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Old 03-11-2004, 03:02 PM   #1
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Methadone with Oxycontin

Hi all I'm new here and have a question. I have been on high doses of Oxycontin for 2 years and I am wondering if anyone is perscribed Oxycontin and Methadone. I would assume the Methadone would be breakthrough? Oxycontin gave me my life back but my Dr says no more Oxy. I am afraid to switch all together but may ask for a mixture of both. Will she laugh me out of the office? The Oxycontin is not as effective as before and I barely make it through. If she didn't write my script a few days early each month I would be in a world of hurt.

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Old 03-11-2004, 10:48 PM   #2
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Lightbulb Re: Methadone with Oxycontin

Methadone is a long acting pain med in the same class as oxycontin, so No, you would not take it as a breakthrough med. I myself have just switched from oxycontin 40mg twice a day and percocet twice a day to methadone 10mg 3 times a day for my chronic back pain, I am 33 yr. old male and have had 4 major back surgerys in the last 7 months so I am no stranger to pain!! I gotta tell ya, my pain doctor has been telling about methadone for the last 4 months but I was determined that I was going to stay on the oxycontin because I thought it was just the best pain med out there because everyone is always talking about it, but I am so PLEASED that I made the switch and encourage you to ask about it! Hey, also I really suggest reading up on long acting pain meds. before going back to your doctor. And the best thing about methadone in my opinion is that you dont have to keep increasing your dose after a period of time in order to keep managing the same amount of pain. I think you will find that methadone will kill the same pain with SMALLER doses than oxycontin. Also it will make you feel more balanced than oxy does! Well I wish you good luck, and let me know what you decide.
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Old 03-12-2004, 07:33 AM   #3
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Re: Methadone with Oxycontin

Hi GL, There is nothing wrong with using oxycodone as BT med with methadone, But requesting to stay on Oxy, when it's so contreveraial and red flags most docs who prescribe it, may be unreasonable to request before you even give meth a chance.

Methadone isn't a long acting med in the sense that it has a controlled release like the other LA meds. But due to it's long half life You have residual methadone in your system for up to five days from the first dose. Each subsequent dose of meth builds upon the remaining half life untill you level out on the 5th day. By the 5th day, due to the half life you basically have twice the serum level you would from a single dose.

In acute pain it's dosed every 4 hours, I can actually feel it loosing some anelgesic effect after about 4 hours but you still have half the previous days dose in your system and some from the day before, the day before and the day before.
IE say you take 10mgs 4 times a day
On monday you take 40 mgs,
On tuesday you take 40mgs but have 20mgs left from monday =60 mgs
On wed you take 40 mgs, have 20 mgs left from tues. and 10 mgs left from monday=70mgs
On thursday you take 40 mgs have 20 mgs from wed , have 10 mgs leftover from tues. and still have 5 mgs from monday=75mgs
On Friday you take 40, have 20 left from thursday, have 10 left from wed. have 5 left from tues. and 2.5 mgs from monday, This gives you the same serum level as if you took 77.5 mgs in a single day.
This is why meth must be titrated slowly and you need to wait for it to build up in your system, after 5 days there isn't much left from the first day so you have a rolling serum level maintained by the same dose each day almost twice the strength of a single days dose. You will also find that each dose taken daily builds upon the previous doses taken that same day. You would likely have more relief at the end of the day then at the begining because of this cumulative effect.

Because of the long half life, You can wake up and skip several doses and not experience any withdrawal syndrome. The long half life makes meth very forgiving.Where if you miss a dose of Oxycontin by 2 hours withdrawal starts. Meth withdrawal doesn't even get to be bad untill the 4th or 5th day when your system has purged all the remainng meth from previous doses.

Meth is cheap,About 1/20th the price of long acting morpine or OxyC.It Binds to the NMDA receptor which other opiates don't, this receptor is believed to increase your pain threshold and decrease tolerance to opiates and helps with neuropathic pain where other opiates may be useles for nerve pain.

The myth that meth can't be abused is simply a myth. However the only way to continue the warm fuzzies you may feel at the initiation of therapy is to continually increase your dose and not allow your body to accomadate to that level. This is dangerous because you could increase it for 2 or 3 days in a row and bam on the 4th day, because so much is still left in your system you overdose.

It's very dangerous to abuse, must be titrated slowly and discontinued slowly. You can switch right from oxy to meth and experience no withdrawal. However if you switch from meth right to Oxy you would be in for a heck of a ride.
Here are a couple articles about meth used for CP.

[url]http://www.ampainsoc.org/pub/bulletin/sep00/upda1.htm[/url]

[url]http://www.mainehospicecouncil.org/MaineLink/vol2no2/methadone_rediscovered.htm[/url]

I switched directly from oxy to meth and experienced no withdrawal and was able to maintain the same dose for 2 1/2 years before needing an increase after breaking a pedicle screw.It has just about the same side effect profile as any other pure opiate although we all respond a little differently. You may find meth more sedating than Oxy but if your doc is trying to protect himself from investigation, the best way is to DC prescribing oxyC. Breaking a meth tablet or crushing it to swallow easier does not effect it in any way. Good luck, Shore

PS. most conversion charts you may see are only acurate for single dose comparison because they don't account for the half life.

You also don't have to worry about your pharmacist thinking you are a heroin addict. meth maint patients for addiction do not get their meth from a pharmacy, only through a clinic setting where the dose is given in liquid form so the patient can't tounge or cheek a dose to take home and build up a stash to get high on

Last edited by Shoreline; 03-12-2004 at 07:36 AM.

 
Old 03-12-2004, 09:21 AM   #4
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Re: Methadone with Oxycontin

Hi, I just wanted to chime in here to say that for a period during my pain mgmt treatment last year I was supposed to have been using Methadone actually as my BT med, but it never ended up happening.

It was in the first couple of months of 2003, when I was still back in California. My PM doc who I'd only been seeing for two months or so at the time, I had asked him about Meth and he put me on it for what was then a combo of L5-S1 hernation & S1 hip rotation (and a little bit of a kidney stone problem thrown in for good measure, lol). Anyway, he at first had me on 10mg 4x day, but then at one visit, he wanted me to try Kadian (30mg I think). He had a manufacturer-sponsered study that he'd been waiting to try out on a patient, he knew I didn't have a lot of money. It was a voucher for, if I recall correctly, 20 pills of Kadian that I was supposed to take to a pharmacy and I could get it filled for free, and the plan was to take 1 of the Kadian every 12 hrs, using the 10mg Meth 2x day for BT (that's what he was hoping anyway - if I had to take more Meth for BT, that's simply what I'd have to do). Alas, the first attempt was squashed because it turned out the voucher he gave me had a tear in the paper, prompting no pharmacy to accept it on principle. We tried a 2nd time, but then even though places would take it, nobody I went to could fill it, and I got fed up with going to so many different places (since as I'm sure most of you are aware, you'll not often get good response by calling pharmacies to inquire as to their narcotic inventory, especially if you've never been a customer there - I've literally had pharmacists themselves tell me that, that if you're asking over the phone they'll simply tell you they don't have certain opiates in stock, understandably, for fear of possibly supplying a criminal with the info he needs to rob them).

So, after those two tries we gave up the plan, I never did try Kadian at all (though I'm not sure it would've been effective anyway, since whenver I've been given Morphine IV in the hospital for a stone, it didn't have nearly an impact on my pain as Demerol or Dilauded did, nor did the MSContin I took briefly for a couple weeks by pill either) and we just reverted back to me taking 4 of the 10mg Meth a day alone.

Final point being - YES, I was going to take Meth for BT plan, even though I never did, so it is possible. Or, maybe my doc was unorthodox in that way? I don't know. All I know is, in retrospect I've really come to realize how fortunate I was with that specific PM doc, because now back here in Philly, though granted as I am today I'm not in as much overall pain as I was say, 5 months ago, but at that point 5 mnts ago I was in MORE pain essentially that I was during that old period in 2003, and yet I was taking more meds per day in 2003. That last doc I had in Cali was most definitely NOT opiaphobic. He was willing to try most anything on me, I just had to talk to him about it. My current PM isn't exactly opiaphobic, but he's moreso than the other guy was.

 
Old 03-12-2004, 05:52 PM   #5
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Re: Methadone with Oxycontin

THanks for the replies. I am on 80mg 4 times a day. I just want to keep my life that I lost for two years in pain. My Dr is an angel and works with me . Imagine that she actually says its my body and we are a team to control my pain. Another reason I would like to try both meds is if something happened to my script ,I couldn afford $1000 to replace the Oxycontin. My house was robbed once and thank God my alarm sent the thiefs away. Maybe I should just live with the pain and not worry about it. As far as red flags about Oxycontin, the *&&^^%#$%^& media caused the problem. They taught the people who didn't know how to abuse it the way to crush it up and do whatever they do. Thats a bad spot with me. I too have had a snitty pharmacist who refused to fill my script because she felt that was too high of a dose. This was after she called my Dr. My head almost exploded.
Thanks for your wisdom

GL

 
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