Opioids Changing Painkillers: Methadone --> ?? Suggestions?

[vintage]

One thing that I can heartily agree on is that I have had two awesome doctors, back to back: my PCP in Texas, and my PCP here. Both have been compassionate, and also willing to allow me to do some of my own research, only pointing out possible contradictions, or other issues. They have been like this in both treating my chronic issues (psoriasis and psoriatic arthritis), as well as my pain control. Like the title of the thread says, the only problem I've run into is a state thing, preventing a normal PCP from prescribing methadone in Delaware.


As for my pain meds, I definitely do have a high dosage to get my motor running in the mornings. Currently, during the week, I'm usually taking 3 x 60mg Oxycontin twice daily along with 150mg or so of Oxycodone for breakthrough or 8-12 x 8mg hydromorphone for breakthrough, depending on which breakthrough I have (I try to rotate each month to keep my dependence low). This morning, I was in quite a bit of pain, so I started off with 4 x 60mg Oxycontin instead of 3. When I was getting Methadone for pain, I would do 5 x 10mg Methadone twice daily, with the same Oxycodone/Hydromorphone for breakthrough.


When I go back for my monthly refills, my PCP said we'll try out both Opana and Levorphanol; I'll let you know how that does.

 

[Erikmen]

Doesn´t Methadone block the effects of the other meds?

 

[Erikmen]

I hate to recommend Fentanyl but have you asked about it for your kind of pain?

As you may know, its a dangerous opiod & would be a last resort IMO........

I simply don´t feel anything using Fentanyl. Nothing at all. I had two patches, 50 mcgs each and nothing!!

 

[Erikmen]

I also don´t understand how can anyone be high on Oxys when they are using Methadone.
I used 30 pills of 40 mg, and felt nothing. Again the second day, with half of methadone out of my system, nothing..
It´s frustrating

 

[Pill__Head]

I also don´t understand how can anyone be high on Oxys when they are using Methadone.
I used 30 pills of 40 mg, and felt nothing. Again the second day, with half of methadone out of my system, nothing..
It´s frustrating

Your not the only one out there that as this "trouble"...When I was on Methadone, It took atleast 2-3 days of no dosing 'Done to drain from my system enough to allow me to feel ANY of opiates ( generally I relapsed on Heroin ).

So I'm with you man, I dont understand how people are popping all these pills and shooting through/over their Methadone. Either they are complete idiots, and "think" they are getting high ontop of their 'done, OR for whatever reason they actually are getting high on top of their methadone.. everyone is different..IDK..

 

[Erikmen]

My morning starts ...

And the methadone does not block the oxys?

 

[vintage]

Doesn´t Methadone block the effects of the other meds?

I also don´t understand how can anyone be high on Oxys when they are using Methadone.
I used 30 pills of 40 mg, and felt nothing. Again the second day, with half of methadone out of my system, nothing..
It´s frustrating

I have never experienced any type of blockage with Methadone and other painkillers. I could use both Oxycodone and Hydromorphone for breakthrough and definitely felt the effects of using them. I've been using Methadone on and off for 15 years with no issues like this.

I simply don´t feel anything using Fentanyl.

This is me and morphine. They always try to stick me on it in the emergency room, and qickly find out that even at high dosages, it does very little too me except give me heat flashes.

 

[Erikmen]

That´s good for your in some sense. Take care.

 

[Erikmen]

I have blockage from 70 mgs of methadone, and, believe me I have tried almost everything to try to make this worth.
In terms of analgesia, yes, it does work fine. What I miss is the good feeling. When I mix Oxys, fent. and others I get very sleepy.

 

[cosmicjive]

Your not the only one out there that as this "trouble"...When I was on Methadone, It took atleast 2-3 days of no dosing 'Done to drain from my system enough to allow me to feel ANY of opiates ( generally I relapsed on Heroin ).

So I'm with you man, I dont understand how people are popping all these pills and shooting through/over their Methadone. Either they are complete idiots, and "think" they are getting high ontop of their 'done, OR for whatever reason they actually are getting high on top of their methadone.. everyone is different..IDK..

Never underestimate the power of the placebo effect!

I am glad to hear that your doc is being so understanding, Vintage; that's great. I can't imagine what my doc would have said if I asked her to script Levorphanol; she was pretty easy-going, but I think that might have tested her mellowness. "And, Doctor, if the Levorphanol doesn't cut it, maybe we could try Sufentanil next?"

Also, did you say you are you taking one of those biologics for your psoriasis/psoriatic arthritis? I can't remember...but anyhoozle, that right there is another amazingly good reason to never, ever IV your meds. Those biologics can help you along with some major infections. (Though, I think you already said you would never IV, so that's good.)

 

[vintage]

As a note, I do want to say that I wasn't trying to be snarky or anything when I said I didn't have issues with Methadone and other painkillers, it was just meant as a statement. From what I have read "lower" doses do not act as an opiate antagonist, but "higher" doses do. I would imagine that the lower/higher statements are relative to your tolerance. For me at least, I can state with 100% certainty that it's not a placebo effect for me on the doses and combinations that I have been on. That may change if I ever tried it in different combinations.

I am glad to hear that your doc is being so understanding, Vintage; that's great.

Both my old doctor and my new one have been fantastic. And believe me, I've had others in the past that thought anything above Percocet was ludicrous. A good example is the time I spent in the hospital this time around, and when I went to the dentist last month. He wanted to prescribe Percocet, and couldn't understand when I told him that wasn't going to do anything. I'd destroy myself with the APAP.

Also, did you say you are you taking one of those biologics for your psoriasis/psoriatic arthritis?

No, I am not, although since I have this new high deductible plan now and everything is now covered 100% for the rest of the year, I will probably will. Am going to get everything done this year that I need to get done :D

 

[boredswfl]

I am wondering how many mg of methadone would equal a dosage of 60mg oxycodone
thanks

 

[Cliffy78]

I know in my state you have to either me a pain management dr. Or an addiction specialist to prescribe methadone. Not sure about Delaware but it's probably the same...

 

[vintage]

According to the pharmacist that I spoke with, the 10mg is able to be prescribed by a PCP for pain without them needing a specialized license. She said that she has a number of PCPs in the area that prescribe the 10mg without issues or specialized licenses.

However, the 40mg are considered to be for use in addiction and do require a specialized license.

This is something that I haven't checked, but as I said, it came directly from the head pharmacist at my pharmacy, and I wouldn't think they'd have any reason to lie. She gave me the names of two doctors in the area that she sees prescribe the 10mgs on a regular basis, so I'm going to hit them up this week.

 

[Cliffy78]

That seems about right, makes sense to them I guess lol.
So do those meds control your pain for the most part?
Your very lucky to have understanding drs brother. I've been on 15mg oxy 3x a day for 5 years and they don't really do the trick but if I bitch I risk losing those even. Pain is such a pain in the ass.
I know what u mean about the er too, just went a few weeks ago and they insisted on the morphine even though I'm allergic, made thinks twice as bad. Then they just ended up giving me the dilaudid anyways, wtf!!! lol. I hope you get your 'done man, it's so hard when the gov. Gets involved in our healthcare.

 

[vintage]

The meds do control my pain for the most part. The problem for me is that Methadone controls my pain much better than Oxycontin/Oxymorphone/Oxycodone. The reason is that part of my pain is nerve pain, and opioids don't control the nerve pain as well. For example, I used to take 5 x 10mg Methadone twice a day, and I was almost completely pain free. When I moved up north, as I stated, my PCP won't prescribe methadone at all (am hoping now that I have this list from the pharmacist that I can find one that does), but has no problem prescribing me anything else in any quantity that I want. And having this new high deductible insurance is nice ... now that I have paid that deductible ($2500), everything from here on out, visits and prescriptions, are 100% covered. So money isn't an issue.

What I'm doing at the moment is rotating between two sets of pain killers. Month #1 I do Oxycontin 80mg x 2 twice daily (so 4 x 80mg a day) with 4 x 8mg daily Hydromorphone for breakthrough. Month #2 I do Oxymorphone 40mg x 2 twice daily (so 4 x 40mg a day), with 4 x 30mg daily Oxycodone for breakthrough. I also have a bottle of 120 x 10mg Oxymorphone IR that I get monthly as an additional breakthrough in case the other breakthrough runs out. My insurance has a cap of 120 pills per prescription, so even though I need more at times, I can't get it.

 

[madonit]

Hi Vintage, Hi All bluelighters,
Ive been on a prescribed opiate of some sort scince i was 21 ish due to opiate dependance and pain issues. Im in a dillema on what to say about meds when i go see my doc in around 18 hours. Ive been prescribed mainly methadone until about 2011. I was on fentanyl patches 100mcg replaced every 48-72 hours and methadone at the same time.

I was also using upto 100mg of oral morphine a day on top bought of the street so my doc agreed to change me to 12 hourly morphine. I started on 50mg x 2 daily and had to go up to 150 twice daily to feel comftable after coming off my methadone and patches as same time (but not sedated or high in anyway). 3 years+ down the line Im really struggling with my morphine dose at the moment (this is only opiate i get now I did used to get methadone and fentanyl up untill about early 2011 ) and am so tempted to go back on fentanyl if im allowed to.

Its a dam strong drug fentanyl but it really lacks euphoria, this is the reason i changed to morphine in first place but i have become so tollerant with it i am going to have to try and ask for an alternative opiate to try (we are very limited here no hydrocodone or oxymorphone in the uk or that levorphanol either i dont think We have palladone and oxycodone but these are very rarely prescribed normally) I might ask to swap half of my ms contin dose for 37-62mcg fentanyl patch. Im unsure if i could get a small amount of a few different opioids to decide what one works best for me so think im gonna have to ask for the fentanyl back. I so miss being able to suck on 1/6-1/4 of a 100mcg patch when having bad days. 1-4mg of fentanyl sublingually/bucally is stomping when in bad pain. Can anyone think of any strong opiates used in uk that i have not mentioned ??? Unfortunatly out the synthetics dextromoramide (Palfium) is no supposedly no longer stocked by uk pharmacys scince about 2004-2005, Phenazocine or Narphen thats 3-4x stronger than morphine orally like palfium was discontinued in 2001. So generic dipipanone (Diconal) is the last one left i think now but is probably out the question and to be honest id be a little scared to mention it in case doc thinks bad things and stops my px. I could not cope on methadone now, even though some people say id get more of 100mg methadone than 150mg 2x daily of 12 hourly morphine !!!!

ugo2slo4me i dont think benzos will help him instead of the opiates hes on unless vintage is looking to detox. Nitrazepam and Diazepam are good detox tools when used correctly but to suggest vintage do that could be dangerous as fitting can be induced from opiate cold turkey although uncomman compared to benzo's but strong opioids specially methadone pethidine and fentanyl.
I dont know what to do maybe i should start my own thread but then i gotta go bed in bout 20 mins confuseddd.com is the word lol. Ive Also worked out how to drain the d trans matrix type patches of their fentanyl for dilution for other uses

Also is it true that the fentanyl in the patches is in a freebase form and not the citrate at 1:1 ratio ?!?!? If it is then that means the 200mcg lollypops only contain 100mcg as fentanyl freebase.

@Boredswfl IMO The correct conversion from oxycontin or oxycodone 60mg daily to methadone is between 15 and 30mg daily due to accumulation and methadones very high oral bio thats higher than oxy (oxy is about 65% and methadone is about 80% effective orally which is why injectable methadone is only a fraction stronger compared to same oral dose. Plus it is also 2x stronger at least than oxycodone probably more . Do not exceed 15mg to start then a maximum 20-30mg for 5-7 days as methadone accumulates a lot in most people.

In the uk they use a heavily diluted 1mg/1ml mixture to allow for tiny dose increments. Methadone tablets do not even exist here except as physeptone 5mg tablets but these are only licensed for pain and when addicts travel abroad. We have a blue concentrated solution thats 10mg per ml and a brown one that is 20mg per ml (the blue sugar free one is injectable because its like water that just tinted blue. The brown one is probably too as long as its sugar free. Its not gloopy like the usa concentrates like that pink stuff either but im suprised your methadone tablets go upto 40-45mg each specially the water soluble ones. People would inject those here in the uk and love it. The long lasting heroin hits we used to get from cooking up with blue methadone instead of water was unreal.

Also having been on methadone myself for years on end i look at methadone not as a antagonist but not a full agonist either. Maybe a agonist with blocking properties would be a good description of it . I think its more of a receptor soaker if you get what i mean in the way it saturates your receptors after doses around 60-70mg and higher on regular basis.

Wish me luck for tomorrow please guys any advice greatly appriciated PEACE LOVE AND UNITY
Safe people