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Switching from methadone to fentanyl patches
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KatBaskin posted:
Hi Everyone, I posted earlier today and am new to the board. I didn't know to put the subject of my post at the top and put my name there, it reads KatBaskin. I need your comments please. I am so thankful for you all. You have helped me so very much just reading what you all say to each other. I asked my pcp to take over my pain mgt, because some of you did that and he said he would! I have been going to pain mgt. drs for a long time and I have nothing good to say about the several I went to for years. I just started the patch and I have been on methadone. I have been on as much as 240 mgs and asked to get down to 100mgs and did so about a year ago. Now iam down to 60-80 mgs and have switched to the 50mg patch along with six 15 mg of oxycodone. I'm still in pain. Please let me know what you think.
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greg8846 responded:
Hi KatBaskin:

It may take a little while to get pain relief from the patch. I have never cared for them as i didn't get any relief from them Is your doctor using the Oxycontin, (Oxycodone) for breakthrough pain or an adjuct to increase the pain relief from the patch. Fentanyl is a very strong pain medication. For some foks it works, others it doesn't. Your doctor may increase you on your Oxycodone to give you more pain relief. Or he can go to the 75 mcg Patch. The patches are measured in micrograms versus milligrams, micgro are smaller units than the milligrams because the drug is that strong. Why did he take you off of the Methadone, its a pretty safe drug with limited side effects. Do you take the Oxycodone one tablet so many times per day or all at once. There are several ways that your doctor can achieve good pain control but it takes time it does not happen oner night. I hope this has helped you some. Keep me posted please.

Greg Armstrong
 
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KatBaskin replied to greg8846's response:
Thanks, Greg. I asked the Dr. to take me off the methadone. I had been taking 240 mg. of it and got down to 100 a yr. ago. Recently I tapered down to 60-80 a day and then asked for the patch. I have been on methadone for about 10 yrs. and wanted to try the patch. My pcp won't write scripts for methadone and I badly wanted away from the pain mgt. clinics. I take the oxycodone 2 15mgs. 3 times a day. I am so hoping this works for me. I really need it to. Thank you so very much for talking to me. Love, Kat
 
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futurexboy2 responded:
I have a question, are you still taking the Methadone along with the 50 mcg patch and 6 by 15 mg oxycodone or just taking the 50 mcg patch and the 6 by 15 oxycodone? You say your still in pain but asked to be taken down on your med intake, maybe you went to far down too fast? Its quite a decrease from 240 mgs of Methadone a day to 60/80 mgs a day. I've never taken or been on the patch so I don't know how it works, and the most Methadone I've ever taken is 80 mgs a day but do realize it's got a big ceiling when it comes to your daily dose and dealing with tolerance. One way to make Methadone more effective is to change to another opiate for a few months and then switch back, I did and it worked good for me, plus having a BT medication. Good Luck with the change and may I ask why you wanted to change to your regular PCP instead of a PM doctor?
 
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KatBaskin replied to futurexboy2's response:
Thanks for taking the time to talk to me. Yes, I am still taking 30 mgs of methadone along with the patch, but will stop in 2 days completly. I haven't taken 240 mgs for over a yr. I have recently only been on 60-80 per day. The reason I wanted to have my pcp take over my pain mgt. was so that I could get away from pain clinics that treat you badly and don't seem to care about your pain. That's why. Again, thanks for sharing. Kat
 
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futurexboy2 replied to KatBaskin's response:
Hi KatBaskin, Interesting, how is the patch working for you, is it giving you better pain relief than the Methadone or about the same? I wonder because I take Methadone along with Oxycodine 15mg RR by 3 a day, 60 mg on the Methadone. I read here a lot of us are on the patch and wonder how it works in comparison and do you like it better or worst or just about the same? I've taken Methadone for many years and so far its been my medication that works best, but I do always wonder if there's better out there. I was on Methadone 80 mgs a day and switched to Aviniza 60 mg by 2 a day which just didn't work very good for me, but it did reduce my tolerance for Methadone over the 4 months I took it, I went back to the Methadone and a BT medication this time and it has worked really the best of all. How are you doing now and please keep us informed how it works and all, thanks for your help here on the forum...PS: I know what you mean by the PM doctors, I've never even asked my PCP if he would take over my meds and really don't think he would, I know he won't prescribe Methadone, I don't have a clue why doctors have a phobia when it comes to this medication, strange, but I know they do...Thanks for any help you can share, futurexboy
 
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KatBaskin replied to futurexboy2's response:
Hi futurexboy2, The DR. increased the patch to 75mcg on Tuesday and to be perfectly honest, I really can't tell any difference. I still hurt really bad. I'm trying to wait for it to work,but the methadone worked really well for me for a really long time. I hope I haven't made a huge mistake doing this because my pcp really cares and is trying to help me and as I said I want away from Pain mgt. I live in Arkansas and I have been to quite a few pain drs. and none even come close to my pcp. I am now off the methadone completely and I can't tell that I miss it. Just 2 days tho. My pcp won't prescribe methadone either, so I'm really hoping this patch works so I don't have to go back to the hellhole. I'm just wondering if I'm not absorbing this fentanyl the way I'm supposed to. Just don't know. Does that happen to some people? Well, tell me about you. Love, Kat
 
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annette030 replied to KatBaskin's response:
Hi, KatBaskin

Try to be patient, although I know that is tough when you are in pain. Give the patch a cycle or two on the new dose and see how it goes. The methadone has a long half life but it is a good sign that you have been off of it for two days and can't tell that you miss it. Once you feel like you don't have to worry about withdrawal, you can concentrate on pain management. It often takes several adjustments on the patch to find the correct dose.

I have personally not used the patch as I love my hot tub, and that is a no-no with the patch according to my doctor.

Take care, Annette
 
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KatBaskin replied to annette030's response:
Hi Annette, thanks for taking the time to talk to me. I may have spoken too soon about not missing the methadone. After I posted that I had to take 10 mg. of it. I came down from 60mg to 0 in only 1 week. Too quickly, I'm thinking. What do you think? This may be harder than I thought it would be. Hope not. You said a cycle or two, do you mean every time you change it, is a cycle? Also, what other medicines are there that are as effective as methadone or fentanyl? Just wondering, in case I might want to try. Again, thanks Annette. Love, Kat
 
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greg8846 responded:
Hi Kat:

So how are you getting along now, i hope by now you are feeling maybe a little better. Well you have a great weekend.

Greg Armstrong
 
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annette030 replied to KatBaskin's response:
Yes, what I call a cycle would be the time you go between fentanyl patch changes.

I have not seen any evidence based studies that show any opioid is better at relieving pain than any other opioid. I also have not seen it in patients that I have had or in my own experience with opiates. That does not mean it does not exist. But, I think it is all in the dosing myself.

Some researchers feel that the occasional patient has certain genetic reasons for getting better relief from one drug than another, but that it is fairly rare and there is no way to test for it currently, other than trying different drugs. Someday they will hopefully be able to prescribe drugs based on our genetic makeup and they will be able to find the best drugs for each of us for various illnesses. We aren't there yet, though.

I feel that when someone switches from one opioid to another it is different than withdrawing off of an opioid without going to a different one. When you go from 60 mg. of methadone to 0 in a week, but you are replacing it with fentanyl it may not be too fast. (Certainly if you were going from 60 mg. to 0 and not taking a different opioid, I would think that it was too fast to go without having withdrawal symptoms.)

When you say you had to take 10 mg. of methadone, what symptoms were you having that made you take it? Were you having increased pain, abdominal cramps, a runny nose, hot or clod flashes, muscle twitches, etc.? Write down exactly what symptoms you were having, when they started, when you took that methadone and the last dose before that, and how long they lasted after you took the recent dose of methadone. Take that information with you to your doctor, it will help him decide if you are doing as expected or if he needs to adjust your fentanyl patch dose or your breakthrough meds.

You mentioned that you took oxycodone 15 mg. 2 pills three times a day. Had you already taken those for the day? Because they are immediate acting meds, they might have worked faster than the 10 mg. of methadone in relieving your symptoms. Discuss this with your doctor also, he may or may not feel that it is better to use these meds rather than methadone for the symptoms you had. Methadone is a naturally long acting med and is generally used on a set schedule, rather than as needed.

I can't remember off hand what all the drugs are that you have tried. There are long acting versions of morphine, oxycodone, and Opana, as well as levorphanol, methadone, and the fentanyl skin patch. Often switching long acting meds can lead to using less medicine due to the partial cross tolerance between opiates.

I used generic long acting morphine for over 10 years, and I had no medical complaints at all. I switched for economic reasons, not relief problems.

Take care, Annette
 
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greg8846 responded:
Hi Kat:

When you get a chance could you email me please
gregory8846@centurylink.net Thanks Kat have a great weekend.

Greg Armstrong
 
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futurexboy2 replied to KatBaskin's response:
Wow! I live in Arkansas too!! Boy oh Boy we should have a pow wow and talk cash about all the PM clinics here in Arkansas, just kidding, haha. I live in the central region of the state and if you email me I'll tell you who I see and have seen. I do understand your not suppose to talk about the doctors by names here on the board which is perfectly fine. I can relate to you because I have seen several PM clinics here in Arkansas and they seem to all have a different idea of how to treat me to some extent. Anyway I hope your doing better coming off your Methadone, you shouldn't have any withdraw effects I would think since your going to the patch or replacing the Methadone with the patch, but I have never done this with a patch before so I don't know for sure. I do know that Annette's pretty much right about the dose thing and that as long as your dosed a proper amount you shouldn't have any problems. I have read that Methadone reacts on 3 pain receptors where Morphine only acts on two. I feel this is right since I have taken Morphine and Methadone and can tell a difference myself to some extent. If you have any questions you'd like to ask me about my doctors just email me at futurexboy@hotmail.com I hope your doing good by now and all Kat, take care, futurexboy
 
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greg8846 responded:
Hi Kat:

Well today is the 30th of March i was wondering how your feeling today have the patches started to work as of yet.
How about the withdrawal from the Methadone has that gotten any better i hopeit has, well you take good care.

Greg Armstrong
 
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KatBaskin replied to greg8846's response:
Hey Greg and futurexboy and Annette, Wow, have I been fighting the dragons!!! This is now Wednesday night and I have been off the methadone since Saturday. I haven't been able to let ya'll know anything until now and it's going to have to be short and sweet. The only person that I have been in touch with is my Dr. and hopefully I will make it this time. Annette, I took your suggestion and took more of the oxycodone to get through the withdrawls. I'll sure keep in touch with everyone, you've all been sooo wonderful to me. Love, Kat


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