Greetings from Washington, Methadone Aya questions...

[Tony6Strings]

Hello all. First post. I feel blessed to have found this place. I'm a recovering addict, a methadone patient for the last five years, a proud father of a beautiful 15 month old girl and we have one on the way. I want to be a better human being and closer to my creator. That's why I'm interested in DMT and am here poking around. I've smoked several times to full breakthrough. I want to try Aya and am concerned about possible interactions between MAOI and methadone. Any other methadone patients here? I take 120 mg methadone daily and will in all likelihood continue doing so for the rest of my life. Can I still drink Aya? I'm planning to brew my first with yellow caapi and mimosa. Then I'd like to try with Syrian Rue. Not too interested on speculation, lots of vague info on the net saying its contraindicated, but I've found no documentation of the combo of drugs causing death, only that it theoretically could. I'm looking for answers from other methadone patients who have consumed these substances. Please and thank you. Hello again all just happy as all fuck to be here and be human.

 

[CatPharm]

Hi tony6, im sorry i dont have the definitive info that you are seeking. I also came up short on this subject but the reasons werent for myself, but for a couple who are very much in the same scenario as yourself. Theyve backed out for now, as being not willing to jeoperdize the future of their young children by not having accurate information. I really hope others can shed some light on this, and if i find anything of value to add to this, ill be sure to post....peace

 

[leratiomyces]

Sorry, no definitive answer for you (and I'll doubt you'll get one).
However, in an effort to gather available evidence, it would be an idea to change the question to,
"Does methadone interact with moclobemide?"

Both moclobemide and the maoi in aya are RIMAs.

In considering the above question, the following article had a nice summary of the evidence,

https://www.sps.nhs.uk/wp-content/uploads/2017/09/UKMi_QA_MAOI_and_Opioids_Sep_2017.docx

Unfortunately you still don't get a definitive answer.
There are two hazards to consider,
1. Potentiation of methadone, due to inhibition of the appropriate metabolising enzyme, by the RIMA.
2. Serotonin syndrome.

My opinion is that the risk of the above is very low. But you can't put your health in the hands of an "internet opinion".

Once again, sorry I don't have something more definitive.

 

[dragonrider]

Yeah, this could be dangerous. I've been told that even kratom, wich is probably a milder opiate than methadon, is realy dsngerous to combine with ayahuasca.

 

[Hendrix87]

I've decided to ween myself off of anti depressants with my doctors help, I also take 140mg oxycontin daily and have asked around on this website if there would be any problems taking dmt while on oxycontin and so far no one seems to think that there should be any problems.

When it comes to methadone though and ayawaska then i honestly have no idea if it's safe to mix them. Sorry man. But surely you could ask around and see if people have ever taken ayawaska while also on methodone, You could then see if they experienced any problems or not.

I hope you find the answer and things work out well regardless. ✌

 

[Electro Monk]

serotonin overdose is no fun at all. i had a few mild ones when smoking weed on snri, and it was really unpleasant.

it can also kill you because your body loses the ability to regulate heat and heartbeat. it does not help that one starts also sweating like crazy. this can easily dehydrate you, worsening the symptoms, and you might not be conscious enough to drink.

hendrix, dmt and snri is (afaik) not dangerous. it will block the receptors tho and it will just kill the trip before it can start.
snri and maoi is very dangerous.

 

[downwardsfromzero]

As I understand it, there is also a risk of serotonin syndrome when combining opiates with MAOI, so ayahuasca is best left alone until one is properly opiate-free.

 

[null24]

My dose is lower than yours, I'm at 40mg, and I've never done aya but i have never had any issues whatsoever with harmalas related to methadone. In fact I've just completed my first rue xtract and have been experimenting quite a bit.

Ive had issues with MAOIs in the past but am not sure it was actually related. My brain does not like SSRIs and seemed to feel some of the same side effects that make them contraindicated for me when taking rue in the past, but that had zero to do with methadone. And i have not been experiencing that lately which leads me to think it was more situational than chemical.

I'm not sure why you are getting so many responses that give you no information relative to your question, and I'm not making any suggestions to you either, but thought my experience was at least relevant.

The guidelines here prevent making any kind of medical advice and I'm not a professional, but have lots of experience navigating methadone and psychedelics.

 

[corpus callosum]

120mg methadone is a fair dose.

I have reviewed the data sheets issued by 2 different pharmaceutical firms who make methadone and the pertinent section relating to concomitant MAOI use is interesting. Both cite the well documented problems with MAOI use with meperidine (aka pethidine) and, on the basis of this, deem concomitant MAOI use with methadone as being an absolute contraindication and the two should not be used within 14 days of each other. However, the monograph makes no distinction between MAOIs acting on A or B (nor upon reversibility) and one hedges its bets by initially pronouncing the use of the two as contraindicated in spite of no firm studies having been made but then in a table suggests its "unclear" how hazardous it is and suggests the combination is avoided. Pethidine does have serotoninergic effects not mirrored by methadone.

The sitting on the fence relates to the fact that the interaction with MAOIs to each of the opioids has not been specifically tested, and caution trumps hard science and possible unwanted legal wrangles. However, I have seen a paper in an anaesthetics journal which has stated that MAOIs are not overly problematic with morphine or oxycodone. Methadone is similarly a mu agonist but one of its isomers also antagonises the NMDA receptor which makes it distinct from both morphine and oxycodone.

Lastly certain harmala alkaloids can induce CYP3a4 which is required to process methadone which could lead to a lower plasma level of methadone.


This is the 'official' position, and I accept it is lacking in clarity.

 

[null24]

120mg methadone is a fair dose.

I have reviewed the data sheets issued by 2 different pharmaceutical firms who make methadone and the pertinent section relating to concomitant MAOI use is interesting. Both cite the well documented problems with MAOI use with meperidine (aka pethidine) and, on the basis of this, deem concomitant MAOI use with methadone as being an absolute contraindication and the two should not be used within 14 days of each other. However, the monograph makes no distinction between MAOIs acting on A or B (nor upon reversibility) and one hedges its bets by initially pronouncing the use of the two as contraindicated in spite of no firm studies having been made but then in a table suggests its "unclear" how hazardous it is and suggests the combination is avoided. Pethidine does have serotoninergic effects not mirrored by methadone.

The sitting on the fence relates to the fact that the interaction with MAOIs to each of the opioids has not been specifically tested, and caution trumps hard science and possible unwanted legal wrangles. However, I have seen a paper in an anaesthetics journal which has stated that MAOIs are not overly problematic with morphine or oxycodone. Methadone is similarly a mu agonist but one of its isomers also antagonises the NMDA receptor which makes it distinct from both morphine and oxycodone.

Lastly certain harmala alkaloids can induce CYP3a4 which is required to process methadone which could lead to a lower plasma level of methadone.


This is the 'official' position, and I accept it is lacking in clarity.

Thank you, we were hoping you'd chime in with your expertise.

I am taking away from this, or the last part on harmalas and CYP3a4 that rather than increase the effects of methadone, they will rather reduceit's efficacy. Am i reading that correctly?

 

[leratiomyces]

Hi Null,

With regard to the effect that harmala alkaloids have on serum methadone levels, you should read the following paper,

"Inhibition of Human Cytochrome P450 Enzymes 3A4 and 2D6 by β‐Carboline Alkaloids, Harmine Derivatives", by Zhao

Here is the relevant paragraph out of the discussion;

"In the present study, characteristic effects of β‐ carboline alkaloids on human P450 activity were analysed and the inhibition mechanism was evaluated. Our results demonstrated that most of the β‐carboline alkaloids investigated exhibited moderate or weak inhibition against human CYP3A4 and CYP2D6, but harmane and harmol significantly inhibited human CYP3A4".

Based on this paper it would be reasonable to expect that if one dosed some harmala alkaloids (as a one off), that serum methadone levels would rise temporarily. I would not draw the same conclusion if you dosed harmala alkaloids daily for an extended period of time.

Corpus has a source of information that leads to the opposite conclusion - would be interesting to see/hear that, so that a logical conclusion can be drawn.

Hope that helps

 

[corpus callosum]

"Inhibition of Human Cytochrome P450 Enzymes 3A4 and 2D6 by β‐Carboline Alkaloids, Harmine Derivatives", by Zhao

Here is the relevant paragraph out of the discussion;

"In the present study, characteristic effects of β‐ carboline alkaloids on human P450 activity were analysed and the inhibition mechanism was evaluated. Our results demonstrated that most of the β‐carboline alkaloids investigated exhibited moderate or weak inhibition against human CYP3A4 and CYP2D6, but harmane and harmol significantly inhibited human CYP3A4".

Based on this paper it would be reasonable to expect that if one dosed some harmala alkaloids (as a one off), that serum methadone levels would rise temporarily. I would not draw the same conclusion if you dosed harmala alkaloids daily for an extended period of time.

Thanks for posting this; I've not read this paper previously.

This muddies the waters further; the paper below, in the last section prior to the conclusion, mentions increased expression of CYP3a4 by harmine and harmaline in particular on HepG2 cells, a line which is commonly used to investigate such matters. Zhaos paper mentions weak or moderate inhibition by the alkaloids other than harmol and harmane; I wonder what the net effect of this increased CYP3a4 expression with mild to moderate inhibition would be.

Pharmacological and therapeutic effects of Peganum harmala and its main alkaloids

Wild Syrian rue (Peganum harmala L. family Zygophyllaceae) is well-known in Iran and various parts of this plant including, its seeds, bark, and root have been used as folk medicine. Recent years of research has demonstrated different pharmacological ...

www.ncbi.nlm.nih.gov

Furthermore, methadone when commenced also has an ability to induce CYP3a4 which can contribute to the difficulty in establishing an appropriate dose in the early part of methadone maintenance.

 

[leratiomyces]

Thanks for the reference Corpus.

I've had a read through the paper that your reference, refers to;

Peganum harmala L. Differentially Modulates Cytochrome P450 Gene Expression in Human Hepatoma HepG2 Cells Mohamed A.M. El Gendy and Ayman O.S. El-Kadi

To be honest I was expecting to find that induction of CYP3A4 occurs only after prolonged exposure to harmala alkaloids. But this it not the case - it occurs after short exposure. The relevant paragraphs from the above article are as follows;

"P. harmala extract significantly increased the expression of CYP3A4 at all the concentrations tested. P. harmala extract at concentration of 1, 10 and 50 μg/ml significantly increased the expression of CYP3A4 by 26%, 54% and 31%, respectively"

and

"HepG2 cells were incubated with different plant extract concentrations (1, 10 and 50 μg/ml), for 6h"

So, as you have suggested Corpus, you may have the situation where harmala alkaloids might inhibit CYP3A4 (elevating serum methadone levels), whilst also inducing CYP3A4 (lowering serum methadone levels).

The net effect would be.........anyone's guess.
A dissatisfying conclusion to an interesting conversation.

 

[null24]

Hmmm. Okay. So... what advice could be given along these lines? Proceed with caution? It seems that the studies are not conclusive and even contradictory. Should we rely on anecdotal reports?

I'm nut terribly sensitive to small increases or decreases of my dose. I could not go a day without dosing at all without minor withdrawal setting in at about 25 hours, but can half dose for one or even two days without consequence. I know other patients who claim to experience severe withdrawal much easier, especially patients with over 5 years on it or who are older.

I've honestly never worried about a serum increase, but i have been known to be reckless with opiates and have a very high tolerance to them. Also I've always stayed under 90 and am currently on 40mg/day. Once one gets to the dosages that OP is on, 125mg, i think more caution is in order.

I did not know there was so little information on this. I understand that methadone is one of the most studied drugs in the pharmacology, i wonder if searching on it rather than harmalas would yield better results?

 

[corpus callosum]

This is an interesting abstract which my earlier post alluded to; it puts methadone in the same group as definitely problematic opioids (meperidine/ tramadol/ propoxyphene/ DXM) because of their common phenylpiperidine structure and some serotonin re-uptake inhibitory effects, which render them all able to precipitate serotonin syndrome with MAOIs.

Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity - PubMed

Toxicity resulting from excessive intra-synaptic serotonin, historically referred to as serotonin syndrome, is now understood to be an intra-synaptic serotonin concentration-related phenomenon. Recent research more clearly delineates serotonin toxicity as a discreet toxidrome characterized by...

www.ncbi.nlm.nih.gov

 

[null24]

This is an interesting abstract which my earlier post alluded to; it puts methadone in the same group as definitely problematic opioids (meperidine/ tramadol/ propoxyphene/ DXM) because of their common phenylpiperidine structure and some serotonin re-uptake inhibitory effects, which render them all able to precipitate serotonin syndrome with MAOIs.

Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity - PubMed

Toxicity resulting from excessive intra-synaptic serotonin, historically referred to as serotonin syndrome, is now understood to be an intra-synaptic serotonin concentration-related phenomenon. Recent research more clearly delineates serotonin toxicity as a discreet toxidrome characterized by...

www.ncbi.nlm.nih.gov

Really really interesting. IME i haven't known many to experiment while on methadone. Often the two populations sort of preclude each other. A lot of folks in methadone are traumatized by their lives in addiction and the events that led to it initially. The thought of taking a deep look and being at the mercy of the same consciousness that has proven to be an uncontrollable, life threatening adversary is terrifying. Many have used psychedelics in their pre-addiction past recreationally in bad settings and have had bad experiences. It's been difficult to proselytize to many of them, although at my clinic, we are building a little group of interested parties.

I've only ever seen one person experience serotonin syndrome while on methadone (or was aware of, rather), he had taken a prescription MAOI and had another factor going on medically that i can't recall that set him apart and therefore his condition didn't cause any alarm.

So OP, the advice would be to not take aya while on methadone to be 100% safe. Especially in a remote setting. However that does not mean you are screwed.

It is generally recommended to get off methadone before experimenting or working with psychedelics because it can dull one cognitively and the experience could be muted, and that effect with continued use could negatively affect integration. As you pointed out though, many of us are most likely on it for the long term of not the duration, and withdrawal can take a very long time to manifest due to its Half-Life. This could lead one to believe that they have conquered it only to be puking between their legs on the toilet in ten days of they were to, say for example, conduct a fast (under 12 month) detox or go cold turkey on even a single digit dose.

(Btw, i have been able to successfully detox with almost total resolution and non manifestation of physical wd symptoms, if anyone would like advice on that. However it is the emotional issues that arise that led to repeated relapse, my last "run" and current position. It is relatively easy to mitigate the leg cramps, insomnia, nausea, etc, but the things that made you turn to opiates initially may still be there, under the surface subdued by the methadone and ready to return with a vengeance.

However I've felt that if one is ready and willing to engage in the hard work necessary to identify the roots of this addiction, and then to take the steps to resolution, that recovery is possible and psychedelics can help catalyze the construction of the foundation necessary for that inner work and they can move from addiction to dependence which is a monkey of a different color. If you need t stay on the medication (and heres a legit semantic conversation on the difference between drugs and medicines) even for life it is still possible to recover. Recovery is not synonymous with abstinence.

... etc....

So...to be safe OP, after all this, i guess the advice is no don't do it. However the use of tryptamines alone may be beneficial to you. There are several tools that don't present a problem with your medication regimen

It is sad that this potentially effective treatment may be contraindicated, but even though i still am on a methadone program, my use of psychedelics has allowed me to perform the workthat has seen my life change dramatically for the better, after 25 years and half of my life spent in addiction, suicidality, poverty, criminality, homelessness, anger and depression into one of service, happiness, creativity, fulfillment and saw the shame that and guilt that surrounded my past sublimate into a personal unique gift and the very qualification of my professional life.

Thanks for this conversation. I'm surprised this hasn't been taken up more extensively. I'm pretty reticent about my use due to the ignorant stigma associated with it in the general population and especially in the wellness community. It's generally on a need to know basis but I'm kind of coming out of the closet. Concern and fear has arisen due to the perceived possibility of people discounting my writing on using psychedelics in recovery and that i may be considered a hypocrite, but not being open about it isn't being 100% honest to readers and I've been wrestling with it. Thanks for helping me come out!

 

[Fidelsbeard]

I have been in a methadone programme for 20 years and stabilised my life, I have been homeless but now am working and have two teenage daughters. I cannot say if the experience is muted but when I use Changa as opposed to enhanced leaf I get a curious sensation where I need to stretch, sort of in my shoulders and back...

 

[Tony6Strings]

Thank you all very much for your input. Here's an update. I've been dosing with Syrian Rue for about a month now. No ill effects or harm has come from interaction with my methadone. The first couple times I ate raw seeds, 3 grams per experience at least sometimes more. Brewed some tea after a few experiences with eating seeds. I had one horrible night where I ate five grams of seeds and took a big swallow of the tea I had just brewed. I spent the whole night throwing up every fifteen minutes to half hour. After the first hour I was bringing up nothing but bile. That was not a fun night. But, from what I understand it's not an uncommon occurrence when overdoing it with Rue. Needless to say I've been much more careful since then. Have just performed my first Manske salt extraction with success (thank you Nexus). So, on the issue of interaction of harmalas and methadone, this methadone patient is no longer concerned. I am putting it out there for the next methadone patient who is considering ayahuasca. I'm not a doctor and I'm not saying it is safe for everyone or anyone else taking methadone. I'm just sharing my experience. I'm 32 years old, 175 lbs, 6'2', take 120 mgs methadone a day. Have been on methadone several years now. Smoke a gram of BHO a day, every day, for the last couple years, as part of my recovery regimen. Have used rue and combinations of rue and mimosa hostilis a handful of times now, around ten or twelve, with no ill effects that resemble anything I read about serotonin syndrome. Also interaction with my methadone was minimal, IE it did not make my medicine run through me causing early withdrawal (some drugs can do this I was worried), did not seem to potentiate my methadone in any way either. Ok folks. Once again thanks very much, I'm very impressed by the amount of knowledgeable people hanging out at this forum.

 

[DrknChildlike]

Hello everybody,. This is a dead thread two years old BUT it is the only thread where a methadone MAT patient has documented using Aya, harmalas/ extract/ changa, whether to fortunate neutral or disastrous effect that i've found.

A person of at topia has just asked this question and stirred up the interest in myself as well.

I take 160 mg a day. Ive read most all of the technical medical papers I could find on the subject and like in this thread came up with only confusion and want for a definitive answer. I think in the past I have read other anecdotal accounts on a forum dedicated to only aya not dmt smokeable proper, and on that forum I remember reading several ppl had taken it while others cautioned against it, as you can imagine.


I am wondering if any definitive or atleast insightful answer/ diagnosis to the question whether methadone patients can dose aya.

I myself have taken small amounts of rue to no I'll effect several years ago when I was curious about it and plan to most probably try the actual drink in the future but only after cutting my dose in half for two days and none the initial day and do some more very small scale testing with root bark instead of rue..

I would like tp be able to answer this other lads question at the topia to put his mind at ease but I know I probably shouldn't.

If any more testing and or first person experiences have accumulated since i last researched this question have come around please let me know..


Sorry for bing so long winded and thanks for amy and all replies!

Remember its easy to say no you must quit. But aya is a medicine that might help ppl aflicted with behavioral issues such as addiction and a somewhat straightforward answer would be great.

 

[DrknChildlike]

sgreat.sorry i should have said a person at mycotopia asked this question which got me thinking. Sorry I wrote this funny I'm tired and my kid is jumping all over me lol