oh well. i'm screwed. thanks, methadone.

[defanged]

I won't bother doing the rundown of my extensive drug history; not only is it boring for everyone, but the only aspect of the whole lengthy, pathetic and repetitive tale is that approx. 7 years ago I gave up and started MMT. I was an IV heroin user, and had gotten to the point where I needed 2 to 3 bundles a day just to be functional, which was incredibly expensive. Additionally, my vasculature had gotten so bad that every shot was an exercise in the worst kind of frustration and torture. (Not to mention the multiple bouts of cellulitis, most of which required surgical intervention...)

So, I started on methadone. Fast forward to now: I'm on 230 mg a day (in fact, I hold the dubious honor of having the highest dose at my clinic). If I miss a day, I'll inevitably be too sick the following morning to drive to the clinic myself and have to bum a ride from my father. Most days I'm awake before 6 AM (clinic opens at 9) - - definitely the longest 3 hours of my day.

Here's where it gets less whiny, and more actually medically problematic: I was in bad car accident 4 or 5 months ago. I broke 6 ribs, and suffered two orbital fractures. My head went through the windshield, too. Unfortunately, every doctor I dealt with while I was in the hospital - from the ER docs to the regular guys up on the trauma floor - was of the erroneous opinion that a) additional opioids on top of the methadone that I had been taking for years would probably kill me and b) that anyway, all that methadone was enough all by itself to treat acute post-MVA, mulltiple fracture-type pain.

This same situation has happened many times now.

I know I'm probably going to be on meth for the rest of my life; I just want to learn the magic words that unlock the mysterious door to adequate analgesia, on the unfortunate occasions when the need arises.

 

[Kittycat5]

If I knew I would tell you. Methadone scares doctors. Sorry you cant get relief.

 

[Dmoney913]

I agree ^^ have you tried to potentiate your methadone during the times you need relief?

 

[Crack'r]

Tell them you are still in pain. Tell them again and again. Don't ask for anything specific, tell them you will try anything to help take it away, and actually give anything they suggest a chance to work. If it doesn't, tell them. It also doesn't hurt to admit you have screwed up in the past and you will do anything to earn some trust so you don't have to be in pain. You can also tell them the pain is effecting your quality of life and you are getting desperate not to hurt and that the pain makes you not trust yourself not to relapse and you do not want that. They do have a responsibility to keep you comfortable and your past mistakes shouldn't punish you now when you are trying to do the right thing. Tell them to monitor you and your vitals if they are unsure. When in pain your heart rate and blood pressure almost always are high and when the pain gets better it comes down and they know that. Ask for a consult with them and a pain specialist if they don't trust themselves to administer therapeutic amounts of pain meds. It also really helps to have a parent or family member there that can verify you are in pain.

That said, you may be screwed for opiate pain relief. After enough abuse they start to not be effective for pain relief even in mega doses. I don't really know what to suggest if that is the case. Pain sucks and maybe you can eventually taper down from your methadone and maybe that will allow some pain relief in the future?

 

[Kittycat5]

Defanged, answer a few things for me.

1. Were any of these doctors PM specialists as Crackr said?
2. How bad is your pain now (1-10) and is it 24 hours a day intense or you have a lot of breakthrough type pain but lower levels of constant pain?
3. Does methadone do anything to provide relief? If so, how long does analgesia last? Is your dose 230 all at once, or in divided doses?


You know, this kinda pisses me off in a way. Yes, the half-life of methadone can be a million years. Thats why its great for maintence off opiates. But its also a massively variable drug and analgesia can last as little as 4 hours. I get their trepidation in adding on, but for fucksake, they need to do their goddamn jobs and help you. Have they offered anything, opioid or not? Suggest a change in regimen? Anything?

 

[patheboss420]

those drs are being extremly neive and should have there lisences revoked. it is a known fact that once an individual has baeen on methadone for a long enough period of time it loses its pain killing effects in terms of if your were to endure a serious injury or mirgrane h/a ect... being that you become toleeant to the dose and it is the exactg opposite because your on such a high dose methadone your tolernce is so high that only many huge doses of fentenyl would kill u. i worry about the same issues that is striat bs and id go do research on what im saying im thinkin sue the hospital or dr. your in methadone maitnece for addicgtion not pain management so the dose your on has no bearing on serious pain endured in times of emergency they definity couldve killed u based on the pain you were in the methadone had no pain killling efffects being your toleent to a dose after so long and if you endure serious injury you should be treated as any indiviual coming in offf the streets. id advise to take your chances next time and just say your not on anything if u in up in the er being your in 230 2mg of dilidid which is wat thed give the norm person in times of duress wouldnt kill u lol sorry to hear u have gone thru stuff i worry about but havfe never experianced

 

[Dtresearch17]

just find a new doctor, i am on suboxone and i have no problem getting pain pills,benzos or anything else. its just
a shitty doctor

 

[Kittycat5]

just find a new doctor, i am on suboxone and i have no problem getting pain pills,benzos or anything else. its just
a shitty doctor

Well thats often easier said than done with a history of drug abuse, on MMT, and for all we know still in pretty bad shape after the accident. Maybe someday, yes but I wouldnt want to suggest just giving up his care altogether.

 

[Ligaturd]

I would suggest going through the painful process of tapering down. It's risky as it puts people into desperation mode but if done slow enough it should be bearable, althought long and agonizingly boring... If you got to a more manageable level of methadone for your daily dose, doctors wouldn't be as scared of killing you of respiratory depression. I understand their worry as well because they are liable for your death. This is the only choice you have really...

 

[Jekyl Anhydride]

When I was in Methadone Maintenance Therapy they would not let anyone go over 150 mgs per day without special testing because of Torsades de Pointes or Long Q-T syndrome (a heart arrhythmia that develops from methadone) . Anyone higher than 150mg would have a Peak & Trough Test that determined the C max and AUC (high & low blood levels of methadone). The crappy doctor at my clinic worked like 10 hours a week but the nurses we're pretty dam good at solving problems by splitting doses even 3-4 times a day. Methadone prescribed for pain is called Dolophine and it's dosed in daily multiples for the best efficacy in pain management. If you have "Take Home Doses" this would be far more practical than showing up at the clinic 4 times a day and it might be difficult for a while missing that sledge hammer dose once a day but might provide more relief in the long run. Grapefruit juice (white 100%juice) will lengthen the half life of the methadone slightly as well as cimetidine (tagamet hb) during the transition to multiple daily doses but I would hope your clinic could provide some support and guidance. MMT can be like a tar pit up to your waist, hang in there and keep grasping for that rope to freedom.