Tuesday, 29 April 2008

Diary: Methadone vs. Morphine Opinion

DIARY: As you probably know, I am on SROM(slow release oral morphine) now instead of methadone and it’s amazing the difference it makes to my life. The problem is that my tolerance is growing slowly as my body adapts to the opiates. It took me years to get my methadone levels right and even then I changed it at least twice a year. So I went to the doctor and he gave me a long story about the health department and schedule 8 drugs.

Morphine cannot be prescribed to anyone for the treatment of addiction. I already know this and my prescription is primarily to manage my pain. For a heroin addict like myself who was on methadone, morphine is usually a big no-no and it took an application from a pharmacotherapist, the OK of a D & A counsellor and permission from my doctor to get a permit from the health department. Now that my tolerance is rising, I need my dosage to increase which is common for long term morphine patients. I was told flat out that I would need to see the pharmacotherapist again to get another recommendation, return to my doctor and he can then make another submission to the health department. All this will take about a month. My doctor explained that he thought it was ridiculous and was not impressed with the circumspection of the health department.

So what are my options over the next month? I already use heroin once a month and I don’t want to increase that but I can’t think of any alternatives. These are the silly illogical policies that I am faced with. If they are so paranoid about me abusing drugs, why make it so hard to obtain legal medication? They must know there is no alternative except for magically just getting through this period. Jeepers.

I am convinced SROM should be an alternative for methadone. My doctor’s first words to me the other day were, “How’s it going ... I bet you’re doing a lot better now?”. And he was right. I know some countries use SROM but why it isn’t used more often is a shame. It’s understandable though as the fear of diversion must be overwhelming for the authorities. The fear that a tiny percentage might hock their medication must terrify them. A long term addict like myself needs their meds and would not risk going through the cycle of rise-money-score-sleep again. Long term addicts are the small percentage who have tried everything to quit but have some medical issue stopping them. I realise the importance of stability and the daily ritual of stabilising with substitution treatment is the only thing keeping my life together. 3 months ago I was ready to give up, now I am getting back into the swing of life. The reason is simply a different medication - SROM.


Firesnake said...

Thanks for an honest appraisal, Terry.

I agree 100%. Methadone is b/w 35 - 40 dollars per week [over 150 per month]. Pulse charge 40, other chains sometimes less. Noting many dependents are on CL benefit, SROM would be about 3 - 5 dollars per month, and less and less as reduction ensues.

Methadone should be free or minimal cost, and provided in weekly batches. To date the only pharmacist to argue this have been ridiculed - because "junkies" are a gold mine.

But "officially" it's the drugs and the junkies - not living arse out of pants poor - of course, that causes problems. Who'd pinch food to feed your kids just because you're broke? Only a criminal - send them to the colony for stealing bread.

Weird eh? We whimper about the crimes that had Brits deported to Australia but cannot see we do worse today. Another conviction, no matter how small, is a massive blow to "recovery" - whatever the f*** that means. I'm in Vic. We have no spent convictions policy. So, say bye bye to working, if checks are required in your profession. 6 years Uni all for nada. Go Aussies!

My colleagues with Secular political ties, list Australian legislation in many areas as akin to "Saudi Arabia, Afghanistan, Iran, Iraq, Africa and other politically/religious dysfunctional regimes." I'd add the USA, too.

Methadone is a crappy choice when we note it's "holding" capacity varies from well under 24 hours, to up to 70 hours plus. This is IMHO the primary reason why MMT is accused of "parking" addicts. Nice big yummy doses, or piddling wake up at 2am shitting/sweating/shaking doses?

It's the guidelines designed to protect GP's from liability for Drug related harm in clients that are the problem. Best thing for some intractables is a diagnosis of X that requires opioid pain relief.

Think of Yucel/Lubmann's research;



We need to begin accepting addiction is a 'disability' of unique status. Neuroanatomical changes are real. What's the use of being straight if you're like an amputee without a prothesis? We friggin throw crappy SSRI's at slightly depressed people, knowing they're hit-n-miss plus many are highly addictive - far more than heroin/opioids.

Look at paroxetine - AROPAX here in Oz;

Then add on visiting a chemist almost daily. Some are great, most have bizarre "you're a criminal and junkie" approach, and customers love to glare. Wonderful for self esteem, and joyful when your boss pops in for some Panadol.

If you work, as the dose drops you no feel dat good. So, night time dosing which is supposed to hold clients overnight and through the following day, becomes harder and morning dosing becomes essential [unless relapse is an option].

Firesnake said...
This comment has been removed by the author.
Firesnake said...


Friend of mine died of endocarditis due to whacking his MS contin. About 10 per day. He was shit scared of methadone but for ill defined reasons. Namely, loss of autonomy, becomming an official "junkie" and daily visits. I worked daily with him, and nursed him until IC. Last words falling into coma? "Don't tell them how many I use". He died scared he'd loose access to his meds, and be made to go on 'done.

So, whilst we fear abuse of meds via blackmarket hanky panky, the evidence is thin. He'd been on SROM for over 20 years. He relapsed, and he died because he was afraid of being pulled off morphine, and forced onto 'done.

Died because he thought if he opened up, he'd loose his remaining freedoms. And the drug-free psycho's want to crank it up. None have a clue beyond profit, power and the chance to influence other policies.

He's dead, because SROM isn't an option. Peoples lives are screwed because of the same. Careers die, because of the same.

Methadone does save many, many lives. No doubt there.

But because of time constraints, cost, GP visits, monitoring, insults like urinalysis [an invasion of many rights] the trade off is a miserable existence for those seeking autonomy and long, long maintenance for those who drop out of life.

It must change, and bloody soon.