Methadone Question

[nursegirl6572]

I almost feel silly asking this, because I consider myself pretty knowledgeable about most medications, but what the hey....always room to learn right?

A lot of my patients these days with chronic pain issues (cancer, etc) are prescribed Methadone.  And, of course many people take other Narcotics on as "as needed" basis for pain (Percocet, Vicodin, etc)...and I tell you, it seems that the people who have been on long-term Methadone are WAY more concerned about getting their dose of that versus an "as needed" dose of another narcotic.

I guess Methadone also gives the user a "high", similar to a Percocet?  I've had people on pretty high doses of Methadone, and it's funny...after administering any of these meds, you can clearly see a difference in them after they've had a dose.  I guess my question is...is the feeling similar?  And, how does a dose of Methadone equate to say a dose of regular Percocet (5/325)?  

I know that the Methadone is dosed automatically, and the other Narcotics are dosed on an "as needed" basis, and maybe that's what makes the difference...that if these people aren't getting their scheduled dose of Methadone, they feel a difference, both with pain control, and they way it makes them feel?

I know I'm sorta all over the place....I just would love some insight on Methadone being used in pain control situations (not detox/rehab).  I love to be enlightened.  :0)

Thanks to you all in advance.

[enough170]

hey nursegirl, i am a nurse also, and i to would love to know about this, i am in the uk and as yet we dont use methadone as a pain reliever, so i am curious to know about this.  truthfully, i didnt even realise it could be used as a pain reliever untill i joined this site!!  thats what i love about my job always learning new things :-) emma xx

[Prospero73]

I have been told (by a methadone addict) that it was the best of all pain relievers.  I have also  been told ( by a doc who worked in a methadone program) that it was five times as addictive as heroin.  

[kim715]

I took vicodin for years.I was on methadone for over a year.It really was 2 different 'feelings'.I didn't get that euphoric,warm and fuzzy feeling from methadone like I did when I was abusing the vicodin.Methadone made me feel more relaxed and out of it then vicodin did.Vicodin gave me tons of false energy and a feeling of being able to conquer anything.There was a big difference in how I felt between the 2.The methadone did control my back pain alot better then the vicodin did towards the end.However I did notice that once I was on the methadone for a while I started to have a lot of joint pain and swelling.So much so that when I would get up in the morning I would have to walk down my stairs one step at a time because my knees would really hurt and my ankles were always swollen,as well as my hands.Since I have stopped taking the methadone I don't have any of those symptoms anymore.I hope this helps..All the best...Kim

[nick30]

you might get more answers by posting on the PM forum.
perhaps your patients are just more frightened of withdrawals from not getting methadone? once a dose is missed it takes far longer for methadone levels in the blood to get back up due to it usually being re-released from the internal organs as well as the actual dose. it can tkae 3-5 days after a missed dose to get it back to it's original level. not sure if that's the answer you are after.

Nick

[christos24]

Hey there, Ive been at a methadone clinic for a little over a year. Before that I was on suboxone 32mgs daily for 9 months, but that didn't hold. I am currently at 120mgs daily and I can tell you from personal experience and from others that have been going for many years that methadone is by far the most addictive and depending opioid there is. It does give the user somewhat of a buzz not exactly comparable to shooting up heroin or fentanyl, but yes it would be better than vicodin or a small amount of percocet. The difference in the buzz is that methadone as you know has a much longer half0life than say oxycodone or hydrocodone, other than buprenorphine and a select few others it has one of the longer ones right around 24 hours on average. Depending on metabolism some have it go faster, some could go every two days. Suboxone having an average half-life of 37 hours. For me I have an extremely fast metabolism so if I dosed at 10:00am by 8:00pm I am already getting ansy and nervous about dosing again. That is what your pain patients taht ahve been on methadone for longer than 4 months are experiencing. Since they are there for chronic pain issues the doses you are most likely prescribing don't go much higher than 60-80 mgs and even that is a high dose for any reason. Back when the first methadone clinics were opening up in NYC the ceiling dose was 60mgs only recently have we been seeing people at clinics on doses up to 500mgs, which is absolutely unnecessary.  
The buzz methadone gives really is only prominent in the first two weeks of daily dosing. At the clinic after theya re evaluated and the doctor decides what to start at you will dose between 30-40mgs. Then you can gradually move your dose up if necessary 5mgs every couple of days depending on the clinic.
After being on methadone, having a full on dependence, and talking with other clients it is clear that no severity of addiction to any opiates, no matter what intense or strength it is no person needs to go any higher than 160mgs. The higher you go it only makes it harder to get down to taper and only makes the withdrawals that much more severe. It also will not get anyone higher or give a better buzz, it will only add to the drowsy feeling. I guess if someone is looking for a buzz with little to no euphoria and cant stay awaken and act like a complete zombie then they can go up higher and higher.
The buzz is definitely limited for methadone compared to oxycontin or heroin where the more you take the higher you get, basically the buzz for methadone gets replaced by the constant struggle to make sure youll have your next dose. If you absolutely need to one can go 24 hours without dosing, but say if I missed a weekend or have no methadone for anywhere near or longer than 48hrs. it is by far the absolute worst wds ever experienced.
For new pain patients I would try any and all other pain meds before going to methadone, it should only be used as a last resort. No doubt there are many people and patients who have been able to regain their life abck and their pain has basically ceased and they can do things they couldn't have before going on methadone, but other opioids will work just as well and not leave you with the worst wds imaginable lasting for 2 mths. The wds if you ever Cold Turkey peak at about 3 weeks and last for at least two months, its horrendous to be in that situation or to sadly watch someone wd'ing on methadone. Its unbearable. I would definitely be weary to put more patients on methadone regardless of the dose, if they have chronic pain and you know they will need a constant pain med then I would definitely try other opioids before it. After that initial few months taking methadone becomes a necessary means of living, the person much get it and they will go to whatever lengths necessary to receive it. Surprisingly, many doctors and people find it so strange that methadone which doesn't give that power surge of euphoria has such an absolute hold on a person within only a few months. But it is the brutal truth. All you can think about is your next dose and if your withdrawing you can't sleep, you shake and convulse uncontrollably. For the small buzz you get for 8 hours that first two weeks of dosing isn't worth the months and months of pure hell and pain you get in return. Hope I could shed a little light on methadone. I know you are incredibly knowledgeable and you probably know alot of what Ive said, but I hope maybe something I said was helpful in anyway. I do want to reiterate that since I went to the methadone clinic last year that I have remained clean and can definitely be a true life saver, but at the same time you also sell your soul completely over to the methadone god. It is truly a helpful pain agent, but its truly the most addictive and severe opioid available. Christos

[Prospero73]

Thanks for your informative post, which reinforces everything my son told me about methadone, its addictive properties, and the agony and length of withdrawal.  When he got off suboxone (which he took as an outpatient) and later subutex (in rehab), he was rarely able to go more than a few days.  From the standpoint of a family member who didn't always have a clue whether he was using or not, if he seemed like he was getting better, he had probably relapsed, and if he seemed like he was totally messed up, he was probably clean.  It was very confusing.

[theeagle]

Its starting to be rather common in the US to prescribe methadone for pain management. Some schools feel that long term use of methadone is much easier on the body than the other narcotic agents. Pain doses usually run at 10mg's 3 or 4 times a day. It is definitely the most addictive thing that I have run into. Doses at clinics have been as high as several hundred mg's.  There is a reason that the people at methadone clinics named it "liquid handcuffs" - the obsession to dose is incredible if you are on a steady dose. And the withdrawals are the worst in the narcotic world. I have withdrawn from morphine, heroin, hydrocodone, and a few other things. The methadone withdrawal was several times worse than any of the others. And it lasted considerably longer.

[Prospero73]

As a survivor of the psychedelic 60's, I've always had a libertarian attitude toward drugs, but the current favorable attitude of the medical profession on prescribing methadone for pain management has me worried.  Continued heavy use is associated with profound personality changes, there is a real danger of overdose, the combination with other prescription drugs, especially Xanax or other benzos, is potentially fatal, and the withdrawal process is prolonged and horrible.

[theeagle]

I am also a survivor of the 60's  - - even though the Vietnamese shot at me and I did horrendous amounts of drugs. I cant disagree about the danger of overdose. I woke up in an ER once and all the way to ICU on a ventilator once. The line between high and die is way too thin with that stuff. And the withdrawals are indescribable. I would take waterboarding any day over methadone. At least today I am doing just fine. And I attribute the success this time to my participation on this forum.

[nick30]

Methadone is safe when used correctly but gets dangerous very quickly when abused because the respiratory depression outlasts the analgesia, so people assume once it wears off that it is safe to take more. it isn't. It's definately different to most other narcs. It is often even misunderstood by doctors. I've never taken it for any reason so i can't really understand why chronic pain patients are so attached to it. From what i've heard it doesn't provide any significant high so there must be another reason for it to be elevated over PRN meds.

[Janalf]

From my personal experience watching a loved one try, for four years, to overcome methadone addiction, and the consequent misery, shame, guilt and horrendous physical withdrawals that attended those attempts, I personally feel it should be banned, and NEVER, EVER be prescribed by doctors. It is a truly evil drug, stays in the system for months, and leaves the user a zombie, motivated solely to search for the next dose.

[sacvic50]

I have to agree with all the others that find methadone to be inherently evil.  I went from being physically dependent on hydrocodone to the Stanford University Med Ctr.'s Pain and detox clinic to being kicked out of rehab after less than a week and sent home on this wonderful concoction that they called a blinded pain cocktail that was composed of a high dose of Methadone, Atavan, Klonipin, and something else.  I went to the clinic because I had been prescribed and then self medicated to cover the pain of a blown knee.  Instead of helping me off the Norco's they convinced me that the Norcos just weren't strong enough and that is why I was taking 30 or 40 a day.  I came home from rehab and was absolutely wasted on my cocktail. I was falling asleep standing up in the doorways.  My speech was slurred.. I was a mess. When my family called to inquire why I had been cut loose with stronger drugs than I went in with they told us I just had to adjust to the dosage.  I was on that **** for 7 or 8 months. When I was forced to quit cold turkey as I had some legal issues and was invited to be a guest in a county jail while they sorted things out and shipped me around for almost a month to finally release me after they figured out I had been a victim of the worst kind of identity theft.  (If someone wants to steal my credit go ahead and knock yourself out.  But if you are going to commit a few random felonies and then relocate, please chose a name other than mine.  I have been there and done that.  And while I was cleared and released after just shy of a month of being in custody I was coming off of my pain cocktail at the time and it was pretty horrible.  No sleep for 23 days, I prayed my head would just go ahead and explode.  Hours on the toilet, incessant vomitting.. lovely side effects like that.  What killed me is that I was a patient at on of the most prestigious medical schools in the country.  I had my bottle of cocktail with me at the time of arrest and all my family called and tried to make them give me my meds because I was so sick.  I was told to just buck up.  I didn't really need the drugs.  It wasn't like I was kicking heroin.  Those girls got put into the methadone program immediately.  Because Mine was a Prescription and Medically necessary I was denied access to the Methadone.  
     I am still battling with Opiate dependence.  But when they finally got me back home and the judge apologized for the month of my life that was stolen.  They released me and gave me my quart bottle of Methadone cocktail back to me.  I went out the door of that jail straight over to the dirt and dumped that s---t out.  I don't care how bad the pain gets, I don't care how much I am craving a pill I would not take Methadone again for any reason.