Methadone Question

[PieceByPiece]

Is methadone only used as a substitute for SHORT acting opioids addiction only?

 

[Rybee]

I think your question is two parted?

Short acting only? Most opiates in general are short acting, relatively speaking. Though obviously there's a difference between the half-lives Fentanyl and Morphine say, but there aren't many opiates that are long lasting, unless they have an ER/XR formula.

Addiction only? Nope, I used to be prescribed Methadone for chronic pain.

Methadone's a slippery slope back to rehabilitation, what's your train of thought when you're asking the question?

 

[chelle216]

As far as I'm aware, anyone with a serious opiate addiction (in the US) can enroll in methadone maintenance. The only instance I'm aware of that can result in a clinic turning someone away who is using opiates is in the case of trying to go to MMT from a pain management script. For example, if receiving a long acting opiate prescribed for pain as opposed to one prescribed for addiction (all forms of bupe) a clinic will likely tell you that you must at least attempt rehab first in order to establish that you're an addict with an active addiction. I know that seems screwy but I guess it's part of some legal procedure or something.

 

[PieceByPiece]

Well, if you're on short acting morphine (4 hrs), would they prescribe you methadone (which I heard is long acting) to stop you from going into withdrawal?

So instead of dosing 6 times a day, they replaced with once/twice daily dose of methadone stop withdrawal?

 

[Ignio]

If you are a pain patient that gets addicted to say morphine or oxycodone due to having to take it for a long time, doctors will often just taper patients down to 0 mg while staying on whatever opioid the pain patient were using to treat pain. If however, this does not succeed or pain patients start to exhibit addictive behavior while being a pain patient a doctor might choose to refer the patient to a methadone clinic (with the primary reason often being, I think, to cover his own ass and avoid being accused of providing opioids to an addict even though this addict is a pain patient). But I have seen long-term pain patients who are not showing any addictive behavior being changed to methadone to tapper out, but in this case the methadone will not be prescribed from a addiction facility but from a 'normal' doctor, who is allowed to prescribed methadone.

Methadone is also an excellent opioid to use for pain management on it own accord. I received methadone combined with oxycodone in a period to treat pain as methadone was more effective than any other opioid I tried.
However, where I am from, methadone has a bad reputation and a lot of people think that methadone's only use is to treat heroin addicts. Thus, some pain patients avoid it or avoid telling anyone that they are getting methadone for their pain. It is a shame as I think it is one of the best pain killers there is. Some regular doctors here even avoid prescribing it as they think it is to be used to treat addictions only. At the same time many regular doctors are not allowed to prescribe methadone in my country due to the dosage accumulation methadone will cause, thus doctors need a special permission before they can prescribe methadone.

When I contacted my doctor as a oxycodone addict he had to keep prescribing oxycodone to me, until I could get a time at a rehab facility, as he wasn't allowed to prescribe methadone. I started as a pain patient, but after I have admitted my abuse, even when I need opioids for pain I am not gonna get anything but methadone. Doctors here are not gonna prescribe morphine or oxycodone to a known addict, only methadone. If you ask me this is stupid, but doctors often think that methadone will not cause the same euphoria as other opioids, thus methadone is said to possess less abusive risks. However, this is not even close to true in my opinion. I have seen several people attempting to get into methadone substitution treatment without really having a bad addiction to strong opioids. Maybe they have been taking tramadol or oral morphine for a while and then discovers that being in methadone treatment will give them a free, easy and continuous access to opioids. In this case, they come from a relatively manageable addiction to a much worse addiction. Sad that this happens, but it does. I think some methadone clinics use a lot of resources on avoiding giving methadone substitution to people who are not yet in a position where you can consider methadone a better solution than their current situation.

In my country if you reach the point where you can be classified as an addict and have to enter substitution treatment, you will not have to pay for anything. Everything will be free, from therapy, rehab facilities, to the necessary medication. Meanwhile, especially oxycodone is very expensive even on prescription. As a pain client who was studying at the university, I did not earn enough to be able to pay for all my prescriptions and I had to get help from my parents to afford all my medication. At the worst times, I got medication for around 100 dollars each week while my monthly income was around 1100 dollars, so 400 dollars a month for medication was a lot. As a pain patient I had economic troubles, but then I got addicted, and now everything is free. The welfare state is funny sometimes in that way

 

[chelle216]

No, doctors (and I've asked at least 3 some time ago) outside of a clinic can't prescribe methadone for anything but pain. Though, it could be argued that withdrawal warrants the labeling to say "for pain", however, I'm not sure how common it is for doctors to switch their pain patients to a methadone taper for addiction problems. This is something you'd have to inconspicuously ask around your doctors office about. By law, a doctor CAN (that doesn't mean they will) intervene for up to 3 days with medication if you're in the process of finding treatment. I've never personally met anyone that this type of good fortune. Once you admit that your pain regimen has turned into an addiction you're screwed in the majority of cases, especially now in 2016. Most doctors will get rid of a patient with a problem before they come under any fire by the DEA. On top of that, I've watched pain patients get turned away, forced into accepting a limited amount of the original script, or flat out handed their ass by their pharmacists (though this isn't always undeserving).

I was also prescribed methadone some ten years ago. Three years in I was told I'd be given a mandatory taper since the dr fell under scrutiny. I immediately contacted the area clinics to get on a waiting list, and I was told that it wasn't possible- due to it being prescribed for pain- until I had been to rehab and started using again. REALLY? I absolutely questioned this as one of the more outlandish pieces of advice I'd been given. I ultimately got off of it (uneventfully) by some rational foresight, pill hoarding and willpower.
In my case, this goes to show that it doesn't matter what type of money or welfare you bring into your addiction with you, because it only comes down to the person with the addiction getting their shit together.

 

[Ignio]

When doctors have prescribed me medication for some alternative use than the intended use, they just prescribe it with an official statement saying that it is to treat what it is intended to treat, while they are well aware that the actual purpose is another purpose.

But in regards to DEA, I have heard several stories about pain patients and their doctors getting the attention of the DEA.

In my country the oversight of doctors is not as serious as it seems to be in the states, leaving them with more maneuverability. This can both be good and bad. Pain killers are widely available on the black market in my country and to mention on thing an 80 mg OxyContin costs around 15 dollars in average. So it is cheaper than I see in other countries which might be because more oxycodone is being prescribed pr capita than in the US for an example.

 

[SKR]

I think your question is two parted?

Short acting only? Most opiates in general are short acting, relatively speaking. Though obviously there's a difference between the half-lives Fentanyl and Morphine say, but there aren't many opiates that are long lasting, unless they have an ER/XR formula.

Addiction only? Nope, I used to be prescribed Methadone for chronic pain.

Methadone's a slippery slope back to rehabilitation, what's your train of thought when you're asking the question?

How was the pain relief? Good?

 

[Ignio]

How was the pain relief? Good?

Methadone was the most effective pain killing opioid for me. When I started on Methadone I started on 40 mg combined with 80 mg of OxyContin plus the choice to make up to 20 mg IR oxycodone. Before that, when I was taking oxycodone alone, I needed 200 mg of OxyContin plus the option to take 50 mg IR oxycodone. Nearly almost everyday I had to take the entire 50 mg of optional IR oxycodone, while post methadone, this was much less often. So it reduced my dose of oxycodone significantly while at the same time reducing my pain much better than oxycodone or alone or oxycodone combined with other opioids that I tried.

 

[SKR]

^Thanks Ignio, I asked the question before I actually read the rest of your posts (Impulsive post due to alcohol). It's easier for me to be given up to 80mg Methadone than it is is to get adequate pain relief through my General practitioner Dr, although before I make the switch from Suboxone to Methadone I'm going to give my GP Dr the opportunity to put me back on shorter acting full agonists - The issue as always will be dose. I'm far far away from being opiate naive. I was like you my friend - up to 500mgs daily Oxycodone IR but generally I could sustain (With my monthly supply) 240-300mgs per day but became tolerant to it all and it was a fraction of the price to jump on Suboxone but my pain is obviously not controlled by Suboxone no matter the dose, so I'm very interested to switch to Methadone at my sub clinic who offer both. Thank you for your response Ignio, I appreciate your experience, Take care

 

[Ignio]

Thanks Ignio ... It's easier for me to be given up to 80mg Methadone than it is is to get adequate pain relief through my General practitioner Dr.

First off, you are welcome. Feel free to ask further questions if you have any. It seems like my previous experience is quite similar to my past experience.

What do you mean with the sentence I have quoted? That it would be easier to go to a methadone clinic and get the dose you need to cover your pain sufficiently, than it is to go to your doctor and get him to prescribe a dosages of oxycodone that is high enough to make your pain manageable? Implicitly saying (amongst other reasons, however with one being one of the most influential) that due to the focus in recent years in the US on the increasing number of people, rich as poor, who starts abusing oxycodone (no matter whether they get them prescribed or get them from the black market) more and more often ends up as heroin addicts? And this trend and the focus upon it then makes doctors very reluctant to prescribe high (enough) amounts of oxycodone (or opioids in general) to pain patients even though the patients desperately needs them?

The issue as always will be dose. I'm far far away from being opiate naive. I was like you my friend - up to 500mgs daily Oxycodone IR but generally I could sustain (With my monthly supply) 240-300mgs per day

Considering how much oxycodone you take each day I would definitely advice you to combine your oxycodone with one more pail killer. Methadone would be an excellent opportunity, both due methadone being a very effective painkiller, but also as your doctor might be one of the doctors who think, that methadone does not possess abusive risks in the same way as oxycodone does. The combo does not necessarily have to be oxycodone and methadone. In Denmark we have a relatively small range of opiats of opioids to select from (codeine, tramadol, tapentadol morphine, pethidine, oxycodone, buprenorphine and fentanyl - and in some special cases ketobemidone) compared to the choices you have in the US. Buprenorphine is in my opinion worthless as a pain killer and Fentanyl (at least that you get to take home) is only available as patches and is almost exclusively given to dying cancer patients (although they are very easy to find on the black market). Very recently, Hydromorphone and tapentadol was introduced to the Danish market, however is seems like no doctors are aware of this as I have never seen it prescribed (and I know a lot of pain patients) and never see it on the black market. Thus, in Denmark, we cannot get hydrocodone or oxymorphone on prescription, which seems to be two popular pain killers in the US.

So basicly, as a pain patient in Denmark you have the choice between oral codeine, tramadol, morphine, oxycodone and in some special cases ketobemidone (Sold under the name Ketogan, extreeemely euphoric even compared with oxycodone et cetera. Ketobemidone (orally) hits you with an euphoria that can be so strong that it feels like you have IVed it while lasting several hours - ketobemidone is also available as suppositories which hits you even harder). Methadone is an opportunity, but as I mentioned, due to the bad reputation it has wrongly been given in Denmark, it is very rarely used. And most doctors want you to try all the other opportunities before you get methadone as a pain patient, unless you are lucky (As I am) to have a doctor who actually know what he is doing.To that be honest, I don't get that doctors would prescribe oral morphine to anyone. Here it is as expensive as oxycodone, but due to the low bioavailability of oral morphine, you need to take double the dosage at least compared to oxycodone making morphine very expensive. So as a severe pain patients, your only real options are oxycodone and ketobemidone in Denmark (Hopefully doctors will soon start prescribing hydromorphone, but doctors in Denmark are notoriously slow accept new medications as it often requires that they educate themselves and take a course about the drug, which they are reluctant to do). It is the same with Tapentadol. I almost demanded to get switched from tramadol to tapentadol as tapentadol doesn't mess as much with your neuroreceptors, but my doctor at the time would not prescribe it under any circumstances, even when I brought him studies from PubMed showing benefits of tapentadol compared to tramadol (Plus I have epilepsy, making tramadol that much more dangerous for me).

Oral buprenorphine is rarely given to pain patients unless in dosages of 0,2 or 0,4 mg. Fentanyl is only available as transdermal patches and only to cancer patients (which is evident in the black market prices - a 100 mcg/hours patch costs around 100-135 dollars here. I don't get why people will pay that much. but they do. Black market fentanyl analogues would be much cheaper).

Compared to the US, it seems like our choices of pain killers are very limited in Denmark. However, doctors are not as afraid of prescribing oxycodone here as they seem to be nowadays in the US. This is evident in the black market prices as well. An 80 mg OxyContin often costs somewhere between 10 and 15 dollars depending on the city and the amount you take. From what I can see, this is extremely cheap compared to most other countries). [A little comment: I hope it is okay to write about prices, as I do it to support my claim that doctors in Denmark prescribe more oxycodone pr. capita than doctors in the US (and most other places, despite Germany, as far as I remember fra a report I read i 2014)]

 

[chelle216]

Ok, just like to add, though not in all cases, that after some calling around this morning, if you try to go to MMT from sub you'll also have to go to detox. Funny when most of these places prescribe sub as well.

 

[Anza]

Okay ...here's my delimma.
I've been on Methadone maintenance for 4 years now.
(For opiate withdrawal not Heroine.) Recently I found myself in the hospital, where they took very good care of me and made sure I had my methadone doses along with other pain meds at low doses.
Now that I'm disgharged, this University medical center wants to take over ALL OF MY CARE. They want to increase my Methadone to 150mg a day !
Does this sound normal or healthy ?

 

[TheRapperGoneBad]

Okay ...here's my delimma.
I've been on Methadone maintenance for 4 years now.
(For opiate withdrawal not Heroine.) Recently I found myself in the hospital, where they took very good care of me and made sure I had my methadone doses along with other pain meds at low doses.
Now that I'm disgharged, this University medical center wants to take over ALL OF MY CARE. They want to increase my Methadone to 150mg a day !
Does this sound normal or healthy ?

Why do you take methadone?
What dose are to currently on?
What is the reason for raising your dosage?

 

[Anza]

Why do you take methadone?
What dose are to currently on?
What is the reason for raising your dosage?

I originally started methadone clinic cuz I had been using my prescribed pain meds for many years. But I moved to a different county where I didn't have insurance or any way at all to get a doctor to prescribe any.
So I started withdrawing really bad and a local clinic put me on methadone for opiate withdrawal.
My dose was 80 mg a day for over 4 years. It was working great for my pain, my cravings, my triggers, EVERYTHING !! I've been doing great during this maintenance dose.
But now I have a new physical illness that's causing alot of excruciating pain in my legs. I can't walk without help and I'm even miserable just lying down.
After being in the hospital 7 days the Oncologist/Pain Management doctor prescribed me 160 mg a day (four 10 mg tabs every six hours)
It just seems like a lot to me.
?????