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Misc Methadone + IV benzo---how dangerous?

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waldo777

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Feb 26, 2010
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I'm on 120mg methadone for MMT and need oral surgery, last time I went in (pre-MMT), they gave me IV midazolam to put me to sleep. (Midazolam is a potent, but short acting benzo). I CANNOT disclose that I'm on methadone as the doctor is a good family friend. Last time I went under, I had about 300mg's of oxycodone in my system taken in 2 doses over the course of 6 hours, just FYI

I spoke to the doctor at the methadone clinic and he totaly brushed me off. But, once he realized it was my safety I was asking about, his only advise was to have them start small and monitor more aggresively b/c I should tell them: "I've had trouble w/ anesthesia in the past". ....not very illuminating advise, but still a little helpful.

So my questions are:

-has anyone been put under while on MMT, if so, what steps did you take safety wise?
-anyone have any general knowledge or experience?
-if the docotrs are monitoring my breathing, does that eliminate the dangers of the benzo + methadone combo?

I know you're not doctors and can't give medical advise etc...just looking for whatever help and thoughts I can find to form my own opinion, anything you guys can offer is appreciated, thanks
 
I honestly think you should tell the doctor, family friend or not, that you are on methadone. If anything, he'll be happy that your not on heroin or oxycontin, and getting your life back on track.
 
waldo777 said:
So my questions are:


...-if the docotrs are monitoring my breathing, does that eliminate the dangers of the benzo + methadone combo?

I know you're not doctors and can't give medical advise etc...just looking for whatever help and thoughts I can find to form my own opinion, anything you guys can offer is appreciated, thanks
Click to expand...

No. Monitoring equipment is simply monitoring equipment--it won't prevent you from experiencing respiratory depression, only alert the doctor/anesthesiologist that you are. And there they are, trying to resuscitate you without knowing what medications you are taking.

You are obligated to disclose to your physician the medications you are currently taking. Even if he is a family friend, he is still bound to protect your right to confidentiality, and for him to violate your protected rights and disclose to your family would certainly mean disciplinary action by the state licensure board (and I would pursue it if this happened, but it won't).

Alternatively, you could find a new doctor. What is the procedure?

PS I am a doctor.
 
I think Missykins, or rather Dr. Missykins :), summed it up perfectly. Respiratory arrest is not something that you want to play around with. The equipment monitoring you would alert the staff that your respiratory system was not performing correctly, however it will do nothing to help fix that problem once it arises. Does the staff in a dental office have the training, skill, medication, or equipment necessary to bring you back safely out of an arrest? (They may, I have no idea.) I'm willing to bet that it isn't something they have regular practice with. It's hard enough to get people to go to the dentist in the first place, adding possible death to their list of qualms wouldn't be very good for business. :)

I understand that it may be uncomfortable for you to disclose your MMT to this particular dentist/DR. however that's much better than the alternative. Besides, if you tell them in confidentiality, they aren't going to risk their entire medical career over repeating it to anyone. Just my $0.02. Good luck.

WP

P.S.- Not to sound like a fear monger, as the situations/settings are radically different, however of all the people I have personally known of who have died from an opiate related OD, (upwards of a dozen) about 90% of them were mixing methadone in combination with some benzo.
 
I would disclose the fact that you are, indeed, on MMT. This is not a shameful thing at all, it is, in fact, prescribed by an M.D. Tell him you are just telling him as a patient to a doctor, and ask him not to say anything to whomever you fear he might. It is quite important that the anaesthesiologist know that you have such a large dose of a potent opioid-agonist in your system. To not tell him would be irresponsible and a threat to your saftey. Just so you know, not every anaesthesia combo and the dose is the same, it varies quite a bit. What might have been used last time won't necessarily be what they use this time. Just be safe, and tell him.
 
It's your life! Methadone is a serious, potent opioid. Midazolam is a very serious, potent benzo. Both of these repress your breathing alot.

You don't want to even think about being resuscitated by an oral surgeon, you're most likely not going to be in a full on hospital with the necessary resources to bring you back.
 
Your doctor won't be your close family friend if you end up dead.

You really need to disclose this information with him. If something were to go wrong and they do not know that you are on methadone, you may die because they won't know why you are experiencing repiratory depression, so they won't know how to treat it. Imagine dying because you didn't want someone to know you are on MMT. The doctor will feel horrible and his relationship with your family may be ruined.

Can you compromise by going to a different doctor for this procedure?
 
tricomb said:
It's your life! Methadone is a serious, potent opioid. Midazolam is a very serious, potent benzo. Both of these repress your breathing alot.

You don't want to even think about being resuscitated by an oral surgeon, you're most likely not going to be in a full on hospital with the necessary resources to bring you back.
Click to expand...

I take it that this a "twilight sedation-type" procedure. It's highly unlikely that an anesthesiologist will be involved at all.
 
Thank you all for the replies---and for the virtual slap in the face I needed!

Ya'll are right, I need to tell him for my own safety. And I thought about the subtle threat of "this needs to go under doctor-patient confidentiality, or else" statement. But was worried he would risk the medical board reprimand from disclosing that I'm on MMT , b/c doing so would be worth it to him. But your right, I'm not doing illegal drugs, and I am being monitored by doctors at the clinic, so he wouldn't need to be THAT worried. At least not worried enough to risk his career over.

I'm having 2 wisdom teeth removed, but the surgery is complicated by the fact that 1 tooth has migrated into a large nerve and they are worried that I could loose sensation in part of my face if they don't do it perfectly. The last time I had my other two wisdom teeth removed, w/ no complicating factors, they still put me under with Midazolam, so I assume they will do the same unless I give them reason not to.

I think he will honor the doctor patient confidentiality, and will make it clear I don't want this disclosed for good measure. But regardless, death is simply too big a risk for me to not tell the doctor about MMT--privacy doesn't really matter if your dead!

(PS, its a damn expensive operation, this guy is widely considered one of the best in our area, and my family is paying for it for me, so there's no justifiable reason why I would want another, random dentist to do the work instead)

Anyway, thanks everyone for making this an easy decision for me and for all your input. Now I just gotta be strong enough to handle the post-op pain w/out any painkillers :)
 
Who are you worried he would disclose this information to, family members and friends?

Who else would he disclose this to? It's not like he would put your name in some database that would let the rest of the medical community know that you are on MMT.

I originally just thought that you didn't want him to know because he is a family friend and you were embarassed to let him know that you had a drug problem. Maybe I am missing something.

Edit: Also, since you are on 120mg of methadone I doubt that any post-op pain meds would do anything for you, especially the ones that are traditionally prescribed after wisdom tooth removal. You will be in the same amount of pain with or without some 5/500 vicodins or some tylenol 3s.
 
Tommyboy said:
Edit: Also, since you are on 120mg of methadone I doubt that any post-op pain meds would do anything for you, especially the ones that are traditionally prescribed after wisdom tooth removal. You will be in the same amount of pain with or without some 5/500 vicodins or some tylenol 3s.
Click to expand...

So it sounds as if they are going to use midazolam in combination with regional blocks (ie, bupivicaine), but they haven't communicated that to you. It is a common protocol in dentistry.

The fact that you take methadone will certainly affect the post-op meds available to you, so there's another reason to discuss this with the doctor. When I was taking Suboxone I had a tooth root abscess that no oral pain med could touch, but believe it or not, naproxen helped more than anything else. Just don't take it with Tylenol.
 
I am glad to see this thread come to the right conclusion.
Always tell your doctor what medications you are on, especially when undergoing anaesthesia.
Also, don't worry about him disclosing anything. Be proud you are no longer on heroin, not ashamed that you are on methadone.

I am going to close this as it has run its course.
 
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