Methadone...Pain Management and Abuse (Updated)

Methadone prescriptions have been on the rise in Oregon because it is a cheap and effective pain reliever. It's usually associated with people coming off heroin addictions, but methadone is also a good, but very addictive alternative (with less side-effects) to opium/morphine-based pain relievers like OxyContin. Opiates provide users with a euphoric rush, while methadone at prescription levels does not...though if taken at higher levels, it can give a sense of well-being. So, while there are risks of methadone abuse (and it can be a very difficult addiction to kick), they are generally considered lower than with opiate pain relievers.

The Oregon Health Plan (OHP), looking for smart ways to stretch its funding, approved the prescribing of methadone a few years ago...it costs just 10-15 percent of what OxyContin does per dose. As money has become an even greater concern for OHP and the drumbeat regards OxyContin abuse has increased, little wonder methadone prescriptions--and methadone abuse--are on the rise. By the by, the VA has also increased its use of methadone for similar reasons...I don't know if its patients' rate of abuse is up.

Instead of emphasizing efforts to address the mental issues of patients who are in pain, some authorities are simply pressuring doctors who appear to be aggressively prescribing pain relievers. As you can probably tell, this is a continuation of yesterday's thoughts on how agencies fighting drug abuse end up scaring doctors out of prescribing pain relievers for suffering patients.

Here are a couple excerpts of typical scary and misleading article on how methadone use is adversely impacting us in Oregon.

In 2002, methadone killed 103 Oregonians — two more than heroin — making it the state’s most lethal drug.

Use of the drug has seen a dramatic spike.

In Southern Oregon, for instance, methadone use grew more than threefold during the past three years, according to data compiled by the federal Drug Enforcement Administration. In January 2001, Jackson and Josephine county pharmacies sold about 1,000 grams of methadone per month. By midsummer 2003, they were selling 3,500 grams per month.

Since methadone is being prescribed more in place of other drugs, are deaths from those other drugs down? Do medical experts doubt the proper medical justification for any of the methadone prescriptions? How many of the overdoses were accidental--folks seeking a high instead of taking the drug as recommended? How many of the overdoses were successful suicide attempts? Since chronic pain can bring with it depression, are OHP doctors doing the necessary psychological evaluation of patients to determine if they need help to relieve both physical and mental pain?

Without answers to these types of questions, the methodone death statistics are not in context and may be no cause for concern.

Lisa Taylor of Eagle Point lost her brother to methadone in the spring. She knew something wasn’t right when they talked on the phone the night before he died.

“He sounded funny,” she says. “I thought he was intoxicated.”

The next day, she got a call from her brother’s landlord, who said, “You need to come here real quick.”

Jackson County sheriff’s deputies found Taylor’s body and a prescription bottle for 60 methadone tablets, filled two days earlier. Only five pills were left in the bottle.

“Folks are feeling better after they take one,” said Tim Pike, a Jackson County sheriff’s detective and a deputy medical examiner. “And they think, ‘If one made me feel better, two or three will make me feel even better.’ For people who are not used to it, a couple could be lethal.”

Lisa Taylor's brother didn't take 2 or 3 extra methadone, he took around 50...that's not an accidental overdose. People develop a tolerance to methadone over time, but 50 will be lethal to just about everybody. It's sad that the instructions from the doctor, the directions on the label of the pill bottle, and information sheet provided with the prescription weren't enough to protect the victim from killing himself.

If the AP was attempting to be balanced, the article would have also gone into the victim's state of mind, any history of depression or mental illness (and how the doctors were addressing those issues), the amount of pain he'd been in, etc. Instead, the article is written as if the suicide might be the OHP's fault but provides no evidence to back up the insinuations. If that's the best AP can do, our state's newspapers shouldn't purchase and publish such articles.

UPDATE: Here I am criticizing the quality of the AP article, and I not once but twice in the opening paragraph of this post (since fixed) made a huge error--saying that methadone was not addictive. WRONG! I'm surprised that brain cramp wasn't fatal, and still can't believe I didn't catch the error.

Comments

[Michael D. Fein]

I am a chronic pain patient who has been taking Methadone for over two years successfully for pain management. However, I must take exception to the fact that you state of Methadone being non-addictive. On the contrary, Methadone is a highly addictive, narcotic drug, which must be used with caution and under a doctor's strict supervision. You are correct in stating that Methadone has fewer of the negative side-effects of other narcotic analgesics, but it is very addictive, and this should be noted. When people hear that a drug is non-addictive they tend to treat it less seriously, and that can lead to tragic results. Detox from Methadone addiction is a serious if not more so, than detox from Herion. I am an advocate of the use of Methadone in the treatment of chronic pain, but I just wanted to set the record straight concerning the addiction issue.

[RoguePundit]

Michael, thanks for the catch. I obviously had an enormous (and embarassing) brain cramp when I wrote that opening paragraph, wrongly saying that methadone wasn't addictive not once, but twice. All I can figure is that once I made the error, I just kept reading right past it when struggling with some wording later in the post. Lousy excuse though.

Greatly appreciate you taking the time to make that note so I could fix it and not mislead folks (any more).

[John Weber]

Hey i read this story and i feel really bad about it but i love methadones. i snort them during 4th period in my math class and it gives me a great buzz their awesome and i would recommend them to anyone who has a chance to get them.

[margie]

if any of you think there isn't a price to pay for methadone use you are sadly mistaken. there will come a time when the methadone train will stop and you will be the sickest you have ever been in your life. i suggest that you cut down slowly and get off the drug. i speak from experience.

[SFX3295]

I also take Methadone, (80mg a day, as well as about 280mg Oxycontin & 6,400mcg of Fentanyl a day for severe RSD) Methadone is far cheaper than many other narcotics, but it also has one other "issue" that both users and abusers need to be aware of. Methadone metabolites stay in your system for as long as 20 hours, while the active "effects" only last around 8hours at most. This means that if you keep taking it and taking it to maintain the same "feeling", or the same level of analgesia that you can build up to toxic levels without knowing about it. When experienced pain doctors prescribe it, they generally take this into account, but when the inexperienced prescribe it, or sobebody rips it off to get high (or ignores their doctors instructions) then they are playing with fire. Demerol is another dangerous drug for a similar reason, that's why they only use it for VERY short term use.

[keesa]

My dad has been on methadone for about 10 years for chronic pain. He has been extremely depressed for many years. He is paranoid beyond belief always thinking he is being watched by the neighbors and police. The first few years he was prescribed the drug he was drug tested monthly and evaluated by his physician. He no longer is drug tested or evaluated. He has gone on to illegal drugs such as crystal meth and has been using this along with the prescribed methadone for the last 5 years or so. Maybe if his Dr. noticed or cared he was clinically depressed and suicidal he could have helped him...

[kcole]

I have been prescribed methadone for chronic pain due to fibromylagia. I've been taking it for about a week and see a great improvement in my ability to get around. I have never taken or been addicted to any type of drug. I'm beginning to get worried because people tell me I will get addicted to this drug.

[Kearie]

This is my current situation. Copied from an email I sent Scott's mom.

Any advice for me in the next few days, weeks?

When Scott got bailed out of jail, he made a doctors appointment at the
CHAS in the Valley. He got in right away. We talked to a P.A. for a while and explained his history with the drugs, pain pills etc. Then she went and got the Doctor. Scott made it very clear he didn't want any narcotic for his pain and suggested methadone, but only if he could stay on it for a long period of time. The doctor said he could stay on it for life, if he wanted to. She then prescribed him 80mgs a day. She never gave him any instruction on taking them or starting them off slow.

Scott took the first dose when we got back to my place. He was "out" very quickly. When he finally woke up he was upset with himself for sleeping so long. Thank God he decided not to take the next dose. For the first few days he only took 30mgs. Slowly he took himself up to 80mgs and has been on that dose for almost 2 weeks. (Reading up on methadone overdose, if he took the full 80mgs that first day he could have OD'd)

Anyway, yesterday Scott went in to get his 2 week prescription filled and found out that the doctor was on "administrative leave," and won't be back. No other doctor at CHAS prescribes narcotics or methadone.

Thus you have Scott going cold turkey off methadone.
He is still on a small dose of percocet and an anti-inflammatory.

Pray for him.

Kearie

[Chandra]

Hi, I am a chronic-pain patient for almost four years, and after years of ever-increasing narcotic doses (hydrocodone and oxycodone), I was switched to morphine, and then finally to methadone about six months ago. The only problem I'm having with the methadone is finding the appropriate dose. My doctor is working on it with me - I'm currently at 20mg 3 times per day. It is not working, and am concerned about increasing it, although I know it needs increasing. I guess what I'm really asking is your experiece with methadone, and any tolerance you've built to it (I seem to have great problems with tolerance)... Is 60mg/day really that high of a dose? I was previously on 240mg of morphine a day before the methadone... I've been trying to research this, but info has been hard to come by other that substance abuse sites. Any help you could offer would be great. (I live in Portland, and am on OHP)
Thank you so much,
Chandra

[RoguePundit]

Converting the doses of other pain killers to methadone doses is a tremendously inexact art (genetics, size, etc.), and some people certainly gain tolerance to it way more quickly than others.

Each of the sites below tries to give approximate conversions from other drugs to methadone.

http://www.hsc.wvu.edu/sop/wvcdhi/faq/methadonedosing.asp

http://www.findarticles.com/p/articles/mi_m3225/is_7_71/ai_n13795443/pg_3

http://www.whocancerpain.wisc.edu/eng/18_1/Interview.html

Hope that helps some. Cancer pain sites seem to have more info on various pain killers than do chronic pain sites.

[Dr.Methadone]

60 mg of methadone is not a high dose at all. It could easily kill someone who wasn't opioid/opiate dependant but for anyone who' been on it for a long time the dose can be raised by as much as 20mg every week or two. A friend was taking 240mg of methadone for chronic pain, 80mg three times a day. That would kill about 16 children and 4-5 adults so be careful. Methadone is the one painkiller you dont want to take too much of. If you have never taken it before and want to get high don't take more than 5 or 10mg. If you take a bunch of pills you will die. 10mg will get someone who's not used to painkillers "high" for 24+ hours. Don't use this stuff to get high! And if you do, keep the dose low!

[MICHAEL G CONNELL]

NEW USER OF METHADONE,
I AM A SUFFERER OF CHRONIC PAIN FOR MORE THAN 10 YEARS. FUSHION C5-6, 4,5 , LOWER BACK PAIN AND AGRAVATED ARTH. AGE = 45 . I TOOK MOST OPIATES THE FIRST YEAR, DEM,MORPH, ECT. HOWEVER, PERCOCET FOR THE LAST 10 YEARS UNTILL 3 MONTHS AGO WHEN I SWITHCED TO METHADONE. MY REASONS FOR SWITCHING WERE SIMPLE IN THEORY BUT HARD TO MENTALY ADMIT.
TYPCALY I WAS PHYSICALY ADDICTED WHICH COMES ALONG WITH THE TERATORY, HOWEVER OVER THE LAST COUPLE YEARS I BECAME MENTALY ADDICTED. I WAS CONSTANTLY SWITCHING FROM ONE ANTI-DEPRESSANT TO ANOTHER WITH NO RELIEVE. FINALY I WAS FORCED TO ADMIT THAT I NO LONGER CONTROLLED MY PERCOCET, IT CONTROLLED ME. I WAS NO LONGER TAKING IT IN LARGER DOSES DURING TIMES OF SEVERE PAIN, BUT DUING TIMES OF DEPRESSION. I TOLD MY DOCTOR IT WAS NO LONGER AN ACCEPTABLE WAY TO DEAL WITH THE PAIN, I HAD TO FIND AN ALTERNATIVE. LUCKY FOR ME, MY DOCTOR WAS UP ON METHADONE AND WAS AWARE OF IT'S PAIN RELIEVING CAPABILITYS AS I WAS NOT. I HAD THE TYPACAL REACTION OF, I THOUGHT THAT WAS FOR ADDICTS.
ANYHOOT, YOU ALL PROBALY KNOW THIS SO OFTEN STORY. I KNOW WE ARE ALL DIFFERENT, AND REACT DIFFERENTLY TO OPIATES AND DOSEAGES AND I AM NO DIFFERENT. I PROBALLY COULD HAVE TAKEN 8 TO 10 PERCOCET EVERY DAY WITH MODERATE AND EXCEPTABEL RELIEF. METHADONE THOUGH, I AM CURRENTLY ONLY TAKING 20 MG A DAY AND AM HAVING A LIFE I DIDN'T KNOW WAS POSSABEL. NO MORE UP AND DOWN MENATLY WHICH WAS THE CONSTANT PROBLEM I COULDN'T TAKE ANY MORE WITH THE PERCOCET. AND THE PAIN RELEIF IS OUTSTANDING. M
MY POINT WAS TO LET PEOPLE KNOW IF YOUR DOCTOR SUGGEST METHADONE AS AN ALTERNITIVE TO YOUR PAIN THEROPY, DON'T DISMISS IT SO QUICKLY BECAUSE OF THE STIGMA THAT IS ASSOCIATED WITH IT. HOWEVER DON'T REALIZE IT IS KNOW DIFFERENT IN THE FACT IT IS AN OPIATE WITH THE SAME POSSABILITYS FOR ABUSE AND ADDICTION THAT COMES WITH THE TERRITORY. BE CAREFUL AND MONITOR YOURSELF WELL ALONG WITH YOUR DOCTORS CARE AND HELP.

[Frank]

I take methadone for back pain. I find it works very well and allows me a normal life. I never feel any euphoria or any craving for the drug. In fact I lived like a sick dog till I was given this medication. Follow the pain doctors instructions and you will have no problems. Any problems from this medication are the results of not following the physician’s orders. It’s not something to play around with or to get high on it’s to stop you pain and improve the quality of you life.

[Elizabeth Dreadfulwater]

My friend is addicted to mathadone and i don't think people should use it to get "high". He is a really good person when he is not on methadone. when he is "high" he has mood swings and he sleeps all day and doesn't care about anything. he's become a zomdie and i wish he'd never had tried this . It makes me sad that he doesn't care that his problem affects his friends and family. so if you use methadone to get "high" think about what you ae doing to yourself and the people who care about you.

[Julie]

I am just coming off of methadone. I have been on it for about 2months. I was only on the lowest dosage 20mg a day. For bad back pain after 2 surgerys. Anyway I have been trying to find a list of withdrawl symptoms because i have horrible headaches, I cry all the time, cant go to the bathroom, heart pain. If anyone can find a web link or has any information on it please let me know. Thanks Julie

[Frank]

I take methadone 12.5mg/day for serious back and leg pain. I also use a ten’s unit on my back. I only take the methadone for 2 or 3 days when the pain is most severe and then I stop taking it for a few days till the pain again becomes severe and unbearable. You DON’T get high from methadone it just relieves your pain and your mind remains clear. People who try to get high on methadone get “Dead” instead. Don’t fool around with this medication. I has worked very well for my pain and gave me my life back; however, I have respect for it and take it under the supervision of a pain doctor. Chronic pain is life destroying and there are limited options for relief. Methadone is one of them.

[Brandy]

i have been off methadone since december but i was on 120 mg a day for 6 months or so but that wasnt how i took it. i have taken as much as 14-16 methadone '' wafers'' [thats 40 mg a piece] at a time. i have no idea why im here to tell this story. someone up there must like me. my point is that this drug almost destroyed my life and its nothing to play with. also when i was on it nothing else mattered...i mean nothing...this stuff is the heroin of pills be careful.

[Rob]

I am a 40 yo male who has had chronic pain since an assault by a large group of people (if you can call them that) in 1999. I just had a titanium plate installed in my neck and a fusion of C4 - c6. I have been on perocset (2 - 3x's a day during my awake hours). My pain doc of 5 years just started me on Methodone 2 - 10's twice a day. A bout 3 days ago I got a severe headache that has not let up since and I am in excruciating pain. I have had migraines in the past and been treated and am getting an occipital nerve block for these headaches in 4 days. My question is the intensity of this headache is like no other to date and I am so frustrated I just wish I could go to sleep and not wake up until its subsided. I'm not sure I like this methadone already. The "high" feeling from the percoset is what distracted me from the pain before and the Methadone I'm not sure is working at all. It just knocks me out all day and I am functioning at life worse than ever. I am extremely depressed at this point and don't know what to do anymore. My family thinks I look better since surger but I don't feel better. I can't seem to get across to anyone how much pain I am n right now with htis headache. I would love any support anyone could give because I am very sad right now. It's 3am and I can't sleep because this headache. I don't do drugs or drink and try to stay as healthy as I can considering the pain I am always in. I'm not sure if I should tell my pain doc who I sincerely trust and like that this drug isn't working. My neurosurgeon hit a dead end and today is the last post surgey follow up for another few month.My surgeon referred me to a Neurologist now for the ehadaches and coninued neck pain. When I was jumped I was in a bar after work having some drinks. I quit drinking after that night and hanging out in bars but still this many years later I hurt. Thanks for this was to express how I feel. It has helped a little just putting this in writing. God Bless.

[Robert]

My va doc suggested I take Methadone instead of Morphine. Instead of taking 30 mg of morphine 4 times per day, I'm taking 1 ten mg methadone tab 4 times a day. I wasn't too thrilled at first because there was no rush whatsoever. I had to make a choice: did I want a rush and remain clogged up seriously (constipated)or should I give the methadone a try? Well, that was about two years ago. The pain relief is about equal, but the methadone is easier on the bowels, but suppositories are still needed most every time. I haven't found it addictive at all. I frequently forget to take a dose, something I never forgot when taking morphine.

[Donna J]

My daughter has been taking methadone for about a month now to help with her abuse of herion. She's been experiencing SEVERE joint pain in her hands. This started about a week after she started the methadone. She decided to STOP the methadone cold turkey! The pain in her hands may be getting worse. Some say this is from her just stopping so abruptly. Is there anything she can do to help this pain??? She wants so much to NOT take herion or any other drug...PLEASE HELP! Thanks so much ...........

[Kevin]

I've been on methadone for the last 3 years and it is a fantastic alternative to oxycontin. Don't get me wrong. If I had the choice before I tried methadone I would have taken oxycontin. But after studying the effects of both medicines I find that meth does have the same benefit for me only less money and less side affects. I resented it at first thinking it was stigmatic. Well that was true and I've had more than half of my doctors not believe that it's good for pain. Can you believe that. And one of them were a pain management office. He looked at me like I was a drug addict. The nerve. I'm 54. Have CAD disease. Rheumatory Arthritis, HepC ( cured) Panic Attacks ( from the medications that cured the hep) and a number of other little things I'm not thinking of. We all have our crosses to carry and I don't mind carrying mine. I just think it's immoral that there are idiots out there, and doctors being the most prevelent, do not see the success of methadone to treat chronic pain. Thanks for listening. Kevin

[Kevin]

Hey Rob,
Did your daughter contract Hepatitis C while she was caught up in the addiction. This could be the cause of the bone pain. It might be Arthritis caused by the disease. I beg your pardon if yoiur instulted by the question but would suggest she have the test to see if she has been exposed to the virus. It doesn't take just needles. It can be from sex also but not very likely. The most likely way to contract hep c is through the use of dirty needles. I hope this helps you and if I"m off base forgive me. Kevin

[Lindsey]

I have a friend who has been clean from methadone for about 2 and a half mos after abusing every day for the past two years. She went cold turkey. She was taking 80 mg a day. She is two mos out and still complains of severe bone and joint pain, chills. She happens to be my sister and I helped detox her. It was absolutely awful. she kept saying if I could have one quick fix. Anyway, when do the symptoms quit and how do I know if she is clean?

[Tina]

I am so thankful to have found this site.
Can someone PLEASE recommend what my 70 yearold mother can do to assure she continues using methadone for pain? After years of taking various opiates for several medical conditions a "pain Specialist" put her on methadone, 30 milligrams every 6 hours (although she is sometimes able to take less depending on her daily condition).THIS WAS 8 YEARS AGO, and it was with the understanding that she would most likely be on it for the rest of her life. I am appalled at the incredible lack of compassion she receives from both her primary Dr AND Pain Dr. Her pain Dr has recently advised her to "find a new Dr for her methadone. "He is sick of dealing with her and her chronic illnesses".
I realize this sounds pretty disgusting, but she has been forced to find new pain Drs in the past.
In between finding new pain specialists I have watched my 70 year old ailing mother suffer terrible withdrawals, and my brother and I end up having to take her into the ER which is a joke, as the er dr simply gives her a shot of Demerol or something to that effect sending her home only to start feeling the withdrawl symptoms again several hours later.

I have brought in her RX bottle tryiing to get these ER people to understand that what my mother needs is her methadone refilled( Not a pain shot for the terrible arm pain she IS apparently experiencing from severe sudden withdrawal!)

Currently, her Dr MAY or may not give her one last prescription and is basically telling her to find a new Dr herself.

Within the last week she made an appointment with a so called "pain Dr." just as her current pain Dr instructed her to do.She explained to this new Pain Dr that she needed to find a new pain Dr as per her Drs orders.
My mother came out of the appointment, looked at me with tears in her eyes and advised that "this Dr told me to Get lost!"....

NOW WHERE DO WE GO??? My mother cannot live the previous life again being scorned every weekend in the ER BECAUSE the ER DR thinks she is only there to "get drugs"...(Well, yes, it's called methadone and a DR 8 years ago put her on it to improve the quality of her life, which, when not withdrawing, it definitely HAS!!!)The original Dr is long gone, by the way.

Thanks so much for listening. I just cannot seem to help her find a dr who understands her predicument.

(San Francisco/SanMateo area)

Tina

[Chronic pain suffer/fibromylagia]

I am glad i am finding more information on methadone. 2000 i was in El Salvador and got over 300 mesqueto bites and got real sick. i swelled up all over my body and then
could not breath well. I stayed down there over a month and came home to recieve medical attention. I suffered for a long time. Tests showed that i had and autoemune where my body was fighting inflamation. Then was given the diagnos of Chronic Pain/fibromylagia. then in 2003 I was put on methadone, after the first dose i didnt know what was wrong with me my heart was pounding and i was not feeling well. But i was told that it would go away and my body had to get used to it. So far i been up on my dose due to two flarr ups that the methadone was not working. But now i am reading all this stuff about methadone and it makes me want to get off it. I skipped 8 days and i just read today that just stopping after long use is dangerous. I was woundering why i was not feeling well. so i took my reg dose but i still want to get off them, to see how much pain i have because i know i cant tell during taking methadone. mayde i can go back to the lower dose that worked for years and that only the high dose is needed during flarr ups. To me the real reason is because i dont want people trying to say that i am a herion addict. Also the changes it does to ones body i want to avoid. Thanks for all the information. And be careful everyone and take care.