When to believe, when not to? When is enough, when it's not? - Dosing guide.
Speaking in name of those...
... Living in these days, make us to accept some things that weren't usually "normal" just a couple of years ago. Living in modern world, living an modern - open minded life, brought us some new things that we need to consider as "normal". An perfect example of EX-taboo subject to talk about is "drug addiction" , in a meaning of heroin addiction - AND, sadly, newly produced taboo made by stigmatic behavior of society is substitution treatment of heroin or opiate addicts....
Questioning = Gambling ?
Have you ever been in situation that you HAVE TO question yourself, twice, before you believe in a words of an ex heroin addict, that is currently on substitution treatment ? Have you ever caught in situation when you need to think about whether or not, someone close, is just abusing the trust of the specialized doctor for prescribing an opiate substitute ? Well, all of you are on RIGHT PLACE. We are here to discuss of all these topics that, I bet, are bothering you so much - in some cases over AN DECADE... Yes, some of us, can live in a DECADE of not-reliable, and questioning kind of relation with son,cousin,wife,or husband when it is about something important, and crucial, like: "Is he/she lying me now? Does he/she really need a higher dose,or all he/she wants is to try to get high?" or " Is the dose that my ... is receiving enough for him? Is it too high/low ... ? - The questioning, itself, brings gambling with someones life and getting back him on "old track" - on heroin.
Do you think that someone, person that's on Methadone, is abusing it's dosage to be "high" ? Do you think that the dosage is too high ? Well, we will discuss here little bit about when "enough" is actually "enough".
Usually, those "Methadone Guides" are telling us that dosage between 60-120mg is usually enough for stabilizing the patients condition.The dosage under 60mg is considered insufficient because of lacking in "blockade" effect of heroin's euphoria.Consider this sentence like this: dosages upper than 60mg are considered enough, because there is enough methadone to "cover" all opioid receptors with it's molecules - so the heroin which has little bit less affinity to the mu receptors, and kappa - will not leave ANY effect if it's administrated on any way. So imagine your receptors as an some "wholes" ... And methadone molecules as an "big rocks"... Bigger rocks have a greater speed of rolling to the "whole",and th
ey will came first to the "whole" taking it's full size and not letting anything to pass in to the "whole". Now you have to understand that those "big rocks" also effect on those "wholes", penetrating them - stimulating - to "give" more dopamine. So the "big rocks" were the molecules of methadone,small ones were the heroin molecules,morphine - and the "wholes" were mu-opioid receptors.I think, I've really explained you now how the things are going. Now, the thing is - how many "big rocks" do the person need and when it's enough ?
- It is obvious from the text that 60mg of methadone hydrochloride is enough to reach the point where, generally, people get the "block" effect of the methadone. NOTE : DO NOT MIX METHADONE,FROM TEXT ABOVE AND THE WAY OF FUNCTIONING, WITH OPIATE ANTAGONISTS.METHADONE IS PURE SYNTHETIC OPIATE AGONIST. But, as the maintenance therapies with opiate substitutes are specified, THE INDIVIDUALIZATION IS NEEDED AND CRUCIAL - THERAPY AND THE THERAPEUTIC EFFECT IS DIFFERENT FROM PERSON TO PERSON.
Because of individualization, and different types of reactions to methadone, specialized personnel - that should be approved for prescribing methadone - is adjusting the dosage by several things that are different from person to person.The obvious example is that first dose, that patients get...Someone will be "covered" ,and satisfied, with 20mg ; while the other one wouldn't be able to "handle" his withdrawal symptoms with 40mg even tho he/she is younger than him/her. The factors that affect to the methadone's effect mechanism could be: metabolism,liver state,developing/delivering liver enzymes...and many other factors could be crucial when it is about "the right dosage" for different person. Usually, the dosage between 75-150mg are enough for those who are more than six months in M.M.T (Methadone Maintenance Treatment), and tried to adjust the dosage AND them-self's to lower ones but from some reason - they found them difficult to coup with.
Pressure on the patient, believe or not ?
Pressure on the patient in a meaning of questioning him:"Is the rising of dosage really necessary?" brings nothing but negative effect.The person will feel himself like...Like he did nothing, he gained nothing good while treatment - he gained not a bit of trust back from his closest persons, whether that persons are his parents,his grand-parents,close friends,cow-workers - generally, persons close to him. There is enough stigma in society, in general, attached to the opiate maintenance way of treating, and adding some more pressure and misunderstood facts about opiate that he/her is maintaining on ; will done no good to him.
Understanding the fact that everyone is reacting different on opiate maintaining is really crucial. The worst thing you can do is to NOT BELIEVE to the patient, on opiate maintenance treatment, about his needs for rising and additional (maybe) medications. You, or close friends (not to mention his supervised doctor) will notice if the dose is too high, but generally - patients just want to feel "all right" - trough the all day.They want, generally, to avoid withdrawal effects during day. Imagine them, on work, having withdrawal symptoms in front of their colleagues (not to mention boss or the situation on some meeting where concentration and spiritual "feeling good/normal" are CRUCIAL indeed)
What is maybe even worse than "not believing" to the stable patient( patient that is regular on his appointments and negative on drug tests) , is blackmailing person with "head under the roof" if he/she rises his/her dose. Blackmail, or whatever, in a sense of connecting the dosage with life existence (residential question) - is something that can be a trigger for getting back to heroin and potential death. Do we want our close person to see death? In coma? Generally, in near death experience ?! Well, think about it. I think that non of us want any of that to the closest persons.
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