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Old 01-16-2013, 07:51 PM   #4
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Re: Oxycodone liquid Switching to Methadone? Plus my story in a nutshell

I can answer part of this: Yes methadone is commonly used for chronic pain and is a very good pain med for some folks. Doctor's opinions on it really vary. Yes it gets a lot of bad press of folks overdosing on it, and because its used for addiction, but if you start at a low dose, increase the dose slowly, and don't mix it with benzos, alcohol, etc, its safe.

For addiction people wouldn't get a month's supply at a pharmacy like you do for pain. Its a popular med for pain as well as its cheap and easy to find in pharmacies (a lot of the other long acting meds are brand name only and expensive, so you have to get the pharmacy to order some of them as they don't stock them). The problem is when folks try to get high off of it and end up taking more, as it has a very long half life and builds up in the system.

It was the first long acting pain med I was started on and after trying most of the other ones, I've come back to it as it works so much better than anything else for me. I don't have any side effects from it. A lot of people like it as they say it doesn't affect their mind (they don't feel high or fuzzy). It can cause sedation though, especially at first.

Yes it probably is the only option for a liquid long acting med (as others need a time relase mechanism), but I don't think its a bad one. Its a little unusual for a first long acting med, but in certain cases its a good thing. I'd give it a try. I'd try the methadone before asking your doctor for fentanyl patches, personally. Fentanyl is considered stronger, although it could of course be dosed lower.

Keep in mind they will probably start you on it twice a day, but some folks need to dose it 3 or 4 times a day. Still better than taking oxycodone every few hours, and you should get much much more stable relief. Its likely you'd be kept on a smaller amount of the oxycodone liquid for "breakthrough" pain (ie. as needed).

Do double check the dose with your pharmacist and online just to be sure, especially if your doctor isn't a pain specialist. Some primary care doctors for example have been known to convert a patient's dose and start them way too high on methadone (or other pain meds). Starting at even 10mg a day wouldn't be unusual. Conversion with methadone especially is a big unknown.

What about capsules? Can you manage those? I'm thinking of Kadian specifically, which is a long acting morphine, and also has the advantage of being newly generic (many long acting meds are brand only and therefore expensive). I believe the capsule size is still pretty decent though.

I don't think you can open them and sprinkle it into food, but that is a good question to ask your pharmacist on...they will be much more versed on those specifics of meds then your doctor most likely. I remember Dilaudid pills being small. I know they now have a long acting form of it (Exalgo), but not sure how big a pill it is.

Its a good thought to ask them if any other long acting meds come in liquid or in a way which you could add it to food without destroying the release mechanism (for example you couldn't crush a pill which is long acting). Sorry if I missed it, but if you aren't seeing a pain management specialist, I'd highly recommend it.

They are going to be the best equipped to manage chronic pain, and will likely have more ideas to add to an opiate treatment plan. Tolerance is a big problem with opiates, and its easy for a doctor to keep giving you more and more of the medication, but harder to try to use a combo of treatments to keep the opiate dose as low as possibly.

They may have you jump through some hoops (for example signing a contract to only get pain meds from them and submitting to a urine drug screen), but it'll be better, especially in the long run (its rare a primary doctor will even prescribe a long acting med, and if they do, they likely have a dose ceiling in mind they don't like to exceed, so after that you'd have to switch doctors anyways). Best wishes.
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Kate
constant headache since 2006