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Opioids What was my pain management doctor thinking?

Kadian over methadone?

Don't forget that by the third day of dosing the total methadone in your system is twice that of your daily dosage. So if you've been taking 50 mg/day for two years, you've had 100 mg/day to help control your pain (for a long time). That is contributing to your withdrawals as well. Some metabolites of methadone can stay around for almost to 50 hours (the range is 8 to 50).

I highly doubt your doctor has read that particular article. :!

Besides... Why Kadian? Isn't methadone loads cheaper? I remember when I was on methadone, I could get just about any dose for around a dollar a month (Whereas my OxyContin script that preceded it was about 35 dollars every month).
 
PM doctors and Their Dose Changes: Cross-Tolerance?

MemphisX3 said:
You didn't get screwed you have a doctor that doesn't think someone your age should be on that much pain medication. It's not a conspiracy. And if you switched doctors it'd pretty standard for a new doctor to start you out at the lowest dose. She is protecting her [license]. Either call her and explain and be 100% honest or go in there and explain and be 100% honest. What is your condition?
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But if i read the original post correctly, his PM has been fine with it for six years. Also, pain management doctors are given more "wiggle room" when it comes to prescribing narcotics unlike say a primary care physician (family doctor) or a dentist.

(Although, back in the good old days of prescription opiates, I had a dentist that would prescribe Percocet (5/325) to his patients at every visit if you simply asked for it.)

But the one thing you are spot on about: Opiofile, no matter what, do NOT switch doctors. You risk not getting a regularly prescribed opiate for about five years.

Just politely inform the doctor that the new medicine doesn't provide adequate analgesia and then explain your symptoms without using the word "withdrawal". (Sometimes that's a hot-button for pain docs)
 
Opiofile89 said:
I'll go to methadone or (her other choice was Opana ER or like I said Fentanyl). Anyone here have any comments about Opana ER? Is it just as shitty? Should I just see what she thinks about giving me Duragesic again?

I talked to my pharmacist yesterday and even she couldn't believe I was only given 20mg a day so she let me have my Percocet 2 days early just to stave off WDs as much as possible.
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Opana ER is TERRIBLE. Dont go near it.
 
Everything went smoothly. She didn't care that I had used all 60 Kadian in 7 days, she said whatever I had to do to be comfortable. She had considered Methadone and I asked (this was legit, not just an excuse to get Fentanyl) if I could go back to Duragesic because taking 8-10 pills a day for pain after 2 years and having all these side effects that I never had with Fent I'd like to go on that if she was OK with it. She was perfectly fine with it and wrote 25 ug/HR but said if that's not enough by Monday to put on 2 and we'd find a dose I can tolerate and function on. She actually asked me herself if I had been "sick" from not having enough pain meds. I said yes and she apologized.

I think when you're dealing in hospice and end of life care, the doctors are a lot more understanding, and that is what she specializes in.


Thanks for all the tips and suggestions guys.
 
skoat said:
Glad that worked out for you buddy, I'm still shocked she gave you such a low dose.
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Yeah, I'm still shocked at that too, especially when she clearly admitted today that I'd need 25-50mcg/hr of Fentanyl. From 20mg of Kadian to that much Fent. I'll always be puzzled at that Kadian prescription I guess.
 
Best of Luck

Maybe she just thought that a different medicine would provide better/suberb results.

Anyway, I'm glad you're back to being productive and comfortable.
 
Im confused Opiofile89 and I think you can clear it up for me please....

lots of the posts in this thread talk about how she gave you such a low dose because you just switched to her as your new doc.....

"u shouldnt have switched doctors...."

".....And if you switched doctors it'd pretty standard for a new doctor to start you out at the lowest dose. She is protecting her liscence. Either call her and explain and be 100% honest or go in there and explain and be 100% honest. What is your condition?"

but nowhere in your post did I read that you had changed doctors....all you typed was that your doctor had changed your meds, thats all.

So I guess Im asking if you actually did change doctors or not?(maybe I missed something)

Thank you
 
BAH! People Read What They Want to Read!

I think that (as what seems to be part of the culture of BL) a few posters read too much into his original post and thought that he either was going to change doctors or that he had already changed doctors. Even though he never stated that he was going to do so.
 
pixplzthx said:
I think that (as what seems to be part of the culture of BL) a few posters read too much into his original post and thought that he either was going to change doctors or that he had already changed doctors. Even though he never stated that he was going to do so.
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Maybe your right.....

I was just confused because I didn't see anythign about a doctor change or anything. I hope the OP can state that for sure though so we can set the record straight. It could possibly interfere with the quality of advice given.
 
I thought Methadone blocked opiates at 30mgs?
Why would he give you two technically "IR or breakthrough" pain meds?

I know methadone is long acting but I'm talking in terms of MS Contin and Oxycontin vs Oxy IR and other fast acting meds.

If I were you, you should see about getting put on Oxycontin twice a day for long acting and Oxy IR 4 times a day for breakthrough/fast acting. That's my schedule and it works well for me.

I'm not your doctor though which is why I said ask.
But giving Methadone and Morphine doesn't make sense, that would be like methadone and heroin.. The done builds up in your system also, so at 50mgs a day by the third day you actually have twice to three times that in your body.

You're probably kicking the Done which can only really be solved by goin back on it, your Dr was a fool for taking you off at such a high dose even with switching to Morphine(which in comparison at that dose is not equilalent to the Done you were on anyway.)


If it's bad, you can go to the ER. Tell them you're wihdrawling from Methadone and they have to give you Methadone. It's protocol. That might work for right now.

But you need to get it fixed cause it's not going to go away in a couple days.

Methadone withdrawal for me after getting brought down to 20mgs a day was bad.
 
Sorry I missed the part where you replied and said everything went well.

I'm glad it worked out and I'm sorry for what you've been having to go through, if you don't mind my asking is it your liver or is it something else cause if it's a liver thing taking Percs or anything with Apap can't be good.

Anyway, that is horrible that you can't get a transplant, considering your so young and they give transplants to way older people just isn't fair..
 
I have cystic fibrosis which is a lung disease, and I need a double-lung transplant. Along with that disease I have juvenile diabetes, juvenile arthritis (main reason I'm on pain management - I can't even bend my joints until I've had my pills in the morning - except on the patches), chronic sinusitis that I've had 6 surgeries on to the point that I have so much pressure in my face that causes severe pain every day (the same as a horrible sinus headache, but constant throughout the day) and that is also a reason I am on them.

And to clear it up, I had never mentioned changing doctors, nor had I ever planned to. I have it made with the one I have already. Anyone who is fine with me taking 10x the Kadian dose prescribed and completely understand and then write Fentanyl just because I asked (it always did help my pain the most; there was a point a few years ago I had to go through rehab to get off of it when I thought I might be eligible for transplant. And for the record, the reason I can't get that transplant is BECAUSE I have a history of narcotic use....I guess they don't care about anyone who would even appear to be a junkie). So I have about a year, maybe a little more, maybe a little less left and all this is just to keep me comfortable and productive until then.
 
Good luck to you.....I hope you and your doctor are able to work things out permanently so that you dont have to go through that amount of pain again....

and to Akomplice.....I think that methadones opiate blocking effects are very minimal at 30 mg doses. It doesnt really start to block out other opiates until doses of 50 mg's or more and even at 50 mg's you can easily "break through" the blocking effect with high doses of strong opiates which I believe the OP was also being prescribed. So I dont think he has to worry about the methadone interfering with the effects of his other medications.

But it is true that the methadone causes SEVERE withdrawal for long periods of time when taken off of it abruptly because of its long half life...buit since he replaced the methadone with other strong opiates(especially fentanyl in the end) I think the OP wont have to worry about methadone withdrawal.
 
pixplzthx said:
Wow. That is a fucking tragedy.
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Yeah, it's pretty sad that anyone who has been a chronic LEGAL narcotic user can be denied any transplant because of it. Sure, you can go through rehab and get off of them and be reconsidered, which I DID, and suffered through the pain for a good 8 months, and was still denied because they said I had been on them for too long (2-3 years at that time). So they wanted me to be in agony for the entire time I could have waited for lungs to become available. I couldn't even be prescribed Vicodin and be eligible. It was Tramadol or nothing. So I said to hell with it, I'd rather die in comfort than eventually die in 3 or 4 years in some of the worst pain imaginable.
 
Opiofile89 said:
I have cystic fibrosis which is a lung disease, and I need a double-lung transplant.
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Fuck man. I had spontaneous pneumothorax 11 years ago that required surgery and my lung/lungs have hurt every fucking day since then. Recovery from the surgery was BRUTAL. Live life as comfortable as possible man!!
 
That is such bullsh*t man... Why does being on narcotics even matter YOU NEED THEM. Its not like you'd be on the damn things if you were healthy. I cant even start to rationalize that man. I'm sorry to hear that you've had to battle with this at such a young age... Im 21 and i couldn't imagine being in your shoes. Your a brave guy, my hat goes off to ya. Im glad that your doc realised she made a mistake and hooked ya up with fet. I've never had the pleasure of trying it but i hear its really good. I wish i had a connect for a patch or two =[ all i can get is dope </3
 
HeroinGoblin said:
That is such bullsh*t man... Why does being on narcotics even matter YOU NEED THEM. Its not like you'd be on the damn things if you were healthy. I cant even start to rationalize that man. I'm sorry to hear that you've had to battle with this at such a young age... Im 21 and i couldn't imagine being in your shoes. Your a brave guy, my hat goes off to ya. Im glad that your doc realised she made a mistake and hooked ya up with fet. I've never had the pleasure of trying it but i hear its really good. I wish i had a connect for a patch or two =[ all i can get is dope </3
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yea, to be honest, I always have preffered prescription opiates like oxy, fent, morphine, dilaudid, etc....to street drugs like heroin.

The feeling of knowing for a fact what your taking and the exact dose it is and exactly what inactive chemicals are in it makes me feel much better about it. Especially since there are such strict laws regulating the production of prescription drugs. Your never gonna find a cockroach leg or baby powder mixed in with your pharmaceuticals.

Of course, I would need it in the correct dose levels.

Obviously I would rather have a gram of good quality heroin over a few 7.5/500's. Am I right?
 
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