Methadone Stops Pain Meds?

I take Methadone. I had pain last year and went to the ER. They gave me two shots of Morphine. They did nothing. Now I hear that Methadone stops other pain meds from being efffective. Anybody know?

PAlady ...
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Pamela Neckpain

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Methadone does in fact block some narcotics from being as effective as they normally would be. As PAlady said it hits on a entirely differnt receptor in the brain then general narcotics and only a few others can break thru that barrier and those that also hit on the same receptor work better then thos that dont.

I read where that was in the intent when this med was first created and introduced into the addiction clincs. I also recall reading somewhere that the higher the dose you were on the more blockage effects occur.

This is where the big hype comes in concerning the dangers of methadone for those street addicts who are searching for that ultimate high,they cant ever seem to attain it no matter how much they take of what. I know a lady or I guess I knew here as she has passed on now but she was in the clinic after moving from one of the rural Ky towns that had shut down her pain management Doc for overprescribing Oxy and so therefore having the stigma of being a former patient of that clinic could not find adequate pain management and therefore entered a methadone clinc for her RSD and Fibro, anyway she had been in the clinic for almost a year and was getting "take homes" for a holiday weekend and her Son I believe it was took them off her hands for her. She simply borrowed a fent patch from her FIL and went to bed never to awake again.

Due to methadones long half life in the system she still had plenty of med in her that it made the Fent toxic and she went into respitory arrest while she slept.

Addicts will take methadone when they cant get their hands on Oxy or whatever their drug of choice may be and then maybe they run across some oxy the next day and snort some of that and then the next day to prevent feeling w/ds from that when they have no more will take some more methadone when in actuality the first dose they took and usually they take alot more then we do for pain is still in their system at half the strength they origionally took add to what they now have taken along with some of the oxy that has not left their system yet and now your talking about what can be a lethal dose of narcotic.

The really bad part about all of this is very few Docs that I have worked with or known that treat with Methadone are NOT educated as to how this med works. That is a very scary thought but by far too true. The folks certified and yes not just any Doc can treat addiction in addicts with methadone as they have to have a specific certification to do this,in other words a PCP whom is treating someone in his office for addiction with methadone can and eventually will be cited by the DEA or Lic.board in his or her state.

Any Doctor can use methadone in the treatment of pain as long as that person has no medical history of addiction without any kind og certification or classes on the pathology of the med.

Many times the RPH will catch misprescribing problems for those being treated with methadone from a Doc not knowledgable in how it works. Alot of meds can interfere with absorption and and methadone interferes with lots of other things. It doesnt mix well with far more substances then other narcotics.

All of this is why it necessary to titrate methadone at a much smaller and slower rate then other narcotics. An example is an added 10mgs to a person can zonk them like to a dangerous level if they are not adjusted to this kind of a dose.

It takes awhile when being put on methadone to accustom your body to it without having any kinds of side effects and the doses need to be adjusted slowly and you need time for your body to become accomadated to the med. Far too many times someone will start on methadone and have horrific problems associated with it and instead of giving it time to adjust properly in your system them want off and onto something else passing up what could have been a great cheap pain med for them.

I never suggest to anyone to ask to change to methadone as their primary med or advocate its use in anyone who is not positive they are going to be in this CP life for the long haul,it is as already stated a few times not a med that is by any means easy to come off of and the lowering of dose to ground level is a slow and I mean months slow titration down. I think far too many times some Docs dont give other meds a chance before putting someone on methadone.

I know during post op and the times I have been hospitalized after being put on methadone they had far more trouble stabilizing my pain issues then before I was on the methadone. I said in another post that the ratio of morphine to methadone is somewhere like 1:10 meaning that if I take 60 mgs of methadone I would have to take 600mgs of morphine to equal,that is absurd and would most likely kill me! So anything they give me is generally going to fall short of adequately treating my pain and only a Doc that is knowledgable in this would give me proper pain relief.

Didnt mean to get off on a tangent there. I get carried away sometimes and what I am trying to say gets lost in the saying of it. All goes back to the TBI,sorry.

How glad I am that I found this forum!!  I have MS and degenerative arthritis (w/7 surgeries on knees) along with some other med problems. My neurologist and my PCP are acting like scared chickens because I can't get pain relief. I take Lortab - 4 a day and soma and baclofen as well as neurotin.  I have been taking fentyl patches again after a 6 month respite and have 30 demerol a month (which I usually do not take all) for breakthrough pain.  Without some pain meds the degenerative discs in my back and spams from the MS make walking almost impossible.  Now they have decided to take me off everything and put me on a very large dose of methadone!!  I am terrified of methadone, especially in these amounts.  I take about 11 other meds for diabetes, PAD and bipolar disorder (geeze I sound like a hypocondriac!  But my PCP is not very knowledgeable at all - yet he is all I have here in this small town of 5,000.  My neuro wants the PCP to handle the meds on his own since he is local and the neuro is 45 miles away. I do not over take my meds, but my PCP told me a couple of months ago that I was going to me him loose his licenses and "have to pump gas" and "take food out of his kids mouth!!  I was astounded.  I moved here 3 years ago when my husband retired and was previously seeing doctors at Wake-Forest Medical Center in NC where the care was excellent.  I got refills on my meds there and never was made to feel like a druggie.  I go back to my PCP Tuesday and dread it.  I feel sure he will go with the neuro's recomendation and I am prepared to go with nothing rather than go on the very, very high dosage they want to put me on of methadone.

   Thanks for letting a newbie vent a little, my hubby is tired of hearing it.  I'll check back here often as the info is so good.  Promise not to bend your ear like this again.  I just so needed the methadone info I found here and wanted to thank you for it.

 

Welcome Roann to the forum. I have to say first your Doc should never have made you feel as though you were going to cause him to lose his lic. He would haveto have far more then you on far more then you get and still be doing something wrong! It is HIS JOB to TREAT his patients!!! That includes treating pain just like they taught him in school. He took an oath to do that maybe he needs a nice caligraphed copy of that oth for his bathroom and that way everytime he feels like spewing crap like that he can read it! So sorry but these are the kinds of things that totally enrage me about these Docs. Sounds to me like maybe he Needs to be pumping gas versus seeing patients that are sick huh?

Ok now back to what I was going to tell you. First of they are dead set on this change and it looks as though you are going to be long term opiate treatment them that is Ok and no reason for you to be scared enough to even think of going without pain meds.

The best thing to remember about methadone is the half lfe we keep talking about. Not like when you take a demerol as it is pretty much all but gone afterwhile but more like your Fent patch that you change every 3rds day,the bullk of the med is in there say on day two but 3 still has some. Methadone works kinda like the Fent in terms of staying in your body. Thus the reason to be careful how and when you take it. You wouldnt put a patch on today of say 50mcg and tomorrow add a 100 mcg.

This is what is important in switching from anything to methadone,take the least ammount needed to relieve your pain and get to the amount slowly over a period of time. I dont know any Doc that is familiar with methadone and how it works that would initially begin someone out on the dose they want them to be on in the end.

This can be tricky but you know your pain levels and you know your body better then  anyone and how high of a odse are they actually talking about? Did they give you any idea at all as to how much how often?

Tell them you want to start low and work our way up so that you can obtain the best pain relief with the lowest possible dosing since it looks as if your going to need to be on it longterm possibly forever and lower now means you have plently of room to work with later down the road should ou need it.

Methadone in those high doses to start off will always and I am saying I have never seen it fail,cause extreme lethargy and narcolepsy and if not very careful that in itself can be very dangerous. I mean you fall asleep no matter what or where or whatever if going on or your doing. Alot of folks laugh about it but in general it can be really dangerous and several clinics for addiction have been sued for not taking precautions for this and someone has gotten into an accident before the could drive home safely.

The objective here is to get out of pain with the least amount of side effects right? YOu dont want to sleep your life away I am sure. The only other effect I can think of and this may be important for you is it has a real tendancy to cause weight gain rapidly and all most all of the folks I have seen on methadone crave like NO tomorrow sweets!! I initially gained about 40 lbs the first year I was on it   Took me 2 more years to lose it and then another to learn how to eat healthy and bypass the "little Deb" isle at the supermarket. Since you tend to sleep in strnage patterns getting use to methadone you are awake on and off during the night and eating was how I passed the time!

You of course being diabetic do not want to let that happen.

I think all in all that they are trying to do what they think is best for you and leave you some leeway with other meds in the long term department. Putting you on methadone is really OK  and you should educate yourself to it on your own since it seems your hometown Doc doesnt have alot of knowledge concerning it. I dont want to scare anyone away from using it as it truly has been a GOdsend for me and there is a good chance with the state of mind I was in at the time I went on it I might not even be here to share any of this with you all had someone not had the forethought to try me on it.

I was at such high doses of Lortabs and percs and the constant ups and downs of getting short term meds to work was getting the best of me,then they put me on Oxy in Oklahoma and that made me so very sick everyday but I kept on it until I moved soth and they were in the middle of a drug war over oxy and no one would prescribe it so back to the ups and downs of short term meds again and I was at my ropes end for sure! Anway here it is almost 10 years later and I retain alot of my old life that I had lost, I still have those days when the pain beats me and the methadone but they are alot fewer and farther between now.

Just remember to start low and add slowly, If they tell you to take 2-10mgs three times a day then take one three times a day and see if that works if on day two your sleeping all day or waking up and not realizing you were even asleep at all then go back down more the next day and try 2 a day.then and only then after a period of time you feel ok with that dose then add only a half a dose every few weeks and I sure wish here that you could find a good person that could write you a titration schedule as I use to know a few on the old forum I was in but have not been here long enough to run into one. Try searching the internet and just google methadone titration and see what pops and if you get sent to a site for adiccts dont panic as their Docs are the greatest for this! They actually went to classes and are certified in dosing methadone. Any help you can take to your PCP in terms of dosing and titration would probably be a nice thing for him and you. I will als see if I can touch bases with someone I know and see what I can find.

Just educate yourself here and you should be fine and this isnt anything we dont already do with other meds it is just a little more complicated with methadone since not alot of Docs treating pain patients are familiar with its actions.

On one more note here as you already are on Fent then you should not have any conversion sickness or w/ds as fent hits the same receptors in the brain as methadone and as for the demerol whatever the conversion for the fent is will more then cover the demerol,percocet,lortab,thing.

I just dont want to scare anyone away from going on methadone that can benefit from it like alot of us have but as you should already be with any new meds your given the educate yourself thing is very important. I dont take anything and add it to the mix without doing my homework and I probably wrk more with my RPH then my treating Doc in this as he is my best source of info.

It truly saves lives and gives lots of folks new meaning to the CP way for them.

Here is one place that you can visit on the net that has a wealth of info concerning methadone and there are live chats as well as a forum much like this one and even though alot of those folks are on teh methadone for addiction there are some on it for pain as well. It is called methadone anonymous and it can be linked thru any search engine.

Good luck to you and again welcome to the forum as it is a wonderful place to call home as there are such a wealth of folks here with a unlimited amount of advice and info about so many things. And even if you just need a hug? Well this is the place to come there are far more of those here then any place I have found yet. The mods are great and join in the talk instead of sideline and monitor like so many other forums making them "real folks" with real problems like the rest of us!

I can't believe how much information I have received from all of you in just one day!!  I am much more confident about my appointment with my PCD tomorrow and thanks to all of you who have posted, I feel more like I can be in control of what goes in my body.  I am still a wee bit nervous that the Dr. will get so ticked off at me again that he will not give me anything.  As long as I can get my lithium and trazodone for my bipolar I think I can make it until I can find someone to help me. We live in Alabama and plan to visit our sons in Ohio the end of the month.  If I can just get some kind of meds so I can enjoy the trip I'll be on top of the world.  If not, I guess we will have to cancel.  We plan to be there 2-4 weeks so I will need a refill on whatever he decides to write - and I don't think he would even write a refill for Tylenol .  I haven't seen our grandaughter in 3 years and do so hope to go.

Anyway, I am going to go study the posts, I printed them off.  So I will be somewhat knowledgeable when he starts the lecture of the methadone treatment.  They plan to start me on methadone 4 times a day for a total of 60mg as I understood it. Sounds like too much to me, don't want to even think about starting that (if I do at all) prior to my trip. I will let you know how it goes. 

Thanks again, you will never know how much I appreciate all of you.

Wishing you well

I am glad we were able to assist you in some way.

I do want to say that 60mgs based on what your on now is not over the limit by any means but until you know how your going to react to methadone and remember the facts about the half life here, I would take half of that dose to begin with and most Docs arent concerned about taking less then prescribed only more. It may not effect you in anyway today but after tomorrows dose you will see some effects such as the lethargy and narcolepsy occuring so dont do anything dangerous for awhile.

It is a great med for alot of folks and it takes some getting use to but once your adjusted and accomadated to it you cant be too overconfident on it.

I truly hope your not left out in the cold in pain by dissing your so called Doc off as that is truly neglect on his part. I know it is possible as they can be weird and contrary creatures for sure but dont let him intimidate you by any means and you deserve to be treated fairly as Chutz said.

Once I got adjusted and use to my methadone my life took a wonderful turn for the better. It is so nice to go out or even away for the night and not have to worry about did I take enough meds with me or having to obtain water somewhere to take a pill and waiting for it to kick in so I can get back to the plan as with methadone even if you miss a dose you wont feel the effects like with a short acting med or even some of the LA meds. I now take my meds,the entire days dose at one time in the a.m. and yes I take it fairly early so I can lie back down when it kicks in because for just a brief time it makes me sleepy,so I have accounted for this and when I awake an hour or so later I am out of pain and feel well rested and ready to face the day.I have only rarely on a handfull of occasions over the last 8 years of being on it had to take more then I do at the one time daily dose, I wasnt sure if it would work this way for pain but knew it was given at the methadone clinics in a once a day dose and worked for them but once it was in my system good and I was accoomadated well to it then it works like taking it thru out the day on a schedule. Please do NOT attempt this by any means for a good long time and only then when your sure you have no side effects from the med.

I am thrilled for you that your getting to visit your kids and grandchild after such a long separation and hoping you get many many days of relief so you can enjoy the time spent.

Too bad your not staying in Ohio for longer or are not closer as there are some very good pain management centers up there and I have several friends whom make the drive from KY to Ohio each month to see one of them. The way it goes isnt it? Always better treatment away from home. LOl

Have a great vacation and please if you get a chance stay in touch and maybe some pics?

Roann,
That's wonderful news! Make your posts as long as you want - but it's especially sweet to hear something went well with a doc! Your doctor showed he has real character by owning his own errors, and rectifying them. If only most docs would do that, most of us would understand.

The best news is that your trip is a go, and i hope it's all you hope for and more - and that you have all you need to manage your pain while you're away.

Have a great time and be sure to stay in touch! I'm not sure you can post photos here, but you can tell us about all the real hugs you gave and received.

PaLady

NVR and Everyone else,
I need to lie down right now. Just so you know, I'm printing these out. I sift and sort
the information but I want to tell you I learn much more here than in the doctor's office.
Doctors in California aren't very good.
Pamela Neckpain