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Opioids Doc Wants to Switch Me to Methadone - Terrible Idea?

Harrisment

Harrisment

Bluelighter
Joined
Mar 2, 2000
Messages
398
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Planet Telex
I've been seeing Pain Mgmt doctors for several years due to a degenerative disc condition in my lumbar. A few months ago I had to switch doctors, and unfortunately he seems to have a big problem with the drugs I've been prescribed. I'm currently on Oxycontin 20mg 2x day, and Roxicodone 30mg 4x day. In his opinion, being on this dose of narcotics is not sustainable, and he would like me to taper down. The problem is that he thinks the best things for me to taper with are either Methadone or Fentanyl, as he wants me to get on a single drug rather than taking multiple each day. I told him I'd try the Methadone just due to the cheaper cost, but I've read so many horror stories that now I am re-thinking it. The dose he is starting me on is 10mg, 2x day. On Monday I am supposed to start it, but I went ahead and made a follow up appointment with him the same day to express my concerns about this switch.

Is it crazy to put someone with my current dosage on methadone? I'm gainfully employed and fully functional, so it's not as if I'm in a desperate position due to the addiction. I'm terrified of the horrible withdrawals that I've read about it. I also had someone tell me that it will be very difficult to get life insurance in the future if they see Methadone in my prescription history. Thanks for any input.

Apologies for the double post, as I put this in the pain mgmgt thread a few days ago but had not gotten a response.
 
If you're already going to be on opiates anyway, it's not really that big of a deal to switch to methadone if it's going to help you. There are a lot of horror stories out there about it, but most of it is just very exaggerated. Yes the withdrawal from methadone sucks, but if you come off on a low dose, it's not really any worse than other opiates, it just lasts a long time because the drug has a long half-life. Which is a good thing for pain management, because you wont constantly have to redose and it will stay in your system working, easing your pain for much longer.

Also, 20mg's a day is not a high dose of methadone, so you won't get all crazy strung out on it like the people taking 150mg's at a clinic for maintenance.
 
I don't see why he would use fentanyl to taper as its short acting. I suppose a patch would release a steady amount throughout the day, howvevrr I woUld highly recommend Suboxone. You are not on a very high dose and could get by on 1-4mg a day. It is long acting, and easier to get off of than methadone most,y because it is a partial agonist.

If you must go with methadone, go on the smallest dose possible, and because it slowly builds in the body with every dose, you may not be at its full effects till the 4th or 5th day even
 
As long as the methadone dose is high enough, there is absolutely no issue. If you experience persisting WDs, your dose is just too low.
 
seems you are taking more opiates now than what youre methadone dose will be covering. maybe feel a bit of a different coming from where you are now to the 10MG 2x's a day, no? anyone agree w/ that?

40MG/day/Oxy
90/MG/day/Roxy

now 20MG/day/done?

no one see's a problem w/ that?
 
BostonBrownTown said:
seems you are taking more opiates now than what youre methadone dose will be covering. maybe feel a bit of a different coming from where you are now to the 10MG 2x's a day, no? anyone agree w/ that?

40MG/day/Oxy
90/MG/day/Roxy

now 20MG/day/done?

no one see's a problem w/ that?
Click to expand...

It's 80/MG day of Roxy, but yeah. I'm not familiar with methadone, but the doctor acted like that would be a comparable dose. Is it way too low?
 
for addiction I dont see TOO BIG of a problem for it; although, I would still battle it out. but for ACTUAL PAIN I do see a problem; but maybe thats just me and my lock of knowledge when it comes to methadone. I've used many ways but not in ways to treat pain; however, at the time of use I was on a high amount of opiates and had to take around the same amount of methadone (if not higher) to get that same feeling, which is why I brought that up.
 
With regards to switching to methadone, i don't see it as a terrible idea. Methadone is just another opiate and it has been used for pain management for a long time. Although yes the WDs will be longer, they won't be as intense as coming off the dose of oxycodone that you're on - especially if you do a taper. Also as mentioned in a post above it is incredibly long acting so you should only require one dose per day, and if it is an adequate dosage, it will provide round the clock pain relief.

But as BostonBrownTown said 10mg twice a day really doesn't sound like a high enough dose. I would speak to your doctor about the dose. He may be planning to start you on that dose to see how you react and then titrate the dose upwards until you feel adequate pain relief.

But if he thinks that 20mg methadone is the dose you should stay on to keep you well AND provide pain relief, then you may need to see another doctor or convince him to up the dosage.
 
I am a 20 yr Done script.

I am hoping 2 switch 2 oxy er to manage y chronic pain . i am on 20mg of oxy ir atm n 50ml of Done.

It does not work as abase pain killer ime
 
I was on methadone for addiction. I was able to tapper off all the way down to 0.25 mg. I still had withdrawals but not horrible.. I am so thankful for it...

I was never in pain but if I got hurt the methadone never helped, in fact all opiates never helped for pain it only made me feel so good that I didn't care.. In fact I didn't care or feel much until I got down under 10 mg...

Opiates don't stop pain they stop you from giving a shit.. And its a shitty road...

I would jump on the methadone at 65mg and start to taper in a year with 5 mg per month, when you get to 45mg go down 2 mg per month. You can do that down to 15 . after just go down 1 mg per month and when you get to 4 mg start using an eye dropper. Figure one drop is 0.25 mg..

This must be liquid

I was at a clinic and I would get take home bottles I would use eye dropper to take my dose and put some extra drops aside and in a few years I had a soda can worth of extra methadone.. I never had to tap into that but just in case when I signed out of the clinic it would be available... I have been clean for over a year..

I forgot what it felt like to get high many years ago...

I came along way from shooting oxy 80 , I even shot the methadone in the beginning ..
 
BostonBrownTown said:
seems you are taking more opiates now than what youre methadone dose will be covering. maybe feel a bit of a different coming from where you are now to the 10MG 2x's a day, no? anyone agree w/ that?

40MG/day/Oxy
90/MG/day/Roxy

now 20MG/day/done?

no one see's a problem w/ that?
Click to expand...


Yeah, I see a big problem with this. Don't let your doctor change a damn thing unless he's gonna propose fentanyl or way more methadone.

@Harrisment: you're on 160mg of oxycodone daily. I'm well aware you need it for pain, but if someone were taking that much for an opioid habit, they would start in at a methadone clinic at a minimum of 30mg daily. I was doing probably about 160mg oxy equivalent in H when I got on methadone, and after 14 months of being on it now, it still takes 90mg once daily to keep w/d off. I tried going down to 80 and I got sick too quickly unfortunately.

Additionally, methadone WILL lose its analgesic power pretty shortly after you start, whereas no oxyco/oxymorph/hydromorphone/fent patients complain of analgesia fading on those meds.

Let me explain. I had an arm injury two years ago when I was on methadone briefly for 3 months. I was on 75mg daily, took my dose, went to the urgent care that gave me 20x5mg oxycodone and 30mg literally relieved my pain like none other. Last week due to snow on shoes, there's a staircase to climb up to 12 step meeting I attend and I fell 30 stairs hitting my back and head all the way down, received zero pain medication at the hospital, and was in immense pain even though I had taken 85mg of methadone 2 hours prior and I took another 40mg (from my take home dose, regrettably) which did nothing.

Point is, I have a really shitty back to begin with and I was on 10mg oxy 4x/day for it a one time so I frequently wake up with aches and bad pains and my seemingly high dose of 90mg which sometimes is enough to put me to sleep, is not even enough to kill a toothache.

TL;DR: Don't settle for less than 20mg methadone twice daily to START with. Your doctor is just trying to save HIS C-II prescribing record. Your meds are plenty sustainable, I know people who've been on 3 different narcotic pain meds daily with no issues. As others have said, your meds are not the problem but rather this doctor. I hope I didn't come across to authoritatively, I've just been through every opioid and experienced pain management rigamarole and I don't want you to go through withdrawal when your doctor switches you to 20mg m'done daily, which you certainly will.
 
Thank you all for the replies.

Based on what this doctor has told me, he is just against long term opiates for chronic pain. In his opinion if someone requires long term pain meds, then they need to get on a pump. So really, rather than prescribing me the methadone for pain, I really think his end goal is to get me off of the meds entirely. Sadly, it really doesn't surprise me that he is prescribing me such a lower than adequate dose.

I'm going to see him in a few days, but I think what it comes down to is that I need to find a new doctor. I have an appointment with a new one a few days after that, so I may end up having to take the methadone for a few days. I'm hoping he will just agree to give me a couple weeks of my existing meds and give me time to find a new doctor.
 
Your doctor might save your life.. Consider giving it a chance.. The pain you talk about is just you finding reasons for continuing down this road, just keeping it real ..
 
Harrisment said:
Thank you all for the replies.

Based on what this doctor has told me, he is just against long term opiates for chronic pain. In his opinion if someone requires long term pain meds, then they need to get on a pump. So really, rather than prescribing me the methadone for pain, I really think his end goal is to get me off of the meds entirely. Sadly, it really doesn't surprise me that he is prescribing me such a lower than adequate dose.

I'm going to see him in a few days, but I think what it comes down to is that I need to find a new doctor. I have an appointment with a new one a few days after that, so I may end up having to take the methadone for a few days. I'm hoping he will just agree to give me a couple weeks of my existing meds and give me time to find a new doctor.
Click to expand...

I would definitely try the 20mg's first and see if it's enough for you honestly, before doing anything else, because you really don't want to end up on a high dose of methadone (or any opiate really but especially methadone) if you can avoid it.
 
cwake18 said:
Yeah, I see a big problem with this. Don't let your doctor change a damn thing unless he's gonna propose fentanyl or way more methadone.

@Harrisment: you're on 160mg of oxycodone daily. I'm well aware you need it for pain, but if someone were taking that much for an opioid habit, they would start in at a methadone clinic at a minimum of 30mg daily. I was doing probably about 160mg oxy equivalent in H when I got on methadone, and after 14 months of being on it now, it still takes 90mg once daily to keep w/d off. I tried going down to 80 and I got sick too quickly unfortunately.

Additionally, methadone WILL lose its analgesic power pretty shortly after you start, whereas no oxyco/oxymorph/hydromorphone/fent patients complain of analgesia fading on those meds.

Let me explain. I had an arm injury two years ago when I was on methadone briefly for 3 months. I was on 75mg daily, took my dose, went to the urgent care that gave me 20x5mg oxycodone and 30mg literally relieved my pain like none other. Last week due to snow on shoes, there's a staircase to climb up to 12 step meeting I attend and I fell 30 stairs hitting my back and head all the way down, received zero pain medication at the hospital, and was in immense pain even though I had taken 85mg of methadone 2 hours prior and I took another 40mg (from my take home dose, regrettably) which did nothing.

Point is, I have a really shitty back to begin with and I was on 10mg oxy 4x/day for it a one time so I frequently wake up with aches and bad pains and my seemingly high dose of 90mg which sometimes is enough to put me to sleep, is not even enough to kill a toothache.

TL;DR: Don't settle for less than 20mg methadone twice daily to START with. Your doctor is just trying to save HIS C-II prescribing record. Your meds are plenty sustainable, I know people who've been on 3 different narcotic pain meds daily with no issues. As others have said, your meds are not the problem but rather this doctor. I hope I didn't come across to authoritatively, I've just been through every opioid and experienced pain management rigamarole and I don't want you to go through withdrawal when your doctor switches you to 20mg m'done daily, which you certainly will.
Click to expand...

The part in bold is confusing in that it makes it seem like you need the 90mg of methadone to cover your previous habit of 160mg of oxycodone when in reality it's the higher dose of methadone that you are now dependent on, and since you seem to be a fast metabolizer of it you get withdrawals from it around the time you are dosed again.
 
Mr.Scagnattie said:
^^

Yeah 90mg's of methadone seems pretty high to me for 160mg equiv of oxy H habit.
Click to expand...

I can't ever post on this site without getting any form of criticism, I swear.

But you're both right. It's indeed the methadone I'm now dependent on and apparently I am a fast metabolizer, hence the quick onset of w/d when I was reducing my dose by 1mg/day and hit 80mg.

Look, it's heroin. It literally changes every day I'd buy it, always super great quality, in fact doing a tenth (a bag) shot would've usually killed me. I would do 30mg H shots, daily habit varied, but I know I substituted with oxy some days and would use around 150mg, being a junk head is all about how much money I had though, the more money I had, the more dope I did. For example when I lived in colorado I could easily do $100 of dope (tar) in a day, but I'd be hard-pressed to TRY to do $60-70 worth here in Illinois (powder) just due to the quality difference.

For simplicity, let's say I have no idea the oxy equivalence of what my dope habit was, but rather that my opioid dependency level required 75-85mg of once daily liquid dosing to stave off withdrawals for 24-36 hours. That's what I'll say.

And at OP, the others are kind of right now that I think about it, I mean if you're living with unbearable pain, that's that, but I've been to rehab with people who broke more shit in their body than a bull in a china shop, had been heavily medicated by pain mgmt docs, and miraculously (sarcasm) were able to last the whole 70-90 days at rehab with nothing but tylenol and ibuprofen. Same with myself. A lot of people are comforted by their "pain" because it gives them a pass to drugs that people literally die for, and after all, it was the DOC that suggested the narcotics to begin with so it's not like we're the drug-seekers, eh?

Just a thought. Like the other couple said, try the 20mg first. And do NOT take it all at once. Honestly I'd try dosing 10mg morning and maybe 5mg twice at the end of the day, methadone has a long half-life, but it analgesia is no more than 8 hours especially on a single 10mg tab. I'm no doctor, but I've dealt with methadone a lot and I just am worrying about you facing withdrawal for a couple days. It may be good to get down to just some PRN pain meds, eh? But if you need them, you need them.
 
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