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  • Shore - ??? on switching to Methadone

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    Old 04-13-2004, 02:10 PM   #1
    khoff
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    Question Shore - ??? on switching to Methadone

    Shore -

    I take percocet 10mg/2x a day for back pain. It is not doing the job (just slightly strong). I was given oxycontin 10mg/2x but it is also not doing the job. My new PM doc does not prescribe oxycontin and prefers not to even prescribe percocet if possible. He prefers methadone since he says it is better and his patients have told him about the less side effects and feeling normal again with it.

    My question is: Is methadone a stronger med than oyxcodone? If so, how much do you think I would start with and how often daily? I maybe moving from NJ to Virginia soon and I am also concerned that if I have to get a new PM doc there, how hard is getting a Rx for methadone as opposed to oxycodone? I mean I would hate to start something and then have docs say no to prescribing and having to go thru a withdrawl. I also heard it eliminates the "high" feeling with opiods which would be great, and is a NMDA antagonist so no more dex.
    Wondering what you think ?

    - ken

     
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    Old 04-13-2004, 05:19 PM   #2
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    Re: Shore - ??? on switching to Methadone

    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

     
    Old 04-13-2004, 07:52 PM   #3
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    Re: Shore - ??? on switching to Methadone

    I just wanted to coment because I recently made the same switch, except I was on 40mg oxycontin(oxycodone) twice a day and after my fourth back surgery I made the switch to Methadone. Although I am still in alot of pain I will say that the methadone,10mg 4 times a day, helps better than the oxycontin.Shore can tell you better than me but methadone is used as a long term pain med because it builds up in your body. My PM doctor wanted me to try it months ago but I would'nt because I thought oxycontin was the best thing for pain but I was wrong.Plus another good thing about methadone is that you can take the same dose for over a year or two without having to increase the dose. All folks are different but for me the methadone has worked better than anything I have tryed for pain so far. You could just try it for a month or so and see how it works for you.
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    Old 04-14-2004, 09:24 AM   #4
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    Re: Shore - ??? on switching to Methadone

    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

     
    Old 04-14-2004, 01:16 PM   #5
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    Re: Shore - ??? on switching to Methadone

    Hi ken,
    I have confidence that you will be able to discern the difference between methadone maintenance patients and chronic pain patients if you do a search on methadone withdrawal.
    I want to clarify that I am not an addict, I am a chronic pain patient. I injured my back and tailbone over 9 years ago and have been in pretty much constant pain ever since then. I have followed my prescriptions as required for codeine, percocet, hydrocodone, oxycocone, MScontin, and most recently methadone. I started taking methadone over a year ago when my doctor suggested trying it for the pain that was consuming me. I was working at the time and desperate to stay on the job despite my pain. The transition to methadone posed no problems for me and I was directed to take oxycodone in addition to the meth as needed for breakthrough pain.
    The methadone did work well on my pain at first and the dosage was increased once. After several months my pain level increased steadily and my oxy use for breakthrough pain increased but without results. Finally I had to quit my job because just driving there and back was murder on my back. My recent withdrawal from methadone was suggested by my doctor and it was horrible.
    The problem I see with methadone for myself is that because of its half-life it becomes something you have to take on a regular schedule for maintenance and not necessarily related to your pain at that moment. Any of the other pain-killers I took as needed and always as little as possible, sometimes cutting my use drastically for weeks if my pain was bearable....and with no withdrawal effects.
    It is unfortunate that some people have no empathy for heroin addicts because I have met some and they appear to be humans just like me. I also think we can learn from them since opiates are opiates and they have real experience with them.

    peace,
    farmboy7

     
    Old 04-14-2004, 02:43 PM   #6
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    Re: Shore - ??? on switching to Methadone

    Hey farmboy, Because meth has qualities that oxy doesn't but meth has every quality that oxy does, What you experienced was Differential withdrawal, when you switched from meth to oxyC. They could have given you 10 times the amont of OxyContin and it would not have stopped you from going through differencial withdrawal. No matter how much Oxy you take, It's not meth and that's why I experinced withdrawal when I switched from meth to Kadian and why most folks do experience one version of withdrawal when discontinuing it or switching from meth to another med.

    Farmboy, I did not intend to imply that you had addiction issues if it came off that way. I just did tons of research on methadone before I started taking it 31/2 years ago. I know how much digging you have to do or digging in the right place to find medical info on the use of meth for chronic pain. If you type meth withdrawal into Google and do a search, you won't find CP issues for about 40 pages.

    I switched from Oxy to meth, did a trial of Duragesic, switched back to meth and a few months later switched to Kadioan and then generic LA morphine. Then switched back again. Every time I have switched away from meth I have experienced differential withdrawal. It is quite profound but only last about 3 weeks.

    People experience the same problem switching away from Duragesic, first the steps are too large, 50% decreases at several points and secondly Fentanyl has more Kappa activity than any other opiate. The only other drugs in Fentanyls class are Demerol ands the other versions of Fenatnyl used in anesthesiology,ie. Carfentanyl, Suffentanyl and Affentanyl.

    So switching away from the patch is usually bumpy unless the doc knows the tricks of the trade.Only expose half of the portion of the patch that is exposed to your skin because what you absorb is based on the amount of transdermal area that touches the skin. If you only remove half the backing and tape it down well, you can effectively create a 1/2 a 25 ugh patch. Making the steps down easier. Using Demi short term because it has Kappa receptor activity too makes sense although long term use of demi causes seizures.

    The medical comunity actually thinks that meth withdrawal should be easier because of the slow termination and excretion from your system but does acknowledge it lasts longer but believes it's less severe. The only thing I agree with them on, is that it lasts longer and takes longer to start.If you take OxyC around the clock for a month and you miss a dose of oxy by more than 4 hours and you will likely be shaking like a leaf. Meth is much more forgiving.

    When I switched from meth to kadian, I got part way through the titration of kadian but the withdrawal was so unpleaseant I didn't want to simply increase my dose of morphine in hopes of ending the withdrawal. I would have experienced the same thing regardless of my starting dose of kadian, once the meth depletes, It aint fun. But when you have been doing this for 11 years a few bad weeks are worth months or years of relief.

    In my long winded post I said I had no empathy for heroin addicts. I will try to explain, I meant no empathy towards their withdrawal experience, It's a choice they made knowing the consequences , so I don't feel empathy for the withdrawal they experience. Secondly there is no doubt a single addict can bring an entire PM practice down, either by ODing or by selling their meds, the doc gets prosecuted and all the patients are out in the cold 700 times more likely to commit suicide than the average joe.

    I should have been more clear about what I didn't feel emopethy for. My own brother shot and killed himself over addiction issues surounding a back problem. I understand addiction better than most because I have walked on that side of the tracks myself and got clean in-patient when I was 21.

    The thing I was most greatful for was I had not wasted years , even decacdes of my life trying to catch the buzz from something that you will only truly find once. That is, the first time you used and got high on your drug of choice, everything after that is to try to recapture that initial feeling, and it never happens. I have seen family die, friends die, Docs and pharmacists loose their licence . It's not that I don't have empathy for addiction, It's the whining about the unpleaseant consequences of their own actions I have no empathy towards.

    Once in recovery I also have a problem with the preeching from the soap box that because they fell "Victim" to addiction, it's obvious nobody can resist the temptation of their drug of choice. With that I don't agree.

    There are people that can have a glass of wine every now and then and not turn into a drunk. There are people that have absolutely no problem complying with prescription instructions. Just because Joe blow couldn't handle OxyContin, doesn't negate the good this med can do for many people that are capable of following directions. Like yourself and many others.

    Because of my background, which my doc knows of, I look at my PM treatment as the last option and if I screw up I probably won't get a second chance. I know this from my contract, but I didn't need to sign a contract to know my doc wasn't going to belive all the BS stories addicts come up with to replace lost and stolen meds and the ones the cat ate and the dog, the carpet cleaner and all the C-2's stolen from gloveboxes, etc. etc. etc.

    Trust me, there isn't a BS excuse to replace meds every doc and pharmacist haven't heard. 60 pills, 2 a day equals 30 days, It's not a tough concept and my meds don't call me to take more.

    I'm sorry if it seems we got off on the wrong foot but I don't know you from adam. If you write something I don't agree with I will tell you and why and if we have to agree to disagree that's fine. But what you have experienced actually proves my point when you switched from meth to 3 times the oxy and still went through withdrawal. Not the same kind of withdrawal as cold turkey , but withdrawal because the cosequence of taking opiates around the clock is dependence, which isn't the same as addiction. Addiction is destructive, Nothing about any med I take is destructive, they improve the quality of my life and I'm willing to accept the fact that I'm dependent, Big deal.

    Discontinue Paxil cold turkey and see what happens. Are they addicted or dependent? It's not a drug of abuse, There is no pleaseant high, yet stop taking it cold and you're in for a ride.

    Anyway, I'm sorry I didn't properly explain my position and you felt offended farmboy, If you have been at this 9 years we probably have alot in common, because there was no such thing as OxyContin 9 years ago. I started years before oxy was on the market and then it took a couple years to take off. You name a non opiate PM modality and I have done it. Somethings are useful and the rest you toss. keep what works, It's certainly better to have more than a handful of pills to deal with your pain.

    Good luck and welcome, Dave

     
    Old 04-14-2004, 06:32 PM   #7
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    Re: Shore - ??? on switching to Methadone

    Hey shoreline,
    Nah, we didn't get off on the wrong foot and no offense taken here. We all have to be pretty thick-skinned if we have made it this far right? I can see from your response to my post why people have respect for you here and that we agree on a lot of things.
    But as you can tell methadone is a sore spot for me because just one week ago I was in my 5th day of withdrawal. I still can't figure out why my doc did not direct me to resume my regular dose after he knew what happened and that I was still in bad shape on a smaller dosage. I don't want to be overly dramatic, but just adding vomiting to being delerious can be physically dangerous plus I was bordering on being suicidal partly because I had no idea what was going on.
    We also can agree that each opiate has different effects on each person. Many people have told me that they can't tolerate codeine but I used it for years with minimal side effects. Now it seems nothing works for my pain for more than a couple weeks unless dose is increased.
    I understand what you are saying about how addicts can make it tougher for people who are in pain to get the medicine they need. Suspicious doctors and more government regulations. I went to a specialist for help and he sat there and told me I was not in that much pain. He refused to look at my x-rays, said he didn't need to. Then he gave me percocet which did nothing for me and my body doesn't seem to like it. Another doctor lectured me for 20 minutes the first time I saw him, telling me I had to exercise, sit properly,blah-blah-blah and that I could not stay on pain-killers forever. Then he said he would look at my x-rays. He came back all excited and asked me if I had seen what a number I had done on my back. I had. Told him the side view was the best and he agreed. Then he wrote out a prescription with 5 refills and told me to come back if I needed more. I didn't need to because he gave me a years supply.
    From my reading it is my understanding that when methadone is used to get people off heroin that the primary goal is getting off the heroin and maintaining them from going back to it. The goal is not to eventually stop the methadone also because it often results in failure and resumption of heroin use. If a person can quit heroin and return to society and be productive that should be viewed as success. I read this from one of the originators of methadone maintenace programs.
    Now I feel that this thread has been hijacked away from Ken. Sorry Ken! Is everything allright? Have we just got you more mixed up?

    peace
    farmboy

     
    Old 04-15-2004, 06:20 AM   #8
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    Re: Shore - ??? on switching to Methadone

    Hey farmboy, No doubt it's a rough ride, and many folks only think about the physical problems of withdrawal, However the depression is quite profound while going through withdrawal. When I switched away from meth my doc did a cold switch, thinking you can hop from one med to the other with no difficulty. It just doesn't work that way with all meds.

    Right now I'm considering implanting the intrathecal pump. I'm concerned about what I will go through when I switch but 3 weeks of withdrawal... I can hang. The NP that worked with me through the titration of kadian and withdrawal knows well about the problem and she promised to be there for the next time we switched. Now she's on medical leave for the next 4 months so I really don't know if they will properly taper me down as they increase the IT morphine. I know it needs to be done ,my NP knows it needs to be done but when I go back next week to talk to the doc I'm going to be real clear it needs to be done and schedule the implant right after a med refill so I can do it myself if they aren't open to the idea.

    Titration of new meds suck , but with my docs I know there is always light at the end of the tunnel. They won't stop untill I say this is the right dose.
    I called medtronics a few days ago to get more info and I'm glad I made the call, Last week they got FDA aproval for test marketing the sychromed 11, It's almost half the size of the old pump and has a larger resevoir. Like all technology, things are getting smaller and it doesn't make sense to create a large pocket for a big pump only to have to reduce the size of the pocket and the risks asociated with doing that when it comes time to replace the pump in 5 or so years. By then they will probably have the sychromed 111 out which will probably be even smaller and more programable.

    So I'm hitting the pump implant at the right time IF I can take part in the test marketing of the SM11 pump. I'm waiting to hear from the local medtronics rep who's on vacation.

    My understanding is that their are 2 types of aproved use of meth maint for heroin addiction , first is detox, not to last longer than 21 days an not to be repeated more frequently than 30 days after the last attempt to withdrawal from opiates. The second is meth maint. There is no limit on that and you do see folks on MM for 10+ years. The stuff doesn't make you feel good, so It appears to me your simply replacing one addiction for another.

    Yes, meth allows them freedom from frequent IV "Dangerous" dosing but at some point during 10 years I think programs should make attempts to detox and not just maintain. We have docs in the US that have no IDEA meth is even used for CP or that they are allowed to prescribe it. If the docs haven't got the word, you can imagine what the general population thinks about meth. I tell folks to tell people your taking Dolophine, that way they don't know what your taking and it's not a med they are interested in because they don't know if it's an NSAID or an opiate. I've seen CP patients that think Meth is an opiate antagonist, It's a pure agonist. So there is alot of misinformnation regarding meth.

    As far as docs, Yup we have all had the lectures and been warned about the dangers of opiate abuse and addiction. Surgeons are the worst, when their surgery fails, you become an addict that no surgery could have corrected anyway, forget their hardware snapped within 2 years and the fusions never grew, it was an addiction problem, I've hit that wall with all 3 failed surgerries.

    The longer you have been at this the more of the mill tour you have taken.

    There is a rising increase in CP patients involved in meth maint because it's their only options. It's certainly not the ideal way to dose meth for CP but when left with no other choice, I guess MM doesn't sound that bad. I was bed ridden after the last attempted fusion. L1-S1 and I've already broken the heads of two screws from this set of hardware.

    Without long acting meds I would still be in bed If I was still around. I had a heart attack on my 36th bday, from High BP from years of pain, and I have had PM docs tell me that nobody ever died from pain. The CP population is just 700 times more likely to off themselves though.

    The same goes for withdrawal. The medical comunity doesn't see opiate withdrawal as life threatening although deaths do occur, usually at the patients own hand because cold turkey withdrawal and depression is so severe. But suicide isn't the doctors fault. I don't know if I would sleep well knowing the patient I called an addict 6 weeks post op killed themself but I'm not a doc trained to flush their emotions down the toilet when it comes to patients.

    The good thing about meth is the tolerance factor, In 3 years I have had 1 increase and that was only after breaking another screw. The other advantage is the long half life, Every other month I have to go on a search on refill day because after 2 years Eckerds just can't seem to rememeber I need 450 tabs every month, even with phone calls 10 days in advance reminding them..So every other month my first dose of meds may not come untill 3-5 pm that day, the half life carries you just fine , you hurt more but it takes days for withdrawal really to wind up after meth disapates from your system.

    I have lots of research if you are ever looking for something just ask. Welcome and take care, Dave

    Last edited by Shoreline; 04-15-2004 at 06:28 AM.

     
    Old 04-15-2004, 07:04 AM   #9
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    Re: Shore - ??? on switching to Methadone

    Actually guys, I enjoy reading these posts as I know I will always learn something.
    I guess my only question now having read all this, would be a concern on methadone withdrawl should someday I would be able too if the pain went down from a successful surgery/procedure or just time with any type of therapy. Does coming off of methadone have to be so bad? Is there always going to be some type of withdrawl? I ask because I was on serzone and then zoloft for a long time and when I tapered off of them over a few months, I had no side effects at all. Now I know these are different type meds from meth, but does it have to be so bad?

    - Ken

     
    Old 04-15-2004, 08:00 AM   #10
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    Re: Shore - ??? on switching to Methadone

    Thank you Ken, for your excellent questions. I am facing the same thing as you (switching from oxy to meth) and am very nervous and have a lot of questions. I can't wait to hear the answer to your last one (does withdrawal have to be so bad?) I don't want to switch and regret it forever.

    Shore - I have a few more questions. You talk about the depression aspect of withdrawal. Can short-term antidepressant use help get over that hump? Also, I'm concerned that you say Methadone is much more sedating than oxy. I already feel tired all the time. Is there something you can do about that? Is there a medication you could take to increase energy while on meth?

    Linda

     
    Old 04-15-2004, 11:24 AM   #11
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    Re: Shore - ??? on switching to Methadone

    Hi ken and Linda,
    I hope I am not making meth. withdrawal worse than it is but that is what happened to me. Could be different for everyone. I think it was worse because of the way it was done and also because I had no idea what was happening. No warning from the doc. I think I would have opted for a taper down method instead and will be attempting that myself soon. The problem for me was the increased oxycodone use did not make up for the loss of the meth. plus I felt I was taking a lot of oxy since it was triple my usual. He also has now offered a subutex/suboxone plan for the withdrawal but I will probably just do the taper.. Methadone does seem to make me more drowsy/tired than other opiates, it was worse when I first started but you get a little used to it over time.

    Shore,
    Pharmacies! What a joke. You give them the scrip, they look at it and say twenty minutes, you come back and they say,"Oh.we don't have THAT." Walmart doesn't carry anything here anymore,and other pharms. are dropping the opiates too. Too many legal problems thanks to our government. I also worry because I am on a little rock in the middle of the Pacific and we depend on supplies from the mainland. During the last longshoremans strike everyone was stocking up on TP, rice and canned goods. I hope somebody has a stockpile of methadone too!

    peace,
    farmboy

     
    Old 04-16-2004, 08:34 AM   #12
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    Question Re: Shore - ??? on switching to Methadone

    Farmboy -

    I am sorry you had such a difficult time with a withdrawl from meth. I hope you are better now.

    My main concern is getting onto a good pain med that controls the pain but allows me to function. I hope I won't have to be on it for life, but should I, then I accept it. So my concerns now are how I would be able to function on meth, Would I end up being too drugged or tired, correct dosage and titrating up, and should I eventually go off, not having to go thru withdrawl.

    Ken

     
    Old 04-16-2004, 09:06 AM   #13
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    Re: Shore - ??? on switching to Methadone

    Hey Ken, If the side effects aren't to bothersome and you acomadate to them quickly you should be fine to function. Folks on meth maint for addiction can go to work after taking a single dose of 100mgs of meth. Nobody would ever know I take 150 mgs plus the morphine. When yourin pain opiates act very diferently then when your recreating.

    As long as your titration is slow and allows you to get used to the meds, It should not hinder your ability to function. If it does, than you may need to consider a different med. The idea of PM is to improve function so if the side effects don't allow you to function your not acomplishing your goals and then you may need to rethink which med is right for you. Be sure to give it a fair trial and allow your body to accomadate to the side effects before giving up on it.
    Good luck, Dave

     
    Old 04-16-2004, 09:56 AM   #14
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    Re: Shore - ??? on switching to Methadone

    How long would you say is a fair trial? I tend to "panic" when the side effects set in and want to give up right away.

     
    Old 04-16-2004, 11:56 AM   #15
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    Re: Shore - ??? on switching to Methadone

    Hey Linda, It takes 5 days of continuous use for your serum level to level out. So you can't even tell if the dose is right until the night of the 5th day. Then, from a safety point of view you should give it a week to accommodate before considering an increase. If you keep increasing say 20% every 2 weeks you have to accommodate to each dose so it may take 6-8 weeks just to get the dose right and then a month for the most bothersome side effects to deminish. Titration is no fun with any med, it just takes a little longer with meth because of the long half life.

    The two biggies that are hard to control are sedation and sweating. Sedation gets better with time, and some docs are willing to use stimulants. The new one, Provegil, is less like the amphetamines and a class111 , so your doc may be willing to work with that one if the sedation doesn't get better. But you still have to be careful driving at night, any dull hypnotic type activity will certainly put you to sleep. Watching TV. Sitting through a PTA meeting etc. and it's easy to fall asleep.

    The sweating thing...I'm not sure that ever really improves but that's going to depend on the dosage too.
    There is no reason that they can't at least get you comfortable within a month but may take a couple more before you really feel accommodated to the side effects. Any potent opiate can cause constipation so you need to use softener/stimulants prophelacticly so you don't end up impacted. However every side effect I mentioned can occur with any opiate, so it's really just trial and error finding the med that works best for you with the least side effects.
    Take care and good luck, Dave

     
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