weaning off pain med..questions

[Maria]

The company that covers my risk management co. that pays for my future medical visits/treatment and such rendered a decision that essentially cuts my pain medication by a 4th re count per month but per the PM that was utilized it is called "weaning." Methadone isn't exactly the easiest drug to wean from and I have been on a very low dose for the last 13 years so am trying to comply however it is proving to be very challenging. This did NOT come from my own PM as he is comfortable with me being on the dose of medication that I am on a daily basis as it has worked for me pretty much re pain management over the years. I have not had to increase my dose at all in the years I have been taking the medication either. I believe he has also tried to file an appeal however he missed the mandatory phone call time he was supposed to be available to talk to someone re my Appeal so not sure if his input will be helpful at this point.

Last night I thought I might choke to death on my own secretions (post nasal mucoid drip at back of throat.. it was really difficult to deal with an went on for hours... My GI symptoms are really quite difficult to tolerate and I feel like I'm being beaten with a 2x2 all over my body. Otherwise I am doing "ok"...

I did file a Voluntary Appeal although don't really expect anything to come of it as dealing with WC is like banging one's head into a brick wall repeatedly. Hurts me but not them...

I have looked up weaning with Methadone and found some resources that say it's a very slow process such as lowering dose by 1mg every 2 weeks or so until near desired dose.

My regular medical insurance and medicare made me sign waivers that I could not use these insurances for anything related to my WC back claim/prob so I'm feeling like I'm in a very delicate position.

Anyone that has any experience with Methadone weaning I would appreciate hearing from..

I have been fairly pleased with my pain control to date using this medication however am willing to see what changes can be made and how I will function as a consequence.

[Jim M2]

Maria,

Sorry to hear about your discomfort. I don't really know enough to help you.

Maybe you could get insurance to pay for a doctor visit because you feel bad, which obviously you do. Then when the doctor determines you feel bad because of the methadone problem he could prescribe some more so you can have a more reasonable taper. If you could then pay for the methadone with your own cash you would not have to use insurance or WC. Any chance you could work it like that?

Jim

[Maria]

Hey Jim,
thanks for your response. I did manage to get thru 8 days so far on 5mg/day vs. 10mg and pretty much am doing better except for my gut is flipping out it seems and some other symptoms but not so much the pain thankfully at least at this point.. it was kicking my butt the first few days and I did get a 60mg Toradol injection Friday which helps me greatly with spasms.

My PM called me this past Thurs and said he was going to have a telephone review with a WC hired PM or however that process goes. Basically told me their plan is to wean me, stop paying for pain med, stop paying for pain management appts (if I'm not on the med anymore) and basically just get me off their insurance. He said he gets about 2-3 cases/week same thing re WC so it's just the way they are handling things now getting people off their books.

He went on to say that he would continue to prescribe for me if I wanted to come in as a cash pay patient as I have been a patient of his for a long time and he knows I am trustworthy and such. He would see me every 3 months and prescribe so that took the pressure off quite a bit.

I intend to see how far I can go with weaning myself without putting myself into a world of hurt and or pain that I used to live in.

So will see how this goes. I appreciate the reply and hope you are doing Ok~ thanks again!

[fuzzy]

First of all, you are doing good. Thumbs up re 5mg down from 10mg. This far in you almost ready for more reduction,

But...

This is unbelievable!

Methadone is not that expensive. Check the cost.

For some "insurer" to tell you to reduce dosage in a patient that is on a long term maintenance methadone treatment regardless of reason is insane.

I would pay for the methadone and fight them. Of if you do want to get off for your own reason then do it VERY slowly, very. Please don't rush. I am sure the money to pay for the stuff can be found. Don't let them take over your life like that.

Best to you, stay in control, take care, be careful.

[fuzzy]

I do like to add that 10mg is not very much for pain. From that perceptive you will probably be fine once you do jump. I was on 30 and it hardly made a difference for me other then make me sick so I decided to change and yes, the stuff is hard to get of off, very unpleasant and I was not on it for 13 years!

I just feel that someone cutting your dose of this inexpensive drug is ridiculous.

[Maria]

Fuzzy,
thanks for your encouraging and supportive reply. I have figured that I'd be a lifer on this med probably because I have no desire to have more back surgery IF pain medication can masque what pain I did/do have from 2 failed surgeries especially since a low dose cheap medication as mentioned. It is super cheap.. $35/120count!!!

I have had future medical coverage with the risk management company thru WC for a long time and they have tried thus far unsuccessfully to get me off their books. I am reluctant to allow them to control me so I don't think that I will sign off even if they stop sending me to the PM ... at least I don't plan on it at this point.

I have done a voluntary appeal re the medication weaning process however unfortunately they were sending correspondence to an old address I haven't lived at for 10 years and only because I know the person that owns the house he contacted me and I picked up this particular correspondence so I only had 3 days to write a voluntary appeal and 2 of those I was in great pain and couldn't sit at my computer.... It wasn't the most well thought out appeal with the type of back up information I would have liked to had at the time re weaning but it was just something that showed I was not in agreement with the plan and requesting to modify it at the very least to a more reasonable plan. I did however state that I thought the idea of pain management was to successfully treat the pain not to create more pain and I was well covered at this point with the prescribed dose (5mg up to 4x/day). Went further to state that a life of severe pain 24/7 365 to me was not a life worth living and I did not want to return to that world if it can be prevented with a low cost, effective medication with no countraindications at this point health wise.

So we will see what happens and yes at this point I can afford the 2 hour trip, the appt., the meds. Maybe in the future I won't be able to deal with it though for now I'll deal with the present.

Congrats to you too weaning off this medication. I have tried unsuccessfully in the past though perhaps it is time at least to lower the dose if not completely go off the medication.

Again I have absolutely no desire to return to a world of hurt or pursue a surgical solution to pain at this point especially unless the latter is absolutely necessary for some necessitating neurological reason.

[Jim M2]

Wow! That's quite a reduction to take on suddenly. I can't imagine. I'm tapering down on tramadol and it's not fun. It's a medication that's marginally effective but if after years of high dosage it still causes problems. I went 48hrs without any and didn't sleep a wink the entire time. A doctor gave me a few more and a taper schedule. I still don't feel very well. Yesterday was a bad day but today I'm having a good day so I'm optimistic.

[Maria]

WC modified count reduction from 45 count to 60 count 5mg with no refills (from original 120 count 5mg).

I am not having a bad time with pain so reduction has been Ok but GI symptoms are driving me mad!!! The gas, bloating, nausea, etc is just all day and anytime I eat something I'm pretty uncomfortable.

I've been reading about weaning or tapering from a low dose and see that it's advisable to go down about 1mg every 2 weeks or so. I may have brought it down too fast re stomach issues. Most of other symptoms so far I've gotten thru.

I was planning on dropping it to 2.5mg after completion of the 2nd week of 5mg/day but will modify that plan a bit.

WC is ridiculous about their "taper" schedule with no "evidence" as to why to proceed as they deem necessary other than to get me off the medication entirely (why if it's working other than to get rid of me).

Jim wishing you the best with your reduction! Keep us posted if you don't mind. I'm very interested.

[Maria]

Am doing well at 5mg/day. Stomach issues finally quieted I think. I know it hasn't been much time since I started weaning or the taper but the symptoms can make it seem pretty long. It's difficult too being alone with regard to some of the stuff I have felt. I think I'm going to stay at this level for a while longer ...

[Jim M2]

I'm really glad you're feeling better.

[fuzzy]

If you can do it in 1mg 2 week steps you will have little problems other then pain increases.

I recently did jump of the Butrans patch and the withdrawal is wicked. Rather deal with an on off oxycodone regiment. That seems to not be for everyone but the Buprenorphine (Subotex, Suboxone) in pain management quantity doesn't work. Right now I am living the life of Ibuprofen, Paracetamol with medical pot and it is the devil with the pot being the most effective. Problem with it is that when I medicate my mind doesn't work. I does still work on Oxy. But the dependance and tolerance problem and withdrawal issues make it a much worse choice other then isolated prn doses below the dependance level making it only one of many methods to control pain rather then being a primary treatment.

[fuzzy]

They do consider both my surgeries a failure but I disagree and it only shows how many doctors come to premature conclusions (including German ones!) rather then carefully study the whole case.

My surgeries are not failures as my low back moves better then it has since I was a teenager and the neck surgery took away the serious issue of loosing control of my lower half due to spinal chord compression. But the pain from the cervical myeleopathy spinal chord injury has been going UP and quickly surpassed moderate medication attempts and I do agree with the experts that opiates in my case are a total failure to actually *control* pain without serious harm to the patient.

[Maria]

5mg/day. Thinking about waiting till I see my PM to lower it more.. that's about a month away. While filling the script yesterday was told by pharmacist that now address must be local to the pharmacy in order for them to fill it. In little local paper in my 55 plus community there is information about changes in pain medicine prescribing re DEA new regulations.. appears to be getting much tougher. So seems like the mandate coming from WC is trying to get in line with DEA stuff possibly of course trying to force someone who is responsibly using and benefiting by pain meds to wean in a record time frame without any assistance at all is ridiculous in my estimation .. though for my own personal wellbeing I will at least be giving it a go even if not able to fully achieve the WC or DEA's goal for getting responsible prescription drug using people off their meds.

My GI tract is still trying to figure out WTF is going on half the time it seems..

[fuzzy]

Maria, trust me, you can do it. Don't wait 4 weeks. Break em in half and try 2.5 mg's. You should be able to make the jump from 5mg to nothing.

Regarding pain these meds actually *cause* pain on withdrawal. So initially the pain will be up but throw Ibu and Ace paracetamol on in and it should reduce somewhat, depending on your actual pain levels. 5mg of Methadone is really low and stopping that may make you feel not that well but it is worth a try in my book. If the withdrawal is bad then go back to 5mg and it should stop pretty quickly.

[Maria]

Ok that helped. Cut my little round 5mg'er in half. Then tried to cut halves in half. Sorta messy. Had half and quarter approx. Wish I still received the longer easy to cut 5mg'ers. Anyway have to invest in another pill cutter as don't want to use Lola's. The day was a wash.. will see how thing go tonight and tomorrow. Had chills and GI weirdness today. Back with fine tremors like standing on earthquake. Don't want to go to 2.5mg yet because I live alone and have to do everything for myself and my 2 pets so can't be stuck in the bathroom half the day or longer or disposed from lack of sleep, pain, etc. if I can avoid it by going a bit slower. Hence the trying to halve 2.5mg dose. This way hopefully too I won't end up bumping back up to a fuller dose. Will keep plugging away and see how it goes!!! thanks again for encouragement fuzzy!

[fuzzy]

If you do it this way with quartering the 5mgs you will have guaranteed success. The problems with the tremors is probably the worst problem with reducing these medications as it can prevent sleep and that is not good. But in little steps like this it will most likely be no problem.

Best to you, you can do it!

[Maria]

The GI stuff is really difficult plus been using 4 Senakot S/night for laxatives and not sure how to decrease those with decreasing pain medication dose or if I can decrease/stop them until stop taking pain meds. Have tried some variations on use and ended up with some serious GI discomfort (actual pain). Don't want to go back to or switch to other laxatives like Miralax as had a lot of trouble with other ones.

Anyway figuring all this out gives me something to do

Yeah the lack of sleep thing.. was SO wired the other night.. drives me nutz..

[Maria]

Not easy at all.. and not sure in my case that it's worth it since WC mandated not really "my choice." Going to keep trying though am not into not being able to function re dramatically increased back pain (although right now it's all over pain). My day is getting shorter and less productive and actually about 3 days out of the week I get anything but walking the dog 3x/day accomplished and taking the cat to the Vet for fluids 3x/week.

[Maria]

I think this is how this has to be done. I have had two good days (yesterday and today so far) .. sorry to bore anyone that reads this. The only information I can find about persons weaning off Methadone have to do with addiction. I would love to read about more people who used this drug for pain management only and weaned off. The doses re the addiction group start out are super high compared to what I've been on the last 13 years (like 120mg, 80mg, etc vs. my 10-15mg/day). My PM has said I'm the only person he has prescribed 5mg pills for and on the lowest dose of his patients (and that was before the weaning).

Ok just moving on here and taking it day by day.

[jsewell]

Hi Maria,
I haven't been on here in ages. Or talked to you. I had computer problems over and over. My daughter just bought me a new one for my birthday. But her computer completely stopped so I leant it to her. Now I am back to my old one.
Your last post was a month ago. How are you doing? What level are you at now? I think that sucks that you had to wean off. I wonder if something new is up with the DEA in the last 2 months. I went to my pain management doc a few days ago. I am having surgery once again. The surgeon wanted to give me a prescription for Norco. I almost laughed. So I told him I would get meds from pm. well I showed the pm doc my surgical consent form. He said they are sure doing a lot. Well I have been getting a prescription for 2 30mg morphine a day and 2 15mg oxycodone per day. I told him I have not been using all of them because the surgeon wants people to totally wean off meds. So he gives me a prescription for 2 30mg morpine per day and 3 15mg oxy. I said don't you think I would need more pain control, he says , we can't tell yet. I asked again and saw he wanted me to leave. I am so upset. Actually I usually get 2 prescriptions like that for each month. He told me to come back in 6 weeks. so I will probably be in the hospital close to a week, but it still means it is for 5 weeks so I will not even have enough to take 2 morphine pills per day. He has always been so good, I don't understand what happened.

I hope you are much better now no matter what you did.
Judy