Thing is, Methadone is a very sketchy subject in most countries. But more particularly the USA. Also when you consider the strength of the drug, its just too much at once, and let me say for people like you and me and some others here, who have had significant exposure to opiates, it's not really a big issue when you first start. But for those who are opiate naive, or have had relatively little exposure over their whole life, it can be dangerous to just give them some Methadone and say "here ya go, take this".
Its already caused a lot of problems because inexperienced doctors were handing this stuff out to people with migranes or headaches or whatever, and giving them either poor or bad instructions that did not end well for the patient.
For Refractory RLS, there is no question that Methadone should be a top contender on the list, but when we talk about front-line drugs, we have to think about what that term means.. It means regardless of the stage of the illness, those are the drugs you go to first. Which can be very dangerous.
Also I have a unique viewpoint as an addict, and I can say that using sledgehammer when you don't need one is bad for the patient, and bad for the doctors reputation. Its just best to start off slow, even though we end up being the ones suffering, because in the end that earns us credability and if it turns out someone only needs a couple Vicodin a day, well that's a lot better for everyone.
First Post -- Moving to Opiates
Yes, they all have the ability to kill, but Methadone has the distinct ability to kill on the FIRST dose, in opiate naive patients.
Usually you don't hear about someone dying on Oxy unless they were an idiot at a party who took a bunch of 80mg CR's because the first one "wasn't working"
Methadone is much more sedating and because of its long half-life it can be much more subtle.. You literally go to sleep fine, and don't wake up. You just don't see that with other drug OD's for the most part.
When people OD on most other opiates, they either pass out and go into immediate respiratory failure, or that plus seizures and spasms (Codeine - particularly horrible OD to die from, and painful from what I understand)
My mother has question me about loud/heavy breathing in the past when I first started Methadone, and I was at a higher sustained dose. It really is very subtle, because to me I was feeling fine and breathing normal.
Usually you don't hear about someone dying on Oxy unless they were an idiot at a party who took a bunch of 80mg CR's because the first one "wasn't working"
Methadone is much more sedating and because of its long half-life it can be much more subtle.. You literally go to sleep fine, and don't wake up. You just don't see that with other drug OD's for the most part.
When people OD on most other opiates, they either pass out and go into immediate respiratory failure, or that plus seizures and spasms (Codeine - particularly horrible OD to die from, and painful from what I understand)
My mother has question me about loud/heavy breathing in the past when I first started Methadone, and I was at a higher sustained dose. It really is very subtle, because to me I was feeling fine and breathing normal.
"However, I take great offense to the idea that Methadone is any more dangerous than the thousands of other drugs out there.. And the simple fact of the matter is, unless you suffer a medication interaction due to negligence, or take too much either accidentally or due to negligent prescribing - Methadone will NOT kill you. It may do a lot of other unpleasant things, but you're not going to die if it is given the proper respect it deserves and the doctor knows what they are talking about when informing the patient. " your quote Zach, from another page which
I tend to agree with more..
obviously when it comes to these meds equal patient/doctor education is paramount. You and I both I'm sure, have adjusted a dose with other meds and told the doctor what dose works. I would say that trying that with this med is more dangerous, but given that things like that should not be done- it really needs to be stated with any these meds "here is your dose and schedule, accelerate this in any fashion and you will probably stop breathing (and not notice)."
I just do not think everyone needs to go through the pure
hell of failing everything else out there, when it is known how well
methadone works. (and again I am talking about when 24/7 therapy is required)
I tend to agree with more..
obviously when it comes to these meds equal patient/doctor education is paramount. You and I both I'm sure, have adjusted a dose with other meds and told the doctor what dose works. I would say that trying that with this med is more dangerous, but given that things like that should not be done- it really needs to be stated with any these meds "here is your dose and schedule, accelerate this in any fashion and you will probably stop breathing (and not notice)."
I just do not think everyone needs to go through the pure
hell of failing everything else out there, when it is known how well
methadone works. (and again I am talking about when 24/7 therapy is required)
Is it nap time yet ?
In an ideal world, I'm sure we could give Methadone to everyone with Refractory RLS, who needs it..
But its not an ideal world and we have to take the realities of life into account. People ARE stupid, and doctors will make mistakes.
Yes, I believe Methadone is very safe and no more dangerous than any other drug when used as intended under proper supervision.
However I have also, ALWAYS maintained that it should be given as a last resort, and especially in opiate naive individuals should always be started slowly and carefully - splitting the standard 5mg pill in half.
I have never changed my position on this, and I don't believe it is contradictory to recommend these precautions while at the same time believing it is a very safe and effective medication. For me it is a very black and white issue.
Methadone receives tons of negative publicity because of how it is misused by patients or mis-prescribed by doctors. And taking these measures will help insure that anyone I personally recommend Methadone to, is able to become a POSITIVE statistic in the war on legitimacy against banning it. This fight will never die.. It doesn't matter that when used as directed it is very safe, and it doesn't matter that it has killed the least amount of people compared to a lot of other weaker drugs, and the fact that most people die because of improper prescribing, not following directions, or obtaining it illicitly and mixing it with lethal cocktails.
The reason I feel this way is to minimize the damage in any way I can, that can be done to Methadone as a result of me recommending it to someone. It IS extremely powerful, and with power comes a certain amount of respect in my mind. It is not the same as giving someone 2 Vicodin and saying "call me in the morning". If it were prescribed so non-chalantly the death rate would skyrocket, unfortunately. Because inevitably some people will do stupid things, or some doctors will screw up because their ego couldn't be assed to actually learn about something they claim to know about.
Its just the reality of the situation... In order to get a diagnosis of Refractory RLS (24/7 RLS that does not respond to DA's) you HAVE to fail at least two Dopaminergic drugs (Requip, Mirapex, Sinemet), and just because you have Refractory RLS does not mean you need Methadone right off the bat.
Practically ANY opiate will help 99% of people they are given too, so it is always best to start slow and move up the chain, because ultimately if someone finds that a couple Ultram every x hours works for them, or a couple Vicodin, I would much rather have them taking that, then Methadone when it isn't necesarry.
But its not an ideal world and we have to take the realities of life into account. People ARE stupid, and doctors will make mistakes.
Yes, I believe Methadone is very safe and no more dangerous than any other drug when used as intended under proper supervision.
However I have also, ALWAYS maintained that it should be given as a last resort, and especially in opiate naive individuals should always be started slowly and carefully - splitting the standard 5mg pill in half.
I have never changed my position on this, and I don't believe it is contradictory to recommend these precautions while at the same time believing it is a very safe and effective medication. For me it is a very black and white issue.
Methadone receives tons of negative publicity because of how it is misused by patients or mis-prescribed by doctors. And taking these measures will help insure that anyone I personally recommend Methadone to, is able to become a POSITIVE statistic in the war on legitimacy against banning it. This fight will never die.. It doesn't matter that when used as directed it is very safe, and it doesn't matter that it has killed the least amount of people compared to a lot of other weaker drugs, and the fact that most people die because of improper prescribing, not following directions, or obtaining it illicitly and mixing it with lethal cocktails.
The reason I feel this way is to minimize the damage in any way I can, that can be done to Methadone as a result of me recommending it to someone. It IS extremely powerful, and with power comes a certain amount of respect in my mind. It is not the same as giving someone 2 Vicodin and saying "call me in the morning". If it were prescribed so non-chalantly the death rate would skyrocket, unfortunately. Because inevitably some people will do stupid things, or some doctors will screw up because their ego couldn't be assed to actually learn about something they claim to know about.
Its just the reality of the situation... In order to get a diagnosis of Refractory RLS (24/7 RLS that does not respond to DA's) you HAVE to fail at least two Dopaminergic drugs (Requip, Mirapex, Sinemet), and just because you have Refractory RLS does not mean you need Methadone right off the bat.
Practically ANY opiate will help 99% of people they are given too, so it is always best to start slow and move up the chain, because ultimately if someone finds that a couple Ultram every x hours works for them, or a couple Vicodin, I would much rather have them taking that, then Methadone when it isn't necesarry.
Hey Zach(& anyone else), I'll start a new thread to continue a our conversation, I think we got slightly off track from Stogart's topic with another worthwhile subject but I don't want steer his to left field.
Stogart I think there is some great information here, but I do want to apologize, it was not my intent to debate the order of opiates here.
Stogart I think there is some great information here, but I do want to apologize, it was not my intent to debate the order of opiates here.
Is it nap time yet ?
Very interesting stories. My latest venture is going from six .25 mg. Mirapex per day down to three per day, then adding Codeine every other night. It didn't quite work out so I'm on Codeine every night. 1/2 tsp. liquid (2.5 MLS) is the prescription.
I'm getting much less RLS in general, BUT, catch-up time around 1:00 a.m. and It hits with a vengeance. Into the hot bath, play solitaire, stretches. Eventually it goes away and I can get some sleep.
Feel better generally for having cut down on Mirapex. Neurologist said I could eventually eliminate Mirapex and use only Codeine. Any comments?
I'm getting much less RLS in general, BUT, catch-up time around 1:00 a.m. and It hits with a vengeance. Into the hot bath, play solitaire, stretches. Eventually it goes away and I can get some sleep.
Feel better generally for having cut down on Mirapex. Neurologist said I could eventually eliminate Mirapex and use only Codeine. Any comments?
It sounds like it may be a good option for you, if you are responding relatively well to the codeine.
However I would caution against locking yourself into a specific medication in a way that if you tried to ask for something stronger, you would be denied.
My experience with codeine, was roughly 90% RLS relief even if I took the maximum amount my body could process in a 24 hour period. So it does have its limitations based on the severity.
Per the middle of the night RLS issues, have you ever tried taking more codeine at that point? Also, if you have mostly 24/7 RLS and have insurance, you might want to ask your doctor about time released medication instead - to cut down on the doses.. Ultram ER is 100mg over 12 hours I think. So one or two of those a day may potentially match or beat your codeine coverage. Its all trial and error though.
In any case, make sure your doc understands about your middle of the night issues, and that you may want to switch to a time released medication, or a stronger short acting medication, in the future.
Also worth noting.. When you completely stop the Mirapex, your RLS may substantially intensify. I don't know how that works with a slow weening process (gradually reducing your Mirapex, vs cutting it off at once) but most people who stop DA's experience a worsening of their RLS that is bad enough, most experts will recommend a much stronger opiate than codeine for a period of about 2 weeks. Usually something like Oxycodone, or even Methadone
However I would caution against locking yourself into a specific medication in a way that if you tried to ask for something stronger, you would be denied.
My experience with codeine, was roughly 90% RLS relief even if I took the maximum amount my body could process in a 24 hour period. So it does have its limitations based on the severity.
Per the middle of the night RLS issues, have you ever tried taking more codeine at that point? Also, if you have mostly 24/7 RLS and have insurance, you might want to ask your doctor about time released medication instead - to cut down on the doses.. Ultram ER is 100mg over 12 hours I think. So one or two of those a day may potentially match or beat your codeine coverage. Its all trial and error though.
In any case, make sure your doc understands about your middle of the night issues, and that you may want to switch to a time released medication, or a stronger short acting medication, in the future.
Also worth noting.. When you completely stop the Mirapex, your RLS may substantially intensify. I don't know how that works with a slow weening process (gradually reducing your Mirapex, vs cutting it off at once) but most people who stop DA's experience a worsening of their RLS that is bad enough, most experts will recommend a much stronger opiate than codeine for a period of about 2 weeks. Usually something like Oxycodone, or even Methadone