Questions about increasing Methadone.

Posts: 5
Joined: 2008-05-07

I take 30mg. of Methdone per day 3-10mg.  I have been using this since last August for chronic headaches and migranes due to head trauma.  Over the past couple month my dosage has become less effective.  When I have talked to my Dr. about it she seems reluctant to increase my dosage. I started with 30mg and have stayed with the same dose and have never increased or decreased.  I have taken pain medication for over 6 years with this condition.  I did become addicted to opiates and had to quit completely. The pain specialist decided that methadone was my best choice, it keeps me off  opiods and takes care of my pain. I see my Dr. once a month and she gives me a script for 90 pills, it is then up to me to regulate these so they last all month, I usually do pretty well, but it is getting more and more difficult since the low dosage isn't working. 

If anyone can offer advice on how to make her understand what I feel needs to be done, I would really appreciate it.  I am also a little concerned if I am beginning a process of continually increasing my medication and having it eventually stop working all together.

Thank you for any help you can offer.





gcdylan's picture
Posts: 340
Joined: 2007-05-03
Well you probably know that

Well you probably know that Methadone itself is one very potent narcotic in it's own right and yes it somehow binds with the opiod receptors in your brain to not allow any other narcotics to work.(I am not a doctor and I may be mistaken but this is what I was told by a Certified drug counselor) I just would ask her for a small increase and you do not plan to keep going up in mg's. Being a doctor I am sure she has heard many different reason's and just tell her you are being honest and she might very well respect your honesty. But only you know how she works with patients.



Posts: 425
Joined: 2006-04-12
If your doctor knows that

If your doctor knows that you have a past of opiate abuse then that could be the reason why she is not too happy with giving you a higher dose. Just remember to keep calm and explain your situation and why you think you need the raise in dose. Also how long have you been on the 30mg or when was your last increase? My friend was told by his doctor that he never raises the dose for chronic pain patients more than 2 times a year because his doctor said "you shouldn't build tolerance that quickly" although everyone is different and certain people could build a tolerance quicker than 6 months. 



Posts: 5
Joined: 2008-05-07
dosage response

I started methadone in August of last year, I began with 10mg 3 times daily and have never increased or decreased, it's still the same.  So I've been on the same 30mg per day for 9 months now.

Is that average?  It seems like a fairly low dose compared to some that I have read.

 




Posts: 425
Joined: 2006-04-12
Actually the only two people

Actually the only two people that I know personally who are prescribed methadone for chronic pain are at 10mg three times daily the same as you. The difference is that one of the people I know is also prescribed roxicodone 15mg twice daily as a breakthrough med and the other is just on the methadone. Methadone for opiate maintenance is a different story as people being given over 100mg per day is not unheard of. So in my experience your dose is average for pain management.



Director's picture
Posts: 184
Joined: 2007-05-22
Breakthrough meds and Methadone

I have been on Methadone for over five years now, and although it's true that Methadone binds to the same receptors in the brain, it does not prevent other opiates from working.  They will still work, but what happens is you are unable to get any high from them.  If you're taking other drugs for BT pain, then you should be just fine. 

 

 

 




Posts: 852
Joined: 2007-04-12
Narcotics are usually not a

Narcotics are usually not a good choice for migraines anyways, and chronic use can even cause headaches.  Have you tried medications that are specificly for migriane (triptans, seizure meds, beta-blockers, calcium channel blockers, ergot preparations, midrin, NSAID's etc?



Posts: 5
Joined: 2008-05-07
migrane meds.

I have tried numerous triptan meds, as well as several different seizures meds as I have had a history of Grand Mal seizures.  I went to a specialist that dealt directly with migranes and headaches, other than a change in diet and eleminating certain foods that triggered the migranes, they simply prescribed Vicodin.  After several months of that treatment, I stopped seeing him.  The Vicodin did work to stop the migranes but I developed a dependance.  The non-narcotic pain medication was the root cause to many of my seizures.  The seizure medication worked to stop the seizures, but caused temors in my arms and legs.  The only affect the seizure meds had on my migranes was to lesson some of the symtoms. (eye twitching, light sensitivity & perception issues)

I never liked the feeling of being clouded or having muddled thoughts.  The majority of side effects that go along with narcotics, other than the euforia, were very disturbing, but the option of dealing with the mind numbing pain was much worse.  I did develope a dependance on opiates due to the over use and tollerance that I built up with over 6 years of use.  That is when the doctors suggested methadone, they explain that it was a very effective pain releiver and would also help increase the success of staying away from opiates.  Since I started methadone I haven't had any thoughts of going back on opiates until recently since my dosage has become less effective.

Pain controls lives and I have found that out first hand, methadone is the only medication that I have found that controls the headaches and does not make me feel medicated.  I don't know how to get through to my physcian that without my methadone working properly I fear that I will return to opiates to stop the pain.  I don't want it to sound like a threat, I just need her to understand how important I feel this is. 




Posts: 161
Joined: 2008-03-26
livenlearn.....

you do realize methadone IS AN OPIATE right?   u keep saying ...back on opiates,   but you are already on one.  it is different than others, but its still an opiate.   and its a weird choice to treat migraines, ive never seen that.  maybe the dr gave it to you because once u are on a stable dose for a long time, the methadone does its job, and u dont feel medicated at all, maybe this is why she doesnt want to increase your dose.  im in a clininc and on 195mgs a day and i dont feel medicated at all.  i just feel normal, like before i started using. 



gcdylan's picture
Posts: 340
Joined: 2007-05-03
Methadone

Methadone has always facinated me but my cousin around 23-25 yrs ago was on something called Orlamm. He told me it acted like methadone but he did not have to go to the clinic only 2 maybe 3 times a week and he and I worked at the same defence industry, if he was not on this therapy he would not be making a good buck and taking care of his family. I was of course for it. Many in the family outright rejected this type of therapy probably because they know little about opiate addiction. Wow this sometimes became a big old argument around the holiday's while many of my older family member's were sitting around and knocking down a good portion of their favorite booze. Is Orlamm about the same as methadone? Just always wanted to know for I do not think I have ever read about it in this forumCool



phisher's picture
Posts: 2218
Joined: 2006-03-20
From the National Institute of Medicine:

LAAM

Closely related to methadone, the synthetic compound levo-alpha-acetyl-methadol or LAAM (Brand name: ORLAMM®), has an even longer duration of action (from 48 to 72 hours) than methadone, permitting a reduction in frequency of use. In 1994, it was approved as a Schedule II treatment drug for narcotic addiction. Both methadone and LAAM have high abuse potential. Their acceptability as narcotic treatment drugs is predicated on their ability to substitute for heroin, the long duration of action, and their mode of oral administration.


all thoughts and opinions expressed are those of my own and should not be mistaken for medical advice. i am not a doctor nor a pharmacist. all medical questions should be answered by a licensed pharmacist, doctor, or primary care manager.



Posts: 161
Joined: 2008-03-26
orlamm

yes in my travels thru my clinic, i have seen things posted about laam, and it even mentions it on my clinic id, "this patient may be treated with medications including methadone and laam", but i dont think they use it. im pretty sure everybody is on methadone.  infact i think its an old school thing anyways because ive NEVER heard of anyone using it for addiction treatment or otherwise.  but who knows!



Posts: 425
Joined: 2006-04-12
I found a webpage that

I found a webpage that stated that LAAM is no longer produced in the USA. I dont know the credibility of the website but this could be why no one is seeing it used lately and referring to it as an old school med.



Posts: 161
Joined: 2008-03-26
LAAM

Well there ya go!  that makes sense to me, they still have postings about it at my clinic but its kinda mixed in with the methadone info, and i remember on my old clinic id from my previous clinic, on the back it says "patient will be treated with meds such as methadone, suboxone, or LAAM.  Like i said that was my previous clinic, my present clinic is the same company, just a different location, and their ID doesnt mention it at all.  But if its no longer produced than thats our answer, I was actually curious about it myself, thanks Freakonaleash.