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  • switching from methadone to another long acting opiate

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    Old 01-19-2015, 07:43 PM   #1
    jake1980
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    switching from methadone to another long acting opiate

    Hi, my name is Jake. I have suffered from chronic pain all my life from several spinal issues. I have been on methadone and different break thru meds for over 6 years now, I am currently on 105mgs of methadone and Roxicodone 30mg up to four times a day as needed for break thru pain. Evidently the pain clinic I go to has got terrified of dea and said thry cutting everybody back to a total daily dose of under 100mg. They said they are not going to prescribe more than a total of 100mg to anyone. they are saying they are going by morphine equivalancy and multiplying what dose of methadone you are on times 3, they are saying methadone is 3 times the potency of morphine. they told me they want me off the methadone and are going to taper me over 3 months and switch me to another long acting pain medication that is less than 100mg a day in morphine equivalancy. after they cut me down and make the switch from methadone they are taking my roxies away also I don't know if there gonna take them away all at once or taper them, bottom line is between long acting and break thru meds the total daily dose cant exceed 100mg total, I am sick and tired of people with chronic pain having to suffer because other people abusing their pain meds and doctor to afraid of dea to properly treat their paeients this is b.s. I've tried to come of the methadone in past and got so sick I ended up back on it. I know this is going to be hell. They are tapering me at a rate of 10mg a week and just started yesterday. Anybody have any advice that might help it would be greatly appreciated.

     
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    Old 01-20-2015, 09:47 AM   #2
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    Re: switching from methadone to another long acting opiate

    Jake1980-

    Sorry you are having to deal with sort of thing-it isn't enough, having to deal with the daily stress of CP-but then to have your source of relief tampered with.....

    There is a lot of this going on in recent times-and it's really frightening.

    Methadone is a tough drug to drop off.......esp if you have been on it a long time-it is THE toughest opiate imho, to go down and off to another, when I was on methadone(I wanted off of it due neg side effcts)I went to Oxycontin 60mg tid(before they ruined it due to abuse)and when they changed that med, making it, well not effective for severe CP- from,then Opana, also not a good match-I went to Fentanyl patch, and have been on stable dose since.

    I believe there is a class of CP's that don't due to well on LA oral Opiates/opioids. But do very well on the patch=simply because not subjected to first metabolic pass, and I believe being on methadone drove my tolerance high-making those other LA drugs ineffective-for me......

    My dose is 100mcg and way above your soon to be implemented 100mg ceiling-I am not sure how they think that will work-You can't apply" cookie cutter "treatment across the board like that because everybody is so .......different, the way meds affect you will be totally different to the next.

    Now if my PM told me he's simply reducing my Fentanyl dose to equal no more than 100mg of morphine-and morphine was not a good drug for me anyways-no relief, that would drop my fentanyl patch down 25mcg-and I would def be suffering high pain levels.

    There is no comforting answer here-you are going to go through more trials and errors.

    Maybe switching up people's meds instead of increasing?

    I don't know.

    This is so crazy.

    If a paient is stable on a certain dose for long period of time, and doing well, because of it_Like myself, It should not be changed up on the patient. It is nt like we get TOTAL relief anyways-just more tolerable levels of pain at given times .

    You are not alone, op-. I hope it works out.
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    Old 01-20-2015, 07:24 PM   #3
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    Re: switching from methadone to another long acting opiate

    I'm so sorry you are going through this. I just went through a similar thing....my pain clinic is also enacting an across the board dose ceiling. They must be getting some sort of outside pressure, whether from the DEA, state, insurance, or all three. It makes no sense as some folks will easily build a tolerance above that amount, and others can maintain on Vicodin for decades, each obtaining the same pain relief. Its also very tough on a patient to drastically reduce their opiates, vs. say having a ceiling from the start (or even not using them from the start). I think when they are doing something like this they should take it more case by case, or even grandfather existing patients in and say sorry but no more dose increases (but not require dose decreases). There are some folks who end up doing better on lower doses or even without opiates (due to hyperalgesia), but I think they are exceptions to the rule, not the vast majority of patients as some doctors believe. 100mg/day morphine equivalent is a very low dose for long term management of chronic pain unfortunately.

    At my pain clinic the ceiling for Methadone is 60-80mg/day (not sure if there is a Morphine equivalent ceiling and they converted that to Methadone or not). I was on 120mg/day Methadone, and they literally wouldn't even let me just taper down to meet the new requirement. They insisted on trying Suboxone, with the hope it would be a good pain med for me, or at a minimum get my tolerance down so I could switch back to a lower Methadone dose. It turned out to be a big mess (see my separate thread), but the end result was pretty decent, at 40mg/day Methadone with fairly close to the same pain relief. I did however end up partially tapering down first, from 120mg/day to 80mg/day. Honestly I had no significant issues going from 120mg/day to 80mg/day in 3 weeks. I know however if I had continued it would have begun to be difficult.

    I had the most withdrawal switching from Methadone to Oxycodone, which they wanted me on for a few weeks to get the Methadone out of my system so I could start Suboxone. They just weren't able to give me enough to keep me comfortable. The other time I tried to switch from Methadone I also had great difficulty getting any withdrawal symptom relief and pain relief from the dosages they started me on, or even double (they usually are quite conservative and start you at even 50% of the expected dose).

    In the end I think I would have done better just tapering the Methadone from 120mg/day to 60mg/day and learning to live with it. It put my body through a lot of stress to literally have withdrawal for a month (plus I didn't tolerate the Suboxone well and had a migraine for over a week). I think they thought the Suboxone would be a less painful way to get my tolerance down, but I disagreed. However, I do like having some dosage wiggle room, have some less side effects (not as much as I expected though), and understand my doctors wanted to be able to put on my chart that I had tried Suboxone. I don't think they get what we go through when we aren't sitting in their office for 10-15 minutes once a month!

    I see some big issues with what you said so far. For one, conversion to and from Methadone is wildly variable, and at a minimum is known to not be linear. That is a big issue with dose ceilings, as they have to pick a conversion table to use (they don't all match, especially with Methadone). Secondly, they should not be reducing you Xmg/week but instead X% a week. It won't be so bad in the beginning (10mg out of 105mg), but after a few reductions, that 10mg/week will be a larger percentage. Hopefully that 10mg/week reduction is just for a few weeks and then you will be seen again to re-evaluate.

    So are you saying you need to get down to 33mg/day Methadone or equivalent of another medication, including breakthrough meds? That will be very difficult, especially once you get to the lower doses. Methadone is actually a good med to taper with as it is very long acting, so as long as you taper slowly, until you get to very low doses, it is often symptom-free. If it was me and I was in your shoes, I would ask to taper with the Methadone and see how your pain levels were at the end dose. It is quite tough for many folks to go from Methadone to anything else and get the same pain relief.

    Also, it may not hurt to set up some consultations with other pain specialists to see if anyone would consider continuing your high dose opiate therapy, or had other ideas for you. However, I wouldn't be surprised if you came up empty handed, as this dose reduction is happening a lot nowadays. I didn't even bother as I had seen the other local pain doctors before finding mine, and knew they were significantly less opiate-friendly.

    In the short term, if you are at 105mg/day and taper at 10mg/week, I'd guess you could expect to have little to no symptoms the first week or maybe two, then increasing after that. I'd discuss with your doctor making it a percentage thing, as after a few weeks 10mg/week is too much to comfortably do. I'd at least ask for something to help you sleep, as that is often the biggest issue with withdrawal. Clonidine is a common med to try for withdrawal symptoms. Its a blood pressure med but helps calm the central nervous system. Long term I'd ask them what you are supposed to do for pain relief. Hang in there! Best wishes.
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