Opana ER 40 mg twice daily
Opana ER 30 mg twice daily
Methadone 75mg twice daily
Nucynta 75mg twice daily
Roxycodone 50mg three times daily
Clonopine 3mg three times daily
Sorry... my bad.
So your friend is taking in total:
- 150mg methadone/day
- 140 mg ER oxymorphone/day
- correction: 300mg tapentadol/day (according to the last post where you said "it is actually 4 x 75 mg per day")
- 150mg oxycodone/day
- 9mg clonazepam/day *Wait are you now saying the clonazepam is 1mg 3x a day for a total of 3mg?
?!?!?
All that would be enough to make most people crazy (well obviously that would kill non-tolerant people of course). Is your friend dying? I know people dying of cancer who are not prescribed that much drugs. IF your friend is even legitimately prescribed all this stuff?? Is it from multiple doctors who are not in contact with each other or something? I don't know a single doctor who would prescribe that combination and those doses. If your friend is NOT legitimately prescribed all these drugs and is self-medicating &/or addicted that's one thing, but you said
prescribed so I'm really shocked about that. Why are 4 opioids necessary? Normally one would just get one long-acting opioid and one short-acting opioid for breakthrough pain. And 3mg of clonazepam 3x a day is a lot. How long has your friend been on all these drugs?
Cannabis can affect different people
very differently. For me it seems to make everything worse, especially my mental state, but also my pain, insomnia, etc, and the effects can be quite long-lasting, while others find it extremely beneficial and are able to drastically lower their doses of pharmaceutical painkillers. If your friend feels like the cannabis triggered his/her mental issues then it may not be a good idea for them to use cannabis.
Not sure what else I can say without more info.
EDIT: I see you posted while I was typing this. Will add some more thoughts in a sec.
EDIT:
Ok I think your friend seriously needs to find a GOOD pain management doctor who is responsible for all prescriptions and is supportive of and knowledgeable about non-opioid treatments and non-drug treatments. A great doctor can be hard to find but is really worth the effort. Secondly, I would ask about switching to a smaller number of opioid drugs, even if the doses of the remaining drugs need to go up at first to compensate. One shouldn't need 4 different opioids. Perhaps his doctor will have some suggestions for more effective pain management using opioids that have less side effects. There may be some options like switching to one strong long-acting opioid like fentanyl patches plus one short-acting opioid for breakthrough.
I can see the point of the tapentadol if it provides effective antidepressant effects or perhaps gives some pain relieving properties that the other opioids don't, because it is a norepinephrine reuptake inhibitor in addition to being an opioid, but it's also possible it could be causing side effects. If your friend decides to quit the tapentadol it would be best to taper off it instead of stopping abruptly due to its aforementioned mechanism of action.
Perhaps instead of the methadone + oxymorphone your friend could consider switching to a single long-acting opioid?
Both oxycodone and tapentadol can be stimulating, so maybe trying to not take them very late in the day would be a good idea. Perhaps if your friend can get his opioid usage under control he wouldn't need the clonazepam in order to sleep.
Has your friend talked to his/her doctors about the mental issues he/she is experiencing??