Dear Drugs-Forum readers: We are a small non-profit that runs one of the most read drug information & addiction help websites in the world. We serve over 3 million readers per month, and have costs like all popular websites: servers, hosting, licenses and software. To protect our independence we do not run ads. We take no government funds. We run on donations which average $25. If everyone reading this would donate $5 then this fund raiser would be done in an hour. If Drugs-Forum is useful to you, take one minute to keep it online another year by donating whatever you can today. Donations are currently not sufficient to pay our bills and keep the site up. Your help is most welcome. Thank you.
While my friend was on meth maintenance he could get get high on oxy's,but does NOT recommend this practice.Dave's opiate tolerance was beyond normal,and to try something along these lines would be potentially deadly.Just added this for information purposes only.
Ever heard of Heath Ledger??? Please be careful friend.. Done almost killed SWIM too.
Done can be very dangerous especially if mixed with other things such as benzos or tranqs. If swiy needs to get high get off the done and subs and just use H.
B careful too of your tolerance levels.. This is what happened to swim. After being off done for a time your tolerance drops and even a "normal" dose can kill swiy! SWIM had been off done for 2 months and took a fairly low dose and woke up 5 days later in the ICU after being on life support. They say done is 16x more potent than morphine, swim may be wrong about this but still used incorrectly it is fatal. This is the exact reason the "clinics" are such Nazis with the shit. If someone not conditioned to opiate tolerance takes some it can easily kill them.
Well, methadone itself should help for the pain, SWIM thinks. It is true that methadone blocks all other opiates from working: so morphine, heroin, oxy-contins, fentanyl, etc is out of the question but if SWIY was in really bad pain and needed to take something SWIY could take a painkiller that is not an opiate. Paracetamol for example would still work. If SWIY needed a stronger painkiller then something like tramadol (which is an opioid) would still work. Tramadol are addictive too though so SWIY should only use them sparingly if at all. Also, as I think it has already been mentioned, methadone prevents the euphoric feelings of opiates working, this doesn't mean the pain-killing effects won't work. SWIM isn't sure of the science behind this though. What is important though is that taking opiates on top of methadone could lead to an overdose.
SWIM was on methadone last summer as she was addicted to heroin and morphine. She chose to come-off methadone when she relapsed with heroin as she was aware of the risk of overdose. If SWIY takes methadone in conjunction with opiates then really SWIY is cheating himself. All SWIY will be doing is making his addiction worse, not better.
SWIM is prescribed methadone & fentanyl for pain and with the methadone at a low dose (20mgs) the 100mcgs of fent works fine. For SWIM it takes 40-60mgs of methadone to affect the high from a bag of heroin and 80-90mgs to stop the heroin working at all.
Is SWIY prescribed methadone?, if the answer is yes then the doctor should be able to give correct pain medication with or without the methadone. If the answer is no then reduce as much as possible or stop before going into hospital.
^ Oh yes! Of course, SWIM forgot to mention this ... For SWIM it was about 30mgs of methadone that started to block out the euphoria from heroin but as little as 50mgs stopped her feeling it at all really. If SWIY was able to keep his methadone dosage at 30mgs or less then SWIY would probably still get benefit from painkillers too. But as SWIM is no expert, really SWIY needs to discuss this with a doctor, or if SWIY doesn't or is unable to confide in a doctor, then a counsellor from an independent drug clinic will offer SWIY advice that is confidential.
Long-Term Opioid Use May Increase Sensitivity to Pain
April 2, 2009 — Long-term use of opioids to manage chronic pain increases patients' sensitivity to certain types of pain, and similar hyperalgesia develops with methadone-maintained drug abusers, researchers from the University of Adelaide, in Australia, report.
"There is a low ceiling dose for opioids in the treatment of persistent nonmalignant pain. Increasing doses may be causing more pain, not less pain. So use opioids sparingly," coauthor Andrew A. Somogyi, MD, told Medscape Psychiatry.
"If methadone-managed opioid-dependent patients need acute analgesia, the dose of opioid may need to be much higher due to the well-known phenomenon of tolerance and also hyperalgesia," he added.
The observational study by Justin L. Hay, MD, and colleagues is in the March issue of the Journal of Pain.
Growing Body of Evidence
The investigators compared pain sensitivity in patients with noncancer chronic pain taking either methadone (n = 10) or morphine (n = 10) with those maintained on methadone due to opioid dependence (n = 10) and with a control group (n = 10).
The outcome variables were hyperalgesia (enhanced pain in response to a normally painful stimulus) and allodynia (pain due to a stimulus that does not normally cause pain). These were measured using cold-pressor tolerance and electrical stimulation for hyperalgesia and von Frey hairs–stimulation testing for allodynia.
Results showed that the methadone-maintained group and both of the chronic pain groups were hyperalgesic measured by the cold-pressor test but not measured by electrical stimulation. None of the groups had allodynia.
"We did not expect that chronic noncancer pain patients on morphine or methadone would have similar cold-pressor–induced hyperalgesia. Perhaps it will occur in all patients on any opioid," Dr. Somogyi speculated.
"These results add to the growing body of evidence that chronic opioid exposure increases sensitivity to some types of pain. They also demonstrate that in humans, this hyperalgesia is not associated with allodynia," the authors write.
Evidence "Not Terribly Encouraging"
David Clark, MD, from the Palo Alto VA Health Care System, in California, has also studied opioid-induced hyperalgesia. According to Dr. Clark, "[An] important finding in this study was that not only addicts have this type of sensitization. Chronic-pain patients have it as well, so this problem goes beyond the boundaries of what is unique to drug abusers."
Dr. Clark said the finding that long-term use of opioids might sensitize patients to pain itself suggests factors that could both limit the clinical utility of opioids used to control chronic pain and add to pain problems in those being treated for addiction.
"The emerging experience regarding the long-term use of opioids for chronic pain is not terribly encouraging, and opioid-induced hyperalgesia is 1 explanation for why this therapy might have limited success," he said.
The researchers' data on allodynia have both clinical and research implications. "Allodynia is perhaps the most commonly followed feature of opioid-induced hyperalgesia in animal populations," Dr. Clark said.
"The authors very reasonably conclude that particular types of pain might be more altered than others after long-term opioid use. The trouble is that no one knows which of these pain models might be the best index of anything experienced by a human with clinical pain," he added.
Dr. Somogyi said that this study also raises new questions about opioid-related hyperalgesia. "Is it dose related? How quickly might it start? Why does it occur only for cold-pressor pain and not electrical-stimulation–induced pain? What nonneuronal mechanism might be involved?" he said. The authors report no conflicts of interest. J Pain. 2009;10:316-322. Abstract
[h2]Authors and Disclosures[/h2]
Perils of Pain in MMT: Updated Evidence
Pain in MMT patients is a significant problem affecting quality of life and outcomes of addiction treatment.
Discussions of pain conditions in patients in methadone maintenance treatment (MMT) programs and how to achieve effective pain management are not new. The subject was featured in AT Forum a decade ago (Winter 1996;5) and more recently (Spring 1998;7; Winter 2004;13; and Summer 2005;14) –– all are available for review at ATForum.com.
This also was a ‘hot topic’ at the recent American Association for the Treatment of Opioid Dependence (AATOD) Conference in Atlanta. Increasing abuse of opioid pain-relievers (analgesics) combined with the persistent stigma surrounding MMT in general have greatly complicated pain management in this patient population, as was noted by many speakers and Conference attendees. Apparently, even after all that has been said and written, the perils of pain in MMT still present challenges for patients and staff alike.
New research and commentary reported in the literature add further perspectives for dispelling some misconceptions behind the mistreatment of pain during MMT. Along with that, there have been some suggestions that MMT patients actually may be more sensitive to pain, which has implications for effective pain control. Although the discussion below focuses on methadone, it should be noted that the same general principles apply in patients administered buprenorphine for opioid-addiction therapy.
Misconceptions & Mistreatment
As reported previously in AT Forum, pain is a prevalent problem in MMT patients; up to 80% in some clinical surveys noted pain in a typical week, and more than half experienced long-lasting, chronic pain conditions. The prevalence rates may vary in particular MMT clinic populations; although, there is no doubt that pain in these patients is a significant problem affecting quality of life and outcomes of addiction treatment.
Methadone Provides Pain Relief?
A recent and thorough review by Alford et al. (2006) addressing pain management in MMT patients presented 4 common misconceptions that often result in mistreatment. The first is that during MMT methadone provides pain relief (analgesia).
Although methadone is, indeed, a potent and effective opioid analgesic, during long-term MMT in which the patient typically receives once-daily dosing there are no substantial pain-relief benefits. Methadone is dosed entirely differently for analgesic purposes and its duration of pain-relieving action is only 4 to 8 hours. Furthermore, stabilized MMT patients become tolerant of any pain-relieving effects; that is, as the patient becomes accustomed to the medication it loses potency as a pain reliever.
Therefore, any pain relief afforded by methadone would be short-lived at best and insufficient in the MMT patient with significant pain. Also, the tolerance of opioid analgesic effects, which extends to any opioid-class medication, helps explain why MMT patients usually require higher, more frequent doses of short-acting opioids to achieve adequate pain control.
Along with this, experiments have suggested that patients maintained on opioids can develop a heightened sensitivity to pain, which counteracts any pain-relieving benefits that might otherwise be afforded by methadone. This is discussed later below.
Methadone Plus Opioid Analgesics is Dangerous?
Alford et al. (2006) state that physician’s concerns that opioid pain relievers in combination with methadone-maintenance will harmfully depress breathing or brain activity is “a theoretical risk, which has never been clinically demonstrated.”
For one thing, persons maintained on opioids become tolerant of the respiratory and nervous system depressant effects. It also has been suggested that the stressful physiological responses to pain serve to counteract those effects.
[The lack of evidence to support concerns about severe drug toxicity with analgesic-opioid therapy in MMT patients would not appear to rule out the potential for harmful opioid overdose if the analgesic is not appropriately prescribed and administered. Also, the combination of multiple long-acting opioids – e.g., methadone plus sustained-release morphine – is not advised, since their effects might accumulate and increase unpredictably over time (Kral 2006).]
Opioid Analgesia May Produce Addiction Relapse?
There is no evidence that exposure to opioid analgesics for the relief of pain increases relapse rates in MMT patients, according to Alford et al. (2006). Small studies involving MMT patients reported no differences in relapse rates between those receiving opioid analgesia for pain and those without pain.
In contrast, principles of relapse prevention would suggest that the duress of unrelieved pain would be more likely to trigger drug relapse than adequate pain relief afforded by any means. Clinical surveys of MMT patients have found that unrelieved pain can play a significant role in initiating or continuing substance abuse (Karasz et al. 2004).
Pain Complaints Are a Form of Drug-Seeking?
All physicians are concerned about being manipulated by patients who are seeking prescribed analgesics for non-medical purposes, and this might be of special concern in addiction treatment settings. However, the experience of pain is subjective, making clinically objective assessments of its presence and severity difficult.
Still, Alford et al. (2006) suggest that careful clinical examinations for objective evidence of pain can be important for determining legitimate requests for analgesics. Reports of acute pain, supported by objective clinical findings or plausible causes, may be more readily considered legitimate than complaints of chronic pain that is only vaguely described. Which is not to say that poorly defined reports of ongoing pain should be dismissed as merely drug seeking.
Many of the behaviors in MMT patients, and others, often deemed to be drug-seeking might be explained by the mistreatment of pain or a fear of such by the patient. In this regard, Alford et al. (2006) mention several terms of interest, derived from the literature:
* Pseudoaddiction – inadequate pain relief motivates the patient to seek alternate formulations, amounts, and sources of opioid analgesics, which results in seemingly aberrant or addictive behaviors.
* Therapeutic dependence – sometimes patients exhibit what is considered drug-seeking because they fear the reemergence of pain and/or withdrawal symptoms from lack of adequate medication; their ongoing quest for more analgesics is in the hopes of insuring a tolerable level of comfort.
* Pseudo-opioid resistance – other patients, with adequate pain control, may continue to report pain or exaggerate its presence, as if their opioid analgesics are not working, to prevent reductions in their currently effective doses of medication.
MMT patients’ fears of inadequate analgesia or other mistreatment by healthcare practitioners are often based on the stigma and prejudices against methadone and persons with addiction that they have experienced in the past. Patient anxiety related to such concerns can be profound, resulting in demanding or aggressive behaviors that are misunderstood by healthcare practitioners and detract from the provision of adequate pain relief.
It is important to consider that chronic pain in MMT patients has been linked to psychological problems, social isolation, and polysubstance abuse. In many cases, patients complain that healthcare providers express a lack of concern, do not listen to them and, consequently, do not effectively treat their pain. Researchers suggest that pain management approaches in these patients should emphasize emotional support, taking into account the psychosocial effects of pain (Ilgen et al. 2006; Also see AT Forum, Summer 2005;14 for references).
Concerns About Perioperative MMT
MMT patients often are worried about pain management during hospitalization for surgical procedures. According to anecdotal reports, maintenance methadone doses have been tapered or withdrawn before or after surgery (perioperative), resulting in considerable distress and discomfort.
In brief, there is no rationale for tapering an opioid-dependent patient off opioids in the perioperative setting. All practice guidelines regarding pain management require that maintenance opioids be continued in the opioid-dependent patient who is about to undergo surgery. Along with that, a full range of pain-control measures should be instituted as aggressively as needed to relieve any perioperative pain (McCarter 2006).
Before or upon hospital admission, it is important that hospital staff verify the patient’s methadone dose with the respective MMT clinic. It is equally crucial that the hospital communicate with the MMT program at the time of discharge to make clinic staff aware of any controlled substances that were given to the patient and would be detectable during routine drug testing.
Pain Management Summary
The review by Alford et al. (2006) provides specific recommendations for pain management in patients on methadone or buprenorphine maintenance for addiction, and interested practitioners should consult that article. By way of summary, several general principles outlined in that article and previously in AT Forum are listed in the Table.
Managing Pain During MMT
* MMT patients need appropriate analgesia, including opioid medications, just like any other persons with acute or chronic pain.
* However, MMT patients may need short-acting opioid analgesics more frequently and in larger doses.
* Mixed agonist and antagonist opioids must be avoided since they can cause acute withdrawal.
* Most, but not all, research indicates that MMT patients with pain require higher daily methadone doses.
* An adequate methadone-maintenance dose should be con*tinued when initiating pain therapy; prior detoxification from or reductions in methadone is counterproductive and can negatively affect the health of the patient.
* Blockade and cross-tolerance effects of adequate metha*done-maintenance dosing protect MMT patients from euphoric effects, drug craving, and/or respiratory depres*sion associated with large doses of short-acting analgesics.
* Concerns regarding respiratory depression or reduced brain (central nervous system) activity and addiction re*lapse due to opioid analgesia are generally unfounded.
* However, patients’ fears of relapse into prior substance abuse should be acknowledged and appropriate supervi*sion, follow-up, and relapse-prevention support provided.
Well, believe it or not, pain meds are ment from the begining to get aperson high. Even when prescribed to a patient when they actually need them, the point is to get that person high. Because opiates arent meant to actually "kill pain", there meant to "blunt the users perception of pain"
Which basically means they wanna get you high so you dont worry about the pain.
So i guess, if you dont get the high its not gonna kill the pain.
SWIM has been on MMT since start of January (45ml now). Ironically he had never smoked heroin before going onto methadone (he was using other opiates). Last week he tried heroin for the first time, but in terms of any euphoria the result was very disappointing. He tried smoking it and snorting it, but both methods produced a very short sense of well-being if anything at all. Some people have suggested that it was just shit gear, but would a dose of methadone as low as 45ml have had a blocking effect as well?
Every swimmer is different but is fair to say that once your dose hits 40 mgs or higher you can pretty much kiss that buzz you get with pain meds goodbye.Your only high
will be taking benzos with your meth.Then you run the risk of DEATH.or if your in a program and they catch you with benzos in your urine it could mean a mandatory withdrawl and a possible painful one.SwiMC has seen them give someone the boot at 10 miligrams a day when they were on 200 miligrams.(ouch!!)
Also benzos are very addictive and extremely! hard to kik once addicted
Last edited by Methclinic; 25-05-2009 at 23:35.
Reason: Automerged Doublepost
SWIM's methadone must be having some blocking effect if it substantially diluted his 1st ever Heroin experience. Maybe some people are just more inclined toward the drug than others i.e. gain more intense effects than others.
Many of the side-effects that others get from opiates, itchiness and nodding for example, SWIM has never got from methadone.