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    Old 11-27-2007, 08:36 PM   #1
    mrscoop
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    Angry very nervous about changing meds--need advice

    Anyone with any advice--please--. I currently have no insurance--ahhhh--my scripts are totalling as much as my mortgage!! My pm doc suggests switching to methadone. Currently I'm on 320mg/day oxy, 20mg/ml oxyfast BT. He'll, I'm assuming, wean me from one to another. He said it would take weekly visits to monitor the meds. I fully respect this doc and don't for a minute question his judgements. I'm having a mental block with the methadone though. He was very clear to say that it originally was made for pain but was found later to work well for heroin withdrawl. My fear is that if I ever go off pmeds --methodone--(he has mentioned I won't be coming off anytime soon) that the withdrawl would be far worse than the oxy I'm already on. I don't know that I have all the info I need to make a decision on which meds would be better (more effective) with less withdrawl symptoms. The only reason, as I stated earlier, for the change is $$$$(about a $1100.00/month difference). Is methadone a federally subsidized med making it so cheap. Any info/advice asap on methadone would be helpful. I am fully satisfied with the relief I get with the oxy and hate to change. I just can't seem to get over this mental block. When I asked the pharmacist about the meth., (knowing full well I take the meds for pain and have dealt with her for quite some time) she asked me "when did I start with the Heroin Problem?" Needless to say I lost it on her!!! I just need someone on this site to give me some info without assuming I have a "drug problem". The only problem I have is that I can't get good information about a potentially dangerous narcotic!!!!

     
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    Old 11-28-2007, 02:50 AM   #2
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    Re: very nervous about changing meds--need advice

    Meth. Is a lot cheaper. Also,theres members on this board who say the Meth. works great for pain control. I
    Ive known people on meth[at the time] that were weened off very slowly,they had withdrawls of course,but with any opiate w'ds are going to happen.Now if somwone were to stop meth all together,with no tapper plan,then yes! They would be horrific.Please keep us updated. You may find[as some others did] the meth. works better!
    Yes,its also for heroin w'ds,but theres many meds out there for different things,for example,I take nerotin for nerve pain,its also for bi-polar,which I'm not.

    Last edited by madhatter; 11-28-2007 at 02:52 AM.

     
    Old 11-28-2007, 05:15 AM   #3
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    Re: very nervous about changing meds--need advice

    It's really a shame that a pharmacist in this day and age would even suggest bringing a script for methadone would indicate you have a heroin problem. Heroin addicts aren't given scripts for hundreds of pills to be filled at retail pharmacies. Their doses are monitored and given daily only at methadone clinics. Anyone bringing a script to a pharmacy for meth is obviously taking it for pain. Your pharmacist should know this and the remark was totally inappropriate. Personally I would have used that moment to suggest you need a more educated pharmacist to handle your meds if his only knowledge of meth is it's use for opiate maint for addiction.

    Come on, How many addicts bring scripts for hundreds of methadone pills a month and are trusted not to gobble a month supply in 8 days? It absolutely never happens. Even folks that have been on meth maint for years, at best are given 2 day supplies at the clinic to get through the weekend so they don't have to choose between church or standing in line at the clinic on Sunday morning.

    Docs are going to start on the safe side and slowly work their way up. The good thing about meth is that even if they start you low, it may not provide the pain relief you need, but even a small dose will prevent withdrawal. I bounced between meth and morphine for years based on insurance coverage. No taper just cold switches from one to the other. You experience some differential withdrawal, but nothing more than a patient dealing only with pain issues would experience when making any cold switch. A cold switch away from meth is no worse than a cold switch away from any opiate. The idea that meth withdrawal is so much more severe is part of that myth and perpetuated by addicts that are still on meth maint 10 years later because they can't tolerate life without some kind of opiate. The fact is , had an addict been switched to morphine, it would prevent withdrawal just as well and discontinuing any opiate would be just as unpleaseant. Meth maint is just replacing one addiction for another when your still on meth maint a decade later.

    If they were to give heroin addicts morphine daily instead of heroin, the right dose of morphine would also prevent heroin withdrawal, but once discontinued the addict would have to face the stark world of sobriety and reality. You would see the same avoidance of discontinuing any opiate used to replace their opiate of choice. The only difference is that meth doesn't produce the high in controlled doses that other opiates create.

    Addiction is addiction, whether it’s to meth, heroin, OxyContin or Vicodin. The difficulty in stopping any opiate is the same for any addict. A hydrocodone addict will go through months of withdrawal just like a heroin addict. Physical dependence is inevitable for CP patients using opiates to control their pain, but without the psych component that makes facing life without their drug of choice virtually impossible. Someone dependent on methadone or any other opiate will also face withdrawal when stopped cold turkey, but CP patients don’t steal from their family, rob pharmacies and do home invasions of cancer patients for pain relief.

    There is a difference between simple physical dependence and true addiction your pharmacist doesn’t seem to be aware of. I’ve yet to meet an addict whose quality of life was improved by their continued use of opiates. However I have met many CP patients who’s quality of life was restored by controlled and proper use of long term opiates.

    The thing about meth, is you shouldn't pick and choose what part of the propaganda you want to believe, either believe it all like your pharmacist or dismiss it all when used for pain like your doc suggests. Believe your doc, he's being honest and accurate and if you had an addiction problem, stopping any opiate would be just as difficult when you through the psychological component of addiction on top of the physical aspect of dependence. Don't let misinformation and a stigma attached to methadone prevent you from finding relief. No opiate is easy to stop after years of use, the diference is the psych component that's not present when opiates are only used for pain.

    Good luck, Dave

     
    Old 11-28-2007, 01:32 PM   #4
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    Re: very nervous about changing meds--need advice

    Thanks for all your input. I feel much better having gotten the responses from both of you. Any feedback on why the drug is sooo much cheaper? Is it because it is federally subsidized from pharmacuetical(sp?) companies? Also is it possible for my doc to intermix both the methadone and oxy? Taking the methadone to replace the ER oxycotin but still keep the oxyfast for BT? The liq. works exceptionally well for me and I hate to have to replace it for something new. Thanks in advance for all your feedback. I really appreciate it. This way I won't be hitting the PM doc up with all these questions on my next visit!!

     
    Old 11-28-2007, 02:23 PM   #5
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    Re: very nervous about changing meds--need advice

    Dave, I don't think I could have worded things any better. My hats off to you.

    Scoop,
    I would think that you could intermix the oxy liquid with the methadone. I don't see any reason why you couldn't. I am sure he will decrease the oxy as he is increasing the methadone. The hardest thing is going to be finding just the right dose that will give you adequate relief. I hope things go well and let us know how things go.

    Brian

     
    Old 11-28-2007, 02:23 PM   #6
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    Re: very nervous about changing meds--need advice

    Quote:
    Originally Posted by mrscoop View Post
    Thanks for all your input. I feel much better having gotten the responses from both of you. Any feedback on why the drug is sooo much cheaper? Is it because it is federally subsidized from pharmacuetical(sp?) companies? Also is it possible for my doc to intermix both the methadone and oxy? Taking the methadone to replace the ER oxycotin but still keep the oxyfast for BT? The liq. works exceptionally well for me and I hate to have to replace it for something new. Thanks in advance for all your feedback. I really appreciate it. This way I won't be hitting the PM doc up with all these questions on my next visit!!
    I imagine you'll begin starting at a low methadone dose while titrating off of the oxy. But he could simply stop the oxy and start you on a meth conversion. Don't be worried when you see how low the meth dose is. For those who've been taking high narcotic doses, they convert to meth via a ratio, like 8:1 or even 10:1. Your doc sounds very wise, so just go with what he prescribes. And there's no reason you can't continue to use the oxyfast for BT. But given my great experience with meth, I bet you'll find, after settling on the appropriate dose, that you may need no BT med. I needed no BT med with meth and stayed on 80mg/day for years. I had come from the fentanyl patches at 175mcg/hour every 48 hours. That's very high, plus I was using 4-5 fentanyl lollipops perday at 1,600mcg each. Going from that to 80mg of meth a day was a breeze - no withdrawals at all. And I didn't start at 80mg/day, it was lower and we worked up to it.

    I don't know why meth is so cheap, just be glad it is.

    Best of Luck!

    steve

     
    Old 11-28-2007, 05:13 PM   #7
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    Re: very nervous about changing meds--need advice

    As always - Dave has explained the methadone issue very well. I especially like the fact that he has emphasized that withdrawal from methadone is NO DIFFERENT than withdrawal from other opioids!! For some reason the hype surrounding the supposed torture of methadone withdrawals gets the top spot on the "press release". It's just not proven that you can tell the difference between the agony of oxycontyn withdrawal and methadone withdrawal. If stopped cold-turkey, every narcotic is going to give you similar symptoms. As far as methadone being subsidised by the government, I have never seen any data on that issue. It would really shock me if that were the case. I think methadone is so cheap because it's been around forever and is not being marketed to recoup the cost of researching and developing its formula. It is an excellent pain killer. I was on it for about 2 years with oxycodone 30 mg. for breakthrough pain. My dosage for those two years stayed around 120 mg. per day until I switched to the Duragesic Patch. I hope you will give it a chance - all the best - Memere (K'Mac)

     
    Old 11-28-2007, 06:41 PM   #8
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    Re: very nervous about changing meds--need advice

    Dear mrscoop,

    Yes...I agree that Dave performed an excellent job in his discussion, and Memere (K'Mac)(!) appropriately "AMEN"ed his emphasis on methadone's place in the pain management world!

    Furthermore, we can never, ever, ever over-read that there is a drastic difference between addiction and dependence. People wouldn't generally think that I could go to a nuttier place...BUT...I simply travel further and further into crazy oblivion when people misuse those words!! The basic definitions should be blatantly apparent. (By the way [and off-subject], I also find it irritating when people incorrectly pronounce the word "realtor". It is "real" plus "tor"--NOT "real" plus "uh" plus "tor"!! Whew...I feel better.) Addiction is where people will do just about anything (lying, stealing, etc.) to get their euphoric fix. Dependence is where your body needs the medication--Rx'd by an appropriate physician--to function at its best. You're not out to get high. You're actually out to feel better through adequate pain relief--not excessive opiate (and other types of medicines) intake!

    I'm sure you are aware of all of this, of course. I just needed to vent...again.

    Give the methadone a try, and let us know how it goes. Please don't give the ignorant hype a second thought! Methadone is a pain reliever with great results for most people.

    We wish only the best for you,
    Jon (Conductor)

    P.S. "Hello" to Memere (K'Mac)...one of our favorites!

     
    Old 11-28-2007, 07:47 PM   #9
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    Re: very nervous about changing meds--need advice

    OK Jon, don't get me started....."inner-state" instead of interstate...."Febuwary"
    instead of February...."libary" instead of library....the list goes on.
    My grammar may not be correct but I'm a pronunciation snob. I confess. Commit me now!!

    Sorry, I'm done.~Mush

    ps Everyone's advice on Methadone is spot on.
    __________________
    undiagnosed lung and back pain after pneumonia in '03, tmj, migraines,(two failed surgeries for) Kienbock's disease

    Last edited by trowftd3; 11-28-2007 at 07:49 PM.

     
    Old 11-29-2007, 05:12 AM   #10
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    Re: very nervous about changing meds--need advice

    Hi mrsCoop, The only federal subsidized methadone, is that which is recieved at a meth clinic for addiction. Nobody is geting federaly subsidized meth at Walgreens or Right aid. Addicts only get tjheir meth from the clinic where the price is subsidized.. Patients are charged based on income for their daily dose that must be swallowed in front of an employee of the clinic.

    It's another half truth. It's true in the world of meth maint for addiction, and isn't in the world of pain management. Cost has to due with cost of production and market demand. A MMT clinic guys straight frm a wholesaler and the price charged addicts is based on income.
    Meth is subsidized at clinics because the govt sees MMT as a way to prevent crime to aquire a drug of choice and the huge long term expense of the risky behavior involved in IV drug use. It's cheaper to subsidize a meth clinc than to take care of an aids or Hep C patient for the next 10 -20 years.

    Meth wasn't popular for CP because of the stigma and the wide reaction each individual has which makes it unpredictable in treating post op or acute pain. But as CP patients we have the time to adjust a dose slowly over months. As a post surgical patient they need to know what works and how your going to repond. If hey took 100 people taking 400 mgs of morphine a day you would likely end up with a hundred diferent final doses after the titration period.

    Somepatients would convert at 3:1 and some patient would convert at 10:1 and the rest, every ratio in between. This makes the average GP or surgeon uncomfortable not knowing what an apropriate dose of meth is if a patient just had a hip replaced or back surgery and it makes some PM docs uncomfortable not knowing how to convert from one
    long acting to meth.

    Sorry, no subsidy for the CP patient, you aren't a high risk patient, prone to violence and exposure to aids and hep C simply because you have CP and no other choice financially when you don't have insurance. Any other myth you would like busted on meth.? The unpredictable response is why meth never took off as an acute pain med, The germans did invent it when the opium flow was stopped, but even with a potent new med, without being able to predict it's effect on an opiate naive patient, it never became a popular drug for acute injury because that variable made it unsafe.

    That's the only reason it isn't used in acute care and doesn't have a demand that drives the price of one 10 mg pill to to 10 bucks a piece. The real question is why is long acting morphine so expensive. Their using the same technlogy long acting contact uses that was created in the 70's on a drug that's been in use for over 200 years. There is no explanation for the price of LA morphine other than supply and demand. They don't even need opium to make morphine anymore. It was synthasized in '79 and there is no longer a need to import opium to even create morphine or codeine. If they still had to import the stuff from half way arond the world, it may make some sense. However pure greed and the desire for exececutive oficers in the pharma biz to make 8 figure incomes is why other LA meds are priced the way they are.

    Supply and demand is nice way to describe the parasytic relationship we have with the pharma industry. You die or hurt without their med so they can can charge whatever they want.
    Take care, Dave

    Last edited by Shoreline; 11-30-2007 at 05:19 AM.

     
    Old 11-29-2007, 07:39 AM   #11
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    Re: very nervous about changing meds--need advice

    I guess I have to be odd man out and disagree with the issue of methadone withdrawal. My therapist for CP is the director of a local drug rehab center and has witnessed all kinds of withdrawals. From her experience the long, drawn out withdrawals suffered from ceasing methadone therapy or addiction is really worse than the other opioids.

    But it can be treated in such a way that it doesn't have to be so bad. It's just that the treatment has to be very prolonged because methadone is stored in the body's tissues and causes what's called "tissue dependence." This happens to some degree with all opioids but not nearly as much as with methadone. So it takes much longer for the methadone to "leak out" from all the body tissue. But, again, this is treatable. You just have to be sure your doc understands this and is willing to bring you off of it extremely slowly and uses all of the withdrawal protocols at his/her disposal.

    I don't mean to be contradictory to what else has been written, but I believe this is accurate. But I'm always willing to be wrong. Enough said.

    steve

     
    Old 11-29-2007, 08:17 AM   #12
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    Re: very nervous about changing meds--need advice

    Quote:
    Originally Posted by mrscoop View Post
    Anyone with any advice--please--. I currently have no insurance--ahhhh--my scripts are totalling as much as my mortgage!! My pm doc suggests switching to methadone. Currently I'm on 320mg/day oxy, 20mg/ml oxyfast BT. He'll, I'm assuming, wean me from one to another. He said it would take weekly visits to monitor the meds. I fully respect this doc and don't for a minute question his judgements. I'm having a mental block with the methadone though. He was very clear to say that it originally was made for pain but was found later to work well for heroin withdrawl. My fear is that if I ever go off pmeds --methodone--(he has mentioned I won't be coming off anytime soon) that the withdrawl would be far worse than the oxy I'm already on. I don't know that I have all the info I need to make a decision on which meds would be better (more effective) with less withdrawl symptoms. The only reason, as I stated earlier, for the change is $$$$(about a $1100.00/month difference). Is methadone a federally subsidized med making it so cheap. Any info/advice asap on methadone would be helpful. I am fully satisfied with the relief I get with the oxy and hate to change. I just can't seem to get over this mental block. When I asked the pharmacist about the meth., (knowing full well I take the meds for pain and have dealt with her for quite some time) she asked me "when did I start with the Heroin Problem?" Needless to say I lost it on her!!! I just need someone on this site to give me some info without assuming I have a "drug problem". The only problem I have is that I can't get good information about a potentially dangerous narcotic!!!!
    Methadone is a very , very good pain reliever. Your doctor is correct, it was originally used for pain management and found to be helpful in drug abuse.
    My best advice would be to taper very slowly , since methadone has a long half life. It is certainly cheaper than oxycontin, oxycodone.
    What your PM should do is replace part of your oxy dose with a methadone dose instead, tapering the methadone up and the oxy down, until you are only taking the methadone as your main pain medication , although you may still need something short acting for breakthrough.
    Most pharmacists are well aware that methadone is used primarily for severe pain, and are not quite so ignorant to assume that someone is using it for heroin detox.
    If you should decide that methadone is not for you, you have to taper off slowly, reducing your dosage by about 10 % over a week , maybe less depending on how your body handles the reduction.
    I was put on it for RSD, and it worked really well at the time, but I had the same feelings that you did, how people would look at me given that most people are familiar with it being used as a detox drug.
    Hang in there, and I hope this helped.
    Sandi

     
    Old 11-29-2007, 08:34 PM   #13
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    Re: very nervous about changing meds--need advice

    Thanks so much for the feedback. all so very helpful but some very confusing. Dave--you lost me on a couple of things. Not sure if it's just too late at night to absorb it all--I'll reread everything again in the am!! And Steve, life w/o BT meds would be heavenly!! Thanks to all--makes you feel less alone and stupid when others have come across the same or similiar situations. I'll let you all know how my appt. goes. Thanks again! V---

     
    Old 11-29-2007, 08:37 PM   #14
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    Re: very nervous about changing meds--need advice

    sandi--I'm not understanding RSD--or I'm tired and temp. brain dead!!! Could you interpret? Thanks.

     
    Old 11-30-2007, 04:56 AM   #15
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    Re: very nervous about changing meds--need advice

    Hey Steve, I think it's perfectly fine to agree to disagree. The last thing I woukld want to see is everyone simply agreeing because that's what theyheard or that's what their doc said. Your info came from someone that's been treatting MMT patients and comparing their experience to CP patients. These are addicts, it's not a nice word, But when you remove the psych and addiction aspect from withdrawal it's a very different experience.

    I've discontinmued and switched cold turkey away from methadone at least 4 times and although it can be unpleaeant, when only dealing with the physical, it's nothing like what an addict experiences. Most of us aren't addicts and don't have the psych baggage that someone that spent too much time devoting their live to the pursuit of chasing a high that can never be found.

    There is also a completely opposite theory that suggest meth withdrawal is easier because the half life is so long it's virtually self tapering. A detox from an MMT facility consits of a 21 day taper, no exceptions, It's what the Fed law allows and they only allow 2 attempts per year. So if 5 days into it, they want to stop, They can go right back to the old dose and end the discomfort asap. Addicts aren't known for their ability to think much passed their present circumstance. They aren't even allowed to try again for months and if they have done it twice that year allrerady, it's not even an option to try again.

    21 days is a fast taper, but you have the stuff in your system for days as you said so it's not like waking up with no opiate in your system the way a short acting med would or any of the long acting meds that don't have a 30 hour half life. 14 hours after a missed dose of oxy and withdrawal begins. The real withdrawal from meth doesn't begin untiill 4 or 5 days into stopping meth cold turkey from my expereince.

    Personally I think the truth lies somehwhere in between the two theories, but then again, is it really comparing apples to apples when you talk about what an addict experiences and what a CP patient does when you remove all the psychilogical baggage of addiction. We spend so much time trying to educate the difference between simple physical dependency and addiction and here we are back at square one. There is no difference when it comes to withdrawal? Your not comparing apples to apples, or do you see no difference betwen anaddict and a CP patients psychological state when it comes to discontinuing a med and changing a way of life that is so ingrained in their system that the succes rate of opiate addiction recovery is around 10%.

    CP patients can be tapered at a much slower rate,they don't have the psych bagage that goes with addiction and yet here we are unable to distinguish between an addict detoxing and a CP patient tapering. How many times have you discontinued methadone or is this simply the observation of a meth maint worker that sees nothing but addicts struggling to stick to a rapid, govt aproved taper that addicts always have the choice to end and going back on MMT when they don't like how they feel and can't see past the day to day existance they have learned from meth maint and their drug use prior to seeking treatment.

    The mere fact that stopping the taper and going back to the maint regemin creates an entirely different mind set is a huge factor. Why feel bad if you have a choice to stop and continue on with what youhave been doing for years. When a PM patient switches away from meth, going back isn't as easy as deciding you don't want to play anymore. There is either a difference between addiction or not. Ya have to figgure out what side of the debate you actually believe, not just what one healthcare worker said. How many docs are ignored by a CP patients when told they shouldn't use opiates to treat pain? Where those docs right or is the compasionate doc wittat willprescribe right? I saw at least 10 PM docs over a 7 year period that didn't use opiates at all. That's what they believed, did it make them right?

    I'm sorry, but I don't agree you can apply what your providor saw during their stint in the world of MMT to the world of PM. Her opinion is based on the observation of addicts, not PM patients. What other similarities do we have with addicts on meth maint? Her perspective is certainly Jaded by the 100% rate of addiction to opiates seen in MMT versuses the 3-20% rate of addiction in PM depending on whose theory you want to believe.

    If the net and 14 years of PM has tought me anything, everyone has a different opinion and you can find a study or paper to support just about any position or theory you want to side with when it comes to the use of opiates.

    Not trying meth for pain due to fear of addiction or potential withhdrawal is rediclous. I bopped back and forth bewteen meth and morphine based on prescription insurance for years. I did cold switches and yet here I am. I never died never needed or recieved adjunct meds to make the transition smoother during those transitions.

    It's fine to agree to disagree, but I'm basing my opinion on what I personally experienced, not on what a healthcare providor witnesed at a clinic for addicts. The fact I'm not an addict makes the situation entirely different. I could see the light at the end of the tunnel, what does an addict see at the end of the tunnel when coming of meth, a 90 percent chance of relapse?

    Last edited by Shoreline; 11-30-2007 at 05:11 AM.

     
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