day).

So what I want to point out is that one "type" of half-life if a drug is consumed just once (and then flushed out of the system), compare to if a drug is consumed one day after another (i.e. more than one day would be enough to make a point).

For better understanding what I mean (am trying to say), please see the Figure 1 on the 2nd page in this Addiction Treatment Forum - Dosing and Safety .pdf file. --Wayfarer (talk) 00:07, 23 October 2010 (UTC)

The correct date of invention of methadone

Near the beginning of this article the date of 1937 is given for when methadone was invented. At the beginning of the History section the date of 1939 is given. Can the correct date be established? (1Gyrfalcon (talk) 23:21, 20 November 2010 (UTC))

"the worst withdrawal imaginable"

The first paragraph under Withdrawal symptoms reads as follows:

At high maintenance doses, sudden cessation of therapy can result in withdrawal symptoms described as "the worst withdrawal imaginable," lasting from weeks to months.[33]

The cited reference (http://www.heroinaddiction.com/heroin_methadone.html) does not include this quote. I suggest deleting the quotation or correcting the reference. —Preceding unsigned comment added by 130.154.0.250 (talk) 22:51, 8 February 2011 (UTC)

You're right. Done. And by the way, you were most welcome to have made the edit yourself. Please feel free to do so in the future when the sources justify it. Unimaginative Username (talk) 08:36, 19 November 2011 (UTC)

"Withdrawal symptoms have shown to be up to twice as severe than those of morphine or heroin at equivalent doses and are significantly more prolonged; methadone withdrawal symptoms can last for several weeks or more." <-- IMO, this statement is complete nonsense and is just mythology. I'll find a reference from a peer reviewed journal, but not everyone says methadone is "the worst withdrawal" or "the hardest opioid to quit." Methadone withdrawal comes on more slowly and lasts longer than the shorter acting opioids, but it is also generally less intense. Personally, I found withdrawal from 1600 mg/day codeine (for 4.5 years) much more intense than withdrawal from 110 mg/day methadone (for about 2 years) AND I would estimate that about 50 mg methadone was equivalent to the dose of codeine I was taking (because I felt satiated at 50 mg, but I liked methadone so kept increasing it). I'll come back with a reference, but I think that statement I've quoted is complete and utter nonsense. 70.49.48.63 (talk) 01:46, 10 March 2012 (UTC)AlkaloidMan

What you're saying can't be true. Codeine has a "ceiling effect" around 300-500mg - Taking any more than that won't have any effect, you'll just be destroying your liver with the added Acetaminophen(assuming you didn't cold water extract - which, given your opiate knowledge, wouldn't surprise. Even if you did, you'd have to be ingesting a ridiculous amount of caffeine) - An addiction to codeine is pretty laughable. It's barely even an opiate. Any doctor that would prescribe a "codeine addict" a dose of methadone comparable to by my own (100 mg a day) deserves to lose their license. And methadone is WIDELY known for having one of the most extreme and prolonged withdrawals. This really isn't something that is debated. At all. For this reason, I wish I had never started methadone - Europes experiments in just using actual heroin (and eventually weening with that) to treat addicts have been far more successful, it's sad the stigma surrounding the substance stops it from being done here. But I didn't have that option, and simply couldn't afford to continue buying off the black market - So I was pretty much forced to resort to methadone *sigh* 198.84.162.153 (talk)

As an individual taking 180mg per day I ran out of my prescription on a holiday weekend and had to to quit cold. I stretched out the pills I had left but came up short anyway and I made it 22 hours before "the worst pain imaginable" did occur. Shocks like electrical strikes spiked through my body causing spasms. I screamed out in this intense pain every few seconds for about a minute or less then the shocks would subside for a few minutes then return again after allowing me to catch my breath. Finally the pharmacy that had held my prescription over that weekend opened up for business and it was filled. My wife fed me 6 pills which i put under my tongue for quicker relief and allowed the pills to melt which, to me, is quicker than swallowing whole. — Preceding unsigned comment added by 75.172.51.132 (talk) 12:00, 16 May 2012 (UTC)

isomethadone

Isomethadone is redirected here. I've drawn isomethadone and put it in the commons if anybody cares to work out where to put it! The file name is Methadoneisomer.jpg. 2829 VC 20:56, 28 February 2011 (UTC)

File:Methadoneisomer.jpg ← linked for convenience:) Do you have a lead ref discussing anything of note about it? Is it pharmacologically related, for example? DMacks (talk) 21:12, 28 February 2011 (UTC)

Do you mean something like this: http://www.druglead.com/cds/isomethadone.html 2829 VC 21:52, 28 February 2011 (UTC)

Half life wasn't consistently reported in article

In the text (under "Metabolism") the half life was listed as 15-60 hours with some references to values even outside of this range. Thus I edited the half life on the side of the page to also reflect 15-60 hours instead of 24-36 hours. People often use this data as a definitive value (for better or worse!) so it would make sense to give a more accurate value here. — Preceding unsigned comment added by 66.214.24.45 (talk) 16:20, 28 November 2011 (UTC)

Max prescription per day

Joseph, R.; Moselhy, H.F. (2005). "National survey of methadone prescribing for maintenance treatment: 'opiophobia' among substance misuse services?". Psychiatric Bulletin 29 (12): 459–461. --- Someone cited the above article as saying that some patients are prescribed upto 750 mg per day of methadone. The article doesn't say that. I quote: "The maximum dose of methadone prescribed for maintenance ranged from 9 to 325 mg, with a mean of 116 mg. The minimum dose ranged from 1 to 70 mg. The mean daily dose for each centre was 47 mg (range 9-100)." Please be careful not to cite references incorrectly. When I saw "750 mg/day", it immediately struck me as an error and I looked up the paper and indeed found no mention of 750 mg/day. — Preceding unsigned comment added by 70.49.48.63 (talk) 02:04, 10 March 2012 (UTC)

Detection in bodily fluids

Place holder for discussing the following:

"It can also be found in urine samples six to ten weeks after the last dose.[citation needed][dubious – discuss] It was generally thought it left the system 2–3 days after last use but this is not the case,[citation needed][dubious – discuss] many factors contribute to how long it will stay in the system. It depends an individual's body weight, metabolism, history of use/abuse and many more factors. In studies done on Methadone users going through detox, individuals experienced different withdrawal symptoms and withdrawal periods even though they received their last dose at the same time.[citation needed][dubious – discuss] When they gave blood and urine samples the methadone showed up in some individuals samples as much as four weeks after it was not evident in other individuals samples.[citation needed]" — Preceding unsigned comment added by 70.114.234.99 (talk) 23:50, 27 June 2012 (UTC)