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    Old 05-22-2004, 06:34 AM   #1
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    Meth question for shoreline

    Hi, I have been reading some of the posts about methadone withdraw. Methadone is one of the drugs being considered for my so far uncontrolled pain. However the withdraw sounds pretty scarey and makes me wonder if it would be worth it even if it would work. Any words of wisdom for me?

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    Old 05-22-2004, 02:26 PM   #2
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    Re: Meth question for shoreline

    Well Angel, Any long acting med yo take 24/7 you will become dependent on. Whether it's morphine, methadone, OxyContion or Durageisic.

    To me withdrawal is withdrawal. There really isn't a med I would prefer to go through withdrawal on. If meth works , and you need pain meds around the clock , why worry about withdrawal? The only time that could happen is if your only reson for taking meth is financial and when you have insurance again you know you want to switch to a med that works better. So you know in advance you will experience some differencial withdrawal.

    In the grand scheme of things though, if someone is going through withdrawal, whether it's morphine, meth, usually what they are presently experienceing is all they have to compare it too, making withdrawal from that med the worst.

    Differencial withdrawal is very different than cold turkey, no opiates in your system withdrawal. Differencial is less severe and doesn't last nearly as long. The full prescribing info on Morphine says withdrawal symptoms from morphine could last as long as 6 months. IiiiiiiHow is that any better than 20 days worth of differential withdrawal.

    If you truly need opiates around the clock, the only time you would consider discontiunuing them is when they can resolve the problem that causes pain. The way I came through the system and the docs I had, Opiates were the last option, there was nothing else to try, no surgery left to give a shot, injections and nerve blocks didn't help and all the psycho bable relaxation stuff didn't get the hospital bed out of my den.

    So by the time opiates were offered, they were the last option. Withdrawal or being cut off was just some fear and the only way that would happen is if I screwed up and blew my docs trust. IN my case I'll likely always be on some kind of med, If the implantthe pump, I'll always be on some kind of opiate. Yes if the pump runs out and a toranado or huracane sweep away the docs office, the pump could run out and I coul;d experience withdrawal. But I really don't think that will happen.

    Meth isn't usually the first line long acting pain med PM docswill use. Titration is tougher, because of the long half lifes, The side effects can be a liitle more intense than some of the other meds but it alsohas some major pluses like NMDA blocking ability, being very cheap, it's very forgiving as far as being late for a dose. i have had to wait untill 5pm for the first dose of the day several times and the only thing I experience is ncreased pain because I don't have pain meds, But due to the half life withdrawal doesn't even start to get fun untill your serum level has dropped significant;ly , usually on the third day.

    If you miss a dose of OxyContin mby 2 hours you start feeling like crap. So what's better, Knwing if you late at all for a dose you will get sick or the posibility that down the road they may come out with a better med and yo will have to switch and experience differential withdrawal for a couple weeks.

    Withdrawaing from Benzo's can cause seizures, Withdrawing from Paxil can cause psychosis. These are consequences of the meds and the docs need to work around the known side effects to make the transition as smooth as poosible, But the whole physical dependence deal ocomes with any long acting opiate. The higher your dose,and the faster yopu come off the nastier the withdrawal.

    It's a decision that many CP patients struglle with. Is the relief you get worth the price you have to pay, "Physical dependence"? Do the benefits and the increased function make the trade worthwhile. My choice is dependnence or bedridden. So the choice is easy. Others don't have such clear choices. Having the pump implanted means I'm done for the rest of my life. I will be dependent on whatever opiate they put in t unless the cone snail juice works out .

    If you are not comfortable with bthe idea of being dependent, then you may want to taslk about your options with the doc. There are meds that are mixed agonist /antagonist like Buprenex and Subutex that have pain relieving abilitry biuty has a limit on how much you can take and on how much pain you can control, but dependence isn't one of the prices you pay, there are other side effects you have to deal with.

    With any pure opiate and you will become dependent. So whether it's meth or morphine or Oxy it really won't matter. Is met worse if it controls tolerance and keeps your dose from skyrocketing. Or is OxyContin better although folks seem to have a harder problem maintaing the same relief on the same dose. Although my dose is hgh, It's stayed the same. So woul;d coming off 150 mgs of meth be worse than coming off 600mgs of OxyContin. I doubt it. If your on a high dose of another med, You would be facing a long slow taper or misery with any opiate.

    If you are in the position of not being able to function without the meds then price of dependence is a small price to pay for freedom from a chair or bed.But it's something everyone has to come to terms with. If your in the initial phase of opiate selection I would be shocked if a doc started with meth. It's just unusual because unless you have allergies to all other opiates, It's unlikely that you have had any exposure to meth so your titration will take longer and must be slower than a drug like Oxy that you don't have to wait 5 days for it to build up just to see if your in the right ballp[ark. But for Neuro pain, It's considered the best choice. So your condition is part of drug selection too.

    If your doc is leaning towards meth, bring up your concerns and if you want to try Oxy or a morphine prep first, by all means you should be allowed to try one of those. The transition ffrom Oxy to meth or morphine to meth is easy, It's the reverse that gets hairy. Moving from meth to morphine, oxy or fentanyl is tough because meth is such a unique med.

    The same thing happens with Duragesic though too.It's easy to switch too but hard to switch away from. It's binds to receptors that morphine and Oxy don't touch. The steps down are rather large, 50% at some points, so discontinuing Duragesic or switching can be rough too. It just takes an experienced doc to manage the withdrawal effects and do the transition in a way you are both comfy with.

    What ever you decide, good luck, Dave

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