Shoreline

Hi Ken, If you do a search for meth withdrawal, You won't be able to distinguish between meth maint patients that have experienced meth withdrawal and what CP patients experience when switching from meth to another med.

You do experience some differential withdrawal when switching away from meth to other opiates, but it won't be like the hell addicts describe when they were booted out of a meth maint program or tried to go cold turkey on their own. I'm afraid the only info you would find would be meth maint info and their withdrawal experience would be very different from simply swithing meds for a CP patient although most addicts don't see the difference. If they can't handle it , nobody can. WRONG!!!.

You are not on a high dose of oxyC or percs, 40mgs a day is pretty minimal for a CP patient. So you meth needs to prevent withdrawl when you switch and what it takes to give you additional pain will apear relatively low.

If I were you doc I would start you at 5 mgs TID or QID and work up from their. a 1:2 conversion , meth being stronger or a 2:3 conversion will be more than adaquate to prevent any withdrawal. Because you really haven't found proper relief with OxyContin you may need to adjust your meth dose untill you reach max benefit with minimal side effects.

What you likely would experience is that once exposed to meth for any length of time it will increase your tolerance to other opiates because it's so much stronger once you attain a smooth serum level. The 15 -20 mgs a day I suggest is going to build up and by the 5th day your serum levels would reflect a patient that took a single dose of 30-35 mgs of meth per day. Which would be considerably stronger than Oxy.

All the equinalgesic tables I have seen only offer single dose comparisons when looking at meth, they don't account for the build up of from the long half life.

So although 15-20 mgs doesn't sound like much, It's awhole lot stronger than oxy. The most recent articles about meth potency suggest meth is actually 5-10 times stronger than morphine and if Oxy is only 50% stronger than morph 20 mgs of meth is a considerable increase.

Going through trial and errror of different meds isn't usually a particularly pleaseant experience because docs tend to start low , better to error on the ide of caution than to over dose a patient. When he makes the switch be sure you know what his expectation are as far as waiting X amount of time before making an increase. 10 days to 2 weeks is plenty of time but any less really wouldn't be safe. So put those cards on the table and ask, If I'm not getting relief from the starting dose, how long do you have to wait to call. If you have an adverse reaction, just call.

To describe a little better about tolerance once exposed to meth, although your tolerance to meth will not rapidly increase. Even if you were to be happy with the initial conversion, say 20mgs a day. If you were to try to switch back to oxy you would likely need 3 times the amount of Oxy you were taking prior to your switch to meth, because of the buildup from the long half life of meth. The transition would be a little bumpy but in the grand scheme of things, taking several months to find the right dose, or experiencing a couple weeks of diferential withdrawal is a ptretty minimal price to pay for relief from a life of intractable pain. IMO

I'm sure an addicts opinion would be different. For me, I just can't find any empathy for someone that shot up heroin for years then switched to meth maint, with no intention on decreasing the dose, just maintaining and preventing withdrawal for a few more years and then complains that meth withdrawal is worse than X Y or Z.Ive seen meth maint patient continue to take the same dose of meth for 10+ years with no attempt to ever decrease the dose, In those cases what have they rally acomplished aside from not taking the health risks of IV med abuse.

Meth withdrawal was terrible compared to what, being a junkie for 10 years. To expect to have a smotth transition after years of abuse and then years of meth maint really isn't realistic. There isn't a quick fix for addiction, unless you have 10-15k for rapid detox under sedation and even then the rate of return to addiction with heroin is extremely high.

The sedation from meth is much more profound than oxy, Oxy is actually a pro drug which tends to energize many users of Oxy, where there isn't anything energizing about meth.

I do understand docs not wanting to prescribe oxyContin and being part of any database of prescribers and for the patient I wouldn't want to be part of a database of oxy users. My own docs PM practice hasn't prescribed oxyC in 3 years. VA was one of the first states to develop a tracking system funded by Purdue.

Anyway, the transition to meth is pretty smooth, meth is at least 2-3 tmes stronger than Oxy so it wouldn't take much meth daily to create an increase in opiates. At the initiation of therapy is the best time to set your goals with your doc. What to shoot for and when to recognize that this is as good as it will get. Have some reasonable activity goals when you go in and discuss them. Being ablt to sit through a dinner with your family, being ablre to sit through a movie, things like that are reasobale. Being able to take a horse into the back country during deer season isn't a reasonable goal to expect to acheive with opiates.
Returning to work or continuing to work is the pinnacle of opiate therapy success.

When it comes to the whole dependence Vs addiction thing. My bottom line is that addiction never improves the qaulity of someones life.Perriod! Physical dependence on a med is just a consequence we must be willing to except and that just means being compliant and making apts, not self medicating, etc. As long as your therapy improves the quality of life your on the right track.

Good luck and let us know where your doc starts you. Take care, Dave