Opioids Being FORCED to switch from DILAUDID to METHADONE. What do I need to know?

I've been on 8mg dilaudid/hydromorphone for pain issues for about 3 years, injecting for the past year (8mg, 5 or 6 times a day).

At the moment there seems to be a dilaudid shortage, none of the 30 pharmacies I called had it in stock and said it could be weeks before they get more.

So I had to ask my pain doc for a replacement. He's putting me on 10mg methadone, 4 times a day.

First of all, he doesn't know I inject, and secondly, I sometimes question the depth of his knowledge. He promised me the methadone will take care of the pain and I won't experience withdrawals.

Is he right? Will it be that easy? I have my doubts, so I thought I'd ask here for any insight anyone might have...

Note my tolerance is through the roof; the dilaudid rarely gets me high anymore, but it's part of my routine now.

Or at least it was!

it has a much longer half-life...don't go over your Rx'ed limit because that stuff keeps working on you for a good day to day and a half...

I don't know how he can guarantee you'll have no w/ds (from the METHADONE, post methadone discontinuation)--unless this will be a long tern switch? Is this a temporary switch? I'm a little surprised Opana or Oxycontin (even fentanyl) didn't come up, or did they? Opana and Oxycodone IR being (like Dilaudid) for breakthrough pain. Or their ER versions for longer lasting relief... like the methadone will be used for.

I imagine the methadone will take care of your pain relief (and opiate cravings) just fine. As stated above just make sure to not overdo thst methadone. Dependency on that (and w/ds) are a biiiitch. How did tge decision to switch to methadone come about?

I know it may be too late, but did you call all of these pharmacies other than the one you went into that was out? The reason I ask it, almost every pharmacy will tell you that they are out over the phone, and sometimes even in person if you just ask without handing them over the script. It's a precaution they take in an attempt to prevent people from setting them up to be robbed. Next time go in to each pharmacy with your prescription instead of calling.

Also, did your doctor say that he has heard about this shortage as well? Maybe he thinks you are abusing the dilaudid, so is switching you to the methadone instead of other opiates.

That's really beside the point though.

I'm sure you will be fine. Give it a good amount of time to kick in, and if you still feel withdrawals then take more. Then you can always taper down a bit to make it last, which should be pretty painless with methadone, considering a taper doesn't really get that bad until the low doses. I know you aren't specifically using this to taper, I am just saying....

BDD -> OD.

You'll get better answers over there.

sorry bro but you are gonna cluck hard of switching to 40mg of methadone im on 250mg's of morphine a day orally prescribed and more of street idd be so ill if i dint take at least 150mg in one dose and even that wudnt take pain away ask for oxymorphone if u cant have dalludid or even oxycontin or mst's. methadone is a lowsey painkiller IMO if you are opioid tollerant

^ Methadone is very strong. It may not be that euphoric for some people, but it does a great job at keeping people from withdrawing.

I told the doc I needed a temporary replacement for the dilaudid and he went straight to methadone. I told him before dillies i had some success with percocet, but all that APAP is bad long term so they switched me to dilaudid.

But for a few weeks it would be fine. I asked him about it but he was pretty adamant that methadone was the way to go.

What I don't understand is if methadone is an opiate and it's good for pain why is it rarely (in my experience) brought up as a painkiller along with vikes, percs, dillies, oxy, etc. I NEVER hear anyone suggesting (or looking) for methadone!

I've never read much about methadone, but I had this idea that it is often used to treat opiate addiction. Is that so? But if methadone kills pain but also has withdrawals, how is THAT any different than the other opiates more commonly used for pain?

My only guess could be that my doctor wants to try and get me off dilaudid so this is his way of getting me started? Next month if I tell him i feel fine and the methadone works, will he want me to stick with it?

What would the advantages/disadvantages be of either? Does methadone ever provide that opiate "soft glow?"

Is the oral bioavailability of methadone similar to the low BA of dilaudid? Can Methadone be snorted or injected for efficient usage?

And I'm sure most of the pharmacies were telling me the truth. I know the 3 places I've gotten it from before were telling me the truth, and the ones that require a script before they will divulge any info said so. And If they were going to lie and give me a curt "sorry no don't have it" they probably wouldnt have put me on hold, asked me the quantity, told me there is a shortage right now, etc.

It's crazy, in a city like Los Angeles NO ONE has dilaudid? That seems pretty serious!

Thanks to everyone for the great replies.

Tommyboy said:

^ Methadone is very strong. It may not be that euphoric for some people, but it does a great job at keeping people from withdrawing.

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Absolutely agree on that its a fact methadone is very potent opioid as a drug ive just never found it works properly on me as if i was to switch bak to methadone to my old prescribed dose before i was on morphine, of 120mg now it woudnt give me no pain releif from it at all and i would be withdrawing for at least 24-48 hours. the only way it would work with me was when i would take a half weeks dose in one go 360mg minimum at least then idd get good pain releif for about 36-48hours then it would wear off and idd start withdrawing again but if i took 7 days worth in one go it would actualy work for a good 5 days maybe 6 but withdrawalws was horrid for a day while waiting to collect again. thats only way methadone has ever worked for me is to not take it regualy. im sure it seems to take a lot longer to work on me than other people and stays in my system longer. have never got on with it at all personally i think its bone soaking crap but each to their own ! all the best guys

Sorry for the barrage of questions, they keep coming to me!

So I'm about to take my last shot of dilaudid and tomorrow morning start swallowing methadone. Is it that simple? No sort of transition?

And what would be the plan, just take one when I start to feel withdrawals? Should I be confident that it will work or should I bring my usual dillie shot to work just in case?

Given my history and tolerance and that I've been injecting, can I really count on a 10mg methadone pill to make me feel normal? I'm over 6 foot and built like a football player, so it usually takes a LOT of anything to work on me...

oh yea not sure about snorting methadone as you cant get high dose methadone tablets in the uk only 5mg ones so ive never tried it but injecting methadone from my past experiences are that it is no stronger than taking the same dose orally difference is the injectables just stops you withdrawing faster and are normally only prescribed for people with needle fever in the uk as the drug workers say you get 9mg out of every 10 absorbed orally hope that helps in some way

yes than can be taken together unlike buperenorphine methadone is a full agonist so there is no waiting period needed in fact start taking the methadone now i would if you already have it 40mg sounds like it wont do much for you to me im afraid

40mg of hydromorphone a day is going to be a lot stronger than 40mg of methadone if you doctor will not even let you go on oxycodone instead then it sounds to me like once he puts you on the methadone he wont change it back when the dalludids come back into stock !

Methadone has a high oral BA. You won't get a rush from IVing it, so just stick to the oral route. Even the junkiest of the junkies take this orally, so this isn't just me saying that because it is safer, it actually is better when taken orally.

Different regions seem to prescribe different things. For example, I never see hydromorphone in NY, and oxymorphone has only recently started being prescribed here. Hydrocodone, oxycodone, morphine and then methadone seem to be the most commonly prescribed by me.

Why don't all doctors prescribe methadone for pain? It takes a long time to kick it. However, it's long half-life makes it last all day, so it is good in that sense. At higher doses it has a blockade effect, making other opiates barely work, which is another reason it may not be prescribed by some doctors for pain, as breakthough pain would be difficult to treat.

As for the nice opiate glow, it is definitely there. The only thing is that is usually goes away after a few days, since the long half-life has your receptor saturated 24/7 just by taking it once daily. This is why it is used for opiate addicts as well, as it will keep them from being sick all day, and does so in only one daily dose.

John_Burrows said:

What I don't understand is if methadone is an opiate and it's good for pain why is it rarely (in my experience) brought up as a painkiller along with vikes, percs, dillies, oxy, etc. I NEVER hear anyone suggesting (or looking) for methadone!

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Because it isn't nearly as good of a pain-killer as other opiates, particularly for people who have built up a high tolerance, and it cause high physical dependence and extremely intense and very long-lasting withdrawal symptoms when you stop taking it. People report withdrawal symptoms from 2 weeks all the way up to several months, and many report never feeling quite the same after quitting. If the plan is to just switch back to the Dilaudid in a week or 2 you should be ok, but don't count on your doctor wanting to switch you back. Also, I'm not sure that the starting dose of 40mg is going to be enough for you if you're used to injecting about 50mg of Dilaudid per day. You might want to make sure you can get more methadone like the very next day if it isn't keeping you from getting withdrawal symptoms. Also some people find the first few days after switching to methadone rough anyway. And 40mg of methadone is not going to give you the same effects as injecting Dilaudid. I'm on 36mg (18 mg 2x a day) and it does nothing as a painkiller, all it does is keep me mostly un-sick for part of the day. This can really vary from person to person though. But you definitely won't get any "high" like you would get from Dilaudid.

I've never read much about methadone, but I had this idea that it is often used to treat opiate addiction. Is that so? But if methadone kills pain but also has withdrawals, how is THAT any different than the other opiates more commonly used for pain?

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Yes methadone maintenance for opiate addiction is the number one thing methadone is used for. The reasons it is "different" is that it is legal and controlled, it has a much lower potential for addictive behaviour (as in users craving it all the time, constantly upping their dose, injecting it, etc), it doesn't make the user feel "high" (especially in low maintenance doses in people who already have a history of opiate use and have a tolerance to opiates) or experience a euphoric rush, and it takes care of the physical dependence leaving the addict more able to have a stable life and work on the psychological reasons behind their addiction. There is plenty of info on methadone available if you want to do some easy research.

My only guess could be that my doctor wants to try and get me off dilaudid so this is his way of getting me started? Next month if I tell him i feel fine and the methadone works, will he want me to stick with it?

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That honestly wouldn't surprise me. And a lot of doctors unfortunately know shockingly little about methadone, or they just believe what they read in a book somewhere (which rarely takes into account the extreme difference in effects on opiate-dependent people compared to opiate-naive people, or the fluctuations in metabolization and duration of effects from person to person).

What would the advantages/disadvantages be of either? Does methadone ever provide that opiate "soft glow?"

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Only in very high doses in people who don't have a very high opiate tolerance. I was once on 100mg and it didn't provide that "glow" or warm hug feeling, but I did have a high heroin habit prior to starting on methadone. This is why so many people still use other opiates while on methadone treatment. They go in thinking it will either be just like their opiate of choice or that it will somehow "cure" them of their addiction, not realizing that all it does at the proper dose is keep them from getting withdrawal sickness. They still have their mental addiction and their pain.

Is the oral bioavailability of methadone similar to the low BA of dilaudid? Can Methadone be snorted or injected for efficient usage?

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People have varying effects regarding strength, but many agree that orally is the most efficient ROA. But there are a lot of different opinions on both these questions. Do a search of the forum, there are tons of threads on alterate modes of administration for methadone. But (depending on where you live) methadone almost always has ingredients added that make it extremely difficult, dangerous even, to inject or snort. Did your doctor say what type of methadone you're getting? Or do you have the prescription yet? In the US it's most often mixed in Tang (fake juice) and they make you drink it in front of the pharmacist, but it might be different for you if you are ostensibly being prescribed it for pain only. I am on solid tablets, (which are better and more consistent IMO) but it's rare in North America.

Let me know if you have any more questions, I have a lot of experience with methadone and have done a ton of research on it and other opiates Good luck!

Thanks for digging in guys, I really appreciate the help.

After reading what you've all said, my biggest concern now is the dosage my doc perscribed. All of you are saying you take one high dose and it lasts all day - but he told me to take one 10mg pill 4 times a day.

What gives?

From what I'm reading it sounds like the less time spent on methadone the better. But I guess that's only if he's not secretly trying to get me off it. Besides, why would someone switch to methadone to help them kick opiates? Why wouldn't your doctor just want you to slowly taper down your regular meds? Especially if kicking methadone is harder!

Alright well since I'm out of dilaudid I guess the only thing I can do is bring the bottle to work and what, keep taking them until i feel alright?

Should I take a larger than 10mg dose tomorrow morning - if everyone says 10mg is a laughable dose for someone with a high resistance...

Also, how fast acting are they? How long after my first dose should I give it before I conclude I need more? Speaking of which, if worse comes to worse, is there any possibility it WON'T work at all, or is the worst case scenario i'll just have to take a lot more?

Any difference between dosing on a full or empty stomach?

Ok guys, I think that's it. I'll definitely read up on it and report back tomorrow and let you know how I'm feeling. Keep your fingers crossed for me, I really can't afford to be shivering in a corner at work!

SWIMMINGDANCER: You asked about the pills... They are from Roxane labs. A small white round pill, maybe 50% larger than the dilaudid pill. It's pure white, no speckles or anything disrupting the texture, and the number 54-142 is printed on them. It SEEMS like a pure, clean pill, but what do I know?

It's labeled METHADONE HCL 10mg and I have 125 of them. Does the HCL mean anything?

Anyway I'm guessing this might be a good candidate for alternate ROA, but honestly I have no interest in chasing a high with this stuff. I just want to make sure I don't get withdrawals and if another ROA would make it more effective in this regard I'd be willing to try.

But a few folks here have said methadone has a high oral BA (whereas dilaudid is less than 50%), so if that's the case, I'm happy to stick with that.

So, does my pill description tell you anything interesting?

I would wait an hour before re-dosing. It is one of the longest times to peak out of all the opiates I have done. As for the HCL, it just means it's a salt of an acid, as opposed to a base. Pretty much all the opiates say HCL at the end, as does heroin #4, although #2 is a base form making it better for smoking.

You can always just use the methadone to detox. It works very well for a short 4 day detox, and I know you have often said that you don't need drugs for pain, it's more of a habit for you.

I’m only half way through the thread so if this has already been said I am sorry.

To the OP, keep in mind that your Dr. thinks you have been taking the dillies properly by mouth, and with this in mind and hydromorphones low oral bioavailability 40mg of methadone should be sufficient. I would say that mg to mg that taken orally methadone is much more potent then hydromoprhone and I would guess that this is reflected in conversion charts also.

Just something to keep in mind here.

I will continue reading and post more if I have more.

I have always had a high tolerance for all pain meds' & methadone didnt touch my pain until I took 30 mg's at once
then I sorta stabled out around 50mg's I think the best ROA was to do a CWE (HCL) & plug the 50 mg's (for me,) it was stronger & lasted longer...

Tommyboy said:

I would wait an hour before re-dosing. It is one of the longest times to peak out of all the opiates I have done. As for the HCL, it just means it's a salt of an acid, as opposed to a base. Pretty much all the opiates say HCL at the end, as does heroin #4, although #2 is a base form making it better for smoking.

You can always just use the methadone to detox. It works very well for a short 4 day detox, and I know you have often said that you don't need drugs for pain, it's more of a habit for you.

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Personally I would give it a bit longer than an hour. I have an extremely fast metabolism & oral meds usually hit me fast.
Regardless methadone usually doesn't kick in good for 2 hours or so & begin to peak till 3-4 hours.
As such I usually recommend waiting 4 hours before redosing. My experiences with others seems to confirm this.
I believe John is aware of the long half life & the dangers involved with that so I won't get into that unless asked.

Now as to whether or not it will hold you it will vary person to person. I find methadone to be very effective as such.
For example not to long ago I switched from wearing 100mcg/hr Fent patches for 4-5 months + IV'ing on top of it to methadone.
I was able to transition from wearing said patch to 30mg of methadone & taper my dose of it very quickly with no w/d's to speak of.
Another example would be when I was doing a good amount of Oxymorphone. I would usually IV 35-50mg per shot.
I was able to hold myself with very minor w/d's with as little as 50-60mg of methadone.
This really speaks volumes to methadone's w/d covering efficiency as Oxymorphone w/d's are brutal.
Though I believe this was partly due to a very low cross tolerance as I had little methadone experience at the time.
I have more now obviously. If your worried about withdrawal's methadone covers them with surprisingly low doses.

Just a note of caution the doses I'm referring to are extremely high. Please do not take them as guidelines or encouragement.
The Oxymorphone/Fent & such that is, the methadone doses are reasonable.
However, with methadone one must always be careful & know the risks involved but that's enough content for a different thread.

Seeing as your referring to Dilaudid I have a bit less experience with that & have never been fully dependent on it.
I've mostly just used it for one off rushes on occasion, but my experience with everything else should equate.
The few times I did do Dilaudid I'd usually IV 20-24mg per shot for a good rush but sadly little to no high.
I was able to hold the w/d's from a day's session of the above at bay with 40mg of methadone & likely could have used much less.
I'm basing a lot of what I say off my prior knowledge of your posts. As IIRC I've read quite a few posts regarding your usage.

I wanted to point out that alternative ROA's with Methadone are relatively pointless as far as I know.
I've never known anyone to have success with them & Methadone has a high oral B/A.
Also due to various properties of Methadone it more saturates one's system than anything else & as such doesn't pack a rush.

I hope that information helps a bit & may help to alleviate any concerns you have regarding w/d's.
As for dosing that's a bit more questionable. 1 large dose seems to work well for alleviating w/d's.
However for pain management dosing is usually spread out to 3 or 4 times daily.
This is because although methadone has a long half-life it's analgesic actions do not last as long as the half-life.
From my experience & the literature seems to agree the analgesic actions seem to last around 6-8 hours.

I wish you the best of luck John & hope that things work out satisfactorily for you.