Methadone Users

Post by **ViewsAskew** » Mon Feb 23, 2009 9:25 pm

Helen518 wrote:Aargh. You know what is funny - I asked my neurologist if the patients he treated that became pregnant reported increase in symptoms during pregnancy and he said no, he did not remember them reporting this.

Wow, his patients may not have, but pregnancy is one of the things that is considered a risk factor for RLS. It's usually that last 3 months that are considered the problems, but some women have problems the entire pregnancy.

I know I'd need some sort of reassurance that the med would work and that I'd have room for adjustment if things got worse.

Neco · Post by **Neco** » Tue Feb 24, 2009 12:45 am

Yeah seems like a tough spot to be in. Since anxiety seems to be so much of a problem for your RLS as well, and you can't really take much in the way of anxiety meds.

Hopefully things will be OK.

I've adjusted my dose as well, taking 2 in the morning and waiting as long as I can to take the third.. Yesterday was pretty rough but I made it until about 10 - 10:30pm, although it did take a while for it to kick in. Tho I was still pretty anxious to take my meds this morning, but I spent a half hour shoveling snow before coming in and doing that.

Guess I'll see how far I get tonight and what tomorrow brings.

Neco · Post by **Neco** » Tue Feb 24, 2009 1:26 pm

I just caught a new episode of House last night, and I feel kind of conflicted about the way they portrayed Methadone.. I understand the concept of artistic license and all that, but it still felt very wrong at some point..

I didn't catch the first 15m or so, but from what I understand, House was being all nice to people and whatnot, and then apparently stopped breathing, etc.. So they're making a fuss over him and his answer is "It's called Vicodin, I took too much!" which elicited a brief chuckle from me..

Then it drags on for a bit with various characters discussing things, like the fact no ones seem him taking Vicodin for a couple days (two separate groups in two different scenes coming to the same conclusion) and Wilson is like.. (paraphrasing here..) "He's being nice because he's happy, he's probably happy because he's not in pain, which means he's taking something stronger than Vicodin... It has to be Heroin!"

Foreman comes to the same conclusion, and calls up Wilson and says the same thing, although he is currently sitting at a table with House, in a restaurant, so he dances around it and foreman picks up and they get off the phone.. So Wilson has ordered drinks, with the intention of seeing if House will his shot of bourbon, which he gets all snarky about and makes some joke about putting him into respiratory arrest (for the second time that day) being some sort of drug test - and he drinks it, says goodnight and leaves.

The next scene is House making himself upchuck into a trashcan in the back of an alley and Wilson busting him. After some dramatic bickering House says "I'm not on Heroin, I'm taking Methadone"..

And this is where it goes sour.. Wilson gets no less rattled over this news, and goes on about "Miss time your dose and you die, mix it with the wrong medication you die, blah blah blah! " "If you need another option for controlling your pain we can - " and House cuts him off, "It doesn't help my pain.. It obliterates it" proceeds to throw his cain away and walks (not limps) away".

The rest of the episode is spent with various people at some point confronting him and insisting he will DIE if he keeps taking Methadone.. Cutty eventually tells him he isn't going to work in her hospitals as long as he is "doing" Methadone.

W...T...F ? This really makes me mad. It's like they went out of their way to convey the image that Methadone is no better, no more safe, and just as bad as a street drug like Heroin... They even suggested House shouldn't be on because of his addiction to Vicodin... ummm Hello? WHAT do they give opiate addicts who are trying to get off Heroin or prescription painkillers? Methadone :roll:

Maybe I'm taking it too personally, but I don't like what they are trying to put into peoples heads.. We all know that it should be started slowly in people with low tolerances, and that it can be dangerous in that regard. But how many other medications can kill you too? It's stupid. I wonder what the writers and medical consultants (which such a show clearly has) would say to all the people with chronic pain who get relief from Methadone.. But they probably weren't thinking that far ahead.

I'm beyond the point of being mad about it though.. And I'll give them credit for accurately portraying things like the tiredness and brain fogginess that some people unfortunately have to deal with.. But he was on Methadone for maybe 3 or 4 days during the timeline of this episode?

Ultimately he quit taking it because he was missing things he normally wouldn't have, by letting a patients parents boss him around, but still, 3 or 4 days is not an accurate portrayal of effects that would potentially fade over time either..

It just makes me wonder how many more people walk away after seeing a drug portrayed like that, with this idea that it is some dangerous things that no one should be allowed to take.

Spiticus · Post by **Spiticus** » Tue Feb 24, 2009 7:47 pm

Wonderful...another misguided perception on methadone. Just what we need. MORE stigma attached to this drug.....eugh.

In regards to an earlier post of your's Zach, I was wondering the same thing. While I'm still fairly new to methadone, I do this I need to increase my dose to 2.5mg in the morning and 5mg at night. I'm not sure how to approach this without seeming like I'm exhibiting drug seeking behavior.

I'm not at all looking for a high of any sort (methadone doesn't give me a high at all). I just honestly believe that I need to up my dosage my another 2.5mg at night.

I'm just scared that my doc will take away everything if I ask.

woodsie357 · Post by **woodsie357** » Tue Feb 24, 2009 8:41 pm

I bet they walk away thinking it's the same thing as heroin just in prescribed form. That's really sad.

I'll bet our scardy pants doctors are going to be more scared to pass it out to anyone.

It's also sad to see someone that's in terrible pain and could use it not use it or be able to use it.

When it comes to sleep, and not getting it,I can't function enough to take care of my needs.

Neco · Post by **Neco** » Tue Feb 24, 2009 8:59 pm

Well I don't know what your daily dose and regime are so I'll just generalize..

The best way to ask about an increase is to tell the doctor you are still having problems. Let them know that when you take the medication it really helps, but you feel like it could help a little better if you had a little bit more..

If you are below the Mayo Clinic guidelines (i.e your daily total dose is less than theirs) you could try working it from that angle.. Show your doc the Algorithm and say that you are still within the range of the Algorithms recommendations so you are interested in a small increase in your dose to see if it will help you manage your symptoms better.

I feel like the Mayo listings are very conservative for severe RLS though, and if you already come close to their max recommendations I don't know how good an idea it would be to bring it into the discussion.

Also important is the timing of your request.. How long have you been on Methadone, and have you had any recent increases, and how long ago was that increase?

Once I gave up posession of my supply to receive daily rations, I leveled out and then hesitantly (and I let him know I was hesitant to ask) asked for a 10 pill increase at the 6th month mark, since the change in my treatment was established.

You could also express your concern in such a way as you don't feel you have found the right stable dose yet and could really use an improvement.. Let him know you are open to discussing changes to when or how you take your meds (how much, how many times a day, with a certain food or without) things like that.. Just do your best to give the appearance of someone who doesn't feel they are getting sufficient relief and is simply interested in working it out in any way they can

Spiticus · Post by **Spiticus** » Tue Feb 24, 2009 9:33 pm

My dosage right now is 2.5 in the morning, 2.5 in the evening. In the evening I still have trouble that I don't have during the day because I"m usually up and around more during the day.

I haven't had any increases, though I've only been on methadone for two weeks. Really, I guess I'm still trying to figure out which dose works best. I'm just worried that an immediate request to increase my dosage from 2.5/2.5 to 2.5/5.0 would seem as if I'm trying to get more. Maybe I should wait it out a bit to see if things get better, but as of now, I feel like I could really use the extra 2.5 in the evening.

Also, just watched that episode of House. Such crap. Apparently anyone who takes methadone will automatically die from it as well as compromise their intellect completely. Oh and they become completely complacent too apparently. It was infuriating.

Post by **ViewsAskew** » Tue Feb 24, 2009 9:46 pm

House is not known for being accurate about anything. If you want truly bizarre, you should watch the episode about this undiagnosed celiac woman who tried to kill someone...right, that's what undiagnosed celiacs do. Yeesh.

That was the last time I watched House. Good acting, good drama, BAD medical writing (which is truly a shame).

Per the methadone, I can't imagine a doc not being receptive if you go in and say, "It's been three weeks and this isn't completely resolving my RLS. The daytime is good, but I still have some RLS at night. I seem to be responding OK to it otherwise. What are my options?"

If he or she gave you the script, I'd think he or she would know enough that 15 mg is the average dose for RLS patients, so 5 mg split throughout the day still has plenty of room for adjustment.

By asking what he or she wants to do, you allow them to stay in charge. You're not asking for anything and not acting like a risk in any way. And, the only way you'd have to worry or change your stance is if he or she says, "Sorry, but that's all you can have." Which I doubt, though it is possible.

Then you can invoke the algorithm or whatever you need to. Just give the doctor a chance to be a doctor first. Then you can take over when and if they don't get it. Even then, take over in a way that allows him or her his doctor power...

Neco · Post by **Neco** » Wed Feb 25, 2009 2:55 am

Well, its nice to know I was not the only one upset about this episode.

http://www.cliqueclack.com/tv/2009/02/2 ... methadone/

SquirmingSusan · Post by **SquirmingSusan** » Wed Feb 25, 2009 5:28 am

Excellent post on that forum, Zach. And there were others who also objected to the portrayal of methadone on that House episode. I think I'm glad I missed that one. And when I do watch it, I'll be forewarned. It seems like some letters to the writers of House are in order, though. Even though, yes, it's TV, and yes, House is usually quite inaccurate, there is just no excuse for the way they deal with some of these issues.

First of all, it's about frickin' time that House gets some decent pain medication! All these years they've been showing him as an addict instead of a pain patient who is looking for relief - he's a classic case of "pseudo addiction" (when a person looks like an addict because they are trying to get relief).

Unfortunately, the portrayal of House as an addict just reinforces our societal stereotype of pain patients as addicts. If House was treated seriously on TV as a pain patient needing pain relief, then maybe over time people would start absorbing that message instead of the addict thing.

I'm so tired of TV shows portraying people seeking pain relief as addicts, and addiction as moral failure instead of a legitimate medical condition that requires compassionate treatment.

Oftentimes TV leads the charge on social issues - why not encourage them to push for changes in the way pain is treated?

OK, enough of the soapbox for tonight. :wink:

Spiticus · Post by **Spiticus** » Thu Feb 26, 2009 9:19 pm

Two questions:

1.) Is there anything out there that is known to drop or keep in check one's tolerance to opiates? I have no idea if such a drug exists but it would seem like a great thing for us who opiates if we could control our own tolerance to them.

2.) Does anyone here use Lyrica along with their Methadone? I know it would have to be in relatively small doses, but was wondering if there was any other person with experience with the combination.

Neco · Post by **Neco** » Thu Feb 26, 2009 10:13 pm

There isn't really any drug they can bundle, or you can take with opiates, to help manage or reverse tolerance, but I did read somewhere a while ago that there has been research in the past with Naloxone.

Naloxone is an opiate agonist that they give to Overdose patients to try and reverse respiratory depression and sedation, to save their life. It basically works by flooding in and kicking everything off the receptors, but has the side effect of precipitating a rapid withdrawal which can be horrible to go through, and may or may not have saftey concerns as well.

Suboxone is manufactured with naloxone in the formula, but it is apparently benign when taken as intended, and only puts in to discourage/prevent misuse by crushing and/or injecting the drug directly.

There was supposedly some research done about including it with opiates, or taking it as a seperate substance, in very minescule amounts.. something like 0.001% of the standard dose, or some funny number like that. It was reported to stop tolerance and in some cases actually rollback tolerance to previous levels, however after a week or so of taking it daily this effect would stop as you in turn build up tolerance to the naloxone.

It seems like promising research, if they can find the right chemical structure to do it with, but I don't know if there is anything more active going on in researching it, and I don't have any links to the info I saw anymore..

There is nothing more I would love then to be able to go back to taking 2 - 4 Vicodin a day, with all the good buzz I used to experience and not have to worry about tolerance or the cycle of addiction... But it's pretty much a pipe dream for me. It's a shame I guess, because I'm a much nicer person to be around and I'd still be quite coherent and lucid.

SquirmingSusan · Post by **SquirmingSusan** » Thu Feb 26, 2009 10:18 pm

hmmm, something to drop tolerance to opioids. It seems like this has been discussed around here, but I can't remember where. I think there have been discussions about rotating the opioids, to lessen tolerance... It's less of an issue, at any rate, with methadone than it is with other opioids. I know that some doctors say that RLS patients do not develop tolerance to methadone, but I'm sure I don't agree with that. I think anyone can develop tolerance to anything, no matter how unlikely. But methadone is way better for me than Vicodin was - I was building tolerance at a scary rate with that, and I only took it for a few months. My methadone dose has been stable, and I've even managed to decrease it more recently.

I have taken Lyrica along with my methadone, and I think that's not uncommon. It worked well, but my hands and feet started to swell up. So I switched back to gabapentin, which also seems to help tame the RLS beast a bit. But since I increased to 3x a day on the gabapentin, my hands and feets are swelling as well. So I've cut back to once a day, and figure if I can't take it enough to help, I might as well just taper off of it. There are other anticonvulsants that are helpful as well, such as Tegretol and Lamictal, that help with RLS with or without the methadone.

Post by **ViewsAskew** » Thu Feb 26, 2009 10:22 pm

From the reading I've done, it seems that the literature is divided regarding this issue. One study showed that people were at the same dose for up to 7 years. Yet, in the Clinical Management of RLS book, it clearly says (about the stronger opioids), "Due to their potential for tolerance and dependence, these drugs are not considered to be a first-line treatment for RLS."

I am pretty darn positive I've become tolerant not once, but twice. Started at 10, went to 15, then to 20 mg of methadone.

There is a study - which is posted in the Pharma thread about RLS studies/research, I think - that in another group of patients (maybe pain patients, can't remember) alternating from one class of opioid to another was being used as an effective strategy to handle tolerance.

I mentioned this possibility to someone in the RLS community (can't remember who) and was told, "That doesn't work here."

Not sure if that was one of those I AM An Expert and I Know Everything comments, if it's been tried, etc.

I do, however, want to try it. The next increase will put me only 5 mg from the max. I'm still in my forties. Given that I've needed an increase about every 8 months (give or take), this could be problematic...

Spiticus · Post by **Spiticus** » Fri Feb 27, 2009 12:03 am

Thanks for all the responses. Seems like the possibility of a tolerance holder/reducer is not in the realm of the impossible but still in a good deal of trial and error.

The reason I ask is because my doctor wants to keep me at 5mg total all day (2.5mg twice a day) and I understand that and it's fine. I'm just trying to think of other things that might help. The Lyrica i have is 50mg (I took it before the methadone for a couple of days to see if it would help). While it didn't do nearly as good as the opiates have done, it did do something to help. That's why I was wondering if the two are ever taken together.

I'm just still having problems, especially at night. It's definitely bearable and that may just have to be the way I live with this.

I just hope that next time I have a girlfriend she doesn't kick me out of bed for kicking her in my sleep like the last one did.