Very Discouraged - Mike's med change update

After transitioning from methadone to Percocet (off methadone for over 30dys), having horrible w/d's as result for weeks, over a month of chronic insomnia (0-2hr sleep every 24-48 hr period), starting to feel better once Opana Er started 48 hrs ago w/Percocet for breakthrough, I AM STARTING TO JERK, KICK, HAVE BODY SURGES AGAIN! This horrible torment immediately wakes me/keeps me from sleeping as a get drowsy and try to drift off to sleep. Can anyone offer any answers to why this is happening? Or offer any words of encouragement to me? My only option left is to go back on methadone which I detest, was becoming ineffective, starting to cause this insomnia but nearly not as bad. Present pain mgmt. person I see only gives me that option if Opana ER doesn't work. Was started out with 2 week supply (10mg every 12hrs). I'm so frustrated, sluggish, tired, I don't know how much more of this I can take. -Mike

Mike- did u try the potassium pills? Do you take any other meds, muscle relaxers, anxiety/depression meds, lyrica?? Sometimes these other meds can help or make things worse thats why I ask. Will your pmd let you switch to the opana ir's too? I find they work SO MUCH better than percs!
I know you feel awful but DON'T go back to the methadone!!! You have come so far this will end!! Go reread Vicky's post about her journey of coming off methadone, it's a hard drug to get off but you can do it & will be so glad that you did.

Mike -- I'm on my phone so need to keep brief... But what dose methadone were you transitioning from? Honestly - I think you are undermedicated.... and thus - still experiencing a level of withdrawal. When you've been on opioids for years - you don't just go through a week of w/d and then it's over (my opinion). It can take up to a year to completely reset things. (To come totally off meds).

I think the Opana is either not working or too low of a dose.

What do you think?

Mike, I am SO sorry you are still going through this!!! If my sLuggestions are repeats I apologize. Have you tried melatonin for sleep? Sometimes it helps "calm down" the muscles too. Magnesium is good for this too. Do muscle relaxers help at all for the jerking/spasms? Have you tried sleep aids (prescription or over the counter?" I really hope you get relief soon. Really hope and encourage you bot to go back on the methedone. You've come so far to have to start the battle all over again. You are strong and persistent. Hang in there we are all here for you.

Mike the others are spot on friend! One of the reasons I ever went to the Butrans was I couldn't get passed the RLS and no sleep! It was literally driving me insane! My co-mods were saying "your posts are all over the place "?? Some I dont ever recall even writing!! It was driving me over the edge, that jittery,stuff and sleep deprivation!

I however do some really weird things on high doses of opiates or anything that is a CNS stimulant and couldn't handle the conversion amounts from methadone to any of the other opiates.

Butrans like suboxone and Subutex have w/d relieving qualities that stopped the "crawling out of your skin " feeling. Once I can stop that I can sleep, eat and function.

You should Not still be doing those things this far out and especially if your getting the conversion amounts correct.

The trouble is most Drs dont have a clue! They think that any opiate at any dose should cover your w/ds.

The only Drs I've found who have any semblance of understanding are those associated with your methadone treatment centers for addiction.

If you've got a PM whose willing to work the situation then your far luckier then most.

The conversion tables for methadone to morphine as an example say the comfortable conversion amounts are going to be 1:10. That's 10 mgs of MS for every 1 mg of methadone!! Yes to most that dose is close to lethal for some higher end doses. If you take say 40mgs of methadone you would need 400 mgs of morphine to cover completely the loss of methadone. Most Drs aren't going to even get close! Most pharmacys wouldn't fill it either!

Make sure your taking the potassium and straight up tell your Dr your not going back on methadone and take it off the table! Find something at the right dose as well and you didn't get yourself here and they need to help you get back.

Hang in there you can pull this off and you're your best advocate for getting the best treatment with the least side effects and harm.

i think so to BlessedX8, i think i may take 6 months until the methadone transition is over. also as others noted, OpanaER seems to call for a higher dose than Endo Pharma indicated. i was offered 3 40mg tabs every 8hrs which would be 360mg/24hrs.. if i could afford it i would be on it. i have found the Opana IR or conventional release oxymorphone can be used as a half-way long-acting med, kindof like levorphanol if any have had chance to try Levo-Dromoran. you are under-dosed for two reasons, one, your pain level, two, cover for methadone transition. also your getting a bunch of acetaminophen from the percocet and they could close the gap by using oxycodone IR at 15-30mgs three to four times a day as needed. i also think hydromorphone at 4 or 8mg dose at same times would be better due to oxycodone having a odd nervy effect near time for next dose and now you need to have balance and a control achieved. the Opana IR is a good idea but not now. it has a little longer kick in time than percocet/most everything. but if you can keep on the Opana ER and ask politely and maybe keep log of not just pain but include everything, but ask if Opana ER can be titrated to effect? maybe 40mgs maybe 400mg but it is smooth and potent and no peaks and valleys.

I can only say, good luck Mike, hope you see a positive turn in your path soon, hopefully you will start to see and feel some improvements.

David

prayer you got, let me go back and refresh the med history and transition. right off "above average" is not true, the maker of it makes a dose up to 40mg??? also many here have mentioned a higher dosing of Opana was needed to do what Endo said ,(this first entry into market and these things do need a little time testing to smooth out standard dosing units), a smaller dose should/would do. in my local area most docs around are in agreement over this. they have let their opinion be known because if you can find "your dose" it is a great tool in arsenal. not as many peaks and valleys kind of like original OxyContin or a quick release drug period. plus oxymorphone has a relatively longer half-life so you titrate over time and you know when it is correct or at what dose level, not only a good sustained release system plus a longer smoother half-life that can almost literally stay level in the bloodstream 24/7,365. then you have taken a big step to killing you pain maker. Breakthrough: need to walk around for a moment and ironically grab a breakthough plus soma plus cup of coffee, 30min. i will shower you with many the different pharmacokinetics which means the distrubution and metabolism and movement through system. kinesis/kinetic=motion/movement. pharmacodynamics-"the effect".

please do not go back to methadone you have come so far. maybe ask to switch to opana ir for breakthrough instead that's a lot stronger..

Nick: I was at 50mg daily before respiratory failure (flatlined). After hospital discharged kicked down to 30mg about 4 yrs ago and last year I've gotten down to 20mg but with the onset of insomnia. I tried to go lower but couldn't w/d hard!!!! My experience with the methadone and my tapering history would lead me to think I'm withdrawing from 30 rather 20 because the 20 has fluctuated at times up to 25 and down to 15. My life has felt worse going from 30 to 20. VA Hospital did a clinic with me almost year ago. Told me at this point they felt the methadone was ineffective. Suggested tramadol. Since w/d now, I think my physical pain level is lot higher than I had hoped for (wanted completely off narcs and to handle pain with other occasional meds), sigh. Hopefully this will help. Mike

Luie: Thanks for the encouragement bro, appreciate it man. -Mike

Blessedx8: Thanks for prayer support, also for admonition concerning how to approach doc in advocating for my needs from an informed position. You and other on this forum have helped to have an informed postion and decision that I've not had before (just blindly trusted docs). Appreciate all you do for me and many other as well. -Mike

Post Edited (blessmymess) : 12/1/2013 1:53:49 AM (GMT-7)