Opioids Worried about drug user.

[down508]

another thing to consider, what pharmacy would knowlingly fill all these pills. I've heard of people getting refused by pharmacists when trying to get xanax and vicodin at the same time. and not to mention the issue of insurance, if he has it I doubt they would be willing to pay for all those, and of he doesn't then I don't see how he would be able to pay for all them.

not to mention the methadone + opana issue.

 

[chrismaccius]

I have never heard of any doctors prescribing benzo's to anyone that was on that many pain killers and they knew it,that is crazy.I would definitely call his doctor and report these symptoms instead of trying to treat anything like these my symptoms myself. If they(symptoms) are as bad as described I would be afraid they would cause a complete psychotic break or something like that. The only time I have ever had anything remotely like what was being described happen in the original post was when I accidently robbotripped.(long story). I hope they definitely get that looked into.

 

[teological]

Not sure if the anti-depressant is the reason he is experiencing hallucinations or not, but I know for sure to keep him away from marijuana if he is experiencing any type of hallucinations. I have seen the end result first hand with regards to cannabis and psychotic outbreaks.

I have read all the posts and I was expecting the patient to have a very severe (pallative?) type of illness for a doc to prescribe this sort of medication. What the OP mentioned above about the surgery makes a little more sense, but still the methadone overpowering the breakthrough meds etc seems to be a consensus among this thread, including me.

Goodluck mate, I hope your friend gets better and finds a good doctor. My uncle was once taken off his blood thinning medication whilst in hospital. The doctor that ordered this did not tell my uncle's domestic doctor, and consequently my uncle had a stroke, that could of been avoided with something as simple as an aspirin. Not all doctors know what they are doing.

Also some of the hallucination, like others have said, seems to be nodding out that opiates produce.

All the best.

 

[Tommyboy]

The methadone just seems massively counter-productive for pain relief. At those doses it must blockcade the receptors to some degree and with pain relief only lasting around 4hrs with methadone it would leave the patient in pain while impairing the action of his other pain meds. Does anyone know which of thee opiate meds has the greater affinity for the receptors? Because I maybe well off the mark here but wouldnt the patient get better pain relief if he dropped the dose of methadone or stopped it entirely?

I touched on the blockade affect of methadone at the beginning of my previous post. It doesn't work the same way as the blockade effect of buprenorphine and other agonist/antagonists. You still get the additional opioids in your system, it's just that most people don't feel much of a difference since they are so used to having the high dose of methadone in their system at all times that their high tolerance doesn't really allow for other opioids to add much euphoria, but I'm not sure about analgesia.

 

[Eva 33]

I'm in chronic pain and am prescribed a few different strong opiates, plus benzos for sleep.

It does look like your friend may be on too much pain medication, but I don't know his pain levels, so it's impossible for me to judge. I assume he's getting all of his meds from the same doctor? A pain management doctor? What is his pain problem?

I've never had hallucinations on opiates, and I have to take a fair amount.

I understand that your friend had a bad reaction to marijauna, but I don't understand why that reaction is persisting after ceasing use.

Hallucinations and hearing voices could be indicative of a psychiatric disorder. Or it could be side effects of the drugs. I know everyone is different, so just because I've never hallucinated on opiates it doesn't mean that other people haven't. Maybe your friend is on too many meds and/or it is a bad mixture of meds.

 

[Username69]

another thing to consider, what pharmacy would knowlingly fill all these pills. I've heard of people getting refused by pharmacists when trying to get xanax and vicodin at the same time. and not to mention the issue of insurance, if he has it I doubt they would be willing to pay for all those, and of he doesn't then I don't see how he would be able to pay for all them.

not to mention the methadone + opana issue.

In reply to this, one pharmacy is used for all the medications except for the clonopine which is filled at a pharmacy (another state) that allows 3-month prescriptions to be filled (held and filled per month for the 3 month period); the same pharmacist fills these pain medication prescriptions on a 28 day cycle without any question; The pain management doctor has a huge caseload of patients that come every 28 days for their running prescriptions - the office routinely does drug testing to be sure that the medication is being taken and not sold on the street. He does have insurance which does cover all the medications with a copay that varies from $5 for the clonopine to $15 and $20 for the other medications. One other drug that I did forget to include is Cymbalta (from the psych.) which is taken on a 90mg even days and 120mg odd days (odd, but something to do with making then last longer between refills - these are mail order and covered with a copay). I have looked up all the medications for other insurance policies, and even with Medicare Part D prescription plan, all are covered, except for the Nuycenta, which I could not find on the Medicare Part D plan. Without insurance there is no way anyone could afford to pay for these out of pocket as many are brand names and quite costly.

 

[Swimmingdancer]

And Cymbalta on top of all the other drugs? I restate: I really think your friend needs a new doctor. You can't help someone if they don't want help, but maybe you could at least try to convince them to see a new doctor (even just for a "second opinion") and help them look for a good one?

I understand that your friend had a bad reaction to marijauna, but I don't understand why that reaction is persisting after ceasing use.

Cannabis can definitely be a trigger for mental health issues, which can persist long after the primary usual effects of the cannabis have worn off. Add all the other meds that he's taking and it makes sense. The cannabis could have just been the tipping point.

 

[Username69]

And Cymbalta on top of all the other drugs? I restate: I really think your friend needs a new doctor. You can't help someone if they don't want help, but maybe you could at least try to convince them to see a new doctor (even just for a "second opinion") and help them look for a good one?


Cannabis can definitely be a trigger for mental health issues, which can persist long after the primary usual effects of the cannabis have worn off. Add all the other meds that he's taking and it makes sense. The cannabis could have just been the tipping point.

The thought of pulling away from his pain management Doc or reducing medications may be more than he can emotionally handle. We as well as others (family and friends and the psych. and primary general Doc) have talked about rehab and detox and while he may talk the talk, he does not ever come close to making an effort. He always falls back on the amount of pain he is in even with all the medications and that he is to afraid to be without; that no one can understand the degree of pain he is in, etc; I do see him as a "legal" addict, and his entire life revolves around the medications and making sure he makes the monthly appointments. On the few rare occasions he agreed to try and stay in the hospital to detox he was calling to be picked up within 8 hours of being there, pulling out his own IV's and threatening the staff. He does have support but has almost virtually withdrawn from connecting with friends and family.

I think you may be right (in all the other suggestions as well) in maybe the cannabis was the tripping point - It could have been the timing with when he had taken his other medications, but adding on one more thing could very well be the straw that broke the camel's back. I always take him to his doctor appointments and to the pharmacy so will try to open some dialog at the next appointments about reducing, changing, or altering the medicinal plan. Thanks to everyone for their input.

 

[down508]

Ya he is on such a high dose that trying to substitute marijuana is not a good idea. Marijuana isnt a very good painkiller because of all the side effects. Its a somewhat psychadelic drug, and the mechanism of action causes paranoia in many users. Until he has fully and safepy detoxing you shouldnt attempt to substitute anything for his pain meds, especially not a psychadeliclike drug like marijuana. I would leave his medication management to his doctors.

 

[Swimmingdancer]

The thought of pulling away from his pain management Doc or reducing medications may be more than he can emotionally handle. We as well as others (family and friends and the psych. and primary general Doc) have talked about rehab and detox and while he may talk the talk, he does not ever come close to making an effort. He always falls back on the amount of pain he is in even with all the medications and that he is to afraid to be without; that no one can understand the degree of pain he is in, etc; I do see him as a "legal" addict, and his entire life revolves around the medications and making sure he makes the monthly appointments. On the few rare occasions he agreed to try and stay in the hospital to detox he was calling to be picked up within 8 hours of being there, pulling out his own IV's and threatening the staff. He does have support but has almost virtually withdrawn from connecting with friends and family.

Yeah I definitely think he is not ready for detox or rehab. As I said before, it's important to go with baby steps. And to reiterate, I think it's really important to encourage him to do some non-drug treatments for his physical and mental health issues. That is super important and can be done while he is taking his meds. It is impossible to lower let alone cease one's opioid usage without working on all the reasons the person uses them in the first place.

As for seeing another doctor, as I said, it could just start as being for a second opinion, which would be much less scary than the idea of committing to switching doctors for all his pain management/prescriptions.

I always take him to his doctor appointments and to the pharmacy so will try to open some dialog at the next appointments about reducing, changing, or altering the medicinal plan. Thanks to everyone for their input.

That's good. Definitely encourage him to talk to his doctor about the mental health issues/side effects he has been having and his options for altering his medication plan. And if he could, as I already mentioned, switch to, say, 2 opioids, a strong long-acting one and a short-acting one for breakthrough, you could explain to him that he could take higher doses of those ones so it would equal out as being basically the same level of pain and anxiety and withdrawal relief - that would be less scary than simply eliminating some of the meds and keeping the doses of the remaining ones the same. He could keep the non-opioid meds (the clonazepam and the Cymbalta) the same for now (although lowering the doses would be ideal). That would be a start at least and maybe something he's be more open to. Does he have some rationalization about why he needs so many different pain drugs?

 

[Deathly]

I have a friend who is going/gone through a similar situation. You must remember that doctor's are always taught that there is no ceiling dosage for pure opioid agonists, and thus some people are prescribed insane amounts of opioids. For those questioning the methadone, I know that it is sometimes added to some patients regimes that are still experiencing pain with high levels of opiates. Methadone is a NMDAR antagonist, and can be used to prevent or reduce the effects of opioid-induced hyperalgesia which becomes more common the longer a patient receives high dosages of opioid agonists.

The friend I know is also prescribed very large amounts of opioids as well as SNRIs for depression/anxiety/pain and lorazepam for sleep/anxiety. They began experiencing neurological and cognitive problems like numbness, memory loss and mild hallucinations. Last I heard they were trying alternative drug treatments with a neurologist who also had experience with pain management and he was pleased with the Dr and the progress.

I would recommend getting your friend to get a second opinion from a good pain management physician and possibly with a neurologist, clinical psychologist or a neuropsychologist. From my experience the neurologists and psych M.D.'s (some of them) are very helpful when it comes to pharmacology, drug interactions and the CNS. Best of luck

 

[Swimmingdancer]

Methadone is a NMDAR antagonist, and can be used to prevent or reduce the effects of opioid-induced hyperalgesia which becomes more common the longer a patient receives high dosages of opioid agonists.

I know that is widely said, but methadone has given me the worst hyperalgesia of any opioid I've used. Part of that might be just because the doses used for methadone tend to be high and methadone is something you constantly have high levels of in your system, plus I took it for so long, but I really do not think it's true that methadone being a mild NMDA antagonist prevents things like hyperalgesia or tolerance.