Doing the Split

Split dosing is something you may have heard about, but really don’t understand.  Actually, it’s very simple.  At its most basic, instead of taking your daily methadone dose once in the morning, you split it in to, taking half in the morning and the other half (ideally) 12 hours later.   “Fast metabolizers” of methadone are generally advised to split their doses.  Methadone is supposed to last 24 hours.  However, there are a group of people – the so called “fast metabolizers” – for whom this does not apply.  These people tend to really “feel” their dose in the morning, and then by the end of the day or the next morning, they are in withdrawal.  Split dosing evens this out, so they don’t feel their dose, and aren’t in withdrawals by the next morning.

I decided to try split dosing for myself.  I have never considered myself a fast metabolizer, although by the time morning rolls around, I can definitely tell my body is ready for my next dose.  My problem has always been the drowsiness associated with methadone.  I certainly don’t get high off it.  However, about 4 hours after I take it (when the blood levels are peaking), I feel like a truck hit me.  For the life of me, I can’t stay awake.  And if I’m driving – well, forget it.  I can’t.

Split dosing has worked really well for me.  The first few days I suffered a tiny bit of withdrawal until the afternoon, since you initially take only half of your dose in the morning.  After less than a week, my body had adapted.  This really changed the way my body felt.  I don’t get walloped with that wall of fatigue any more.  The one trade off is that it has been a little bit harder to wake up the next morning, since there is more methadone in my body the next morning than there was before I split dosed.

All in all, if you’ve got any of the problems I listed above, you might want to try split dosing.  Instead of, say, taking your full dose at 6 a.m., you simply take half at 6 and the other half at 6 p.m.  Now, generally, this will only work for people who have many take home doses.  Your clinic may not want to work with you split dosing if you come in every day and, besides, who wants to go to the clinic twice a day?

If you decide to try this, let me know what you think!

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The Site's Back!

Hello Dear Readers,

Sorry -- I've been gone far too long.  At the end of May I went on vacation, then started preparing for a series on Points, the Blog of the Alcohol and Drugs History Society.  That took quite a bit of time, some other things came up, and, well . . . I let the blog flounder a bit.  Today, Points published my first piece (in a series of 3) for their blog.  It is, quite simply, an introduction to methadone.  Two more pieces, about methadone treatment and the new attack on methadone, will be published soon.

Anyway, I'll be back writing new posts, adding to the site and reading and responding to comments.  Thanks for your patience and please, stay tuned!

Oh, and a special thanks to Trysh Travis at Points for working with me in getting my pieces published.  Thanks, Trysh!

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Mom Sentenced After Baby Born With Withdrawal Symptoms

An Ohio mom is going to jail after her baby was born addicted to heroin.  The mother will be spending two years in jail on child endangerment and a heroin trafficking charge.  The news article didn't specify how much time she got for the child endangerment charge by itself, but the fact that she was charged at all is significant.

This kind of story brings a couple of political issues in to play.  Should a mother be charged with child endangerment for something she did while she was pregnant?  People who are pro-choice argue that by giving fetuses rights, you create a slippery slope that will eventually erode the freedom to have an abortion.  The greater issue, I think, is whether a drug addicted mother should be punished for addicting her fetus to drugs.

Apparently this woman was doing heroin right up until the birth of her baby.  Clearly, she should have been on methadone -- the treatment that all doctors recommend for all heroin addicted mothers-to-be.  The assistant prosecutor told the court about the withdrawal symptoms that the baby went through -- high pitched crying, diarrhea, etc.  A baby born addicted to opiates is not a pretty sight.

But should a woman be punished for continuing to do drugs during her pregnancy?  Not just a slap on the wrist, like probation, but jail time?  What about the woman who smoke crack the first several weeks in to her pregnancy, then stops?  What about the mom who smokes pot?  Or cigarettes?  It can be a slippery slope.

As the article says, opiate addicts don't usually change their behavior just because their life changes -- and that includes getting pregnant.  Clearly it's pretty bad to subject your fetus to this kind of stuff.  But does this woman deserve to be in jail for what she did, and have child protective services take away her baby?  I just don't know.

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Somebody Does Something Stupid, Methadone Blamed

I know I've harped on this before, but let me say it again: if you're on methadone, you have to keep your shit together.  Here's why: the wire services have picked up this story about two people who managed to let a three year old girl wander out of her house and on to a set of train tracks.  The girl is fine, but mom and the boyfriend have been arrested.  It happened while the boyfriend was asleep at the house where the girl lived.  She wandered out, people found her, and the couple got nailed.  Oh yeah, it happened when mom was at the methadone clinic.

This happened in a little Kentucky town.  Why the New York Daily News pick this up?  Now, I'm not saying it's solely because it happened when mom was at the clinic.  But I think that could have played a role.   Every article on the internet prominently mentions that fact.  Parents do stupid shit all the time.  This story has a little more juice because mom irresponsibly left her kid while she had to go get her methadone.

You know what goes through people's minds when they hear this kind of thing.  Hell, just read some of the comments: "Close all the methadone clinics.  Legal dope houses!!! . . She should NOT have that kid!!!!!" 

This woman made an error in judgement in leaving her child with this guy.  Does this merit having her arrested, and possibly having her kid taken away from her?  Maybe this woman was trying to get her life together and found herself in a tight spot.  My clinic doesn't allow kids in the dosing area.  Do you leave your kid with someone while you go to the clinic, or do you miss your dose?

I hammer this point over and over again, because it needs to be said: people on methadone are under a microscope.  To most people we are worthless.  The moment we do something wrong, even if it's something that anyone else would get away with, methadone is blamed.

Keep it together, folks.

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"Teen Mom" Star Amber Portwood Chooses Jail instead of Rehab to Quit . . . Suboxone?

The newest celebrity drug news involves "Teen Mom" star Amber Portwood.  I wouldn't count myself as a "Teen Mom" fan, but it's been hard to avoid her drama.  She regularly beat the hell out of the father of her child, prompting multiple C.P.S. investigations.  Portwood was sentenced to prison for these antics, but a judge gave her the option to enter drug court to avoid incarceration.  Now she has chosen to enter prison instead of rehab, because she feels it's the only way to kick her drug addiction.  So what drug has she decided she can't kick even in rehab, but needs to cold turkey in prison?  Are you ready for it?

Suboxone.

Now, I'm not maligning the poor girl or calling her weak.  I just find it interesting that of all the drugs in the world, the one she's finding most difficult to kick is Suboxone.  I'm wondering if Amber was originally on Suboxone to help her quit some other, stronger opiate, or if she was using the Suboxone on its own to get high.  The news media is now comparing Suboxone to morphine.  I'm a little skeptical of that comparison.  I've done morphine, and I've done Suboxone, and it's like comparing apples to oranges.  Not that there isn't any recreational value to it, but it's negligible.

I can't say I'm surprised at this, though.  I've heard a lot of reports that Suboxone is incredibly hard to quit, and that tapering off of Suboxone is as difficult as tapering off of methadone.  Reckitt Benckiser, Suboxone's manufacturer, wants people to believe that a Suboxone taper is easy and painless, not something that users have to go to prison to quit.  R.B. has definitely convinced doctors that Suboxone tapers are easier than methadone tapers, and that's one reason why doctors are pushing people to go on Suboxone.  The truth seems to be a little different.  Like methadone, people seem to be able to taper down to a low dose, but then experience hell when jumping off.  Even I considered switching from methadone to Suboxone, because I thought that it would be easier when I eventually decided to stop.  More and more people seem to be finding that that is not the case.  People stopping seem to experience full-blown withdrawal symptoms, and suffer from anxiety and insomnia even months after stopping.

Many years ago, before I started methadone, I went on a Suboxone taper.  The doctor gave me a set number of pills, and had me jump off at around 1 mg. per day.  In his mind, I should have had no problem doing it.  When I called him to tell him that I was having withdrawals, he tried to convince me that it was all in my head.

As Suboxone becomes more and more prevalent, expect to see more people reporting that it's not so easy to come off of.  Suboxone was held up to be far superior to methadone.  We now see that at least one of the justifications for that, the ease of quitting, is not be true.

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Parents Kill Toddler with Methadone: What the Hell were they Thinking?

I stumbled across an article in The Guardian U.K. newspaper about a couple who killed their toddler by giving him methadone to calm him down.  I just have one question: what the hell were they thinking?  Obviously, they weren't doing much thinking at all.  The husband and wife got 9 and 4 years in jail, respectively, after being convicted of manslaughter.

Now, I know, having kids can be tough.  When they scream, and scream, and scream it can make you absolutely crazy.  But to think it's a good idea to give your kid -- your toddler, for Christ's sake -- methadone is absolutely nuts.  Maybe we forget sometimes, but when we started methadone treatment, most of us had sky high tolerances.  An average treatment dose of 100 milligrams is enough to kill an opiate-naive person 5 or 10 times over.  Another problem with methadone is that it takes so long to fully kick in that people will take a few doses in rapid succession, thinking that their first dose didn't do anything to them.

I hate to sound like a nag here, but it's exactly this kind of crap that gives methadone a bad name.  The media picks up on the parents who kill their kid with methadone, or the patient's buddy that dies after drinking some stupidly large amount of methadone.  The media takes these stories and runs with them.

As I've mentioned before, when we were users we all gave drugs to friends.  But methadone is so dangerous because of its delayed onset that you risk killing someone every time you give them a dose.

Those of us in treatment don't need these kind of stories going around.  It just provides more ammunition to those who want to crush methadone.

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