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  • Shore - ??? on switching to Methadone

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    Old 04-18-2004, 11:08 PM   #16
    pmgal
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    Re: Shore - ??? on switching to Methadone

    Hi All~
    I've been on methadone 20 mgs daily for a few mos. now. My dr put me on it because I admitted to him I was addicted to vics and percs for 8 yrs. I find myself getting and taking the vics and percs while on the meth I can't seem to stop craving them. Am I not getting enough methadone???? I also find that I can't really feel the vics or percs working for pain as they did before the methadone.
    I'd really like to stop craving the vics and percs, and just stick with the methadone, but I'm having a hard time giving them up~ Any advice will HELP!!!!!
    Pmgal

     
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    Old 04-19-2004, 05:43 AM   #17
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    Re: Shore - ??? on switching to Methadone

    Hi PM gal, Your dealing with the psychological side of addiction. Your don't seem to be going through withdrawal which is great. As far as taking other opiates for pain relief, you still get the analgesic effect. But if you associate the warm fuzzies with pain relief, meth can put a damper on the warm fuzzies from other meds but not interfere with the analgesia the meds provide. So your wasting your time and money on hydro and oxy expecting to get a buzz with meth in your system. Taking more and more to try to capture that buzz won't get you there but it can turn you blue. The whole addiction thing is rediculous anyway. You can spend years trying to recapture the feeling these meds gave you when you first started but you never will because of the tolerance you developed while abusing the meds.

    Start counseling. It really is dangerous to abuse meth and I really don't know why a doc would think a patient wouldn't abuse meth when they have abused other opiates. You can get high on meth, It just takes ever increasing doses which is very dangerous. The dose that gave you a nice buzz yesterday, could kill you when you take the exact same dose today because you still have half left in your system from the day before. So although your dose is the same on day 2 as day 1, your serum level is 50% higher.

    Seek counseling from an addiction specialist, ideally one that also treats chronic pain. I don't think addicts should suffer from chronic pain but prescribing practices should be modified for the patient that has difficulty complying.More frequent visits, one week supplies etc. As far as still taking percs and hydro, If your doc shopping, I assure you, the last place you want to experience withdrawal is on a cold cement floor in jail. When you start making threats to harm yourself they just strip you and give you a paper gown.

    Doc shopping is easier than ever to track with all the data bases and tracking systems in place. Class 2 meds are tracked no matter what state you live in. Continuing to doc shop while being treated by a PM doc that has been kind enough to give you a second chance is very foolish. You could end up with nothing at all for your pain for the rest of your life or worse things can happen, like loosing your spouse, children, home and serving time. In the present climate it's more likely you would be made an example by harsher sentencing. I can't imagine being in so much pain that you need these meds but are still willing to risk being treated for a little buzz.

    If you can't find a counselor try an NA meeting or try talking things over at the addiction board. I obviously won't see eye to eye with every addicts point of view but their advice may hold very true in your case where you know you have a problem with compliance. Getting caught doc shopping and going cold turkey off meth when you get booted from the PM docs practice will be very miserable.The doc is not obliged in any way to taper you comfortably off. If he gives you an option, like entering a detox program, he has not abandoned you and you have no recourse.

    Try to get to the root of why you have to be blasted to feel like your getting pain relief.Obvously there is more than physical pain going on or you wouldn't be abusing the meds. Deal with those issues and the rest will resolve itself.

    Analgesia and euphoria really have nothing to do with one or the other. What is the source of your pain that you need such powerful pain meds? It just doesn't sound like the use of opiates has improved the quality of your life which really negates you as a candidate for opiate therapy. Your very lucky your doc is understanding and I would take this as your last chance to get it right.
    Good luck, Dave

    Last edited by Shoreline; 04-19-2004 at 06:03 AM.

     
    Old 04-19-2004, 12:39 PM   #18
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    Re: Shore - ??? on switching to Methadone

    Hey,
    Just thought I would pop in and tell you about my taper-down off methadone.
    My usual dose was 3 1/2 per day, so first I went to 3 per day for just 2 days and then down to just 2 1/2 yesterday. I started to feel a little of the withdrawal effects yesterday evening but I had already taken my next dose so it went away quickly. I seem to be tired but able to sleep well so why not enjoy the extra shut eye? Other than that no problems so far. I am taking more oxycodone but that was expected. My goal is to go off the meth and keep the oxy increase to a minimum and I want it to be as quick as possible.

    I don't have a set schedule and I know I have cut a lot so far but if I have to take 2 1/2 for 2 weeks now that's OK too. It may take me one month or maybe 6. My pain has been mostly tolerable and it will have to stay there for this to work.
    Best luck to everyone.

    peace,
    farmboy

     
    Old 04-21-2004, 12:14 AM   #19
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    Re: Shore - ??? on switching to Methadone

    Quote:
    Originally Posted by Shoreline
    Hi PM gal, Your dealing with the psychological side of addiction. Your don't seem to be going through withdrawal which is great. As far as taking other opiates for pain relief, you still get the analgesic effect. But if you associate the warm fuzzies with pain relief, meth can put a damper on the warm fuzzies from other meds but not interfere with the analgesia the meds provide. So your wasting your time and money on hydro and oxy expecting to get a buzz with meth in your system. Taking more and more to try to capture that buzz won't get you there but it can turn you blue. The whole addiction thing is rediculous anyway. You can spend years trying to recapture the feeling these meds gave you when you first started but you never will because of the tolerance you developed while abusing the meds.

    Start counseling. It really is dangerous to abuse meth and I really don't know why a doc would think a patient wouldn't abuse meth when they have abused other opiates. You can get high on meth, It just takes ever increasing doses which is very dangerous. The dose that gave you a nice buzz yesterday, could kill you when you take the exact same dose today because you still have half left in your system from the day before. So although your dose is the same on day 2 as day 1, your serum level is 50% higher.

    Seek counseling from an addiction specialist, ideally one that also treats chronic pain. I don't think addicts should suffer from chronic pain but prescribing practices should be modified for the patient that has difficulty complying.More frequent visits, one week supplies etc. As far as still taking percs and hydro, If your doc shopping, I assure you, the last place you want to experience withdrawal is on a cold cement floor in jail. When you start making threats to harm yourself they just strip you and give you a paper gown.

    Doc shopping is easier than ever to track with all the data bases and tracking systems in place. Class 2 meds are tracked no matter what state you live in. Continuing to doc shop while being treated by a PM doc that has been kind enough to give you a second chance is very foolish. You could end up with nothing at all for your pain for the rest of your life or worse things can happen, like loosing your spouse, children, home and serving time. In the present climate it's more likely you would be made an example by harsher sentencing. I can't imagine being in so much pain that you need these meds but are still willing to risk being treated for a little buzz.

    If you can't find a counselor try an NA meeting or try talking things over at the addiction board. I obviously won't see eye to eye with every addicts point of view but their advice may hold very true in your case where you know you have a problem with compliance. Getting caught doc shopping and going cold turkey off meth when you get booted from the PM docs practice will be very miserable.The doc is not obliged in any way to taper you comfortably off. If he gives you an option, like entering a detox program, he has not abandoned you and you have no recourse.

    Try to get to the root of why you have to be blasted to feel like your getting pain relief.Obvously there is more than physical pain going on or you wouldn't be abusing the meds. Deal with those issues and the rest will resolve itself.

    Analgesia and euphoria really have nothing to do with one or the other. What is the source of your pain that you need such powerful pain meds? It just doesn't sound like the use of opiates has improved the quality of your life which really negates you as a candidate for opiate therapy. Your very lucky your doc is understanding and I would take this as your last chance to get it right.
    Good luck, Dave
    Dave~
    I want to thank you for your honesty! I'm so grateful I found this message board!
    I was an alcoholic for many years, but got help and quit 9 yrs ago. Then I started having surgeries here and there where I was given pain meds.....so of course I got hooked on them after awhile. I do have alot of pain issues, from my job, injuries ect..
    I don't shop for drs. and don't take very many vics daily....maybe 4 or 5 7.5's. I've even asked pharmacist who says it's ok to take 20 mg meth and afew vics aday. what do you think about this??

     
    Old 04-21-2004, 09:48 AM   #20
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    Re: Shore - ??? on switching to Methadone

    Using BT meds is fine with meth as long as your only taking them when the pain increases. If a couple vics is how you relax after work then there is a problem. I've been on meth for several years at a much higher dose and have continued to get relief from BT meds
    BT =break through pain. Pain that breaks through your base dose. If your PM doc is the one prescribing both Meth and Vics than you have nothing to worrry. As far as doc shopping, If you have a PM doc treating your X apain and you have your GP prescribing Vics for the same pain, all it takes is two docs treating the same problem with opiates to be called a doc shopper.

    Many PM docs use contracts that spell this out. Use one pharmacy, do not except pain meds for the same condition he is treatng, etc. If the Vikes are left over from your old treatment plan are you going to be OK with just meth, Does your doc prescribe BT meds or would he to someone that has admitted to having a problem. You just have to ask yourself why your taking BT meds? because the physical pain has risen or simply because you have them.

    Ive seen many patients that think because the doc gave them BT meds say 4 Norco a day, that they should take them as part of their PM regemin. If you do this what would you actually do if you fell and your pain level actually did rise. Then you wouldn't have the means to manage any additinal pain.

    The last place a CP patients wants to go is the ER when you have increase in pain. You get labeled and treated very poorly most of the time. So save your BT meds for when you actually have an increase in pain that the meth isn't covering it. Only you know if your taking the Vikes because the meth isn't covering enough pain. If that's the case, Better to get your dose correct now than to wait 3 months and ask for an increase. Rapid tolerance to meth doesn't usually occur.

    I went almost 2 years on the same dose, switched to morphine for about a year and then switched right back to my previous dose. I have BT meds and I may take one per day or I may take 3 or 4 depending on how much I hurt. But I don't take the same amount of BT med every day because I know I would eventually become tolerant to the effects and have nothing for when the pain did hit the ceiling.

    When you reach for the BT meds you really have to ask yourself if your taking them because you hurt more or simply because you want to feel better. I know it kind of sounds the same but feeling good is not the purpose of PM. Increasing your ability to function is the goal.
    Good luck and you can stay sober and take opiates. It all has to do with why your taking them and what do they do for you. I know several recovering addicts or alcoholics that now need PM. Their sobriety isn't compromised untll they know they have crossed the line from simply seeking relief from pain and likeing how a med makes you feel.
    Take care, Dave

    PS. The most common school of thought about BT meds, and this is mentoned in every LA med manufacturers full prescribing info. Is that if you need more than 2 doses of BT meds per day the base med should be increased. Not every doc subscribes to the same school of thought but it's a safe one which doesn't turn your BT meds into part of your daily regemin.

     
    Old 05-12-2004, 04:44 PM   #21
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    Question Re: Shore - ??? on switching to Methadone

    Well, I have finally given into the fact of taking methadone for chronic back pain. The duragesics (25mcg) were too strong, my doc won't write for oxycontin (and percocet for BT) even though it helps, so meth is what he will write for. I mentioned I maybe moving to Virginia and I called the UVA pain center asking what they do, and they do the same, methadone.

    I wonder, can methadone be taken once a day once your up on a regular schedule or do you have to continually take it 3/4 times a day?
    And can it be taken over a lifetime or just so many months/years?

    Currently on oxycodone 40mg a day (between oxy and perc).

    - Ken

     
    Old 05-13-2004, 05:51 AM   #22
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    Re: Shore - ??? on switching to Methadone

    Hey Ken, Therehave been foks on meth maint for decades and they have studdied the effects of what meth does after prolonged use, which is basically nada. ONly 10% of the population can not take meth, that's the exact same percentage that can't take most forms of opiate pain mediations. With meth it's folks that don't have the cytochrome P450 liver enzyme to break it down.. Grapefruit juice has this enzyme and can boost the effectiveness of meth and many other drugs, It can also decrease the effectiveness of other drugs.

    So you can ceratinly tame it long term, Been on it almost 4 years now myself. The only annoying side effect is the profuse swaeting particularly in the summer. That would certainly be dose dependent and there are other factors that effect sweating. Smoking is a big factor. Folks that smoke, sweat more.

    I'm glad you were able to contact UVA. When will you be in Charlottesville. I'll be out that way this summer. Mom was just DX with breast cancer and that's were her surgery and treatment will likely take place.

    It is comforting to know it's cheap and you don't have to worry about loosing scropt beni's and still being able to afford myour pain meds. The myth about BT meds not working while taking meth is just a myth. You may not catch a buzz but you will recieve all the anelgesic effects of any opiate.

    Once a day dosing for Cp wold likely be tough although I have met folks that have gotten away with twice a day. Personally I think you would end up on a higher dose trying to make the anelgesia last up to 12 hours. In acute care it's dosed every 4 and for CP every 6-8 hours. I actually feel it wear off in about 4-5 hours. Not completely off but you do feel the need to redose. I would prefer to avaoid additional side effects from one or two larger doses and try to minimalize side effects with smaller more frequent dosing. I honestly think you will be surprised the the relief meth can offfer.

    The pharmacist will know you are not a meth maint patient. MM patients don't get a one month supply to play with and pharmacists know this so you shouldn't have to worry about some dingbat in the pharmacy thinking you are a heroin addict.

    Don't let some silly stigma prevent you from findng relief. Meth is also very forgiving. On my refill days I have had to wait until as late as 5pm to get my first dose and haven't felt anything but an increase in pain. Miss a dose of OxyContin by 24 hours and you would be a mess. So meth has lots of advantages in several ways. IT's more forgiving, It's dirt cheap, and you don't wake up playing catch up trying to get your first dose of the day in you.
    Good luck, Dave

    Last edited by Shoreline; 05-13-2004 at 06:19 AM.

     
    Old 05-13-2004, 06:39 AM   #23
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    Re: Shore - ??? on switching to Methadone

    Hey shore -

    Once again, thanks for the helpful info. I don't drink grapefruit juice, but man I sure do love those iced teas !

    As far as timing, I see my PM doc end of May. I am sure this is what he will Rx (Meth). I am scheduled to be in Va June 6th thru the 13th. It amazed me that the UVA pain center said they do the evals and start your meds if neccessary, but a PCP actually writes them from then on. In NJ, PCP's never write pain meds, they tell you to go to a PM. Go figure!

    Too bad about the oxy stigma these days since it does help many people and they will needlessly suffer due to fear and ignorance. But too hard to fight city hall anymore. I probably won't actually start the meth until I return to NJ since I don't want to start anything while traveling. I'll keep the percocets for BT just in case, but whatever it takes to keep going, then so be it.
    Never would have imagined this is where I'd be at 43 !!!!!!!!!!

    - Ken

     
    Old 05-13-2004, 08:04 AM   #24
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    Re: Shore - ??? on switching to Methadone

    Shore, you are an absolute wealth of information! I didn't know about grapefruit juice boosting the effects of methadone. I have been taking dextromethorphan and it has helped alot, which I also learned about from you. Lately though, I've been having a tough time, especially since yesterday when I had to go to a doctor who manipulated me in ways that made my pain go through the roof, and I'm still paying. I'm gonna try the grapefruit juice....Thank you so much!!
    Kayley

     
    Old 05-13-2004, 10:16 AM   #25
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    Re: Shore - ??? on switching to Methadone

    Hey Kayle, There is actually an official grapefruit juice drug interaction website. You should probably check to make sure you don't cause a harmful interaction before procedding. Just as it can raise some serum levels as much as 20% it can lower some too.

    Fresh grapefruit works the best though. A half a grapefruit does the trick when your doc doesn't use BT meds.LOL It's been years since I needed a grapefruit and now I take some meds that it's bad to eat grapefruit with.
    Be careful and Take care, Dave

     
    Old 05-13-2004, 01:24 PM   #26
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    Re: Shore - ??? on switching to Methadone

    how about the duragesic patch - does it help for breakthrough with that?

     
    Old 05-14-2004, 12:48 PM   #27
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    Re: Shore - ??? on switching to Methadone

    He Linda, Sorry, I checked the Oficial GJDI website. The CYP450 although considered a liver enzyme it effects absorption in the gut wall. I didn't see were it would have any effect on transdermal delivery of medication and it's absorption.

    It's a shame when a doc won't use BT meds. With the righ BT meds you could have the relief when you need it and not need to jack your overall dose up during the rest of the time when you don't need extra relief. This would specifically hold true if you had additional pain at night, or upon rising in the morning. That's the only downfall of very LA meds, making rapid adjustments. It doesn't make sense to force a patient into accepting an increase they may only need 10 or 15% of the time.

    Hang in their Linda. Well get you straightened out.You should definitely benefit from Dexalone or at least a trial of dextromathorphan or Nemanda for it's NMDA blocking ability or using meth or levodromoran for BT pain for it's NMDA blocking ability.

    Good luck, Dave

    Many drugs interact with grapefruit juice. Grapefruit segments or an extract of unprocessed grapefruit
    cause drug interactions to a similar extent. Seville oranges (used in some marmalades, but not in
    commercial orange juice), purnmelos and tangelos may also cause similar interactions. Based on
    metabolic pathways of drugs that interact with grapefruit, we can predict other drugs that may have
    significant interactions with grapefruit. Grapefruit inhibits metabolism of oral medications by cytochrome
    P450 3A4 isoenzymes in the intestinal wall, decreasing the metabolism of affected drugs and
    increasing the amount of drug entering the bloodstream. increased drug levels can cause more side
    effects and/or toxicity. The interactions are most pronounced for drugs with low oral bioavailability. The
    effect of grapefruit on intestinal enzymes is irreversible and persists for up to 72 hours after grapefruit
    consumption, until more of the drug metabolizing enzymes are produced. Grapefruit is also an inhibitor
    of p-glycoprotein, an efflux pump in intestinal cell wall enterocytes that actively secretes absorbed drug
    back into the gut lumen. Organic anion transporting polypeptide (OATP) is another transporter system
    affected by grapefruit. Drugs that are significantly handled by p-glycoprotein or OATP may have
    decreased absorption when taken with grapefruit, possibly leading to loss of efficacy.

    Last edited by Shoreline; 05-14-2004 at 12:57 PM.

     
    Old 05-19-2004, 04:50 PM   #28
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    Re: Shore - ??? on switching to Methadone

    Hello everyone,
    I think my methadone experience is on here somewhere but I figured I would tell it again plus give an update. I was giving methadone by my doc after trying just about averything else but still experiencing increasing pain. I was taking 17.5 mg/day for about 6 months with oxycodone for BT pain. My pain continued to increase,kept increasing the BT meds, nausea increased anyway, finally had to quit my job. I assumed that by stopping driving 2 hours daily that my pain would decrease drastically and I would cut out most of the meds. My pain level did decrease some and the AM vomiting stopped and the BT meds decreased but I stayed at the same level of Methadone.
    Then my doc decided to take me off the methadone and see what effect that had on the nausea I am still experiencing.(it started before meth) He had me quit cold turkey and triple the oxycodone to make up for it. It was bad from the beginning but on the third day I had a complete meltdown with vomiting and complete distress so I resumed the methadone.
    Now I am doing a taper off the meth. I am about half way there but it's not easy. I did a lot of research and most people say methadone is NOT the same as other opiates for withdrawal including many people who said it is the worst and even worse than heroin. I take about 20 mg/day of oxycodone and each week or so I reduce the methadone by 1.125 mg (1/4 pill) and then increase to about 30 mg oxy to make up the dif. Then over the next week I decrease the oxy back to about 20 mg and then I am ready for another reduction on the Meth.
    Hope this makes sense, it's starting to thunder so i gotta go!

    farmboy

     
    Old 05-20-2004, 04:34 AM   #29
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    Re: Shore - ??? on switching to Methadone

    Quote:
    Originally Posted by farmboy7
    Hi ken,
    I just joined this board so I could respond to you, so you must feel honored, ha ha.
    Anyway, my doctor recently switched me off methadone and increased my oxycodone by triple the amount to make up for it. It did not work! I went into severe withdrawal by the third day, crying like a baby,vomit coming out my nose, the whole bit. My doctor said everyone is different and this should not have happened, but after a lot of reading and talking I am discovering that methadone is considered by a lot of people to be the worst opiate to quit, even worse than heroin. People have told me about tapering down for a YEAR to get to 1mg and still being rough to drop that.
    It does work for pain like other opiates and that is why I am taking it. It does not really make you high but the other opiates never really did either, they were busy working on my pain.(crushed vertabrae+)
    Anyway, my advice would be to do a google search on *methadone* and *methadone withdrawal* and see what you find. I think that opiates can be used properly for pain if you take them only when you need them for pain. Methadone does not seem to fit that category for me as now I have to take it just to maintain my dependence and not be sick from withdrawal. I used to be able to skip a few days or cut way down if my pain was low, but not anymore.

    peace,
    farmboy7
    i hear you on that fb7 thats why i stopped my tolerance not only did i take it for pain but i had to to feel normal and to be able to function i used to be able to skip days to but that ended pretty fast hope your taper is going well what mgs are you down to now keep in touch kelleigh

     
    Old 05-20-2004, 06:48 AM   #30
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    Question Re: Shore - ??? on switching to Methadone

    This question may have been answered before, but I forgot. Is there a difference between methadone (not methadose) between manufacturers roxanne and mellenkroft ? If so, what ?

    Thanks
    Ken

     
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