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Arts470 01-13-2013 07:53 PM

Oxycodone liquid Switching to Methadone? Plus my story in a nutshell
Hello to all the wonderful people out there:

I was rummaging around the net trying to find some info on the proposed switch for me( to be administered by my primary doctor who has been over seeing my pain management) in two weeks from Oxycodone liquid hcl sol 5mg/5ml( dosage= 5ml-10ml every 4 hours/15ml at night time) to Methadone and decided it would be best to actually put my situation out there and see if anyone would be kind enough to share their thoughts and opinions. I am wondering mainly four things(though additional input and anecdotes are very much appreciated).

1. What is the advantage to using Methadone vs Oxycodone?
2. If the time it lasts is the main advantage(I have been wanting something that is more even not so up and down and my pain is constant with severe flare ups when I eat, talk, and move my neck certain directions) than is there another extended release pain medicine other than Methadone?
3. I mostly have heard of Methadone for recovering from Heroin addiction, is it actually as effective as oxycodone at relieving pain?
4. My main concern is being able to get off these meds when all of this is said and done and if I have to( due to chronic pain) use some form of medication it would be very situational and not around the clock. From what I have read online Methadone seems like the absolute worst to get off. This isnt so much of a question as it is a posed thought; I would love to hear feedback on what you think about the topic one way or the other. Would there be a reason why a doctor would think such a switch is a good idea. I know I have mentioned it being a pain carrying around the big bottle going to appointments and whatnot and the easy nature for it to leak here and there, but I would much prefer a little trouble than being stuck taking a medication forever or a month of withdrawls when I want to get off of it.

I have noticed that sometimes background info is helpful/necessary for others to respond, so here is a little bit of my journey/battle. I am a 25 year old woman relatively healthy, yet when I get sick such as with pnemonia/strep/bronchitis growing up- I really get sick. There is no such thing as the 'flu' or a 'cold' with my body I am either all the way healthy or all the way falling quickly into another illness.

I sustained a cracked wisdom tooth on the lower left side in January '12, but due to not having dental insurance I brushed it off, however, after a couple months of increasing sensitivity it began to give me terrible headaches and I went to the dentist in May '12. It was decided the tooth had become infected and due to the large chip in it/pulp exposed that it needed to be pulled out. I had the tooth removed the beginning of June '12. I did pretty good marginal swelling for the first six days and even seemed to get better days 6-9 after the procedure. However, on the tenth day I woke up so swollen my submental area(under chin) was touching my neck four inches down and I couldnt open my mouth at all. I went back to the dentist, he gave me different antibiotics and told me if I got any worse or did not see any improvement over night I needed to go to the ER, the next day I went to the hospital.

I was immediately rushed into surgery as the swelling was beginning to compromise my airway. Four days later I was released, although both my mom and I had a funny feeling I wasnt quite ready to go home. Less than 24 hours after being released my face swelled up even worse I couldnt breath and I had just entered one of the scariest moments of my life. The ambulance came, I was trached and once again off to surgery. I was in the hospital for 10 days that go round, and this time when they released me I had two tubes coming out of my neck to allow the infection to continue draining out. I was told I had Ludwig's Angina which apparently is pretty rare and it was a very serious illness to have. I began to realize I was not going to be going back to work anytime soon. I had the tubes removed a week after leaving the hospital, however, a week after they were removed and holes stitched up I began to swell up again and the trismus(ability to open mouth) was getting worse. A CT scan confirmed I had a new developing abscess and was sent back into surgery. I was in the hospital for 6 days. A week after going home I was once again admitted to the hospital the cellulitis was back and gaining ground and I underwent surgery for the fourth time. This is the middle now the middle of July. Due to the persistent infection my ENT decided to leave the tubes in my neck for quite a bit longer to insure all of the infection was gone before I was sewn back up. The tubes remained in my neck three weeks post surgery.

Throughout the end of July I sawn my ENT/surgeon(I happened to get him in the ER the first time around and sort of stuck with seeing him ever since) once to twice a week, began physical therapy to aid with helping my extremely swollen facial/neck muscles, and upon his direction went to Infectious Disease to see if there was something wrong with my immune system. I knew at this point something was definitely 'not normal' with my body, however, he(ENT) remained optimistic that this was the end to my deep space neck infections yet insistent that the way I reacted to the procedures and anti-biotics was not usual and not appropriate. Into the beginning of August I kept complaining that trismus was getting worse again and talking felt like I was shouting through a pin hole in my throat just to get a small sound out, ENT insisted I was getting better I had just been sick for so long and was probably getting tired of it but to trust I was on the up and up so I let my worry go and trusted their thoughts.

It was August 18th I was set to go to my grandma's 75th birthday in Boston(I am from Minneapolis) but on the evening before my neck scar began pouring out blood and purulent fluid even though my tubes had been pulled out three and a half weeks previous and I had had no drainage for the past three weeks. Needless to say I didnt go to Boston. A CT scan confirmed I had a large subcuntaneous fistula extending into the deep part of my left submandibular gland and in addition my submandibular gland was four times the size of that of my right, it was edging into other spaces causing mass inflammation of my muscles. This was, I believe, the turning point after which my ENT/surgeon began listening to everything I feel and he has since become extremely attentive to minimal changes since I am as he says 'the one in a million chance'. I went into surgery to excise the fistula and had my submandibular gland(left side) removed. My doctor commented to my family after the procedure that he was a little iffy if he should go ahead and remove the gland previous to the surgery, however, when he got to look at it he said the gland was sooo infected it without a doubt would have kept getting me sick and invading other nearby structures- it had to go. I was in the hospital for five days.

This enters in the 'I think I am better' but 'I am really not' phase of treatment. I, along with my surgeon, genuinely believed for the first time since May that I was getting better. The pain for the first time in close to five months became persistent yet intermittent, which is unfortunately now something I can only dream of. For the next month, until the mid October I was going to PT twice a week, seeing my ENT once every two weeks, and ID was continuing to work on my immune system issue. Then it all came crashing down. I remember having to get up early to go to PT getting on the bus at 6am, it was cold and I was burning up. Not sure exactly how I managed to make it through the bus ride followed by the mile walk, but where there is a will there is a way and I knew I needed help. When I arrived, Jennifer(my PT), knew there was something drastically wrong and called up to get me into see ENT right away. I had a temp of 102.7 and was for all intent and purposes delusional, yet, the CT showed nothing minus mass inflammation of my muscles in my face and neck which we already knew of. I was sent to see my oral surgeon with my ENT hoping that she would be able to shed some answers on why I kept getting sick. Xrays confirmed there was indeed root tip and piece of the infected tooth left so we planned oral surgery for Nov. 9th.

The oral surgery went well, however, she stated after looking at the bed of the old tooth she did not believe this to be the place of the problem and said I had to see ID(infectious disease) right away as she was sure I had some sort of super infection keeping me sick. I tried to explain that I was already seeing ID and they didnt think there was anything wrong minus my ENT issues and were still working on my immune system work up. She didnt want to listen- she is never good about that with me. I found out on Nov 14th from ID that I do in fact have an IGg deficiency which would make it hard for me to fight infections once I got one. There is replacement therapy, however, my insurance wont cover it till after one year of being diagnosed, or if it was at even worse levels than it is now. ID expects me to need such therapy in about three to five years unless I remain ill than I may need it fall of '13.

We still didnt have an answer on why my jaw felt like it was being separated and my face being crushed in half; I could tell my ENT felt absolutely terrible and was in a scramble to try and figure it out. I went to Boston to see my family for Thanksgiving with his blessing and my ID docs not blessing( I had just gotten a cold turned bronchitis she was afraid I was going to come down with pnemonia) and while I was up there I went to a maxiofacial oral surgeon/ENT MD for a second opinion via my grandmothers wishes. My fever was still persisting at times making me incoherent, I was not in good shape the day I went in for my second opinion. This man is truly remarkable though, I gave him stacks of manilla folders of records containing bloodwork/surgery notes/office visit notes/scan results and he was pulling things out that had never been brought up to me before. His major concern was that at some point in this whole process my mandible had become infected. I mentioned, well I have had CT's wouldnt that show Osteomyelitis? Oddly, ct scans often miss jaw osteomyelitis especially a newly forming infection in the bone. Given my fever, I was sent back home early to see my ENT in MN.

At my first appointment back home for the first time I broke down and cried, normally I crack jokes in my notebook that I write down and we banter a bit back and forth. I have been a pretty good sport but it had reached the point that I just couldnt do it anymore. He promised we would do something; I could feel that he could sense the change in me that I had been pushed over the brink and it was crucial to find some reason to hope. It is one thing to have an illness that is tearing your life apart it is whole nother thing when the Docs have no idea what is going on and you are left feeling half crazy.

I went for an MRI instead of a CT this time on the Doctor from Bostons opinion since it is better for detecting jaw Osteomyelitis, and sure enough as conclusive as a scan can be the radiologist was convinced my mandible was infected and it was beginning to move up past the medial angle( why my ear is hurting so dang bad). I went in for surgery to drain an abscess that had also developed in my neck as well as a biopsy/culture of my left mandible the week before xmas and got out on Christmas Eve. I had a picc line( a long term iv) put in in the hospital and I was given my first treatment of the Invanz while admitted to make sure I wouldnt have an adverse reaction( I am allergic to penecillin, amoxacillin, and levoflaxin). I was then discharged and began my 8 week course of iv antibiotics(Invanz). My ID doctor did a bunch of leg work and was able to pull some strings with my insurance company so that I am able to have home care instead of be in the hospital for 2 months which I was super excited about. I have been on anti-biotics minus a 16 day lapse since May( 8 1/2 months) mainly Flagyl and Clindamycin with sometimes them throwing in Bactrim mainly before the planned surgeries.

This brings us to the present, I apologize for writing so much it seemed impossible to cut it down any farther without leaving out details. I have about three more weeks of this round of the 8 week anti-biotic iv treatment of Invanz. I just went in for a CT scan this past friday(Jan 11th) after my ENT felt a mass he did not like inside my mouth, the scan was clean for abscesses( which he was ecstatic about) but in all honesty the inflammation around my mandible was worse than it was in the beginning of December yet the infection in my neck has calmed down: you win some you lose some. The plan right now is to finish these next three weeks of the iv treatment then wait one week repeat the MRI, take blood levels twice a week( to check ESR, C Reactive Protein, and WBC), and if things spike or show the infection is persisting I will go back in for a more invasive debridement surgery have some fillament put in and go back on home iv treatment for another 4 to 8 weeks depending.

And here we are full circle to my questions on Oxycodone vs Methadone, this past Friday I saw my primary doctor who has been overseeing my pain management working alongside my ENT/surgeon and Infectious Disease( who is overseeing my iv anti-biotic treatment). I dont drink and minus smoking a little maryjane in college days have never done any form of drugs and to be honest all the meds I take just remind me of being sick vs the life I used to have. I dont want any of them. But to stay on tract, she gave me the same prescription she has been giving me for the last month and a half when the pain started to pick up to the point it was torturous, 55ml/mg a day, however, she mentioned that she wanted me to try and stick to a certain amount every four hours and not to take it as needed. She followed that by saying, ' We will see how you do on this and then depending on that switch you to the Methadone in two weeks'. I am a little disconcerted about this, why would she think Methadone is a good option? I know she mentioned it would cut down having to take it so many times a day, but arent there other options? Is there any form of pain medication that is liquid or a really really tiny pill( I am clueless about any of this stuff and apparently have to start researching before I get put on something hellish)that I could swallow to do the same thing? My approach through this whole muck is that Doctors know best, I do not second guess though I am not a fly on the wall at the same time, but when I heard 'Methadone' it made me straighten up in my chair. Two weeks before she had told me 'Dont let anyone look at you funny or give you crap for the amount of medication you need, you are doing everything right and have been handed a terrible situation. I just wanted to let you know I am proud of you and how you have dealt with these last nine months', but now she is talking Methadone which only makes me think she thinks I need rehab or something. I am so confused. Is it really used for pain management? Does it really work? Is she only thinking of it because it is the only other liquid option available and it is horribly hard for me to swallow?

Any thoughts/questions/opinions on any of this would help so much! Sometimes it gets really lonely on a physical and mental level being sick for so long and I know so many of you have such a harder battle than myself and I am thankful for everyday I have here. Really, I havent talked to anyone that has been in a situation like mine and do not have anyone around me other than my doctors that know anything about these medications, so it would be really great to get some guidance on the matter.

Have a lovely evening!

Paininohio 01-16-2013 07:38 AM

Re: Oxycodone liquid Switching to Methadone? Plus my story in a nutshell
Hello, I don't really have any advice but i just wanted to let you know I was very moved by your story, and I hope you can get everything figured out. I wish you the absolute best of luck.

tiggertoo2174 01-16-2013 08:02 AM

Re: Oxycodone liquid Switching to Methadone? Plus my story in a nutshell
Methadone is far from the only extended release medication, but most are in pill form. It sounds like pills aren't really a good method for you. You could ask the Dr. about fentanyl patches (brand name Duragesic) which is applied to the skin and absorbed thru the skin, a new patch is applied every 48-72 hrs depending on how you react to it. I've never tried it, too many skin allergies to adhesivies, but a lot of people here have used it successfully. You might want to start a new thread specifically asking about it. Normally I would say don't ask for a med by name, but you are in a situation where you have very special needs so you may need to.


tortoisegirl 01-16-2013 08:51 PM

Re: Oxycodone liquid Switching to Methadone? Plus my story in a nutshell
I can answer part of this: Yes methadone is commonly used for chronic pain and is a very good pain med for some folks. Doctor's opinions on it really vary. Yes it gets a lot of bad press of folks overdosing on it, and because its used for addiction, but if you start at a low dose, increase the dose slowly, and don't mix it with benzos, alcohol, etc, its safe.

For addiction people wouldn't get a month's supply at a pharmacy like you do for pain. Its a popular med for pain as well as its cheap and easy to find in pharmacies (a lot of the other long acting meds are brand name only and expensive, so you have to get the pharmacy to order some of them as they don't stock them). The problem is when folks try to get high off of it and end up taking more, as it has a very long half life and builds up in the system.

It was the first long acting pain med I was started on and after trying most of the other ones, I've come back to it as it works so much better than anything else for me. I don't have any side effects from it. A lot of people like it as they say it doesn't affect their mind (they don't feel high or fuzzy). It can cause sedation though, especially at first.

Yes it probably is the only option for a liquid long acting med (as others need a time relase mechanism), but I don't think its a bad one. Its a little unusual for a first long acting med, but in certain cases its a good thing. I'd give it a try. I'd try the methadone before asking your doctor for fentanyl patches, personally. Fentanyl is considered stronger, although it could of course be dosed lower.

Keep in mind they will probably start you on it twice a day, but some folks need to dose it 3 or 4 times a day. Still better than taking oxycodone every few hours, and you should get much much more stable relief. Its likely you'd be kept on a smaller amount of the oxycodone liquid for "breakthrough" pain (ie. as needed).

Do double check the dose with your pharmacist and online just to be sure, especially if your doctor isn't a pain specialist. Some primary care doctors for example have been known to convert a patient's dose and start them way too high on methadone (or other pain meds). Starting at even 10mg a day wouldn't be unusual. Conversion with methadone especially is a big unknown.

What about capsules? Can you manage those? I'm thinking of Kadian specifically, which is a long acting morphine, and also has the advantage of being newly generic (many long acting meds are brand only and therefore expensive). I believe the capsule size is still pretty decent though.

I don't think you can open them and sprinkle it into food, but that is a good question to ask your pharmacist on...they will be much more versed on those specifics of meds then your doctor most likely. I remember Dilaudid pills being small. I know they now have a long acting form of it (Exalgo), but not sure how big a pill it is.

Its a good thought to ask them if any other long acting meds come in liquid or in a way which you could add it to food without destroying the release mechanism (for example you couldn't crush a pill which is long acting). Sorry if I missed it, but if you aren't seeing a pain management specialist, I'd highly recommend it.

They are going to be the best equipped to manage chronic pain, and will likely have more ideas to add to an opiate treatment plan. Tolerance is a big problem with opiates, and its easy for a doctor to keep giving you more and more of the medication, but harder to try to use a combo of treatments to keep the opiate dose as low as possibly.

They may have you jump through some hoops (for example signing a contract to only get pain meds from them and submitting to a urine drug screen), but it'll be better, especially in the long run (its rare a primary doctor will even prescribe a long acting med, and if they do, they likely have a dose ceiling in mind they don't like to exceed, so after that you'd have to switch doctors anyways). Best wishes.

missindi 01-17-2013 05:54 AM

Re: Oxycodone liquid Switching to Methadone? Plus my story in a nutshell
I just wanted to say how much your story moved me. kadian, as mentioned above, is long acting morphine (I've just swapped to it myself and so far so good). It is in capsules but the granules can be sprinkled in any food, no need to swallow a cap.

My PM was thinking methadone (I've been in pm on OxyContin for 7 years) but I am not keen on it because it can have some heart issues, not common, don't worry but I have some minor heart stress from 2 very long surgeries I underwent in 2008 and 2010. When I brought this up with her, she is my neurosurgeon as well as PM, she immediately agreed that kadian was a better option. It is also easier in the short term if you are undergoing further surgeries as methadone can make anaesthetics more complicated. This is why, reading your story, I would think that long acting morphine, fentanyl patch or OxyContin may be better for you at this time. Methadone is wonderful for long term relief though.

Let us know how you go :)

tortoisegirl 01-18-2013 07:00 PM

Re: Oxycodone liquid Switching to Methadone? Plus my story in a nutshell
I looked at the prescribing info for Kadian and agree it says you can open the capsule and add it to food. Sounds like you have another couple options to discuss with your doctor besides the methadone liquid (anything that comes in capsules that can be opened, such as Kadian, and fentanyl patches). Plus, all three of those have generics.

Hopefully your doctor can discuss the pros and cons and you can come to a decision of what route is the best, instead of just starting on methadone as an only option. If I had to give an opinion, I'd go for the Kadian. Both the patches and methadone can be tricky. Everyone responds differently to meds, so there is of course the chance that you'll just end up trying something else shortly after.

Oh and also, I wouldn't worry specifically of one med vs. another being difficult to taper off of, as its always possible to switch to a different med to taper off of, if needed. I actually think methadone is a good med to use to taper as it has a long half life. You just can't expect to do any opiate taper fast and not be miserable. However, usually folks aren't started on a long acting med though if its expected they will be getting off of them in the near future. Plus there are meds that can be helpful for withdrawal.

So in short, that shouldn't be of too much concern when choosing a pain med. Also, you mentioned having to carry around a large bottle: your pharmacy should be able to provide you with a small duplicate bottle which you can put some of the medication in (so you will still have the prescription label on it so you are legal). I ask for this every few months so the date isn't too long ago.

Keep us posted. Best wishes.

Arts470 01-18-2013 09:36 PM

Re: Oxycodone liquid Switching to Methadone? Plus my story in a nutshell
I just wanted to thank everyone for taking the time to reach out and share their thoughts and opinions with me, it has truly given me some things to think over the next week before I see my doctor.

Paininohio and Missindie, thank you so much for your kind words. Sometimes it can get really lonely and secluded being sick as I am sure you know as well. I know I am blessed in so many ways and too have the care I do, however, at times the seclusion from not being able to communicate or having anyone around me that can some what relate can get so heavy. I have always been a very introspective and positive person, yet this is a level of 'solo' is new and I ardently attempt to keep whatever hardship I have on my shoulders and not those I love.

Tigg, thank you for mentioning the patches. I do think after looking into them it maybe a little bit of too big of a step up, however, application wise it is somewhat perfect. I cannot think of a better method and not having to take another medicine so often would be wonderful for me physically and mentally. However, considering I have been able to keep my dose of the oxycodone liquid pretty much the same from the start after my first surgery in June(50ml a day) to Now(55ml a day, just a bit more at bed) and it still works well I don't think I quite need to do that yet. I may have two or three more surgeries ahead of me and having been attempting to stretch out the doses and keep it low just in case it ever gets to a point when the pain once again escalates and I need to make a switch or little bump up that it will still work.

Tortoisegirl, thank you so so much for all the research. After Kadian was mentioned twice I looked it up and saw on their website that it can be opened up and put in applesauce or the like(I do this with my nerve medicine) and that would work just fine as well. It seems like all the other long acting ones according to my pharmacists are pill form that cannot be broken up because of the binding agent like you mentioned. I am in the odd situation of having wonderful wonderful healthcare due to being let go from my job of five years because of being ill and my prescriptions are entirely paid for; my health care/medications/treatments are the only thing that I do not have to worry about as far as a financial hardship by all other accounts I am dead broke. Accessibility can be a bit of a pain, I dealt with that with this liquid med I am on currently, but I have to go to the hospital at least once a week anyhow and they always stock it and my pharmacy that is one block away just started ordering in anything I need since I am on the picc line it helps me avoid having to travel so much by bus in the winter. Your idea about the little bottle is genius- I cannot believe I never thought of asking for that! The legality of it always stopped me from splitting it up and putting in a smaller little shampoo type container which I have contemplated. I did some more reading on Methadone after every here has said it indeed does work for pain I put it back as an option in my mind and affordability seems to be a big factor. I am partly also wondering if my doctor was trying to help me out in that regard as she knows I am still waiting on my disability pay and it has been months and months with no income. However, since cost is not an issue with my insurance the difficulty of getting off of the medicine really is a huge topic for me. Perhaps I need to talk to my doctor frankly about what she and my surgeon really expect, maybe this isnt going to get better as swiftly as I would like it too. I do not know too much about medicines whatsoever, but I know a little bit on the science ends of things. I was wondering if you could explain more why you think this shouldnt be a deciding factor, I am curious since it is probably my biggest motivator to reaching out to you all and finding opinions outside of dealing with the pain itself. Everything I have read outside of this forum on Methadone suggests the 'withdrawl' phase lasts about a month whereas with other forms of long acting medications it is a week. I am a stubborn taurus and when I set my mind to something I can do it, but after being sick for so long I can just not imagine choosing one medicine that is 4x the recovery period from it. I am asking because it seems like you may see a pain management doctor and you probably definitely know more than I do as far as the 'switching to another med to taper bit'. What you said almost reminds me of my doctors response of 'this is not going away anytime soon even when the infection is under control it is a chronic problem ontop of all the other operations done. I think it is best to do whatever we can to keep you comfortable and when the time comes that we can talk about as needed medication we can do that, but it shouldnt be something you have to worry about right now.' It is also possible that my surgeon might have just scared me when he made a comment to me in September when we thought I was getting better that I was going to need some pain meds for a long time, but to know that cutting back was going to be hard and that I shouldnt get mad at myself about it or anything I had just been on them for such a long time at a certain rate. I have never experienced any form of 'withdrawl' so I will be the first to admit the fear in the unknown is definitely part to blame.

Does anyone happen to know if Kadian( I think I read it is morphine long acting) is equatable to oxycodone in strength or is it also a big step up like fentanyl? I know dosing can be compensated for( meaning I would take less ml/mg of the new med or vice versa), but I am interested to know where it stands in strength like for example I know vicodin is weaker than oxycodone. So far Kadian seems like the one I will definitely be asking about. If price/availability is not a consideration point is there a different medication people know of that is possible?

Once again thank you all so so so much!!!

missindi 01-28-2013 03:58 AM

Re: Oxycodone liquid Switching to Methadone? Plus my story in a nutshell
Hey there,

How are you going? I take Kadian (Kapanol as it is called here). I just swapped from oxy because I couldn't cope with the ups and downs anymore. I hate withdrawals, especially when I am a pm patient who has not and will not abuse her meds. Unfortunately the duration of action just gets shorter the longer you take it and even taking OxyContin 3 times a day I was getting wds after 6 hours.

Back to Kadian, the conversion dose is approximately 1.5mg morphine to 1mg oxy. So if you take 50mg oxy a day, you will likely need around 75mg Kadian. However, most pm doctors will take into account what is called cross tolerance, which is based around the fact that these opioids hit the pain receptors slightly differently and so therefore you may have a stronger reaction to morphine even though you have been taking oxycodone for an extended period. The average cross tolerance reduction is about 25%. Soooo, due to this the average pm that is conservative will do a basic one for one mg swap and then increase the morphine as you settle in, those more confident may offer more. In Australia they are pretty conservative so I had a one for one swap and then we raised it 6 (rather painful but no wd) days later.

Hope this helps :)

tortoisegirl 01-28-2013 08:54 PM

Re: Oxycodone liquid Switching to Methadone? Plus my story in a nutshell
Sorry I missed your reply earlier Arts470. Sounds like either Methadone liquid or Kadian (in food) is a good option. Yes I still agree that with the chronic pain and ability to switch to another med if a taper was needed (as well as if you do a taper slow enough, you will barely get withdrawal symptoms), its not something that should be of concern right now.

You wouldn't just stop taking the med (ie. go into full withdrawal), but taper it. I'm guessing that what you read about methadone withdrawal was more on the addiction side as well. But yes its quite easy to switch to another med for a taper if needed, but they definitely wouldn't be putting you on these meds unless they thought you were going to be on it for years, not months. Even the daily oxycodone you are on now would need to be tapered to avoid more severe withdrawal.

I'd just work with your doctor to find a med that works. Keep in mind its very typical to need to try a different med, whether one isn't helpful for the pain at the dose the doctor is comfortable, or you get intolerable side effects.

Yes morphine products such as Kadian would be a good switch strength wise from oxycodone. In fact, morphine is technically weaker (ie. you will be taking a higher daily mg amount for an equivalent dose). Also, keep in mind equivalency charts are just a starting point. It can vary a lot, especially for some people and some meds. Doctors commonly start at 50% of what they think you will need.

Even without price I think its a good medication choice. Fentanyl and dilaudid (Exalgo) are both stronger meds. Oxycontin, Opana, and Nucynta can be more hit & miss. Kadian has a good long acting effect and is a "weaker" med, so better to try when your dose is low. Avinza is another option (brand only) that is very similar to Kadian (also morphine capsule), but even longer acting. Some folks respond better to one or the other.

Yes you are correct than any med can be dosed equivalent, but one reason to go in terms of strength is that side effects will be higher. For example, equivalent doses of hydrocodone and oxycodone. You are likely to get more side effects with the huge dose of hydrocodone. Definitely see what your doctor says though. They will likely have their medication preferences.

I'd first ask something like "in addition to medications that come in liquids, what about any that could be sprinkled over food, like a capsule?" ie. try to get them to come up with the idea, instead of just going in and asking to be prescribed Kadian. If they don't come up with Kadian/Avinza after you asking about pain meds that come in capsules, they I'd have some doubts about them honestly (unless they just don't like to prescribe morphine for whatever reason, but its more likely they wouldn't prescribe oxycontin, methadone, or fentanyl). Best wishes.

Mikeh66 03-19-2013 08:04 AM

Re: Oxycodone liquid Switching to Methadone? Plus my story in a nutshell
I have been on methadone (90mg/day) for a couple of years with no problems. A couple of months after you start you wont even know you are taking a drug with the exception of the pain relief that is fairly good (nothing is perfect).

Best of luck and may God bless you


Boxerluver 03-19-2013 12:06 PM

Re: Oxycodone liquid Switching to Methadone? Plus my story in a nutshell
Something to remember is that fentanyl is stronger but that is why it is prescribed in micrograms. Fentanyl can be equalanalgesically compared to most of the meds. Personally with what you have been through and are going through, starting off on a small 12.5 mcg patch would not be that much stronger than methadone. Obviously speak with your doc and do the research. People get so hung up on how strong fentanyl is, well yeah if you start out at 100mcg. But with as long as you have been on oxy and compared to the methadone, it would not be too strong. But again, speak with your doc. Another option for you as you sound like me in wanting tons of info, maybe make an appointment to just speak with a pain management doctor to get the info and his/her take. Just a thought!

assassoid 03-19-2013 09:18 PM

Re: Oxycodone liquid Switching to Methadone? Plus my story in a nutshell
"My main concern is being able to get off these meds when all of this is said and done and if I have to( due to chronic pain) use some form of medication it would be very situational and not around the clock"

I can attest that methadone with my experience is the absolute hardest to get off of, because it's so long acting. People are talking about Kadian as a possible alternative, I agree. Morphine is easier to get off of than methadone I speak from experience. If you're switched from methadone to another opiate/oid of equal potency it's not really a big deal but coming off of it is a bit harder.

Mikeh66 04-26-2013 08:08 AM

Re: Oxycodone liquid Switching to Methadone? Plus my story in a nutshell
Methadone will last as long as the dosage, by that I mean if you don't get relief all day you only have to increase the dosage. Once you get use to it (you get a little drowsy) there are almost no side effects at all.

I am taking 90mgs/day and have 85% relief all day and night.

Best of luck and God bless you.

tortoisegirl 04-26-2013 02:03 PM

Re: Oxycodone liquid Switching to Methadone? Plus my story in a nutshell
Mikeh66: How often do you take the methadone? For me, I definitely need to take it four times a day, no matter the dose. The majority of the relief wears off after about 5 hours for me. However, I'm probably in that smaller percentage of folks who metabolizes meds fast. For example, I couldn't even get the fentanyl patches to last 48 hours, even being on two and changing one of them each day.

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