otter0407

Dear Lucy,
I am the self-proclaimed queen of withdrawal, after having to wean myself off of so many different meds over the years. I wound up on 300mcg/hr for 36 hours and 10mg of methadone up to eight times a day for breakthroiugh pain. After about a year, because of an increase in pain due to a deterioration in my condition, I opted to let my pain doctor implant a neurostimulator in my back. It took three surgeries to get everything working correctly, but it really has helped. It is like little shocks in the areas where my pain is and I can adjust the strength of the "shock" to each lead implanted. I chose to become my own version of the bionic woman b/c I did not want to be the girl on 400mcg of Fentanyl (you should have seen the looks I got turning in a script for 300mcg to a pharmacist other than the one I usually see). Not only that, but in the time my dose of Fentanyl was 300mcg, I not only could not lose weight, I actually gained weight while strictly dieting. I gained 56 pounds in eight months while following Jenny Craig to the letter! I even forced myself to eat all the stuff I was supposed to in a day, even if I wasn't hungry. I even drank all the water and wrote down everything I put in my mouth, even if it was a tic-tac. None of my man physicians could explain what was going on and pretty much just figured I was lying about how strictly I was dieting. There came a point where b/c I had gained so much weight, I developed metabolic syndrome (pre-diabetes) which was directly caused by my obesity. But no one could tell me how to stop the obesity or lose the weight. Anyway, after I had my implant, I weaned myself off of the fentanyl as fast as I could (PS-if any of you have to do a drug wean, don't let your provider let you suffer needlessly! They can prescribe you a benzodiazapene, like xanax or valium or even an alpha 2 adrenergic agonist called clonidine or as it it better known, Catapres, which is an older type high blood pressure medication that has been shown to help with withdrawal symptoms and even stage fright!)
Anyway, after I was all the way off of the fentanyl, my pain doctor left me on methadone for the pain not covered by my implant b/c I can only turn it up so high before I feel like I am being electricuted. But it wound up that I would have a really active day (for me, anyway) and then wind up having to take a methadone or maybe 2 (20mg) but then for the next few days, my pain was covered by the implant, so I wouldn't take any methadone for a few days and then I would wake up in the middle of the night in withdrawal. I spoke to my pain doctor and he downgraded me to Norco, which is a drug I can take when I need it and if I don't take it I don't have any withdrawal. However, if my pain is bad enough that the implant won't cover it and I have to take more than 6 Norco in a day, then I have to go back to the methadone. But because once I stop the methadone, I am still using the Norco, I don't get the withdrawal anymore. Oh, and FYI, once I weaned off the fentanyl, the weight just started coming off. I didn't even have to try. Turns out that long term use of certain opiod medications can cause weight gain. Who knew?

The thing with Mehtadone isn't that it is so "addictive" but rather it has an extremely long half life, meaning that it stays in your system a long time. Not only that, but the half life differs per person. So, even though you are taking it as directed, you are building up a concentration in your system. And how fast your body metabolizes and excretes the drug is different than how fast someone else would. But it sounds as though your provider has put you on this to control your pain and it sounds as though it is working. Therefore, I wouldn't worry about withdrawal because you shouldn't be experiencing any of that as long as you continue to take your 5mg three times a day.
I would also like to mention something about addiction. Your body does not become addicted to a medication, your mind does! Your body can become dependent to the drug, which means when you stop taking it suddenly, you can experience symptoms of withdrawal. It is lke if you drink a lot of caffiene, all day, every day and then stop. You get a "caffiene headache" from withdrawal. Your body was used to getting that caffiene and when the supply stopped, your body got a bit irritated because it was used to having it-that is dependence, not addiction. And dependence is an expected occurance when one is on certain types of medications for long periods of time. Just like tolerance is expected; it takes different people different periods of time to become tolerant to a dose of medication. In my case, I was on 200mcg of Fentanyl for a year and a half before I became dose tolerant and had to have my dose increased to continue to receive the same amount of pain relief from the same agent. But addiction is a mental thing; it usually develops from abusing the medication in question. For instance, some people, who haven't been on opiod medications for years, will get a feeling of euphoria; a feeling like they love everything and everyone. And perhaps when things get stressful or they have a bad day, they will take their pain medication, for example, even though they are not having pain. They just like that feeling of euphoria, so they take their meds not as directed and not for the reason they were prescribed. That is the definition of abuse of prescription medication. Next, they will find out that they are running out of their pain meds early because they have been using them not only for pain, but to feel good. So now their brain starts thinking, "How can I get more?" Naturally after a while, tolerance will occur, but this time it is tolerance for the amount of medication it takes to get that happy feeling, not necessarily the amount needed to control their pain. By now, this person is constantly thinking about how to get their hands on the amount of medication they need to make them feel good and cover their pain. And maybe their doctor is starting to suspect something is amiss, or not, but all this person is thinking about is the drug and how to get it. This person is addicted when they contemplate stealing prescription pads, or ordering drugs from overseas, or calling up their doctor with stories like "I lost my prescription or someone stole it" and they do it more than once. When all someone can think about is how to get their hands on more of their drug of choice, no matter the damage it could do to their personal/professional lives; that person is addicted! There are nurses who have stolen meds from patients; they are addicted! They are putting their nursing license, job, livelihood, and everything they have worked for at risk just to get the drug because it is all they can think about! That is addiction!

I say all of this because when so many healthcare professionals can't keep the terminology straight, it is important for all people who suffer from chronic pain to know what is what. If you haven't been accused of drug seeking yet, you are lucky! There is even a term called pseudoaddiction, which describes a state in which the patient's pain is under-treated or untreated and all they are doing is trying to get some relief for their never ending pain. And they are frustrated and upset because they hurt and no one is helping them, so sometimes their behavior is considered to be "drug-seeking" when it is the normal behavior of a person who justs wants a break from the pain.
As a nurse, I have been made to suffer through 45 days of greater than 10 out of 10 pain, prior to my spinal fusion, by providers I worked with in the same hospital. That has an affect on you, when you are walking around in uniform, a leader, crying because your pain is so unbearable you can't sleep, think, or do anything other than hurt. And there is no good reason for it, plus as a nurse, you know what is happening to you is wrong! And two years later, I was left in 12 out of 10 pain for 21 days, because an NP had made up her mind that I must be drug seeking because all of the anti-seizure meds I had been tried on over and over again didn't work.
I don't know about any of you, but once you have suffered through any extended period of unrelieved pain, you never want to go through it again. And it is because of uninformed and unfortunately, burnt-out and jaded health care providers, that so many chronic pain patients have to suffer needlessly. The only way to protect ourselves from being undertreated, humiliated, and falsely labeled is to educate ourselves and know that taking a pain medicine that relieves our pain, as directed by our providers, whether or not our body becomes used to it (dependence) or eventually needs more to get the same pain relief as before (tolerance) is normal, not addiction!
Sorry for the soapbox, but if it can happen to someone who has worked in so many areas of medicine and knows how things are supposed to be, I really worry about all the people out there who don't know they are being mistreated. It is in the Patient's Bill of Rights that a patient has the RIGHT to be as pain free as they are safely able to be. And by safely, I mean not given so much of a medication as to cause respiratory distress or other complications. It was only in 2001 that JCAHO, the organization that says whether every health care facility in the country can stay open, issued their Pain Managenent regulations. There are a lot of providers and support staff that have either not taken the mandatory pain manangement training or have forgotten what they have learned. If the people who are supposed to take care of us aren't, we have to educate ourselves on what they should be doing and also that by suffering from chronic pain and requiring medications that make certain providers nervous to prescribe does not make us bad people, criminals, junkies, etc. We are patients who deserve compassion, empathy and respect. And I just hope that by spreading the word, more chronic pain patients can get the treatment that they need.
Anyway, Lucy, you are not going to get "addicted" to methadone, it is helping your pain, and you are taking it regularly, not as needed, so there shouldn't be any gaps in your intake and you shouldn't experience any withdrawal from it. At some point if your doctor decides to switch you off of it, he or she should wean you off it slowly and prescribe something to help with the withdrawal symptoms and if done like that, you shouldn't feel a thing. I have gone throught withdrawal of oxycontin, fentanyl and methadone, and methadone was by far the easiest. So don't worry about that, just enjoy the pain relief And as long as you take your meds as prescribed, you will not become addicted. Good luck and Take care!
C-otter