Opioids swapping to methadone and back

[Nimshie29]

Hi Folks,
My pain medico wants to swap me from fentanyl patches to methadone. Does anyone know how difficult the swap over will be? I am also concerned about when I swap back that the long lasting respiratory depression effect of methadone will make the swap back even more difficult?
I have also read that methadone is harder to get off than other opiates and it tends "to take over your body"? Is this so?
Thanks in anticipation,
Nimshie29

 

[Alex000]

Methadone is a potent, long acting opioid with strong mu activity, and NMDA-antagonist properties as well. It is known for being especially sedating, and potentially dangerous esp. when mixed with other drugs. Methadone will likely help your pain more than fentanyl, and you will likely feel "better" on it, but it may take a little getting used to. It all depends on the dose of fentanyl you are on now, and the dose of methadone you will be on. The switch back would be more of a challenge, yes, because methadone wd's are known to be particularly bad. I wouldn't suggest methadone, unless you are terminally ill, or are in very extreme pain which only methadone could help in quelling. Morphine would be a little easier to deal with.

 

[suessmayr]

DON'T FUCKING DO IT! I've read too many posts from chronic pain patients who have been put on methadone by fuckwit doctors without any regard for the difficulties involved in getting off it. Methadone is probably the most intense opioid to WD from. Nothing else even compares to it. Given that there are so many opioids out there, I agree with the post above, which says that you should really avoid it unless you've exhausted all other options.

Also, methadone, in my view, is like all the negative with none of the positive. It will make you tired as shit (unlike oxycodone) and give you zero buzz or enjoyment (unlike morphine and presumably fentanyl) but it will put you through absolute hell when you decide to get off it.

 

[muvolution]

methadone annihilates pain. If your doctor wants to do it, ask him/her what the plan for getting you off it is.

 

[Tchort]

The idea that Methadone is harder to get off of is dangerous- it has been used to deter addicts from seeking Methadone maintenance, now to deter pain patients from trying a new regimine. No opioid withdrawal is pleasant, it is always difficult, it is always painful. It is a very weak excuse to not try and improve your quality of life. If you are likely to be on potent opioids for chronic pain for a long time, it only makes sense to find the best medication regimine you can.

Many pain patients are happy with being on Methadone (along with other meds) as part of their daily treatment. Its NMDA antagonism makes it uniquely 'qualified' for specific types of pain. It is very cheap, which can be a big help for those without good health insurance. While its half-life is much longer than its usual duration of analgesia (half life 24-36 hours, typical duration of analgesia 6-8 hours), some patients report the palliative effect of having a long-acting opioid offset this potential problem (some say this works out better than an extended-release formulation narcotic like MS-Contin or Opana, some say worse). With proper dosing guidelines and instructions, and proper adjunctive and breakthrough medications, it can be a great tool for minimizing and managing chronic pain.

Methadone is just another opioid. There's nothing particularly special about it- personally I'd imagine the withdrawal from Fentanyl patches would be more difficult than oral Methadone. In any event, the switch should be fairly easy to or from. Since they are both potent mu agonists, there's no risk of precipitated withdrawal, it'll come down to timing and dosage which your doctor will help you calculate and schedule.

Respiratory depression is a factor with any opioid, though when switching from Methadone back to Fentanyl patches this should be less of a factor.

To test whether methadone would prevent
relapse to heroin addiction or respiratory depression
if heroin was tried again, rigorous double
blind studies were conducted. The effects of the
following opiates, while patients were on
methadone, were tested in a Latin square design
protocol: heroin, morphine, dilaudid, methadone,
and saline. An effective blockade effect was
noted at 80 – 120 mg/d, or over, against the narcotic
effects of heroin, morphine, dilaudid and
methadone itself. Significantly, the patients did
not experience respiratory depression (13).

http://www.drugpolicy.org/docUploads/meth347.pdf

The study was:

Dole VP, Nyswander ME, Kreek MJ. Narcotic blockade. Arch
Intern Med 1966; 118:304 – 309.

If you follow your doctor's instructions and listen to your body, respiratory depression shouldn't be much of a factor. Raising your tolerance to opioid analgesics may be a problem depending on how your pain doctor writes the dosing guidelines. If you don't feel right, call his/her office (or emergency number if after office hours) and have your regimine tweaked. Just listen to your doctor and keep them in the loop with whats happening to you. It'll be fine.

 

[suessmayr]

I think it's ignorant and irresponsible to claim that the stories concerned with methadone withdrawal are illegitimate. This is the experience of virtually everyone who has ever been on and off methadone. Besides, the 'deterrence' argument makes absolutely no sense unless it is the doctors who are making up the stories. Whereas in fact, it's the patients who attest to the horrendous withdrawal, and the doctors who usually claim that it isn't so bad.

 

[muvolution]

look, it sounds like you are on long-term opiate maintenance - if so, I would definitely give methadone a shot. It is cheap as all get out, widely available, has a documented history of great performance in pain management, and if you are withdrawn from it, it will certainly be slowly, or you will be switched to another opiate.... I think you are making it into something it isn't.

 

[Tchort]

I think it's ignorant and irresponsible to claim that the stories concerned with methadone withdrawal are illegitimate. This is the experience of virtually everyone who has ever been on and off methadone. Besides, the 'deterrence' argument makes absolutely no sense unless it is the doctors who are making up the stories. Whereas in fact, it's the patients who attest to the horrendous withdrawal, and the doctors who usually claim that it isn't so bad.

Ignorant how? I'm well aware of the horror stories about Methadone withdrawal. I'm also well aware of how addict subculture lore/myths work- and how they have a direct impact on the decisions of users and addicts to seek treatment. The OP in this very post is asking for the input of other users, addicts and any pain patients here. The post asks specifically about these widespread anecdotal reports and associated 'junky lore' that says Methadone is some kind of demon drug that is 'harder to get off of' than any other opioid; taken to its conclusion, that person will avoid using Methadone for treatment of either chronic pain or addiction based on these exaggerated or anecdotal-only reports. The merits of Methadone for both certain types of pain/segments of the chronic pain patient community, and its use in the treatment of opioid addiction, are well documented and backed up by decades of research. It can be used as a valuable tool to make the day to day life and long-term outcomes of either a pain patient or an addict much better than it would be otherwise on either inadequate pain medications or in the case of addicts continued use of illicit drugs. It's a case of 'cross that bridge when you come to it'. It's just not a very compelling reason to advise someone to avoid even trying a treatment that may make a qualitative positive difference in their life.

 

[MartinFn]

Just a question..Can the OP use fentanyl and methadone together? (I suppose by taking less fentanyl..). And can he use methadone for breakthrough pain (i mean, let's say he's in fentanyl, he has the patch stuck on his body, as regular, but he gets a "pain attack", so he takes 3-4 percs to stop it..can methadone replace the percs in this case, or not?)...thanks..%)


MartinFn

 

[muvolution]

A Pain Doctor would be more likely to Rx Methadone as the long-acting drug and fentanyl lolipops or something for BT meds.

 

[Nimshie29]

Thanks for the input.
Looks like I need to do some more research.
Has anyone in this forum come off methadone and not had a severe withdrawal?
Please advise the difference between senior moderator, blue lighter and blue lighter crew?
thanks,
Nimshie29

 

[brutus]

Without a doubt, methadone was the hardest opiate to quit. I have went through hydrocodone, oxycodone, codeine, and bupe withdrawals and none of them felt like the two month hell of quitting methadone. I am not trying to scare you, but methadone is not a drug to be taken lightly.

 

[suessmayr]

I think it's ignorant and irresponsible to claim that the stories concerned with methadone withdrawal are illegitimate. This is the experience of virtually everyone who has ever been on and off methadone. Besides, the 'deterrence' argument makes absolutely no sense unless it is the doctors who are making up the stories. Whereas in fact, it's the patients who attest to the horrendous withdrawal, and the doctors who usually claim that it isn't so bad.

Tchort - Respectfully, you seem to be confouding medical reports with reports given by people who have actually been on and off methadone. My point is that the people who attest, constantly and emphatically, to the horrendous withdrawal associated with methadone, do not have any interest in doing anything other than reporting the truth. In this way, their stories cannot be just dismissed. The argument is illogical, that methadone has been demonised by the people who have actually experienced its withdrawal. What purpose could this possibly serve? These people have no other interest than to report their own experiences - they're bonda fide addicts; they're not concerned with issues of social deterrance and so forth. And even the argument that methadone has been demonised by the medical profession fails absolutely from every point of view. The only people who 'demonise' MMT are conservative morons with no clue or education.

And I'm not denying that methadone is a superbly effective chronic pain medication. But it's childish and short-sighted to just look at the short-term solutions. This is what gets all of us into trouble. If the OP is cool with staying on methadone for the rest of his/her life, then yeah, she should go for it. But if she's not, she needs to give serious consideration to the experiences - and there are thousands - of people who have come off methadone and been deeply traumatised by the experience.

 

[artaxerxes]

Well put, suessmayr and wiggi! (And thanks again for your reply.)

By the time my PM doctor suggested methadone, I had the benefit of 4-5 years of learning about methadone's dangers from first-hand reports on BL and opio. So I was very reluctant to take it.

I think it holds a particular danger for people who struggle with depression/mental health issues because the lethargy and intense depression that are part of 'done WDs are significantly worse than I've experienced with other opiates/oids. I also recently noticed that the longer I'm on it, the stronger the emotional/psychological effects become. But that's totally subjective, so take it for what it's worth.

The new PM doctor emphasized what an amazingly effective pain medication methadone was for my condition (ruptured discs, crushed nerve, scar tissue from surgeries, rheumatoid and osteo-arthritis, stenosis, etc.). I clearly expressed my concerns about it and at length, and he brushed them aside. I brought up the intensity and length of the WDs and he couldn't have been more casual when he said, "Oh, it's just like anything else. We taper you off." My response: "Yeah, but doesn't it take a few months to fully w/d from methadone?" "No, No, Miz Snones, it's just like hydrocodone. It only takes a week or two." Uh-huh.

I did end up trying methadone and one thing he said is true: IME it is the most effective pain medication for intense nerve pain.But it's not even close to benign. The deadening effect it has on one's emotions, not to mention libido, even at a low dose of 30-40mg, are significant.

I'm part of a new program my HMO has developed, part of which involves attending weekly sessions devoted to strategies for managing pain, so I've been able to talk to the other patients. The same doctor has been pushing 'done on them. It's his trademark apparently.

None of them had the benefit of a BL education, and some of them had a rude surprise when they decided they'd stop taking their 'done. One guy ended up in the emergency room convinced he was going to die because his bp was so high and he'd been having panic attacks that lasted hours. Before he started his taper, he consulted with the doctor who told him to just cut down 5mg a day then stop. In a week. (!!)

I've also talked to pain patients outside of my program, and they've had similar experiences in which their doctors did not adequately warn them about methadone's negative effects. I think it's fair to assume that, while some pain specialists are true professionals who have done ample research and have then shared it with their patients, there are plenty of doctors out there who treat methadone far too lightly, downplaying its side-effects and, especially, the severity and length of withdrawals.

Some background: I have 10 years+ experience with PM, and I've worked with a series of doctors, NPs, surgeons, and my incredible physical therapist. I've also supported my mother in her lengthy battle with cancer. I've run into the same issues with many of her doctors.

Among free-range psychiatrists not associated with my HMO, again there exists the same laissez-faire attitude towards prescribing, tapering, WDs and their duty to provide critical information to their patients. I've come to believe that since doctors are experimenting with other people's bodies and minds, they just don't understand the degree of suffering and danger that's associated with rapid cessation of powerful medications. Or with the long-term effects of taking those kind of meds.

The exception is my current psych who is made of awesome with a side of awesomesauce. Not only is he extremely well-informed on the meds he prescribes, he's honest and self-confident enough to admit that he can't keep up with every new drug and its characteristics. So he actually asks his patients for their experiences (!!).

I operate on a need-to-know basis with doctors until I feel I can trust them. He's the only doctor to whom I've introduced BL and other harm-reduction sites. He even thanked me for providing him new resources. (Again, !!!) Also, as an ex-hippie poet, I kind have the feeling he might find a non-clinical use for some of the new knowledge. I hope he does. He's a good guy who treats his patients well and with respect.

I bring him up because he's the kind of doctor to look for. If I had to repeat the epic that's been my battle with spinal injuries, I would interview as many doctors as necessary before I found someone like him. I've come to the conclusion that educating yourself and becoming your own medical advocate is the only way to ensure your health and safety.

Drug interactions can kill. So can ODing on methadone. Hydro/APAP can destroy your liver. I didn't learn those essential facts from doctors; I learned them and many more from HR forums like BL and the experiences and wisdom shared by other drug users.

So I'll take this opportunity to thank all of you BLers whose posts have saved lives and helped so many of us BLers get through tough times by offering advice, wisdom, experience and compassion. Much love.

 

[Tchort]

Tchort - Respectfully, you seem to be confouding medical reports with reports given by people who have actually been on and off methadone. My point is that the people who attest, constantly and emphatically, to the horrendous withdrawal associated with methadone, do not have any interest in doing anything other than reporting the truth. In this way, their stories cannot be just dismissed. The argument is illogical, that methadone has been demonised by the people who have actually experienced its withdrawal. What purpose could this possibly serve? These people have no other interest than to report their own experiences - they're bonda fide addicts; they're not concerned with issues of social deterrance and so forth. And even the argument that methadone has been demonised by the medical profession fails absolutely from every point of view. The only people who 'demonise' MMT are conservative morons with no clue or education.

And I'm not denying that methadone is a superbly effective chronic pain medication. But it's childish and short-sighted to just look at the short-term solutions. This is what gets all of us into trouble. If the OP is cool with staying on methadone for the rest of his/her life, then yeah, she should go for it. But if she's not, she needs to give serious consideration to the experiences - and there are thousands - of people who have come off methadone and been deeply traumatised by the experience.

How much weight to give anecdotal reports when contemplating treatment is what's at issue. In the OP's case, there doesn't seem to be any reason to believe their doctor wouldn't switch them to another opioid if and when they wish to discontinue treatment with opioids. In that specific case, the argument over whether or not getting on Methadone for any reason due to the widely held belief that it is 'worse' to discontinue than any other opioid is moot; since the OP seemingly has the option to get on Methadone, then switch to another potent opioid before making moves to discontinue opioids. If they have the option to not even have to discontinue use of Methadone to abstinence, why the push to deter them? You say no one is demonizing Methadone, yet I would say that:

DON'T FUCKING DO IT! I've read too many posts from chronic pain patients who have been put on methadone by fuckwit doctors without any regard for the difficulties involved in getting off it. Methadone is probably the most intense opioid to WD from. Nothing else even compares to it. Given that there are so many opioids out there, I agree with the post above, which says that you should really avoid it unless you've exhausted all other options.

Also, methadone, in my view, is like all the negative with none of the positive. It will make you tired as shit (unlike oxycodone) and give you zero buzz or enjoyment (unlike morphine and presumably fentanyl) but it will put you through absolute hell when you decide to get off it.

is an example of demonization of Methadone. My personal experience with Methadone has been that it is less painful than Heroin withdrawal, and lacks the intense psychological aspects of Buprenorphine withdrawal. But I'm not speaking from my own experiences with the drug, only from the standpoint of someone who while an addict watched the 'addict culture' use the horror stories of Methadone withdrawal deter actively using heroin addicts from seeking treatment; and as a member of BL seeing posts such as that routinely deter people from seeking potentially beneficial treatment without anyone taking the other side. Standing in line at a Methadone clinic and listening to other clients pitch these stories back and forth about how they plan on going back to heroin before quitting because of what they've heard about Methadone withdrawal. It's an extremely frustrating situation, and I think a harm reduction forum should be an oasis from drug myths and addict lore. Your mileage may vary- but to say there are no positives from seeking Methadone treatment for either chronic pain conditions or addiction maintenance is disingenous as you later say that it does offer such positive elements.

I get your intentions, and it's important that we look out for eachother. The benefits and shortcomings of different drugs and treatments should be evaluated openly and fully when discussing them. But emphasizing these reports from this drug has had a harmful effect on opioid users (specifically addicts) for decades in the form of deterring people from potentially beneficial treatment and continuing risky and dangerous behavior.

 

[Fire&Water]

I would have the tendancy to agree w/ Tchort - Yeah maybe it annhiilates pain at first...but toleance builds just as fast
as any other full on pain agonist Most Dr.'s wouldnt let this happen, but it's not unusual to build up to a 150-250 mg.
dose. But it only takes half this dosage to put most methadone patients in a deep depression, let alone suicidal thoughts. It's a creeping malaise to say the least...I'll just stop there.

 

[muvolution]

Tchort just nailed it. How much of these second-hand reports do you believe? For me, Hydromorphone w/d was nothing like people said it would be, and neither was bupe or heroin.

I think these stories about Methadone are exaggerated because usually it is an ORT med and thus the patients resent it. It is a GREAT pain medication and I would urge you to cut through the crap and try it for the good of your body.

 

[suessmayr]

Tchort - I accept your point about the option of transfer to another opiate. The issue of the severity of methadone WD does become more or less immaterial in this context.

But again, you're confounding 'anecdotal' reports with direct, personal experience. I'm not talking in vague terms about things I heard someone else mention; I'm talking about the hundreds of posts you'll be able to find on BL in two seconds, written by people who have been through the WD and who consider it to be much more debilitating than almost any other opiate WD.

Also, I find it comically rich that you're dismissing the personal experiences of people who have actually been through methadone WD without ever having experienced them yourself. Your argument is essentially this: 'I have heard alot of talk about methadone WD amongst people who appear not to have experienced it themselves > therefore, methadone WD has been demonised'.

If anyone's point of view ought to be ignored then it's apparently your own, given that you're the only person in this thread without any relevant personal experience.

 

[yohnbalzaci]

I found methadone to work well for my back pain(hern.l4-l5,l5-s1..fusion-l3-l4,double pinched nerves,Fibromyalgia and a whole shit load of scar tissue) and had been taking 80mg for about 10 years. My medical got all screwed up,switched to a new doctor and he put me on dilaudid and i think that the Dil. has worked even better than the methadone. Granted ive only taken it a few months im starting to like it more. Seems to have improved my quality of life, being able to do more(not a ton more but for us pain patients we take what we can get)and being able to do stuff for longer before i have to sit or lay down. I havent noticed any withdrawl symtoms,im guessing its because i switched from one pain killer to another and not just stopping completely.And i didnt notice much of a mental change with the switch...idk if Dil. has the same mental effects as what has been "said/stated/proven"(whatever) about methadone but yeah. Anyways, from personal opinion id try the Dil. for month or two before commiting to Methadone.

 

[Tchort]

If anyone's point of view ought to be ignored then it's apparently your own, given that you're the only person in this thread without any relevant personal experience.

I have had experience with Methadone withdrawal. Plenty of it to boot. But rather than fight the anecdotal battle (i.e. my experience with Methadone withdrawal syndrome is less severe than Heroin withdrawal and less psychologically tormenting than Buprenorphine withdrawal syndrome so therefore you are wrong), My point is that despite my personal experience, what should be evaluated are the sound, verifiable facts about Methadone; about it's use for a number of purposes (addiction detoxification, maintenance, as a potent pain medication for a variety of specific conditions, etc) and the volumes of medical literature backing up it's efficacy in certain areas, its side effects in different situations, and potential benefits in different personal medical and psychological situations of different patient populations. So I'd say that's a bullshit cop out on your part to not take what I'd have to say seriously even if its backed up by the myriad of studies done on the uses of Methadone treatment to positively benefit the lives of different patient groups (another example being the use of Methadone maintenance in pregnant heroin addicts- it has been well documented that treatment with MMT is the first line treatment for such women patients because it can lead to a healthy newborn baby with proper neonatal care and post-birth medications; whereas continued heroin use with its ups and downs of blood serum levels of opioids or cold turkey withdrawal may be enough to seriously damage the health of the fetus/child or even lead to spontaneous termination of the pregnancy even in the latter stages). Should a pregnant heroin addict avoid Methadone, even though it will not only increase the health and prospects for the fetus/child, but also the overall health and stability of the mother, because of the stories about Methadone withdrawal?

We could also look up the numerous reports that Heroin withdrawal is the most excrutiating opioid withdrawal syndrome; this does not mean that Diamorphine isn't a very effective severe pain medication, an excellent palliative, and an invaluable resource for the treatment of otherwise treatment resistant, chronic and long-term heroin addicts.

I don't think my personal experience with Methadone withdrawal should color the conversation. Your whole argument is that personal reports are the be all end all when it comes to determining whether Methadone is worth taking in any circumstance, by any person, for any medical reason. I'm far from the only BL member who has reported finding Methadone withdrawal syndrome to be more benign than that of other opioids. Rachamim is a member who wrote about his experiences that Methadone withdrawal was a cake-walk compared to Hydromorphone and Morphine withdrawal if my memory serves. I have years of experience with Methadone, have gone off of it for different lengths of times for different reasons at reasonably high therapeutic dosages. I recall Rach having decades of experience and numerous detox's with Methadone and other potent opioids. It simply is not 100% true that Methadone withdrawal is more severe, more painful, worse, than the withdrawal syndrome of other opioids.

I'd go further and say that even if this were so; even if Methadone withdrawal syndrome was qualitatively more painful and unpleasant in every way than the withdrawal syndrome particular to any other opioid, it simply would not change the fact that it has documented (and well documented at that) impacts on the physiological conditions of addicts and chronic pain patients. A cold turkey, a 21 day reduction (the AMA Gold Standard for treating heroin addiction), or a very long and slow taper from Methadone are simply not the only options open to a person who has become dependant on Methadone for medicinal reasons. And again, even if it were, even if those were the only options, the potential for drastic improvements in the day to day lives of persons suffering from substance abuse disorders and chronic pain leading to a much higher standard of living would still be worth it in my opinion. Thankfully, neither of those 2 scenarios are facts. That being said, there just isn't any compelling evidence that the negatives outweigh the positives.