PAUL'S STORY: A MASSIVE DOSE
Some people will need higher than usual doses of methadone or buprenorphine for it to work properly for them. This might be because they have a high tolerance or an unusually fast metabolism.
Doses above 200mg of methadone or 32mg of buprenorphine per day need special approval from NSW Health, which your doctor will need to apply for
Paul has been on methadone for nearly 30 years and is currently on 420mg daily due to his ultra-rapid metabolism.
Paul
I’m on a massive daily dose of methadone – 420mg, which works to be 92mL of syrup. This is how I start my day; I wake up, have 2 Valiums and 2 clonazepam (which I take for my Central Nervous System damage), a couple of cones, and then I go to the chemist to get my dose.
I have an ultra-rapid metabolism – I eat like a horse but am very skinny. I can’t get fat. My body just processes everything quickly, so I naturally have a high tolerance. I’ve never overdosed in my life, I’ve never dropped from heroin, and I’ve never been Narcan’d. Not once. In fact, I’ve only thrown up from heroin once, and it was the first shot I ever had.
I guess it makes sense then that I have a high tolerance for methadone. I’m not the only person who has this problem either – I know someone who’s on 600mg and know of someone in Chicago on 850mg.
Back when I was living in Sydney, I was dosing at a public clinic and wasn’t getting any takeaways so I would come in every single day to dose. One day, I had an appointment with the doctor, and he saw my eyes – my pupils were as big as golf balls! I was on 200mg at the time. The doctor asked me “did you miss your dose yesterday” and I said no. He asked me, “have you had any ice or speed?” and I offered to piss in a cup for him right there and then!
When my urine drug test came up negative, he told me that with special authority I could get on more than 200mg. I had to do what is known as ‘peak and trough’ tests – they test the levels of methadone in your blood just before you dose, and then about 5 hours afterwards. What the tests showed were that, for me, 200mg of methadone had the effects of what the average person got from 50-75mg.
I had to have five different specialists go over my results, and they all came to the same conclusion – 200mg wasn’t enough for me. When I found out, it made complete sense, because the whole time I was on the program before then I was using up to two grams of heroin on top daily… and would still always be sick! This was back in 1999, so I’ve been on an incredibly high dose for 20 years now, and on the program for 8 years on top of that.
I dose at a public clinic in a regional town – it’s not perfect, but I can bear it. I’m a trusted patient – all my urine samples have shown that I’m not using opioids on top of my dose. My doctor does the right thing by me, and I’ve been on their books since 1993. I have health check-ups regularly, and my heart is all good. My liver is a bit conked out, I have breathing problems, and blood cancer to top it all off.
For the first six years that I was on the program, I was injecting all my takeaways – I still love the needle to this day, although I’m not injecting opioids anymore. But my doctor back then gave it to me straight – he explained that if I didn’t stop shooting my doses, chances are I’d end up with endocarditis, deep vein thrombosis, or toxic shock. I pulled up after that conversation. 
Truth is, I feel fine being on the program. I’ll be on it the rest of my life, and I’m totally comfortable with that. I know that with my body and my health I need to be on it forever. I know that it’s not a smart idea to try come off it because I’d start using again. I don’t want to use heroin at all on the dose I’m on now – on very rare occasions I still shoot a bit of cocaine as a little treat.
I’m no longer sticking needles into myself daily, and I’m not going back to that life – not when I’m stable on the program. I’m refusing to let myself end up back on the streets, doing crime, getting pinched, and going back to prison. I’m older now and it’s not the same game. I’m not on methadone for the fun of it, I’m on it to live a life. I’m simply happy to be on the program and not be a human pin cushion anymore.