Re: From Opana ER back to Methadone
Hi Wife of sick and hurting. I'm glad he's feeling more like his old self, but I would hate to see people give meds such a short chance before seeing if they can be beneficial. methadone is asuch aunique opiate, there really is no other pain med that has all the properties meth has. I used it off and on for several years due tolack of insurance. When I had insurance I would use a LA morphine product, and when I didn't have insuirance I used meth because it was all that is afordable when you reach that kind of dosage level.
What I'm getting at is that because other opiates don't have the same properties as meth, specifiaclly NMDA blocking abilty that when you switch away frommeth it's pretty common to experience differential withdrawal. Differential withdrawal is just what it sounds like, withdrawal due to the differences between meth and all the other opiates. Every time I switched,away from meth I went through about 2 weeks of misery where taking more morphine really didn't make a difference because I still wasn't getting the properties that meth has.
We knew the conversion from having to switch when I would max my befit for the year or when I lost benefits completely so it wasn't a matter of the dose not being right, It was simply a matter of waiting for all the meth to leave my system and my body to adjust. If he did a cold switch last thursday, meaning no taper off of meth and onto oxyMorph, It's not likely he even got all the meth out off his system before switching back. It's a shame docs don't inform patients beter or do crossover tapers, there is a great misbelief that you can hop from one opiate to the other without any negative effects as log as the dose is right. That's simply not true. Meth has all the properties that morphine or oxyMorphone have but the other meds don't have all the properties meth has. So switching to meth is usually very easy, no withdrawal, just amatte4 of titrating the dose. However switching away from meth can be a bear and I've experienced it every time, even whhen I switched from meth to a morphine pump. It wasn't a matter of not enough morphine all though they did start low, But meth is so unique, It's not uncommon to experience a mildeeer version of withdrawal "differential withdrawal". The same is true when switching away from duragesic. If you have taken Fentanyl for months and do a cold switch to another drug, the same can ocur, Fentanyl also has it's own unique properties which can make changing meds a little more difficcult. It's not the same propwerties that meth has, so switching between meth and fent is no easier.
My point is, although yoeveryone is satisfied going back to meth and it's making a hige improvement, He wasn't off meth long enough to get passed purging meth from his system or acomadating to not having it any longer. Opana may have worked had he stuck it out, it may hav been a miserable 2-3 weeks, but if he simply couldn't tolerate meth side effects, it wouldn't be uncommon to feel bad for several weeks regardless of what the conversion from one med to another is.
This strange differencial withdrawal only ocurs when switching away from meth or switching away from Febnntanyl, so dI don't want everyone to panic simply because they are changing drugs. Some people are more sensetive to the differences qand some aren't. But in all fairness, Opana was never given a fair shot IMO.
Fortunately everyone is happy, but if switching back to meth wasn't an option due to intolerable side effects, all you can really do is ride out the wirthdrawal for a couple weeks and then work on titrating the med to a level that isn't so impairing and provides equal or beter relief.
Just a little opiate 411. The only reason I mention this is because I would hate to see other folks give up so quickly when there are so few LA pain meds available. If we only gave each med 5-7 days, after 6 weeks there would be nothing else to try. This doesn't give any med a fair trial and I've seen docs give up entirely on opiates because the patient is so disatisfied they report little improvement or severe side effects that would likely deminish and the doc moves on to the next. After trying all the LA meds and reporting little improvement or intolerable side effects, a doc may come to the conclusion that the patient simply doesn't respond well to opiates.
Once that's decided It may take years to get them to try opiates again. So you have to be patient, informed and know what to expect when changing from one med to the next.
Expecting to make adjustments in dosage is normal for all opiates. Expecting to get passed some differencial withdrawal from discontinuing meth or fentanyl seems to be something docs don't tellpatients but they need to know so they don't misinterpret feeling bad as being under medicated or the new med simply being innefective or side effects too severe. In your husbands case, he will never really know if Opana would have worked if he had gotten passed the first few weeks without meth and given his body time to acomadate and time to adjust the dose if it was too sedating.
Fortunately things worked out in this case, but sometimes people are switching because the side effects are too severe and returning to that med simply because of unexpected withdrawal is a real shame the doc could have prevented if he had taken the time to explain there is a difference in the way certain meds work whcih can result in a milder version of withdrawal.Lack of energy, lethargy, drowsines and yawning are all sym,ptoms of withdrawal, so we will never really know if it would have worked out better in the long run.
Unfortunately too many docs think you don't need a variable taper and can just replace one for another " a cold switch" without any problem. That's just not the case with those two specific meds. Drowsiness is a side effect that deminsishes with time, so does differential withdrawal, but when you don't know what's going on or don't expect anything to be different from previous changes in meds, someone could rule out every opiate in just weeks which leaves them with few alternatives..
Again, I'm glad he has something working so well, but in general, switching away from meth is tough and takes time to give the new med a fair trial. Knowing what to expect makes it a little easier for those considering a change in the future.
Take care, Dave