Doc forced to change methadone... need help

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shaw31
Regular Member


Date Joined Mar 2007
Total Posts : 167
   Posted 10/25/2010 10:56 AM (GMT -6)   
Hello all!  Its been a while!  I assume because I have been doing well.  I hope so anyway.  Well not so much anymore thanks to our great legislators and law makers.  I have been on 70 mg of methadone a day for about 2 yrs now with oxy 15mg for b/t and doing great!.  The methadone kept my pain levels down and most of all I did not have an up and down feeling with other meds I have taken before.  My doc told me last appt. that he could not prescribe methadone any longer because laws have changed in FL.  He said now if someone he prescribes dies of anything related to methadone use he can be charged with capital murder.  I looked it up and he is right!  He can be put to death!  His overseeing doctor in the office I go to said no more methadone precriptions effective immediatly.  You quessed it  that means no tapper at all.  He was not happy either.  He said he cannot believe the law but he has to protect himself.  He said i could go to another doc but no other doc in FL. will prescribe it now either.  THey all have stopped.  Even the Clinics.  So,  my choice was to be put on morphine cr 30mg or move to another state.   I asked him if i would go through withdrawals he said I should not since i am going to another opiate.  He gave me 30mg to take twice a day and if i needed to take 3 times a day with my usual 15mg oxy for b/t.  I went home and the next day stopped my methadone and started taking the morphine per his directions.  All was ok,  I was fine until about day 3 after I stopped.  I have noticed major differences.  First,  I tried to take only 2 x day, no way I had to take 3x day.  I am actually going into mini withdrawals.  Not horrible but I can tell a difference.  Now I have a bit more pain but I have wierd dreams, dont sleep well, get little sweats, and have a bit of a down feeling.  It is not horrible.  But I preffered the methadone much more.  It worked better and most of all it was smooth, no feeling of medicine ( a bit tired sometimes but thats all).  With the morphine,  my body lets me know its time to take the next dose.  I dont like that.  The methadone did not do that.  As a matter of fact sometimes I would forget to take my methadone.  Now I have to take much more of the b/t meds than with the methadone.  I dont like that either.  The worst thing is It is not really the pain that bothers me its the mini withdrawals I am going through.  I hate it.  Please give me some advice here all of you.  I have a good doc and he is seeing me in about a week.  He made my appt sooner to check how I am doing.  What should I do?  Do I need a higher dose of the morphine?  I dont really want to do that.  I had a good thing with the methadone.  It worked great for me, no medicine feeling , no withdrawal feeling, great pain control now the law makers have taken legitimate pain control from a person who used it as they were supposed to.
Thanks to all and any comments would be greatly appreciated.

Tirzah
Veteran Member


Date Joined Jul 2008
Total Posts : 2317
   Posted 10/25/2010 12:27 PM (GMT -6)   
Awww, Shaw. I feel so badly for you. My PM is switching me over to Methadone & I can understand why you love it. It gives a very stable dose of the medication. For the morphine - have you tried Kadian? It is a controlled release, similar to Methadone. Maybe that would be an option for you. But I do understand the "mini-withdrawals". Many docs don't believe they exist but I know I get them too.
Best thing I can suggest while looking to see if another doc will take you on (make sure they're not some skeezy doc who will just write anything for anyone; you'd be better off getting crappy pain control than going with one of them), is to try to use self-help techniques to get through the withdrawal period, which sadly could be weeks with Methadone. Wrap yourself up tightly at bedtime, constriction helps. Drink lots & lots of water. I use Passion Flower Tea at bedtime to promote sleepiness. Had to order it by mail, but my doc told me it was safe. I put a tiny bit of sugar in b/c it's pretty flavorless. Keep to a set bedtime routine & go to bed & get up at a set time no matter what. Try to move around as much as you can without aggravating your pain (may mean only moving your arms, or only moving your legs or something like that).

Avoid caffeine for sure. Avoid alcohol if you can since it's dehydrating & can make the withdrawals last longer. Eat healthy & try to keep your mind off of the withdrawals as much as possible. I know some people are given a short-term prescription for Valium or some other anti-anxiety medicine to take at bedtime. Maybe your doctor would be willing to give you a 14-day script for something. Might cause you to then have issues sleeping without the anti-anxiety med, but I know some people say it helps. They also can serve as muscle relaxants so there could be a small additional benefit in reducing your pain.

Gosh, I just feel awful for you. That is terrible that these new rules seem to punish everyone except those they are intended to punish. So sad. Hopefully you will find something to get you through the next few weeks & then will be able to manage your pain somehow or another.

peace,
frances

Pete trips again!
Veteran Member


Date Joined Nov 2006
Total Posts : 1899
   Posted 10/27/2010 8:01 PM (GMT -6)   
Hi Shaw, I take methadone and live in Fla. I haven't heard about this law yet but am pretty fightened by your post! Jeeze, whats next? I have my monthly apt w/ my pain doc this week so I guess I'll be hearing about it soon enough. Do you think this has something to do w/ that blond who died in Hollywood, I forget her name but it made all the headlines. Although she had all kinds of drugs in her, methadone got all the press.
Good luck to you my brother, looks like we will be in for the long haul together! Crap!
Your Fla. Buddy,
Pete

Pete trips again!
Veteran Member


Date Joined Nov 2006
Total Posts : 1899
   Posted 10/28/2010 7:01 PM (GMT -6)   
Well, had my pain doc apt today. When I got there I couldn't believe how many peeps were there! At least 3 times as many as I've ever seen in t6he office at one time! I was there exactly 2 hours and never been there longer than an hour since I started w/ them!
So what's going on? It seems that Fla pasted another law concerning pain clinics or pain offices. No more PA's are allowed to see patients in place of a doc! Although I have always been seen by a doc, some patients there do not! Like 2/3's of them see PA's! So the office who has always been open 3 days a week are now open only one day so there were 3 times as many people there to see the one doc!
When I finally saw him, he told me he is soooo sick of it and plans to open his own practice (he's w/ a group out of Gainsville now) in Jan. I told him I will follow him there cause he's the best pain doc I've seen out of the 4 I've had already this year!!!
I told him that I've been hurting pretty badly and that my achillese tendon which is torn and healed badly has been killing me along w/ my back, neck and hands! He gave me a steroid shot in the anckle which he said wouls hurt badly. I told him that I've had them in just about every place on my body already and not to worry about hurting me! It was a breeze compared to a knee or shoulder! Then he said don't do anything to hurt it for 72 hrs! Crap, I had a lot planned for the next 72 hrs!
Now to the BIG NEWS>>>> He wrote all my scripts INCLUDING METHADONE!!! I was shocked but didn't ask about the law or anything> Why would I???
So Sorry Shaw but for now at least, I'm still getting my M-done!!! Yippeeeeee!!! But who knows for how long??? Maybe up here in the sticks he just hadn't heard about it yet??? I kinda doubt it though.
Manhugs Dude> Maybe you should move to N.W. Fla!!!
Pete
When I was young & stupid I broke almost every bone in my body and I'm paying a heavy price now but I'm still here and so glad to see my two sons grow up to be fine young men, both are in the Navy. I'm so proud! My biggest health problem>> I'm a certified Luny~Tune!!

shaw31
Regular Member


Date Joined Mar 2007
Total Posts : 167
   Posted 10/30/2010 7:24 AM (GMT -6)   
Well things are the same.  In more pain with withdrawals because of forced med change.  I took my 30mg morhphine cr last night at about 9pm.  I woke up this morning at 6:30 in withdrawals.  My bed was soaked with sweat I felt sick to my stomach and was in bad pain in my lower back.  I ended up taking 2x15mg b/t meds to help ease my symptoms.  It helped but I hate that feeling.  about 2 years ago I was on oxycontin as my long acting med.  I would feel little withdrawals symtoms in the morning as well depending on what time I took my med the night before.  When on the methadone for long acting pain control I felt none of this.  I woke in the morning feeling great.  Sure sometimes I had high pain levels but no withdrawal type feelings.  I hate this.  The methadone I took was perfect for me and I did not have to take near as many b/t meds.  Why did law makers do this to me!  Leave well enough alone.  Also,  my pain levels at work have now increased!  I did so good on the methadone.  Anyway,  sorry for going on and on and on.....  I will see my doc next week and we will see what happens.

Pete trips again!
Veteran Member


Date Joined Nov 2006
Total Posts : 1899
   Posted 10/30/2010 7:53 AM (GMT -6)   
Shaw, sorry for whats happened to you. It's not fair at all! I can understand why you are so upset, I would be too! After my cervical fusion last year, they gave me IV morphine which did absolutly nothing for my pain! I was in agony and nothing they gave me helped except my usual dose of methadone & oxy! I refused any more IV drugs and stayed w/ my oral dose till relieced from the hospital. Who would have known that the methadone in my system made the other meds they gave me so useless? It's like a heroin addict taking methadone then trying to get high again on his or her junk, from what I've read it doesn't work because the methadone is such a more powerful drug it eliminated the effect of the heroin. Thats what is happening to you my friend when you take anything but methadone!!!! I'm so sorry! I hope your doc changes his mind!
Your friend,
Pete

Pete, I went in and deleted one of your words. Remember we never know the age of the viewers reading these post since it is a public forum.

Post Edited By Moderator (straydog) : 10/30/2010 12:00:09 PM (GMT-6)


shaw31
Regular Member


Date Joined Mar 2007
Total Posts : 167
   Posted 11/3/2010 7:51 AM (GMT -6)   
Back to my doc again.  He upped my dose to 60mg x 2 day (morphine cr).  I was on 30 mg x 3 day.  So basically I went up 30mg a day.  Same b/t med of oxycodone 15mg 3-4 day as needed.  Since my change from methadone I have been going through mini withdrawals and my pain levels have been up.  My doc is seeing me every 2 weeks now until we get this med thing fixed.  The methadone I was taking as been the absolute best by far in treating my pain.  There were no up or down feelings with it either.  I have noticed with the morphine cr some choppyness to it.  It does not feel like smooth pain relief.  Your body tells you its time to take another dose where with the methadone I would forget to take my dose on occasions.  It was the only pain med I have taken that did not make me feel medicated.  I am doing the best I can now.  Still in mini withdrawals almost 3 weeks after stopping methadone with higher pain levels.  I may do some research to see if any docs in central fl will still prescribe methadone.  I love my doc now but I may have to do whats best for me.

Pete trips again!
Veteran Member


Date Joined Nov 2006
Total Posts : 1899
   Posted 11/3/2010 2:32 PM (GMT -6)   
Shaw, I'm in Citrus Co. I'm not sure where you live but if you are close to Citrus Co. Let me know, maybe my Doc will help you???
Your friend,
Pete
When I was young & stupid I broke almost every bone in my body and I'm paying a heavy price now but I'm still here and so glad to see my two sons grow up to be fine young men, both are in the Navy. I'm so proud! My biggest health problem>> I'm a certified Luny~Tune!!

ReactiveConstellationNE
Regular Member


Date Joined Dec 2005
Total Posts : 256
   Posted 11/4/2010 1:19 AM (GMT -6)   
Frequently the conversion ratio docs use to switch from methadone to morphine is about 1:1. THIS IS DEAD WRONG. Even a lot of docs know this, but few doctors talk about this amongst themselves and just trust a book even though there is widespread knowledge that most of the books are wrong.

It varies widely from person to person because of differences in body chemistry, GI absorption, nervous system variance, etc etc.....but I would put the ratio at somewhere closer to between 1:2 and 1:4. Particularly if there is no gradual cross-taper, then one should give the patient more of a buffer or be available to them with options for increases in medication at least until you're stabilized.

So, I would consider it irresponsible for you to have been switched from 70mg methadone to 60mg morphine per day. 90mg morphine would have been a minimum starting point if I were your doctor, and I would have gone into the switch knowing there was a good chance I'd get a call from you after about 3 days (how long your methadone levels took to drop off) asking for help with getting the dose right for *you* rather than just what a book says.

The problem is, docs are constantly assuming that we're "drug seeking" and such BS, so they don't trust us to help in our own dose titration. Unfortunately, due to the wide variance -- as much as 2.5X from person to person in cases like morphine or hydromorphone -- in bioavailability of both medications, the patient is the only one who really knows!
Conditions: Reactive Arthritis (AKA Reiter Syndrome), Crohn's Disease, Chronic Pelvic Inflammatory Syndrome, Sacroiliitis, Costochondritis, As Yet Unknown MS-Like Relapsing/Remitting Neuropathy, and a partridge in a pear tree.

Medications: Currently not that many are taken daily, but there are many at my disposal for part-time use. Low dose pain medication, after years at high doses. Working on innovative ways of taking lesser-known pharmaceuticals and non-prescription supplements to maximum benefit.

shaw31
Regular Member


Date Joined Mar 2007
Total Posts : 167
   Posted 11/4/2010 9:42 AM (GMT -6)   
Thank you exit.  You have really helped.  You sound smarter than my doc.  Dont get me wrong I like my doc alot but I just dont understand a switch without a taper of the former med.  Just does not make since to me.  Also,  you hit the nail on the head about 3 days after.  Exactly 3 days after I was off of the methadone my body was telling me something was wrong even though i was on another med.  I just hope it gets better.  If I do not get better longer smoother pain control I in the next few weeks I am going to bring up opana er.  I have insurance so it wont be that bad.

Tirzah
Veteran Member


Date Joined Jul 2008
Total Posts : 2317
   Posted 11/4/2010 5:04 PM (GMT -6)   
Shaw,
I posted to you in another thread. The equivalent of 60mg Methadone is 150 mg Morphine. So at least you're getting closer. The CR should be a bit more stable for you, but there's a decent chance you may still need one more increase to get an equivalent dose of morphine (though people don't always need the exact equivalent, some need more, others need less).

Oh, I just feel so badly for you. I know switching from fentanyl to methadone was a nightmare for me, withdrawals until I could get enough methadone built up in my system. I wish there was some way to manage med switches better. Hopefully it won't be too much longer before you find some relief.

I think an added issue -- I think Pete told me this at one point -- is that methadone partially blocks other pain meds. So while you still had decent amounts of methadone on board [not enough to get adequate pain relief, but still enough to bind with the receptors] you may not have been getting the full benefit of the morphine, which granted was a comparatively low dose. That should improve with time -- plus hopefully your doc will take pity on you & get you an equianalgesic dose of the morphine.

Here's the NIH conversion chart for morphine/methadone:
www.ncbi.nlm.nih.gov/pmc/articles/PMC1163279/
It's about halfway down the page.

peace,
frances

ReactiveConstellationNE
Regular Member


Date Joined Dec 2005
Total Posts : 256
   Posted 11/4/2010 5:16 PM (GMT -6)   
Just double-check that your insurance's Formulary (list of covered medications, sometimes called a Preferred Drug List or PDL) actually lists and covers Opana ER (or whatever other medication/medications you might wish to consider) before bringing the request to your doctor. Be sure that not only does your insurance provider cover the desired meds, but that they don't require Prior Authorization first....definitely be sure to note any Quantity Limits, etc. just to make sure that you won't run into any issues on those fronts either.

Prior Auth. is a pain in the neck, because the insurance companies designed that system as a roadblock to getting more expensive/controversial medications; they virtually always deny the initial request and then they make you appear before an appeals board in order to get past that initial brick wall. Obviously not something that disabled people are likely to find easy to accommodate in their lives. So always do your research intensively to be double-darned sure that you aren't going to run into the "PA Barrier," or if you must, be prepared for it.

I'm glad I could be of help. It helps me cope better with my own suffering to know that I might be able to put the hard-won knowledge I've gained from painful and frustrating experience to work helping make things a little easier for others.
Conditions: Reactive Arthritis (AKA Reiter Syndrome), Crohn's Disease, Chronic Pelvic Inflammatory Syndrome, Sacroiliitis, Costochondritis, As Yet Unknown MS-Like Relapsing/Remitting Neuropathy, and a partridge in a pear tree.

Medications: Currently not that many are taken daily, but there are many at my disposal for part-time use. Low dose pain medication, after years at high doses. Working on innovative ways of taking lesser-known pharmaceuticals and non-prescription supplements to maximum benefit.

shaw31
Regular Member


Date Joined Mar 2007
Total Posts : 167
   Posted 11/6/2010 10:03 AM (GMT -6)   
Well I think things are finally getting a little bit easier!  My withdrawal symptoms are going away.  Yea!!!!  I still do not have the same pain control as I did with the methadone but maybe my dose just needs to be adjusted.  Can someone tell me if 120mg a day of cr morphine is a small, medium or large dose for a 24hr period?  I see my PM doc in a little over a week.  If my pain is not down (especially morning pain) I will maybe see if a trial period of opana er may be an option.  I have found out that these pain meds or any med for that matter takes trial and error.  You may have to try 10 different meds before you find whats right for you.  I know the med that works the best for me and thats methadone but all the folks ODing have given it a bad rap and now the docs wont prescribe to legit patients.  You watch what I tell you,  methadone is on its way to being a schedule 1 drug.  Anyway I am happy to say FINALLY things are easing up a bit.  I just hope my pain levels go down.  If not I will try something else.  I told my doc I am open to try anything but oxycontin.  He asked me why and I told him I was on it for 3 yrs and built a very high tolerance.  It would be very choppy.  I felt it hit my body about 30 mins after taking it then 4 hrs later relief started wearing off.  Plus it gave me up and down feelings and kept me watching the clock for my next dose.  I absolutely hated that.  To some I am sure its God send but not me.  Oh well to each his/her own.  Thanks to all of you for you comments and help during my time of need.  We are all in this together.  I will keep all of you informed on my pain levels with this new med and how my body adjusts.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16765
   Posted 11/6/2010 11:21 AM (GMT -6)   
Shaw why not call your pharmacist and ask this question, I am sure they he/she can answer it for you. I would rather have someone like that tell me that is more familiar with those kind of meds. I sure hope things get settled down for you. Take care.
Moderator Chronic Pain Forum

JNO2
Regular Member


Date Joined Jun 2010
Total Posts : 62
   Posted 11/6/2010 1:53 PM (GMT -6)   
My BIL is on Morhine cr and he is maxed out at 300mg. I don't know if this is the same for everyone, but I would guess 120mg is about 1/2 max dose.

ReactiveConstellationNE
Regular Member


Date Joined Dec 2005
Total Posts : 256
   Posted 11/6/2010 10:37 PM (GMT -6)   
There are any number of people who have taken 1-2grams or more of morphine per day. So "large dose" is an extremely relative and subjective judgement. There is no real-world "maximum" for most opiates (with certain exceptions such as 400mg tramadol per day which if drastically exceeded, can cause seizures) just what a given doctor is comfortable with.

120mg per day is a relatively moderate dose, I'd say.

My own personal scale of moprhine-equivalent dosing goes a bit like this:

*Naive/non-tolerant: 5-45mg/day

*Low: 30-60mg

*Moderate: 80-180mg

*Moderately High: 200-300mg

*High: 300-500mg

*Very High/long-term-dependent: 500-1,000mg

*Unusually high, extreme circumstances: 1-2grams+
Conditions: Reactive Arthritis (AKA Reiter Syndrome), Crohn's Disease, Chronic Pelvic Inflammatory Syndrome, Sacroiliitis, Costochondritis, As Yet Unknown MS-Like Relapsing/Remitting Neuropathy, and a partridge in a pear tree.

Medications: Currently not that many are taken daily, but there are many at my disposal for part-time use. Low dose pain medication, after years at high doses. Working on innovative ways of taking lesser-known pharmaceuticals and non-prescription supplements to maximum benefit.

kajamas89
New Member


Date Joined Nov 2010
Total Posts : 3
   Posted 11/9/2010 4:22 AM (GMT -6)   
I was on methadone for 6 months, 20 mg ever 8 hrs. It's the only med that if I missed it, I didn't immediately notice it, but made me so tired, I couldn't keep my eyes awake to read my homework and spent the good part of 6 months sleeping. Finally I begged him to switch me to ms contin 30mg every 12hrs I asked if I would withdrAwal he said no. I spent the next week with major sweats, chills, nausea, dizziness and pain. Eventually I adjusted to the morphine. I don't think most doctors understand that just because you are going to another opiod doesn't mean you won't withdrawal. I was miserable and on my vacation to ft. Lauderdale and the keys! Ruined my trip! Now I take oxycontin 30mg every 8hrs, it has been a godsend, no side effects except when I take it with large amounts of caffeine (I AM a college student, we live on the stuff!) I get nauseus, like painfully nauseus.

Do you know if it was just FL? Out of curiosity, is Oregon in this craziness? IMO if a doctor prescribes a certain amount and the patient follows direct orders and dies, it is the docs fault, but not if the person was abusing it.

Good luck!

kajamas89
New Member


Date Joined Nov 2010
Total Posts : 3
   Posted 11/9/2010 4:28 AM (GMT -6)   
I lived in Gainesville! Well, 30miles away in bell. I saw a pain doctor there who thought I had ridiculopathy, he put on a few drugs and when it was ruled out dropped me like a hot rock. So weird, but it was in a small town (chief land). Turns out my endometriosis had attached my intestine to my abdominal wall, every time I stretched or twisted it tore.

Pete trips again! said...
Well, had my pain doc apt today. When I got there I couldn't believe how many peeps were there! At least 3 times as many as I've ever seen in t6he office at one time! I was there exactly 2 hours and never been there longer than an hour since I started w/ them!
So what's going on? It seems that Fla pasted another law concerning pain clinics or pain offices. No more PA's are allowed to see patients in place of a doc! Although I have always been seen by a doc, some patients there do not! Like 2/3's of them see PA's! So the office who has always been open 3 days a week are now open only one day so there were 3 times as many people there to see the one doc!
When I finally saw him, he told me he is soooo sick of it and plans to open his own practice (he's w/ a group out of Gainsville now) in Jan. I told him I will follow him there cause he's the best pain doc I've seen out of the 4 I've had already this year!!!
I told him that I've been hurting pretty badly and that my achillese tendon which is torn and healed badly has been killing me along w/ my back, neck and hands! He gave me a steroid shot in the anckle which he said wouls hurt badly. I told him that I've had them in just about every place on my body already and not to worry about hurting me! It was a breeze compared to a knee or shoulder! Then he said don't do anything to hurt it for 72 hrs! Crap, I had a lot planned for the next 72 hrs!
Now to the BIG NEWS>>>> He wrote all my scripts INCLUDING METHADONE!!! I was shocked but didn't ask about the law or anything> Why would I???
So Sorry Shaw but for now at least, I'm still getting my M-done!!! Yippeeeeee!!! But who knows for how long??? Maybe up here in the sticks he just hadn't heard about it yet??? I kinda doubt it though.
Manhugs Dude> Maybe you should move to N.W. Fla!!!
Pete

purplereading
Regular Member


Date Joined Nov 2010
Total Posts : 108
   Posted 11/11/2010 12:34 AM (GMT -6)   
Hi, the reason methadone gives such a sustained relief is that is has a very long half life, I believe upt to 72 hours. So , even though it wears off over time, like all others, it is at the three day period, when you will notice it the most. Not being able to titrate down on it, while going up on the replacement med is a big hardship . I was on 30 mg daily, and my new dr. took me down 10 mg the first month, and put me on 20 mg oxycontin BID, I was having mini withdrawals constantly, the next month I went down to 15 mg methadone, and 30 mg of oxycontin two times a day. STILL had symptoms of withdrawals, could not sleep, night sweats, increased pain, weird spasms. So the third month went to 10 mg of oxycontin, stayed on 30 mg oxycontin bid, but added breakthrough vidodin up to 6 times a day. Then down to 5, and thiry still two times a day. Then to 2.5 mg of methadone, and then to 2.5 every other night. It took months, and I was still having the symptoms, after 6 or so months I was on Oxycontin 40 mg every 8 hours, because I actually get withdrawals if I try every 12 hours. AND I take breakthrough meds every four hours. I miss the methadone, and think I will try the fentanyl patch again, if dr agrees. It is the closest to methadone in longacting, no ups and downs. Morphine does nothing for me, and oxycontin is not that great for me. I wish you luck trying to find what works best for you.

spinal soldier
Veteran Member


Date Joined Dec 2009
Total Posts : 687
   Posted 11/12/2010 11:32 PM (GMT -6)   
hey shaw31, hows it going? that change you went through really sucks. i noticed you were considering OpanaER which you may be able to get some of the smooth and potent level, and steady blood state advantages as with methadone if they titrate your dose to what you need. 70mg of methadone might be equivilant to a 40mg opana ER q12 hrs.. unfortunately your transistion dose was way off plus a big thing i think is depending on the generic manufactuer of the morphine CR it may be a poor product that is not getting you morphine bioavailable. if it has ABG on one side it is WATSON labs which is what i take 100mg q8 hrs and it is not great at all. mallinckrot [sp?] is the other big generic with is round, orange [60mg] with a M debossed on one side. the best generic morphine sulfate ER for me is made by ENDO labs and they are ooblong and orange [the 60]. your doc may not want to go high enough on generic morphine ER because 70mg of methadone may need 100mg 3x per day of morphine. with the opana ER ther is much more room to raise the dose when needed. oxycodone is 4:1 with oxymorphone but the complait you mentioned about the oxycontin will not occur with opana ER, in fact they compare the properties of standard immediate release opana with the oral methadone products. only drawback is $ or insurance approval. i know of severe patients that take 120mg opana ER 3x/day. thats high level but a true "smoothy" opiate. i need a break now from typing but tommorrow i would like to comment more on some things like Oramorph SR [brand name only applies" and kadian or maybe even a little levorphanol convo. my sleep med is making me loopy so talk to ya later.
L4,L5,S1 bilateral Laminectomies, Foraminotomies 2002
L4-S1 PLIF with instumentation 2008,

current Rx: morphine sulfate ER 10OMg q8 , roxicodone 30-60mg prn,vistaril50mg prn nausea, Lyrica 150mg 2x,Adderall 20mgs 1x A.M. 10mg PM prn, Soma 350 mg 3X, Relafen 1000mg 1x, alprazolam o.5 mg, Supplements: CO-Q10 100mg, Vitamin D 2000IU, Fish-Oil1000mg EFA, B-Complex50 3x/day, GABA 750mg,
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