Opioids Mixing Methadone with Baclofen and/or Clonazepam

[lostincontrol]

I'd like to begin this post by stating that after conducting extensive research, I am aware that taking methadone in addition to any benzodiazepine runs the risk of respiratory depression and possibly death and that the lethality of the combination is directly related to one's individual tolerance to both medications. Therefore, I'm trying to get advice and input from others who are far more experienced than I am on whether or not the amount of each drug I would like to take has a high chance of producing an overdose.

I am a 26 year old female and have congenital talocalcaneal hindfoot coalition of my left foot, which means that the bones in the back of my foot which should be able to move independently have fused together and cause limited range of motion, pain, muscle spasms and tightness of my left calf, weakness and most recently, sciatica of my left buttocks and back thigh due to spasms from misalignment of the hip. I need surgery to reconstruct my foot and extend the Achilles's tendon, however will not be able to afford it until the preexisting exclusion of my health insurance expires and I can manage the time off of work. Because of this, I have been in and out of pain management for the past three to four years to treat the pain and spasms caused by the condition. When I was originally diagnosed, I was prescribed Norco 10mg x4 a day, Oxycodone 7.5mg x2 a day, 800mg Gabapentin x4 a day and 10mg of Baclofen x3 a day by pain management. During this time, I developed a taste for opiates and developed an addiction, unable to differentiate at times the desire for more medication due to want or physical need. In addition, I developed a panic disorder and have been prescribed Clonazepam 1mg x2 a day, unable to find relief with SSRIs, Buspar or other medications. Due to the intermittent nature of the panic attacks, I would often take .5mg for relief from anxiety and 1mg at most. If in opiate withdraw, I would take 4 to 5mg spread out throughout a day. Since then, I have moved to three different states, lost insurance from lack of work, and came off and on opiates and benzos. I rarely have bought pills off the street, occasionally using 15-30 mg of oxycodone or low dose morphine from a friend, despite running out and have never used them in any way other than oral route, withdrawing for extended periods of time when not having access to doctors.

Recently, I have been in pain management again after gaining employment almost a year ago. At the max, my pain management doctor would prescribe Norco 10 x4 a day with Baclofen 10 x3 and refused to increase my doses. The cycle continued, taking more medication than prescribed, running out and unable to procure more, having no connection to outside sources and fear of doctor shopping. At the most, I would take 60 to 100mg of hydrocodone spread out throughout a day. I made the decision to begin methadone maintenance almost two weeks ago in order to find pain relief and avoid losing my job and friends to addictive thoughts and behaviors. I began methadone at 20mg and increased my dose to 30mg three days later, which is what I'm currently at now. When taking the methadone, I feel somewhat high with altered perception from about one hour to 6 hours after taking my dose, gradually diminishing throughout the day until the morning where I feel normal but in horrendous pain. Since taking the methadone, my pain is relieved for about 9 hours and lessened a little for the rest of the time until my next dose, however I have been having panic attacks basically everyday. Having no experience with methadone, I believe since the effect are similar but not identical to hydrocodone or oxycodone, my paranoia and fears about how I feel are triggering anxiety since I have not stabilized yet. In addition, since I have no experience with methadone, I am terrified of taking both the Baclofen or the Clonazepam despite desperately needing both. My leg feels almost like a brick with spasms and the anxiety is crippling at times.

So with this, I ask: With my history, would taking the Baclofen as prescribed 10mg at three times a day and .5mg-1mg of Clonazepam once a day cause likely overdose and/or death with the 30mg of Methadone once a day. I will add that when I was admitted to the Methadone clinic, I informed both the doctor and the counselor that I was prescribed the Baclofen at 10mg x3 a day and Clonazepam 1mg x2 a day and neither of them batted an eye or warned me of any interactions between any of these medications. I am aware that I sound like a raving lunatic and likely overreacting due to the anxiety, so I thank anyone who has bared with me and read this post.

 

[Tryptamite]

I'm going to go out on a limb and say that taking the drugs at the prescribed doses will be ok with your maintenance dose of methadone BUT you should know that both drugs will potentiate respiratory depression with methadone and possibly with each other.
You should take one dose of baclofen or clonazepam and wait to feel the effects before taking the other medication. Go slow and you should be ok. It is possible that you might look (and feel or maybe not feel) high, with slurred words, drippy eyes, etc. I know I was like this when I was on methadone and took Valium.

Is it possible your anxiety stems from the pain you experience?

 

[lostincontrol]

It's completely possible that the anxiety stems from the pain. My anxiety triggers almost always include hyper-awareness of bodily functions, developing panic attacks when observing an increase in heart rate or an unfamiliar altered state of consciousness, such as dizziness. For example, a known trigger is too much caffeine intake, which increases my heart rate but could definitely increase the tension and pain in my leg, though I don't notice it because of the developing state of panic. It's almost on the edge of hypochondriasis, for instance this morning my leg pain was so great while the Methadone was kicking in that I believed my cold toes and tingling in my leg could be the result of poor circulation, which in my head computed as dire emergency such as a blood clot. Completely irrational thoughts and feelings despite knowing the logic of what I was feeling. The most debilitating aspect of the panic attack is the fear of death, which occurs each time with any panic attack I have for any trigger.

 

[Tryptamite]

How long have you been taking clonazepam/baclofen for? Do you still take the gabapentin?

Is it possible your anxiety/panic attacks stem from rebound anxiogenisis/WDs for one or more of these substances? From what I gather you haven't taken them since you got on methadone.

I'm just shooting in the dark here, I don't want you to think you are in WDs if you actually aren't and develop an unhealthy mental dependence on these drugs. If fact you are already on methadone, the less substances you need to take the better.

 

[lostincontrol]

I have been taking the Clonazepam and the Baclofen this round for about 7 months straight. The Baclofen has been daily intake at the 30mg while the Clonazepam has been more intermittent. I have gone days without taking the Clonazepam before having another panic attack or extreme anxiety and responding with .5-1mg, though I know the half-life is quite long therefore withdraw symptoms likely haven't had time to develop or the following attack is a withdraw symptom in and of itself. I have almost certainly developed dependence to both of these medications. I do not take the Gabapentin and have not in a couple of years. I have been taking both of these medications still, but since starting the Methadone I've taken 10mg a day of the Baclofen almost every day at bedtime, as far away from the previous morning dose of Methadone as possible and have taken the Clonazepam at .5mg at bedtime probably 3 times in 10 days. So the Baclofen has been certainly at a reduced dose than I'm used to, while the Clonazepam is more close to normal, though still less. However, I have not taken the Baclofen and the Clonazepam in the same day since starting the Methadone. If I take something, the fear has prevented me from mixing further since I'm already incredibly afraid when I have been taking the amounts stated so far. Hence the questioning since I'd like to be able to take my medications closer to the amount that I was before starting the Methadone, since I know the medications improve my pain and mental status.

 

[Tryptamite]

Well if you are happy to take the medication I say go for it as long as you are wary about how you take them. You likely will be able for both but may have to reduce the dosage of one or both (relative to your original dosages) depending on how they affect you in combination with the methadone.

When you have your surgery you can begin to taper the medications and WD as comfortably as possible. I'd say the best plan of action would be methadone first, then baclofen and finally the clonazepam. If you decide to do that.

 

[lostincontrol]

I will go slowly and have my roommate around to monitor my state in case of any problems. If I am able to take the medications without having visible problems during the day, should I be able to sleep while on them? So for instance, if I work up to .5mg Clonazepam and 10mg Baclofen together with Methadone while awake for a couple of days, could I potentially take the combination if needed and sleep without potential complications or would sleeping increase the risk despite no ill affects while awake? I'd really like to be able to take a nap during the day if needed or lay down for pain relief without fearing falling asleep. I also fully intend to withdraw from all medications following successful surgery and be done with this nightmare.

 

[Tryptamite]

You intend to stay up for days?

I think if you take it slow and feel ok with a small dose of medicines with your methadone you should be able to sleep without fear. Sleeping and overdosing should only be a problem if your breathing is very noticeably depressed. If you feel ok and your roommate confirms that you don't look "stoned" I wouldn't be nervous about going to sleep.

But you are right to work up slowly (over a few days) to the dosages you wish to take with the methadone.

 

[lostincontrol]

I very obviously miswrote what I meant lol. I enjoy sleep when it comes and I don't plan on staying awake, I simply poorly tried to convey that I feel more comfortable taking the medication then staying up for a few hours at least, but would like to have the freedom to take them and immediately sleep at times. Regardless, thank you for the advice, I appreciate it. It helps to get an idea of what to do safely and makes sense.

 

[BeenArrested4Pot]

You're two weeks into the methadone so you are likely more stabilized than you feel you are. In my experience methadone is much more sedating in comparison to oxy and hydrocodone. Both drugs, particularly the clonazepam, will potentiate the methadone to some degree.

It sounds like your panic attacks are bothering you as much, or more than your opiate addiction. If this is the case I would focus on the clonazepam , which you have used to successfully treat the panic attacks in the past. If you typically consumed 0.5 - 1.0 mg with your previous opiate dose, I suggest scaling it back some with the methadone... Methadone is simply more potent.

You should be looking at starting around .25 mg as your opening dose. You should also consider lowering your methadone dose if that is a possibility, until you are comfortable with the reaction between the two; maybe lower the dose back to 20 mg temporarily if you can handle it.

Once you have stabilized a bit more and feel comfortable with the combination you can experiment with the Balcofen. This should be less risky in comparison to the clonazepam but you should still take it slow and start with a fraction of your typical dose with the previous opiates. I would be hesitant to begin by adding a third drug to the combo, instead I suggest you skip the clonazepam one day and experiment with the balcofen (maybe when you have a day off and you aren't expecting much stress).

Hope you feel better soon!

-Triz

 

[papaown]

You should go to a different pain management center and tell them the exact problem you're having (without admitting that you've ever abused your medication). Simply show your medical records and tell them about how your doctor is under prescribing you and that you are miserable. I really would not use methadone for longterm treatment.