Doc forced to change methadone... need help

Hello all!  Its been a while!  I assume because I have been doing well.  I hope so anyway.  Well not so much anymore thanks to our great legislators and law makers.  I have been on 70 mg of methadone a day for about 2 yrs now with oxy 15mg for b/t and doing great!.  The methadone kept my pain levels down and most of all I did not have an up and down feeling with other meds I have taken before.  My doc told me last appt. that he could not prescribe methadone any longer because laws have changed in FL.  He said now if someone he prescribes dies of anything related to methadone use he can be charged with capital murder.  I looked it up and he is right!  He can be put to death!  His overseeing doctor in the office I go to said no more methadone precriptions effective immediatly.  You quessed it  that means no tapper at all.  He was not happy either.  He said he cannot believe the law but he has to protect himself.  He said i could go to another doc but no other doc in FL. will prescribe it now either.  THey all have stopped.  Even the Clinics.  So,  my choice was to be put on morphine cr 30mg or move to another state.   I asked him if i would go through withdrawals he said I should not since i am going to another opiate.  He gave me 30mg to take twice a day and if i needed to take 3 times a day with my usual 15mg oxy for b/t.  I went home and the next day stopped my methadone and started taking the morphine per his directions.  All was ok,  I was fine until about day 3 after I stopped.  I have noticed major differences.  First,  I tried to take only 2 x day, no way I had to take 3x day.  I am actually going into mini withdrawals.  Not horrible but I can tell a difference.  Now I have a bit more pain but I have wierd dreams, dont sleep well, get little sweats, and have a bit of a down feeling.  It is not horrible.  But I preffered the methadone much more.  It worked better and most of all it was smooth, no feeling of medicine ( a bit tired sometimes but thats all).  With the morphine,  my body lets me know its time to take the next dose.  I dont like that.  The methadone did not do that.  As a matter of fact sometimes I would forget to take my methadone.  Now I have to take much more of the b/t meds than with the methadone.  I dont like that either.  The worst thing is It is not really the pain that bothers me its the mini withdrawals I am going through.  I hate it.  Please give me some advice here all of you.  I have a good doc and he is seeing me in about a week.  He made my appt sooner to check how I am doing.  What should I do?  Do I need a higher dose of the morphine?  I dont really want to do that.  I had a good thing with the methadone.  It worked great for me, no medicine feeling , no withdrawal feeling, great pain control now the law makers have taken legitimate pain control from a person who used it as they were supposed to.

Thanks to all and any comments would be greatly appreciated.

Hi Shaw, I take methadone and live in Fla. I haven't heard about this law yet but am pretty fightened by your post! Jeeze, whats next? I have my monthly apt w/ my pain doc this week so I guess I'll be hearing about it soon enough. Do you think this has something to do w/ that blond who died in Hollywood, I forget her name but it made all the headlines. Although she had all kinds of drugs in her, methadone got all the press.

Good luck to you my brother, looks like we will be in for the long haul together! Crap!

Your Fla. Buddy,

Pete

Well things are the same.  In more pain with withdrawals because of forced med change.  I took my 30mg morhphine cr last night at about 9pm.  I woke up this morning at 6:30 in withdrawals.  My bed was soaked with sweat I felt sick to my stomach and was in bad pain in my lower back.  I ended up taking 2x15mg b/t meds to help ease my symptoms.  It helped but I hate that feeling.  about 2 years ago I was on oxycontin as my long acting med.  I would feel little withdrawals symtoms in the morning as well depending on what time I took my med the night before.  When on the methadone for long acting pain control I felt none of this.  I woke in the morning feeling great.  Sure sometimes I had high pain levels but no withdrawal type feelings.  I hate this.  The methadone I took was perfect for me and I did not have to take near as many b/t meds.  Why did law makers do this to me!  Leave well enough alone.  Also,  my pain levels at work have now increased!  I did so good on the methadone.  Anyway,  sorry for going on and on and on.....  I will see my doc next week and we will see what happens.

Back to my doc again.  He upped my dose to 60mg x 2 day (morphine cr).  I was on 30 mg x 3 day.  So basically I went up 30mg a day.  Same b/t med of oxycodone 15mg 3-4 day as needed.  Since my change from methadone I have been going through mini withdrawals and my pain levels have been up.  My doc is seeing me every 2 weeks now until we get this med thing fixed.  The methadone I was taking as been the absolute best by far in treating my pain.  There were no up or down feelings with it either.  I have noticed with the morphine cr some choppyness to it.  It does not feel like smooth pain relief.  Your body tells you its time to take another dose where with the methadone I would forget to take my dose on occasions.  It was the only pain med I have taken that did not make me feel medicated.  I am doing the best I can now.  Still in mini withdrawals almost 3 weeks after stopping methadone with higher pain levels.  I may do some research to see if any docs in central fl will still prescribe methadone.  I love my doc now but I may have to do whats best for me.

Frequently the conversion ratio docs use to switch from methadone to morphine is about 1:1. THIS IS DEAD WRONG. Even a lot of docs know this, but few doctors talk about this amongst themselves and just trust a book even though there is widespread knowledge that most of the books are wrong.

It varies widely from person to person because of differences in body chemistry, GI absorption, nervous system variance, etc etc.....but I would put the ratio at somewhere closer to between 1:2 and 1:4. Particularly if there is no gradual cross-taper, then one should give the patient more of a buffer or be available to them with options for increases in medication at least until you're stabilized.

So, I would consider it irresponsible for you to have been switched from 70mg methadone to 60mg morphine per day. 90mg morphine would have been a minimum starting point if I were your doctor, and I would have gone into the switch knowing there was a good chance I'd get a call from you after about 3 days (how long your methadone levels took to drop off) asking for help with getting the dose right for *you* rather than just what a book says.

The problem is, docs are constantly assuming that we're "drug seeking" and such BS, so they don't trust us to help in our own dose titration. Unfortunately, due to the wide variance -- as much as 2.5X from person to person in cases like morphine or hydromorphone -- in bioavailability of both medications, the patient is the only one who really knows!

Shaw,
I posted to you in another thread. The equivalent of 60mg Methadone is 150 mg Morphine. So at least you're getting closer. The CR should be a bit more stable for you, but there's a decent chance you may still need one more increase to get an equivalent dose of morphine (though people don't always need the exact equivalent, some need more, others need less).

Oh, I just feel so badly for you. I know switching from fentanyl to methadone was a nightmare for me, withdrawals until I could get enough methadone built up in my system. I wish there was some way to manage med switches better. Hopefully it won't be too much longer before you find some relief.

I think an added issue -- I think Pete told me this at one point -- is that methadone partially blocks other pain meds. So while you still had decent amounts of methadone on board [not enough to get adequate pain relief, but still enough to bind with the receptors] you may not have been getting the full benefit of the morphine, which granted was a comparatively low dose. That should improve with time -- plus hopefully your doc will take pity on you & get you an equianalgesic dose of the morphine.

Here's the NIH conversion chart for morphine/methadone:
www.ncbi.nlm.nih.gov/pmc/articles/PMC1163279/
It's about halfway down the page.

peace,
frances

Well I think things are finally getting a little bit easier!  My withdrawal symptoms are going away.  Yea!!!!  I still do not have the same pain control as I did with the methadone but maybe my dose just needs to be adjusted.  Can someone tell me if 120mg a day of cr morphine is a small, medium or large dose for a 24hr period?  I see my PM doc in a little over a week.  If my pain is not down (especially morning pain) I will maybe see if a trial period of opana er may be an option.  I have found out that these pain meds or any med for that matter takes trial and error.  You may have to try 10 different meds before you find whats right for you.  I know the med that works the best for me and thats methadone but all the folks ODing have given it a bad rap and now the docs wont prescribe to legit patients.  You watch what I tell you,  methadone is on its way to being a schedule 1 drug.  Anyway I am happy to say FINALLY things are easing up a bit.  I just hope my pain levels go down.  If not I will try something else.  I told my doc I am open to try anything but oxycontin.  He asked me why and I told him I was on it for 3 yrs and built a very high tolerance.  It would be very choppy.  I felt it hit my body about 30 mins after taking it then 4 hrs later relief started wearing off.  Plus it gave me up and down feelings and kept me watching the clock for my next dose.  I absolutely hated that.  To some I am sure its God send but not me.  Oh well to each his/her own.  Thanks to all of you for you comments and help during my time of need.  We are all in this together.  I will keep all of you informed on my pain levels with this new med and how my body adjusts.

My BIL is on Morhine cr and he is maxed out at 300mg. I don't know if this is the same for everyone, but I would guess 120mg is about 1/2 max dose.

I was on methadone for 6 months, 20 mg ever 8 hrs. It's the only med that if I missed it, I didn't immediately notice it, but made me so tired, I couldn't keep my eyes awake to read my homework and spent the good part of 6 months sleeping. Finally I begged him to switch me to ms contin 30mg every 12hrs I asked if I would withdrAwal he said no. I spent the next week with major sweats, chills, nausea, dizziness and pain. Eventually I adjusted to the morphine. I don't think most doctors understand that just because you are going to another opiod doesn't mean you won't withdrawal. I was miserable and on my vacation to ft. Lauderdale and the keys! Ruined my trip! Now I take oxycontin 30mg every 8hrs, it has been a godsend, no side effects except when I take it with large amounts of caffeine (I AM a college student, we live on the stuff!) I get nauseus, like painfully nauseus.

Do you know if it was just FL? Out of curiosity, is Oregon in this craziness? IMO if a doctor prescribes a certain amount and the patient follows direct orders and dies, it is the docs fault, but not if the person was abusing it.

Good luck!

Hi, the reason methadone gives such a sustained relief is that is has a very long half life, I believe upt to 72 hours. So , even though it wears off over time, like all others, it is at the three day period, when you will notice it the most. Not being able to titrate down on it, while going up on the replacement med is a big hardship . I was on 30 mg daily, and my new dr. took me down 10 mg the first month, and put me on 20 mg oxycontin BID, I was having mini withdrawals constantly, the next month I went down to 15 mg methadone, and 30 mg of oxycontin two times a day. STILL had symptoms of withdrawals, could not sleep, night sweats, increased pain, weird spasms. So the third month went to 10 mg of oxycontin, stayed on 30 mg oxycontin bid, but added breakthrough vidodin up to 6 times a day. Then down to 5, and thiry still two times a day. Then to 2.5 mg of methadone, and then to 2.5 every other night. It took months, and I was still having the symptoms, after 6 or so months I was on Oxycontin 40 mg every 8 hours, because I actually get withdrawals if I try every 12 hours. AND I take breakthrough meds every four hours. I miss the methadone, and think I will try the fentanyl patch again, if dr agrees. It is the closest to methadone in longacting, no ups and downs. Morphine does nothing for me, and oxycontin is not that great for me. I wish you luck trying to find what works best for you.