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Old 12-22-2005, 09:10 AM   #1
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Methadone Clinic for Pain Management??

Ok folks this probably sounds wierd, but desperate times breed desperate measures....

I suffer from severe IBS that has only been relieved by opioid medications, Percocet, Lortab, etc. I have tried ALL non-opioid treatments with no luck.

My problem is no doctor will prescribe opioids for IBS on an ongoing basis. I have visited several with no luck.

I refuse to buy meds illegaly. I have recently come up with an idea and I want to know what you guys think....

Methadone is a drug that will successfully treat my problem. I can't get any Internists, GP's, or Gastro's to prescribe it. Do you think I could get it from a methadone clinic? Or, would I first have to be an "addict" then gain access to a methadone clinic?

 
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Old 12-22-2005, 09:24 AM   #2
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Re: Methadone Clinic for Pain Management??

I have a chronic pain condition that my gynocologist wanted me to use methadone to treat since no opiate were working any longer... she cannot prescribe it so she tried to get me referred to a methadone clinic. We have several in the town that I live in but none of them treat for pain management. It is strictly addiction treatment only. I'm not sure if ALL methadone clinics are that way, but they definitely are here.

Have you talked to you primary or gastro about possibly transferring you to a pain managment clinic? If you have a legitmate pain condition that they cannot treat they can't just ignore it... they should be referring you to a doctor that can help you. A pain managment clinic would be my recommendation, not a methadone clinic. You could even call around to some PM clinics in your area and ask if they treat for IBS. Maybe you won't even need a referral depending on your insurance company's policies on this sort of thing.

 
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Old 12-22-2005, 09:31 AM   #3
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Re: Methadone Clinic for Pain Management??

The pain clinics do not think IBS is worthy of opioid therapy. I've called several.

So basically we can be treated at methadone clincs for pain management, but FIRST we must become addicted to heroin??? That way they are not officially treating pain, instead they are treating addiction. That is so ridiculous!

 
Old 12-22-2005, 09:35 AM   #4
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Re: Methadone Clinic for Pain Management??

Hi Ruth, You would have to do a UA or present symptoms of withdrawal to prove that you are an addict in order to be treated by a clinic. If someone was cut off by their PM doc they would qualify for methadone maint or a meth detox program at a clinic, but I think you may run into problems if you go in clean asking to be treated for addiction. Meth clinics are controlled by the govt and you do have to be an addict or dependent on opiates or experiencing withdrawal to qaualify. I think the PM route is a better idea. If your were prescribed another script for an opiate and went in with a dirty UA,"opiates in your system" you would then qualify. It's sad some folks have to resort to this but it's really not that uncommon.

You also have to consider that this goes into a data base and may effect things like security clearance and the abilty to obtain a licence for operating large vehicles like trucks or school buses or anything that requires a class C, I think it's called, licence. You basically get permanatly labeled a junkie by our govt. Good luck, Dave

Last edited by Shoreline; 12-22-2005 at 09:39 AM.

 
Old 12-22-2005, 09:39 AM   #5
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Re: Methadone Clinic for Pain Management??

Well I think that the problem is that they have SO many patients that are using them for addiction treatment that they just plain old don't have the time or resources to also treat pain patients. I'm pretty sure that most clinics have a limited amount of patients that can be accepted to the program. I know the clinics here each have only ONE doctor in each.

Also, there is generally a lot more that goes into pain managment. Often, many different medications are used on top of the pain meds to help give you a more well rounded treatment for your pain (antidepressants, sleep meds, etc...). I'm guessing that the doctor's and nurses at the methadone clinics don't know much about that, because their specialties are addiction management only.

By the way, the clinics here treat other addictions other than heroin, they use the methadone maintenance for oxy addictions, hydro addictions, etc... Any opiate addiction. Of course you have to be evaluated and accepted first.

 
Old 12-22-2005, 09:51 AM   #6
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Re: Methadone Clinic for Pain Management??

Thanks for the replies.

I did not think about the government labeling me as a drug abuser. That is definitely something I want to avoid. I need to work for 20 more years.

This is a bad situation.... Knowing there are drugs that will effectively cure me, but I can't get them.

Tina, Why can't your Gyno write a script for methadone? Is methadone treated differently than other opioids?

Last edited by bcruth5; 12-22-2005 at 09:53 AM.

 
Old 12-22-2005, 10:06 AM   #7
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Re: Methadone Clinic for Pain Management??

Well, methadone is not an opiate. And it is my understanding that it is much stronger than opiates. MUCH stronger. I have also heard that it is an extremely hard drug to come off of. The healthcare system that I use (that my insurance covers, have mulitple office all around the area I live in) is pretty strict about how they handle those sorts of drugs. My gyno is not really experienced in pain management, it is not her specialty, and they require that for meds stronger than oxycodone, etc... that she sends those patients to the pain management clinic within their system. That way there is only so many doc's prescribing drugs that are so strong, like methadone. They want to be sure that the doctor's that are prescribing that drug really know how to do it properly and how to get patients OFF of it when the time comes etc... I had to sign a contract to be put on methadone as well.

 
Old 12-22-2005, 11:44 AM   #8
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Re: Methadone Clinic for Pain Management??

Hi Tina, That's not really correct about meth not being an opiate, methadone is a pure opiaite agonist, It has no opiate antagonistic properties. The only reaon it's used for addiction is that it's cheaper on the healthcare system and safer than a junkie injecting heroin. Because of the long half life, 24-30 hours One dose per day will prevent withdrawal so an addict can go in the morning, take a dose and be set untill the next morning. It has all the same properties as morphine, Oxy or Hydro as far as binding to opiate receptors, It just doesn't produce the same Euphoria that other opiates do. However it can be abused and ever increasing doses will produce a similar Euphoric state, but that's extremely dangerous because of the long half life it builds up in your system over 5 days, so if you double your dose a few days in a row a PM patient could easily over dose.

The same treatment for heroin overdose is used for methadone over dose, however they have to continually give more narcan because once the narcan wears off, the meth kicks back in and respiration drops again. Meth just hasn't been a widely used opiate for PM untill recently and many docs still consider it a drug for heroin addicts.

It's also hard to predict the reponse people will have and converting from other opiates is dificult because of the wide response it has in different patients. It's anywhere from 3 to 10 times more potent than morphine depending on the individual patient, that's why it wasn't commonly used because dosing is hard to predict and requires very slow increases to find the right dose for each patient.

Tina is correct that it's very difficult to discontinue beause of the long half life, perhaps that's why you see people on meth maint for decades, But I gues that's still better than risking aids and needing to inject or take other opiates obatined illegally more frequently to prevent withdrawal. I used it for PM for several years prior to my pump implant and it works quite well but had some side effcts I couldn't tolerat after they made an increase in the dose after almost 3 years on the same dose.

If you don't have insurance it's really the only choice. I replaced 1400 dollars worth of Kadian a month with 60 bucks worth of meth when I lost insurance. I'm not sure if Tina is from Canada, But up north docs have to have a special licence to prescribe methadone whether they are treating pain or addiction. In the states, if a doc has a valid DEA number any doc can prescribe meth for pain but a doc can't treat addiction with methadone, Methadone maint for addiction must be dispensed at a clinic.

They aren't going to give an addict 100 or 300 pills a month to go home and be compliant with, meth maint and detox must be done at a registered clinic.

Just because the docs you have met so far won't treat IBS with opiates doesn't mean all docs have the same POV. There is no list of diagnosis that PM docs are allowed to treat with opiates. If your condition is that debilitating and you have tried everything else without success you may find a doc willing to treat you. I have read several post from people that use LA meds solely for IBS and other GI problems that haven't responded to other treatment. So it's not an absolute impossability to find a PM doc that will treat you.

I went through 7 years of CP and PM without pain meds, had 3 surgeries, went to 3 PM clinics and saw a dozen PM docs before I found a doc willing to help me. It's just a matter of finding a doc that believes the benefit outweighs the risk and cost of physical dependence.

The doc that is treating me now has always been in my own back yard, but the group of docs I was in, my GP, surgeons, PM docs, and shrink didn't believe in Opiate therapy to manage pain. Although they likely knew of the clinic I go to now, they wouldn't refer me there. It wasn't untill I was completely disabled, bed wridden and had tried every other possible treatment option before his name was pulled out of the "secret box" of docs that will use opiates to treat intracatable pain and I was finally given some abilty to function thanks to my doc and opiates. I still use other non opiate methods and medications in combination with opiates, but Opiates were the med that allowed me to take the hospital bed out of my den.

Even then, they can only do so much, they won't cure 3 failed surgeries or make a fusion solid or or fix broken hardware. It's not really a cure for IBS but opiate side effects like slowing bowel contractions will help improve your condition. Finding a doc that believes in their benefit is the tough part but not impossible.

Start a thread and ask if anyone is using PM and opiates to treat IBS or chronic colitis or other GI problems. I bet you will be surprised that some docs are willing to manage that type of condition with long term opiates if that's the only option you have left.

I would make a list of every treatment, medication and modality you have ever tried to manage your condition. A concise documant that contains all your history, modalities tried,and the contact info, "who,where,when and addys" of prior failed treatments and hospitilations and present that to the next PM doc you see. It's something a PM doc can insert in your chart and use to justify the need to prescribe these meds for your condition should anyone "DEA, Board of Pharamcy, Medical boards" ever audit his prescribing practices.

Tina is right about being addicted to any opiate to qualify for a meth clinic, It doesn't have to be heroin. People abuse and become addicted to hydrocodone and end up at meth clinics. IMO it' just substituting one addiction for another but it's cheaper than the govt picking up the expense of AIDS or Hep, it reduces crime to pay for illegal opiates to prevent a desperate addict from going through withdrawal. So there is a social benefit to managing addiction in this manner.

Some meth maint patients do return to work and lead productive lives as long as the withdrawal can be prevented and controlled by meth. Each day simply starts with a trip to the local meth clinic for their daily dose of the new opiate they become dependent on. Once a day dosing isn't effective in treating intracatable pain, but the side effect your really taking it for "slowing motility of bowels" will likely last 24 hours between doses due to the long half life.

Most CP patients need to dose meth 2,3, 4 and sometimes more often each day. I could feel the anelgesic effect wearing off in 4-6 hours after each dose.

Good luck, Dave

Last edited by Shoreline; 12-22-2005 at 02:46 PM.

 
Old 12-22-2005, 01:11 PM   #9
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Re: Methadone Clinic for Pain Management??

I'm not sure what's going on, but there's a lot of misinformation being told to patients by these doctors.

First of all, Ruth, I feel bad for you not being able to find a doc that will write a script for you to take care of your IBS. I can tell you from personal experience, it helps a lot. It not only takes care of your pain, but it slows the bowels, which allows you to have more normal bowel movements. Tina, your doctor not being able to write for Methadone is just not true, unless you live up north as Dave pointed out. Any MD (in the US) can write for Methadone and if they tell you they can't, they aren't being honest with you.

I have had IBS for many years and almost eight years ago started taking opiate meds for my IBS! I was on several, but the LA drugs have been Oxycontin, Duragesic patches and now Methadone. I get 540, 10 mg tabs a month. I take 180 mg a day for the IBS. I do have a couple other problems now to go along with the IBS, but to have a doc say they can't write a script for Meth to treat IBS is just not correct.
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Last edited by RetiredDirector; 12-22-2005 at 01:19 PM.

 
Old 12-22-2005, 02:57 PM   #10
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Re: Methadone Clinic for Pain Management??

And there you have it, An IBS patient being treated by a doc with opiates, particularl meth.. Thanks D....
Taking 12 docs to get to the point of managing finding one to manage your pain unfortunuately isn't that uncommon. My cousin had testicuar cancer at 21 and was treated like a drug seeker at ER's and b GP and other speicalist and pased from doc to doc before a urologist actually did an MRI rather than a simple grab and grope calling it epiditimitis, Inflamation of part of the testicle which is pretty common.

He saw 42 docs over an 18 month period and was fortuntae the last doc cought it before it killed him. So don't give up, don't worry about the addiction speaches, every CP patient gets it at some point. The speech that is.Every doc is eager to give their opinin but everyone has an opinion, t doesn't make the correct. Statistically the actual addiction rate among CP patients is lower than that of the general public. Dependence is something entirely different and a physiological trade we must make to function, but physical dependence doesn't equate to addiction. Even though PM patient qualify for meth maint given their crude guidelines using dependence on opiates as the only requirement.
Take care, Dave

Last edited by Shoreline; 12-22-2005 at 03:00 PM.

 
Old 12-22-2005, 03:22 PM   #11
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Re: Methadone Clinic for Pain Management??

As Shoreline (Dave) pointed out, I'm an IBS patient being treated with Methadone. True, all my CP problems started with abdominal pain that was diagoised as Irritable Bowel Syndrome after many tests, including CT scan, endoscopy, colonoscopy, GI Follow through (where you drink the barium and they follow it through the GI tract), x-rays and I'm sure there were more too. Since the point I first went to the doctor (my PCP) and he started me on Hydrocodone for pain, I went up the ladder eventually going on Oxycontin.

I point this out, although I have IBS, and I'm on Social Security Disability due to my CP, I have some other medical problems too. I had lung surgery three years ago for a nonmalignant tumor in the upper lobe of my left lung that turned out to be BOOP (Organizing Pneumonia). I still suffer from neuralgia pain from having all the nerves cut in my back to open up the lung. I didn't realize they went in through the back until I had the surgery. They also had to remove two ribs to get to the lung.

The point is, I was given opiate meds for my IBS only, but I now have other issues as well as the IBS. Methadone (I'm at 60 mg TID) is a wonderful drug for nerve pain. You need to keep looking and some where there is a doc who knows why IBS patients do well with opiates for their problem. It slows the bowels and where a normal person would be constipated, I (IBS suffers) find it helps them be closer to normal. That's assuming you suffer from the diarrhea type.

Good luck on your search Ruth. When you finally find someone to treat you, it will be well worth the hunt.
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Old 12-22-2005, 03:32 PM   #12
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Re: Methadone Clinic for Pain Management??

Okay, I just want to chime in here... as a sufferer of IBS, I can tell you that Director is one of the very select few that will ever get treated with "pain meds" for their IBS.

I've spoken to several of the leading gastroenterologist researchers in the country, and none will prescribe them for IBS... their responses are typically that it can lead to Narcotic Bowel Syndrome, it is something you will become dependant on.. etc etc.... things you've probably already heard.

Do you know benzodiazepines can help, either directly or indirectly with relaxing the smooth muscle in the intestines? Xanax might have an indirect effect because it reduces anxiety and general arousal, which in turn could help relax those muscles. Klonopin may be the one with more of a direct effect, because I believe it's the only one that actually has been shown to decrease the release of serotonin.... which would make it a little worse for depression, but maybe a little better for IBS.

Have you tried the drugs like Lotronex? Researchers are just now finding abnormalities in people with IBS. There are serveral theories... but one involves serotonin. There are different receptor sites, namely the 5ht3 and 5ht4 in dealing with IBS. (we'll call them accelerators(5ht3) and brakes(5ht4).
Lotronex makes its way to the intestines and attaches to the 5ht3 receptor site, and acts as a brake, slowing down bowel transit time.... If you suffered from constipation, Zelnorm would attach itself to the 5ht4 and accelerate the process. These can have a direct effect on the pain... Usually IBS'ers with diarrhea have too much serotonin floating around in their stomach, because they don't have enough SERT to remove it.

There are also new drugs that are specifically being studied for IBS pain.

Asimadoline is in clinical trials right now, and there might even being one taking place where you are at.

You can read all about that drug, but it has been shown to be very promising for all sub-types of IBS, (A-C-D), and a company here in the states in California is helping fund the studies.

I think that is our best bet.

 
Old 12-23-2005, 05:26 AM   #13
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Re: Methadone Clinic for Pain Management??

Thanks for the great replies!! What a caring group of people we have here.

I will continue my search for relief. BTW... I have tried benzo's with no luck.

 
Old 12-23-2005, 10:28 AM   #14
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Re: Methadone Clinic for Pain Management??

Just to clarify about my doctor not prescribing the methadone... She works for a specific (big clinic here in my area) clinic. I'm sure she CAN prescribe methadone because she is a doctor. BUT, it's my understanding that the clinic I go to does not want her to. They want the strong drugs like that to go thru their pain management doctors there at the clinic or at their other clinics throughout the area (they have many). So I'm sure she COULD prescribe it if she wanted to but she doesn't because the people she works for want her to refer methadone patients to the pain managment doctor for their meds. I think it is just a company policy or something. At the same clinic, my primary didn't prescribe me my anti-depressants either. He gave me a referral to a psychiatrist at the same clinic and she prescribes those meds for me. So it seems like they have a lot of little "rules" within this specific organization.

Last edited by tina76; 12-23-2005 at 10:31 AM.

 
Old 12-23-2005, 10:50 AM   #15
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Re: Methadone Clinic for Pain Management??

Also, Shoreline or Director, could you tell me what narcotic bowel syndrome is exactly? Thanks!

Last edited by tina76; 12-23-2005 at 10:51 AM.

 
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