Converting from oxycodone to Methadone with cross tolerance?

[Sentience]

Cross tolerance is the big issue here. I have so much tolerance to oxycodone that oral morphine is significantly stronger.

Anyway, I have been taking oxycodone and morphine for 1 year. I have quite a tolerance for Oxycodone, and a bit less for MSContin.

I typically take 75 to 120mg of oxycodone per day and
15mg to 45mg of MSContin each day.

I have relied more on fast acting Oxycodone because morphine is a lot more sleepy....and despite what some doctors and pharmacists have said, its not because my dosage is too high. Its just a more sleepy drug, and oxycodone at the appropriate doses is almost slightly stimulant, though you can nod at higher doses (which wastes it, imo).

I was prescribed 60mg of Methadone, daily chronic dosing!!! 20mg 3x a day. I was also given 45mg to 60mg daily oxycodone for breakthrough pain, as he wanted a 2:1 or 3:1 ratio of long acting to short acting.

First 20mg dosing, I got a little euphoric. Softer than oxy but lighter and less sedating than morphine. Significantly less euphoria than oxycodone or morphine though.

I took my second dose of 20mg, and I slept for 10 hours.

I took my third dose, a bit late actually having slept through my third dose and was almost ready for what would be my 4th, and I became so sedated that i thought maybe I was going to die. I couldnt get up for the 12 hours, the half life is so long.


So, considering that I have pretty high tolerance specifically for oxycodone and only indirect cross tolerance for methadone, what is the appropriate conversion dose according to the charts (for information purposes only, not a substitute for the advice of a doctor or pharmacist).

 

[Sentience]

Personally, I am concerned that this guy claims to have tons of methadone patients. I wonder if most of them are drug addicts or if he assumed I was doing drugs on the side.

This same doctor has given me problems in the past. He lowered my dosage previously for no apparant reason. 2 months earlier I had said I wanted to ween down because I was having a better month for pain....I thought I would get some points for honesty rather than for hoarding drugs or abusing them....nope. He decides not to lower my dosage then, but 2 months later when I say the pain is worsening again to some of the worst pain I have felt so far, he suddenly
cuts my dosage by a third. He is unable to explain why. 4 times I write him and ask for an explaination. He says its in his notes but he cant be bothered to go look. He leaves me wondering whats going on. He seems annoyed that I write him to update my case and even more annoyed that I do my own research and dont just listen passively to everything he says.

More recently he said that he thinks opiods dont help my pain, and that if this doesnt work he will refer me to a pain specialist who is a real hard ass and doesnt give oxycodone. His only basis for this is that I am still in pain after he cut my dosage for reasons even he doesnt know. Opiates have always helped my pain.


Anyway, I think I almost died. What I am unsure of is how to calculate what dosage I should have gotten after adjusting for high tolerance to oxycodone and no tolerance for methadone.

 

[Call Me"PRIEST"]

well it sounds like you are very well informed about what medications you are taking. it's also good to see that you have done research so that you understand what you're putting in your body.
without more information it's hard to answer your questions. i'm assuming that the dr that is prescribing your meds is not a pain specialist but maybe a family dr or something as such.
one of the reasons that he might have cut your pain meds is that you mentioned you wrote him questioning his prescribing habits. Drs. are like lawyers, they don't like to be questioned. and they don't like to be told what to do. ( i know i have both drs and lawyers in my immediate family). so maybe by questioning him he decided to let you know who is the boss and cut your meds. if i were you i wouldn't question him that much. another reason he could have cut back is that drs now get nervous when prescribing narcotics because of the intense scrutiny they are put under. basically, i wouldn't rock the boat or some of your pills might fall into the water.

as far as cross tolerance and dosage conversion that is a hard thing to calculate because everyone reacts differently to different medications. my suggestion would be to experiment with different dosages and medications. but remember to keep detailed notes so you can keep track. once you find the right combinqtion that works for you, stick with it and try not to deviate from that schedule.

another suggestion would be to research the different medications you take on the internet. the more information you have and the better understanding you get about what you are taking the better off you will be.

 

[Sentience]

Its too late to work things out with this doctor. I told him I would be going to see another doctor, and he told me he is writing my other doctors to ask them who my replacement should be. I told him that I can choose another doctor for myself, thank you very much, and I told him exactly why he lost my confidence.

Things already were not working out. He had cut my dosage for no reason. Its a good thing I had been saving my extra pills so I was able to compensate, but I shouldnt have to. I am very responsible and dont use pain pills to get high...no judgement against people who do....but he cut my dosage, then when I said it wasnt enough he told me my pain wasnt being helped by opiates as an excuse to cut me off completely.

Before we switched to methadone he told me that if this doesnt work out he was going to refer me to another doctor....apparently because I had been complaining about the fatigue associated with the medications he wanted me on and he wanted me just to shut up and not make his job any harder. That isnt going to work for me. I have a daughter and cant be falling asleep all the time. So far oxycodone works better than anything else as far as leaving me functional and offering less sedating pain relief. He already has his mind made up that any more complaints and it was over.

He seems to think that he can still butt his nose into my business after I ditched him as a doctor. He told me that he was going to figure out what doctor should replace him after writing to my doctors.....so he twisted my arm....I had to write my specialists and give them my side of the story, that he lost my confidence because he almost killed me by giving me TOO MUCH medication, rather than me trying to scam because he gave me too little.

You are right about this guys attitude. He thinks he is an authority over me.....if he doesnt want me as a patient fine, but he has no other power over me. I am employing him. I am his boss, he is not mine...yes, he can withhold medication or even write a bad review for the next doctor (which is why I want him out of the loop), but he cant be telling me what to do once our client-provider relationship is over. His authority ends once I walk out the door.

I really didnt want to make a stink about his fuckup. I didnt want to get him in trouble or make him look bad, I just wanted the care I needed. He gave me the impression that he wanted to be involved and write me up like a disobedient drug seeker, sending me to somebody who is really strict in managing my meds, but Im not having it. I am not a drug addict (again, no offense to those who are) outside of the occasional amount of marijuana...I dont really experiment much these days with my health being as it is, but I always used my medication for pain and nothing else.

With the kind of pain I am in, I cant afford for doctors to be treating me skeptically just because he messed up and lost my confidence.

 

[Sentience]

I did some research and it seems like I should have been given 9mg to 18mg of Methadone for my long acting, plus 45mg to 75mg of oxycodone for breakthrough pain.

Instead I was given 60mg of Methadone (almost killed me), and 45mg of oxycodone.


I could have just shut up and save up the difference......I would end up with a huge stockpile of Methadone because he over prescribed....However, I am a little concerned that if he doesnt take a lesson from me that he is going to kill somebody, if he hasnt already.

 

[Call Me"PRIEST"]

you are right that the dr SHOULD listen to you and help you find the right medications that work. and he shouldn't hve any power over you, but unfortunately he does. you might not be adictted to your medications, but you are pyhsically dependant on them. meaning that if he cuts you off you will suffer a great deal. and like i said, drs have this holier than thou attitude over most ppl. they think they are so much smarter than their patients and they don't like patients making any waves or being told how to do their job.
my advice would be to be as kind as possible to him as you transfer to another dr. the last thing you want is a red flag on your file.
good luck with your situation, i hope it works out for you.

 

[Sentience]

Too late.

Anyway, most of my doctors have a lot of respect for me. My GI doc knows that I am in pain. I was a med student before I got sick myself, and my specialists know that I am highly intelligent and responsible. I even helped diagnose myself. When I speak my doctors tend to listen to me. My GP however didnt like informed patients who read. It offended him. I dont have any use for people like that.

And no, my GP cannot withhold meds from me if he isnt my doctor anymore. The worst he can do is write up a bad review, but I think I stole the show from him when he overdosed me and I told my doctors as much. I am not a drug seeker. I am in real pain. It would be one thing if I left right when he lowered my dosage, but its another to leave because he nearly killed me and I want a lower dose administered by somebody who knows what they are doing. After comparing both our stories, him suggesting maybe I am a drug seeker who doesnt follow orders, vs me complaining that he almost killed me by giving me way too high of a dose....it doesnt add up in his favor. After almost dying, I have a valid reason to be looking elsewhere, while most people who just want more drugs end up looking like drug seekers....he actually did me a favor, though thankfully I didnt die.

So, after all that he had the audacity to tell me who my next doctor would be....probably somebody who he thought would listen to him and be ultra strict with me.....He has no right. Not not morally or ethically or in an ideal world, but literally he doesnt have the right. I am allowed to pick my doctor. I did tons of research and I think I found the right one....and if that doesnt work out I have 2 more appointments planned with other doctors who seem open minded....I picked younger doctors who have positive reviews in the listening department.

If I am really cautious I could make what I have left stretch for another 4 months or so. Definitely enough to tapper down gradually, though I still have the underlying pain. I could always supplement with pods or Kratom or whatever the black market has to offer, and of course medical marijuana.

I think as long as the specialists are on my side or admit that I am in pain, I dont think I am going to have trouble getting meds. I have an excellent reason for switching doctors that isnt because I am abusing my meds. Overall I think he is going to look like an ass for over prescribing, rather than me complaining about running out too soon which I didnt.

In a best case scenario, maybe we will get to the root of my pain and I wont need the drugs anymore....I would like that, because there are a lot of drawbacks to needing to be medicated all the time....of course its better than being in pain...but its just not fun when you are in pain all the time and you are just trying to numb yourself. It makes me really tired all the time, except for oxycodone, but I cannot afford the long acting version which isnt generic yet.

Anyway, I bet I wont have any problems getting medication without him. If things dont work out with this other doctor at a different office in the same network, I have a PPO and can go outside the network. I have a backup appointment with another doctor who I know is unable to access my old records because they are with a different hospital network...I might have a third option too, a pot doc, but I would really rather get my meds from someone who is reputable and actually wants to help me when I have other concerns besides medication....because like I said, I actually have medical issues...but I am not beholden to one person for getting meds.