Opinions - Prescribed Percocet with Methadone?

[xGLx]

I'm in dire need of some advice - so let me give some background history to my story first. I'm a 22 year old female who was diagnosed at the age of 7 with Juvenile Rheumatoid Arthritis. I've had numerous joint replacements, and had numerous joints scoped out due to severe damage. I've had numerous joint injections of cortisone.

In early 2005 I had a few surgeries, one being my impacted wisdom teeth removal. They were so impacted they were in my jaw bones. I was given toradol, and Tylenol 3s for the pain. I than began having really bad reactions and learned that I was severely allergic to NSAIDs and Codiene. Or more specifically Tylenol 3s. I was than prescribed Percocet, because right after my wisdom teeth removal I was having braces put on.

After that, we relized that the percocet was helping my minor Rheumatoid Arthritis Pain.. I was only being prescribed maybe 60 tablets a month. I barely took them, only if I was in severe pain.

In 2006 I had joint replacement surgery on my left hand, having 4 knuckles replaced and 4 joints fused with wires. I was casted from my finger tips to my elbow, and had well over 50 stitches, it was quite painful. While in the hospital for 5 days I was on a morphine button which I could push every 3 minutes, after a few days of that I was pulled off and put on two percocet tablets every 6 hours. I was then sent home with the same dosing schedule.

Again, my doctors relized this was appropriate for my Rheumatoid Arthritis, which was active and causing pain. They noticed I wasn't complaining of any pain at all being on this amount of percocet each day.

My doctor than realized my Arthritis was active when I began complaining of pain, so he told me to take two percocet tablets every 4 hours, and than started giving me Oxycontin 10mg tablets to take at night time to sleep because they are 12 hours time release, so I wouldn't be waking up every 4 hours when the percocet ran out of my system, or when the pain would wake me. I noticed my bodies dependancy of the percocet when the 4 hour mark would hit, I'd start feeling twitchy, and feeling like complete and utter crap.

I expressed my concerns to my doctor, and he said of course my body is dependant, not addicted. Because I am not buying the drug off the street, and am legally prescribed it, I am dependant, not addicted.

We than tried to switch me to a pain patch, which would be more time released and I wouldn't have to rely on taking pills every 4 hours. I was than prescribed a Fentanyl patch, and after having the patch on for a day and a half realized that I was having a severe allergic reaction and ended up in the emergency room. The doctor in the ER than put me back on the Percocet until I could follow up with my family doctor when he was open, as this reaction happened over the weekend.

I followed up with the family doctor who than realized I could not be on Fentanyl and put me back on the 2 Percocet Tablets every 4 hours.

Now the same dosing schedule went on until this year. 2 tablets every 4 hours, until I found out I was pregnant, when I was already 16 weeks. I was than sent to a high risk Obstetrician, who spoke with my family physician and they advised me to stay on the narcotics through the pregnancy because it could be much much worse for me to come off the drugs than to stay on. If I came off I could miscarry, go into preterm labor etc because of the stress of the withdrawls not only to me but to my unborn child.. the worse that could happen to my unborn child provided I didn't abuse the narcotics was it would be born with an addiction to opiods.

I asked the doctor to stop prescribing the Oxycontin 10mg tablets, he still I guess out of habit continued to fill it, I began leaving the medication at the pharmacy until he learned I wasn't filling it and reliazed he needed to stop prescribing it. I felt that was way too much narcotics to being taking while pregnant - Percocet AND Oxycontin? Give me a break!

A few times during my pregnancy my doctor would close his office for his little vacations, but my appointments would be randomly cancelled, and I'd be left without my medication. What kind of doctor does this? I'd be advised if I needed it that badly to goto the nearest emergency room or walk in clinic and explain the situation and they'd gladly give me a refill..

Now I'd goto the emergency room, because clinics here do not prescribe that sort of thing. They'd only be able to prescribe me 10 at a time, and say that I'd have to come back the next day that doctors in the ER have a certain limit of narcotics they can prescribe in a night and they couldn't do anything else. Now 10 tablets lasts barely a day and a half so I'd have to go back the next day, than the next doctor would prescribe me 10 more and say the same thing.. than the next doctor would prescribe 30 and that would last 3 and a half days.. I went back a few times.

I had my daughter who was born perfectly healthy despite her addiction to opiods. She started showing withdrawls within the first 24 hours, and was put on liquid morphine every 3 hours. (Poor thing) It was to be expected though. I felt, and still feel so guilty. She is now one month only, and barely on any morphine at all. She is self weening with the weight she gains, by keeping her on the same dose she gains weight which makes her depend on the medication less and less.

Anyways, now my problem is that because the hospital reported to the Children's Aid Society here that I was on a narcotic during pregnancy, they are investigating which I honestly don't blame them.

They seem to have concerns about my narcotic usage.. They want to insure that I'm not abusing my narcotics, and see that my family doctor is slowely weening me down and want to insure that I wont harm my daughter if I withdrawl which I'd NEVER do.

Now they mentioned that a good way to come off the medication quicker than weening down one tablet a day per week would be Methadone.

We have a new methadone clinic that just opened up in town called the OATC (Opiod Addiction Treatment Centre) so I've made the appointments to go there, and met with them and they ask me what I'm doing there.. If I'm not abusing drugs, I don't take more than I'm suppose to, I don't buy drugs off the street, and I certainly don't abuse other substances then what the heck am I doing there?

I feel that I'm on an active pain treatment program that works. I have active Rheumatoid Arthritis, and am in constant pain.. why should I have to go off the narcotics? How is it fair that Children's Aid thinks that if I'm back on full dose (10 tablets a day) that I'll nod off drooling on myself while caring for my child, and than when I try to ween down to satisfy them.. automatically I'm going to harm my child in a withdrawl episode..

So they wanted me to consult a pain specialist, who then said maybe to explore methadone. This doctor also works at the methadone clinic.

Now this is the advise they gave me - I have a appointment this week to find out further information so I figured I'd seek advice first..

They want me to be on Methadone AND Percocet (Full Dose) because apparently being on the methadone it blocks out the euphoric feeling, and need for abuse that percocet gives you so I wouldn't be tempted to abuse it. This way they would insure my dose is infact controlled and monitored.. and if I took more than I should, the methadone would make me sick. So my pain would be managed, and the methadone would insure I'm not abusing it. They basically look at it as it isn't fair to deny me pain treatment because I have a legit reason to be needing narcotics, and my specialist will back that up as well..

Now I'm doing research about Methadone and I'm not reading anything good about it at all. I'm reading that coming off it is worse than heroin. That about 80-90% of people on methadone lose their sex drive. I'm reading all kinds of information and it's all negative.

Now I'd like to note that if I have ever ran out of my Percocet tablets, I've never abused any other substances or opiods I've simply stuck with over the counter stuff like tylenol 1s with codiene. I don't go and seek opiods off the street.

I honestly don't know what to do. I don't know if I should just continue on the weening down schedule of percocet, and get off it completely and live in extreme pain just so Children's Aid isn't breathing down my neck.. or if I should go on the methadone and have to deal with the extreme withdrawls of coming off that in the future.

**My partner is a bit concerned with the sexual side effects of the Methadone - he's concerned that it will conompletely ruin our active sex life which would reuin our relationship completely because there would be no affection or anything.

From what I've read, being on Methadone isn't just something you can start and than realize you don't like it and then stop it.. so it's not like I can start it for a few weeks or few months to see the side effects if gives me and than quit it. From what I read, the withdrawls and come downs of Methadone are pretty harsh, worse then Percocet and worse than Heroin.

I'd also like to note that my doctor did give me a prescription for Valium, to see if maybe instead of taking percocet if I'm not in pain and can bypass it.. just to get over the shakes and withdrawls to try it and see if it helps. It does nothing. First they tried 5mg and than 10mg.. neither worked. I'd always resort back to the percocet. I think that's pretty sad that Valium doesn't even help the withdrawls.. than again I've been on Percocet for a long time now..

Advise please? It would be so greatly appreciated.

[forwhomthebelltolls]

welcome to df. use "swim" - learn it love it live it

does swiy feel that she needs to stop taking opioids? does it affect their quality of life? is she harming herself or others by taking them? or would the pain be unbearable without them?

child services can stuff it. taking pain meds does not make someone a drooling junkie(unless of course they are a drooling junkie that takes pain meds hehe). all of your docs should confirm her story to child services, and that will be that... case closed.

swim would not consider methadone for this. bad move. methadone and oxycodone? sounds silly for the low doses they would give you. why not put swiy on, for example, two oxycontin 20's twice daily, and oxycodone 5mg as needed for break through. no more jitters every 4 hours, and if the pain flares she has oxyir 5's to kill it.

for the state, its a matter of whether she is addicted and her behavior is an unsafe environment for a child. if she is just taking her meds to kill the pain its not abuse. if she stopped taking the meds, and got over the withdrawls, would she be able to walk around, pick the baby up, clean up messes, etc. without meds? something for her to consider.

[xGLx]

Originally Posted by forwhomthebelltolls

welcome to df. use "swim" - learn it love it live it

does swiy feel that she needs to stop taking opioids? does it affect their quality of life? is she harming herself or others by taking them? or would the pain be unbearable without them?

child services can stuff it. taking pain meds does not make someone a drooling junkie(unless of course they are a drooling junkie that takes pain meds hehe). all of your docs should confirm her story to child services, and that will be that... case closed.

swim would not consider methadone for this. bad move. methadone and oxycodone? sounds silly for the low doses they would give you. why not put swiy on, for example, two oxycontin 20's twice daily, and oxycodone 5mg as needed for break through. no more jitters every 4 hours, and if the pain flares she has oxyir 5's to kill it.

for the state, its a matter of whether she is addicted and her behavior is an unsafe environment for a child. if she is just taking her meds to kill the pain its not abuse. if she stopped taking the meds, and got over the withdrawls, would she be able to walk around, pick the baby up, clean up messes, etc. without meds? something for her to consider.

I'm sorry I don't understand the terms you guys use on here yet (SWIM, SWIY)..

The point is, I'm in agonizing pain without pain medication. I need to be on something, because my Arthritis has just gotten to that unbearable state that I cannot tolerate it without anything.

I do get really edgy when I with drawl, I do have anger issues as it is and I do get really grouchy when I run out of my pills. My doctor has me on such a screwed up schedule that each week I get my pills filled I run out the night before my scheduled appointment, and then have to go all night and then almost all day until my appointment until I get my next dose.. pretty stupid.. but I can't complain, it could be worse, I could be cut off all together.

I don't want to go the methadone route. I feel I function perfectly fine on the percocet. I don't drool on myself, I function like a normal human who isn't in pain.. I was able to work at a computer store doing 10.5 hour days.. and work with customers and fix computers while taking 10 percocets per day without problems.

I am able to function and care for my child perfectly fine, and all my doctors will be providing doctors notes.

I was just curious about methadone.. but if it's a bad idea I'd rather skip over it all together, and just withdrawl and come off the percocet slowely than to replace one addiction with another.. and I don't call my percocet addiction a addiction it's more of a dependance.

I know that if I came off the pain medication I would probably have trouble functioning and it would probably affect my taking care of my child. I was told that I'd be in a wheel chair by the time I was 16 and I managed to avoid that so far.

Reputation Comments on this post:

	don't self incriminate... your friend is on meds, not you
	there is no self incrimination issue here - the OP is talking about legal, prescribed meds.

[missparkles]

To be honest methadone is a far better pain reliever than even slow release morphine pills. It's legitimately used in palliative care for cancer patients, purely because it stays in your body for longer. So you can actually tailor your dose specifically. Instead of taking 20mg of an opiate pill which may be too much you can tweak your methadone dose so it suits your pain needs.

The main reason most people complain about methadone WD is because it does take time to reduce when stopping, and the longer it takes to reduce the more chance there are of psychological cravings. But as SWIY won't be psychologically addicted to it (only physically) that shouldn't be an issue.

Also, with her specific medical condition, reduction doesn't look like it will be an issue as she's gonna need pain relief all of the time, after all, the pain isn't going to subside. Sparkles had to use methadone for nearly a year for pain issues and she found it far better than the morphine tablets she was given.

20mgs of morphine was too much, but 10mgs wasn't enough, with methadone she could take just what she needed. Please don't be put off by the fact that methadone is used for addiction treatment, it's first and foremost a strong pain killer used for legitimate pain issues.

Sparkles.

[I_8_my yellow crayon]

Agree with sparkles. Plus, methadone would be far superior to taking 10 percocets a day. It is very rare for doctors to prescribe such large amounts of percocet. At least where swim lives. Usually they opt for a long-acting opiate. Like Time release morphine, hydromorphone, oxycodone, and yes, methadone. Methadone will be effective.

As regard to forum terms. SWIY- Someone who isn't you= this term is used when speaking to others.

SWIM- Someone who isn't me= this is used for when a poster(user) is referring to themselves.

Both of these terms are used to avoid self-incrimination, and incriminating others on this site.

Use these two terms, get along with everyone, don't ask for sources for drugs, don't talk about drug prices, and SWIY will have a great time using the drugs-forum and all it has to offer. It is a massive archive of information that has information being added every minute.

Now, heres a little bit on methadone in pain management.

Methadone, a potent opioid agonist, has many characteristics that make it useful for the treatment of pain when continuous opioid analgesia is indicated. Although available for decades, its use has gained renewed interest due to its low cost and potential activity in neuropathic pain syndromes. Unlike morphine, methadone is a racemic mix; one stereoisomer acts as a NMDA receptor antagonist, the other is a mu-agonist opioid. The NMDA mechanism plays an important role in the prevention of opioid tolerance, potentiation of opioid effects, and efficacy for neuropathic pain syndromes, although this latter impression is largely anecdotal.
Any clinician with a Schedule II DEA license can prescribe methadone for pain; a special license is only required to prescribe methadone for the treatment of addiction. In some jurisdictions, it is necessary to apply the words "for pain" on the prescription. Methadone is highly lipophilic with rapid GI absorption and onset of action. It has a large initial volume of distribution with slow tissue release. Oral bioavailability is high, ~ 80%. Unlike morphine there are no active metabolites; biotransformation to an active drug is not required. The major route of metabolism is hepatic with significant fecal excretion; renal excretion can be enhanced by urine acidification (pH <6.0). Unlike morphine, no dose adjustment is needed in patients with renal failure since there are no active metabolites. Methadone is available in tablet, liquid and injectable forms; oral preparations can be used rectally. Parenteral routes include IV bolus dosing or continuous infusion.
Unlike morphine, hydromorphone or oxycodone, methadone has an extended terminal half-life, up to 190 hours. This half-life does not match the observed duration of analgesia (6-12 hours) after steady state is reached. This long half-life can lead to increased risk for sedation and respiratory depression, especially in the elderly or with rapid dose adjustments. Rapid titration guidelines for other opioids do not apply to methadone. Given recent reports that high-dose methodone MAY be associated with development of Torsades, depending upon life expectancy and goals of care, EKG monitoring may be appropriate when changes in dosage are made. An important property of methadone is that its apparent potency, compared to other opioids, varies with the patient's current exposure to other opioids.
The chart below indicates the
Daily Oral Morphine Dose Equivalents
followed by the
Conversion Ratio of Oral Morphine to Oral Methadone

• <100 mg - 3:1 (i.e., 3 mg morphine:1 mg methadone)
• 101-300 mg - 5:1
• 301-600 mg - 10:1
• 601-800 mg - 12:1
• 801-1000 mg - 15:1
• >1001 mg - 20:1

Due to incomplete cross-tolerance, it is recommended that the initial dose is 50-75% of the equianalgesic dose.

Hope this all helps.
Happy Swimming

Reputation Comments on this post:

excellent post really detailed and informative.

[desertimplant]

Good replies all. SWIM will that add as a pain patient for >15yrs don't let the world and misinformation intimidate swiy into under treating swiy's pain. Swiy sounds like her head is screwed on right and l;ooking after both herself and baby. Since that is being handled correctly, focus as the other suggested on finding a pain med scheme that works. Too many get under-treated due to phobias, fears, and plain old bad info and it is a real shame to see it.
SWIM doesn't have any 'done experience but pretty much everything else yes. Fentanyl, Opana (oxymorphone) hydromorphone, oxycodone (both IR and CR) T3, T4, Lortab\Vicodin all flavors. Not all at once mind you....but the original post looks like the question is why Percocet + Methadone...based on what SWIM has learned one, the 'done is being used as the long acting component while the Percocet is strictly for breakthru or those sharp momentary pains that can occur from moving or when trying to get out of bed.
So there is some wisdom in the doctors thinking beyond just loading swiy up on drugs. As Sparkles and the others have said, work at finding the med and dosing structure that best treats your pain. It will change slightly from time to time due to tolerance. SWIM has an aunt who has the same arthiritic condition since 4 yrs old. She is doing great now at 50+ all thanks to the right kind of pain management. She had to try 100's of combinations as well as non chemical based treatments but now she's pretty stable on methadone with 4mg Dilaudid (hydromorphone) for breathru. She generally uses 10-20% of her monthly script of the Dilaudid since the pain is pretty well handled by the 'done. SWIM can ask her some questions if swiy has more since it sounds like you both have a lot in common

[EyesOfTheWorld]

SWIM- Someone Who Isn't Me, or Someone Who I Met.
SWIY- Someone Who Isn't You.
Used for legal reasons, only need to be used when drugs are being discussed, ie:
"I like steak", fine.
"I love heroin", no good, would need to say "SWIM loves heroin"
Or write in the third person about a fictional animal, space creature or friend/relative of yours.

OK, that out of the way, SWIM also takes methadone and Oxy IRs (percocet without the APAP), for pain and to stay off of heroin. The methadone is an incredible pain killer, not so much of a great high but until swiy gets used to its effects, expect to fall asleep a lot at random times. It will also block the "fun" effects of the Percocet, not sure if it also blocks the pain reliving ones, but SWIM insists on getting both each month, mainly due to the fact that people have been known to buy Oxy IRs.
Methadone WD is truly atrocious, but why would SWIY have to come off of it if they have chronic pain? And if swiy does come off it, a slllooooowww taper will make it far less agonizing, maybe supplement with a few weak opiates or kratom just for the worst parts? Helps SWIM.
Sex drive: SWIM and Ms. SWIM are both on methadone, he for pain and preventing heroin use (sure, doctor), and she on MMT (methadone maintenance for avoiding heroin use), and they are just as horny for each other now, he being 32 and she 29 as they were as high school kids. It's a lot harder to achieve an orgasm, they won't lie to swiy about that, but when they do, fuck the fireworks, it's like Hiroshima and Nagasaki combined. Basically the day of the quickie is gone on methadone, given way to marathon sex. If that appeals to swiy, cool. If not..........talk to your doctors.

[kailey_elise]

Lower doses of methadone seem to help with the sex drive/orgasming issues, & not everyone has them. ALL opioid medication can affect the sex drive, so if one doesn't have much trouble on consistant doses of oxycodone, there shouldn't be a problem on methadone.

Be certain to speak to a PAIN SPECIALIST if one is taking opioid pain relievers long-term.

Methadone can be an excellent pain reliever, & in pain treatment is often "mixed" with short-acting opioids - methadone takes care of the long-term, daily constant pain, and a short-acting med (oxycodone, hydrocodone, hydromorphone) is prescribed daily for breakthrough pain.

Methadone for pain is often dosed 2-3x a day, and for some reason this allows short-acting meds to work for breakthrough pain. My best friend was on methadone 90mg (30mg 3xday) & hydromorphone 8mg (2mg 4Xday) for pain, though with her doctor's knowledge usually just saved up the hydromorphone for Seriously Bad Pain, like during her period (she has problems with her reproductive system). Sadly, after 7 years at the same dose, it appears she started to go through pseudoaddiction because of not enough pain relief which progressed to *actual* addiction to heroin.

Long story short, she's now happily on the methadone clinic, taking 95mg a day, but all at once in the morning. For some reason, breakthrough medications don't seem to work now like they did when she took her dose 3Xday. So make certain one's looking for information regarding methadone and PAIN TREATMENT, as the set up (and apparently, what it does to one's system) are much different than methadone and ADDICTION TREATMENT.

Also, methadone *IS* a med one could try for a few months before they fully decide how they like it; the longer one's on it (like, a year or more), the harder it CAN be coming off of, but the reaction of pain patients seems to be much different than those of opioid addicts. And a slow reduction, just like one might do with any other opioid med they want to get off, works very well with methadone too (as used for pain management).

Make sure the research one's doing is geared towards methadone & PAIN MANAGEMENT.

Good luck!

~Kailey, who saw her friend really shine once her pain was treated with methadone, as it didn't have the same 'ups & downs' as oxycodone...

[UNMASKED]

To the original poster, from swim, who is on methadone with oxycodone for breaktrough...your getting way to panicked about it. its common like said above. methadone doesnt start blocking the eupohoric effects of oxy or other opies (slang btw lol) unless its like 80mg or higher, in swims experience, 90-100mg for it to start blocking. what it did do from day one though..is jack swims tolerance...its strong stuff! but if your really looking to treat your pain and not just to get high. give it a shot. swim will type more when swim has more time. few more quick things.....m done also constipates swim more than any other opie....the long ass half life has its perks though...like...not worrying about withdrawling if your (not referring specifically too you but to swims in general) dumbass makes your script dissapears in like two weeks when it was a month supply. be wise young jedi. lol

[kailey_elise]

My girlfriend told me to add this:

Originally Posted by Kailey's Best Friend

Oh, BTW, methadone was so effective on my pain that, even though I was prescribed 90mg a day, often I would take my 30mg when I woke up and forget to take my 2nd dose - sometimes even my 3rd dose! You also don't have to worry/panic if you didn't/forgot to bring some medication out with you & you ended up being out longer than you anticipated, which was something that always concerned me when I was only on Percocet. The methadone did a LOT to stabilize me in regards to my pain, and I was able to stop worrying all the time about having my damn pills!

~Kailey

[greenfox]

swim is NOT trying to be your mom, but ANYTHING mixed w./ methadone is a BAD idea for a few reasons:

1) it won't work. Done' overpowers EVERYTHING (except MAYBE bupe!)
2) it's more addictive that dog food
3) BUY IT OFF a CRACKHEAD on the street! lol as IF! No absolutely not. No, done' is no laughing matter. SWIM knows people on it for YEARS... it has a RIDICULOUSLY long half life and swiYOU is trying to "mix" it- the done' wins... ALWAYS! People switching from done' to bupe' learn the hard way... SWIyou HAS TO wait at LEAST72 hours before making the switch or... suffer w/d initiated from the bupe.
4) Done' is the government's (in SWIM's opinion) way to keep the smackies in "check" - it's VERY HARD to get "Take homes" and furthermore, they don't usually tell swiyou the dose and even FURTHERMORE from that.... the only REAL purpose it serves is "rescue" meds for TOLERANT junkies. which leads swim to...
5) if an "opiate 'naive' person takes it, risk of death is SEVERE!

SWIM isn't trying to play mommy; goodness knows swim has tried it all but in the end... it's just not worth it. If SWIY is TOLERANT then so be it; it won't get SWIY "high"- if SWIyou IS opiate 'naive' the best advice? STAY AWAY!! Or, like layne staley, SWIY will be "down in (that) hole" before SWIY knows it.

FOR *REAL*!

opiate 'naive'? Take a percocet (not YOU! someone who IS *NOT* you, of course!)

opiate TOLERANT!? SWIyou should stick to oxys and fent. - even HEROIN !! now, THAT is a dope high!

BUt remember, SWIY, dope in ANY form is so f**king addictive, it's not even funny. SWIY does NOT want to have a bupe habit for life, or worse yet, DYING alone in a corner, or maybe even WORSE than slipping into the death sleep- w/d'ing in JAIL! SWIM has BEEN DOWN THAT ROAD and it sucks CHESTNUTS!!!

SWIY:

BE CAREFUL!