Discussions that mention morphine

Pain Management board

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
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
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
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
Using BT meds is fine with meth as long as your only taking them when the pain increases. If a couple vics is how you relax after work then there is a problem. I've been on meth for several years at a much higher dose and have continued to get relief from BT meds
BT =break through pain. Pain that breaks through your base dose. If your PM doc is the one prescribing both Meth and Vics than you have nothing to worrry. As far as doc shopping, If you have a PM doc treating your X apain and you have your GP prescribing Vics for the same pain, all it takes is two docs treating the same problem with opiates to be called a doc shopper.

Many PM docs use contracts that spell this out. Use one pharmacy, do not except pain meds for the same condition he is treatng, etc. If the Vikes are left over from your old treatment plan are you going to be OK with just meth, Does your doc prescribe BT meds or would he to someone that has admitted to having a problem. You just have to ask yourself why your taking BT meds? because the physical pain has risen or simply because you have them.

Ive seen many patients that think because the doc gave them BT meds say 4 Norco a day, that they should take them as part of their PM regemin. If you do this what would you actually do if you fell and your pain level actually did rise. Then you wouldn't have the means to manage any additinal pain.

The last place a CP patients wants to go is the ER when you have increase in pain. You get labeled and treated very poorly most of the time. So save your BT meds for when you actually have an increase in pain that the meth isn't covering it. Only you know if your taking the Vikes because the meth isn't covering enough pain. If that's the case, Better to get your dose correct now than to wait 3 months and ask for an increase. Rapid tolerance to meth doesn't usually occur.

I went almost 2 years on the same dose, switched to morphine for about a year and then switched right back to my previous dose. I have BT meds and I may take one per day or I may take 3 or 4 depending on how much I hurt. But I don't take the same amount of BT med every day because I know I would eventually become tolerant to the effects and have nothing for when the pain did hit the ceiling.

When you reach for the BT meds you really have to ask yourself if your taking them because you hurt more or simply because you want to feel better. I know it kind of sounds the same but feeling good is not the purpose of PM. Increasing your ability to function is the goal.
Good luck and you can stay sober and take opiates. It all has to do with why your taking them and what do they do for you. I know several recovering addicts or alcoholics that now need PM. Their sobriety isn't compromised untll they know they have crossed the line from simply seeking relief from pain and likeing how a med makes you feel.
Take care, Dave

PS. The most common school of thought about BT meds, and this is mentoned in every LA med manufacturers full prescribing info. Is that if you need more than 2 doses of BT meds per day the base med should be increased. Not every doc subscribes to the same school of thought but it's a safe one which doesn't turn your BT meds into part of your daily regemin.
Hey Ken, MellenKrodt is both a pharmacuetical wholesaler, meaning they produce bulk meth , bulk morphine, and other bulk active ingredients for sale to other manufacturers that produce pills for retail sale. Mellenkrodt also has a retail division with a huge generic line where they produce and compound their bulk drugs into pills for retail sale. The generic methadone pill that Mellenkrodt produces for sale is called Methadose. Methadose is not a name brand drug. It's a generic equivelent to Dolophine.

It's no different than a company using a trade name like Roxicet for Percocet. Dolophine is the name brand methadone that generics are supposed to be equivelent to. Because Roxane makes the name brand Dolophine, their generic line is much closer as far as any variation of the amount of active ingredient. It would be hard to explain why 4 10 mg generic Roxane meth tabs didn't provide the same relief as 1 40mg Dolophine diskette since they all come from the same company.

The name can be different as long as it has the correct amount of active ingredient to be considered a generic equivelent is in the tablet, capsule or liquid. If the doc writes a script for Percocet and checks generic, You may get Roxicet, Endocet, or something without a trade name like
Oxy 5/325.

Mellenkrodt is the only bulk producer of methadone in the country, so they sell bulk Methadone HCL to Roxanne to compound into their generic 5mg and 10mg methadone tablets and the name brand Dolophine diskettes. But all the meth in the US comes from Mellenkrodt and is then compounded and marketed by other manufacturers

The difference is that the FDA allows a certain percentage of variation in the amount of active ingredient and still calls it equivelent. After going through withdrawal the first time I had to accept the Methadose tablets from the pharmacy, I had my brother who was Qualtity control for Bayer's special blood products annalyze a Methadose tablet. It came back at 8.2 mgs of methadone HCL. Within the FDA's allowable guidelines to still be labeled a 10mg tablet.

The guidlines allow a +15% or -20% variation in active ingredient and still allows the maufacturer to call it a generic equivelent. So any 10mg tablet of any drug could contain betwen 8.0 mgs of active ingredient and 11.5 mgs of active ingredient. This is why cardiologist don't allow their patients to take generics of certain medications. Because they know they are not all created equal.

If your dose is low, loosing a few mgs isn't going to cause a huge problem. But my dose is 150 mgs a day. If I use the Mellenkrodt Methadose I would only get 123 mgs of methadone per day. If Roxane is on the high side of 10 mgs the gap between both products could be as much as 35%. More than enough to cause someone to experience withdrawal.

If you stick with one product, and Roxxane is hard to stick with because amazingly, the only bulk producer of meth in the country has managed to capture 90% of the entire meth retail market.

Hmm. Sounds like a monopoly to me. Slow distribution of bulk meth to your competitors and the company that relies on Mellenkrodt for raw material can no longer fulfill their obligations to the retailers , so retailers change vendors to ensure a constant supply of methadone tablets, whether they are called methadose or methadone. Mellenkrodt can certainly gaurentee on hand quantities when they are the only producer of meth in the country.

The descision to put 8.2 mgs or 10 mgs into each pill is still up to the manufacturer of each tablet as long as they stay within the variations that the FDA allows. Meth is dirt cheap but if you can get an extra pill out of every 50 mgs of meth that's a 20% increase in product using the same amount of raw material.

I went through the same withdrawal a few months ago when I couldn't find anyone with the quantity of Roxane meth I needed. Fortuantely a mom and pop took the mellencrap back and replaced it with Roxxane methadone. Did all that make sense Ken?
If you start with Methadose, just stick with it and you won't notice a difference, because you will have had nothing to compare it too. Personally I would recomend using the Roxanne but there is no gaurentee you will be able to find a constant supply, and going through withdrawal every other month just isn't worth it.
Take care, Dave
Hey Ken, The most recent articles I read about meth used for chronic pain do admit that the conversion charts we have seen are not acurate as far as meth. They are simply a single dose compairson. But from what I have read, Most researchers think meth is 5-10 times stronger than Morphine. When I swithced from 120mgs of meth I got better relief at 600 mgs of morphine which was 5x the dose.

Oxy is even stronger than morphine so I don't think I would agree that meth is 8-10 times stronger than Oxy. Now if you using Oxy to try to deter meth withdrawal, which won't work as I described in my new thread to Farmboy, I could see where a misinformed doc would continously increase oxy as they decrease meth to avoid withdrawal, you could easily inflate your oxy dose needlessly.

You also have to remeber How meth works. The half life is 24-30 hours
Day one you take 15 mgs
Day 2 you take 15 plus have 7.5 left from the previous day=22.5,
Day 3 you take 15, have 7.5 from the previous day and have 3.75 from the first=27.25
Day 4 you take 15 mgs have 7.5 from the day before, 3.75 from the day before that and 1.8mg from the first=29mgs
This becomes you stable dose after 4-5 days, so you actually have twice as much in your system than you take every day.

What was your old dose of oxy. What it takes to prevent withdrawal andwhat it takes for anelgesia will be two different numbers, so even if you conversion looks a bit low switching too Methadone, It would still likely prevent you from experincing withdrawal from switching from oxy.

I actually started on Oxy and switched from 120mgs of Oxy to 60 mgs of meth as my starting dose.I experienced no withdrawal but the oxy had never managed my pain and I changed docs as my insurnace plan changed. My new doc didn't have a problem increasing my dose untill I was comfortable and more functional and I ended up at 120 mgs of meth
1:1 and stayed there for 3 years.Convertting too meth from oxy can be one factor and converting from meth to oxy can be a completely different factor but 10 times stronger than Oxy sounds very extreme and I've never seen it in any print but everyone responds differently.

You are sounding more confident about moving to Charlottesville. We don't have CVS here. When Revco was sold it was broken up between Eckerds and CVS. I can get Roxanne from Eckerds here but they use a local jobber to supply their C-2's, I imagine my back up mom and pop store uses the same Jobber.

Good luck, Dave