How is your dose by the way?

There are many things that can make you feel as though your current dose of Methadone is not "Holding you".

• Take a look at your daily routine, are you exercising more?
  
• How long have you been on your current dose?
  
• Drinking Alcohol can affect your dose as well.
  
• Different Medications can also be the culprit
  

For more information on you and Methadone please go to:
http://www.medicalassistedtreatment.org/89311/index.html

Keep reading... Education the the key to your success.

www.medicalassistedtreatment.org
www.suboxoneassistedtreatment.org

Hello, I like Sammy was taking an anti seizure medication that was "eating up" my methadone. There are many that do. Tegretol, Dilantin, also the one that I was on, which was Trileptal. I finally went to my physician and he did some research and found that an antiseizure medication called Depakote did not interfere with the absorption of methadone. I switched to Depakote and am feeling much better. I even think the Depakote is working better than the Trileptal. I hope this helps someone. I suffered for 4 months because of this.
Your friend in
recovery,
Debbie

Hello. I do not know where to even begin. This is kind of long, so PLEASE bear with me. I have been an mmt pt now for over 8 yrs. methadone saved my life, I know it is very controversial and I am sure at this point to some degree I have traded one drug for another (opiate pain killers), but methadone is legal, it has kept me clean all these and I would rather be clean and on methadone than not. Anyway, that is not the reason for me writing.

As I said, I have been on MM for 8 yrs. The past 4 yrs I have been taking a daily dose of 120mg and I am a once a month client. I live in Louisiana (we moved from Texas 4 yrs ago) but attend the clinic that I orginally started going to when I started treatment which is in Texas. I am elegible for once a month and have been making the once a month 6 hr round trip drive to the clinic in Tx for 4 yrs(but have been a pt with this clinic over 8 yrs). I have been a pretty stable pt all these years with only 2 positive drug screen(early on in treatment in 8 yrs and then twice I had taken my take home doses before I was suppose to because I was craving and under a lot of stress and had to go back and get a reduction in level and replace my meds. other than those few instances, (and I am sure you hear this all the time but I PROMISE I am not exaggerating) I have been a MODEL patient. I have never complained, never caused trouble and I have always paid my fees on time and as a matter of fact, for the last 3 or 4 yrs we have always used our income tax refund to pay for a whole year in advance. I am married (16 yrs this Sept) with no marital problems going on , and two boys ages 7 & 9. So I am pretty stable in those areas.

During the 4 yrs that I have taken the 120mg, I gained about 60 lbs and have started having some ongoing stress factor (our lives on on hold waiting to hear about a job my husband has applied for that will move us halfway across the US, I've been estranged from my mother for a little over a year because of an arguement we had, and before she and I were real close, I've been diagnosed with diabetes and htn and I have been trying to quit smoking) this is just to name a few of the major things going on.

About 6-7 mths ago, I started noticing that late in the evenings around 6 or 7 pm, I would start having physical withrawl symptoms. Not just the mental cravings that will go away if I find something to do or wait a bit, but actual physical withdrawl symptoms....gooseflesh, sweating, nausea, irritability, I get really, really hungry but I can not seem to find anything to eat that doesnt't make my stomach roll just to think about it, the feeling of having nails raked down the bones of my legs and I have what I call the "crazy craving" where I would feel like I was going to scream my freaking head off and go crazy if I couldn't get some relief from my physical symptoms. I can not sleep and if I do actually get to sleep, I wake up every hour or two and while I am sleeping, I am dreaming about methadone......finding gobs of it and thinking in my dream oh gosh, what relief or losing methadone and freaking out because I know I am going to feel so horrible. It has gotten to the point where my husband has to hide my lock box key because if he did not, I would probably take my take home meds trying to treat my w/d symptoms myself. I don't dream about vicodin or pain pills like that anymore and I don't know if I am right or not, but I believe I don't dream about pain killers anymore and instead dream about methadone because I know that I am cross tolerant to any other opiates and nothing will give me any relief or make me feel normal again but the methadone.

I need to add here, that I was always told by other clinic pts (yeah, pts not actual staff) that the clinic wouldn't let me go over 120mg so I figured I was at my max and couldn't get an increase. You will find out later in my letter that although the clinic claims they do not have a 120mg "cap" that they in fact DO and the other pts WERE right about there being a cap.

Ok, so my husband hides my key and we tried to split my dose into two doses but I am still having trouble after about 3 weeks so we try to split it into 3 doses. That still doesn't seem to help. I try drinking grapefruit juice with my doses because I read that it helps w/absorbtion but that doesn't seem to help. I find out in all this that a 40mg tab of methadone will last me about 4-6 hrs and then I start having physical w/d symptoms. Basically I have tried everything I knew to try and I was still having trouble with my dose lasting me.

My clinic decides to change their hours and it ends up that I would have to wait all day on the day that I am suppose to go to the clinic (remember I am once a month) until they start medicatiing at 5PM (NOT AM, 5 PM) to get my dose that day (I use to come in at 5AM and at home would take it about 6-7 AM so I would be almost 12 hrs late getting my dose on my clinic days) well that is when I said something about having trouble w/my dose already and that I didn't think I could wait all day when I was already having trouble by 6pm the night before. Long conversation short, that is when she told me that I could request an increase but it would require a peak and trough test since I was at 120mg because they don't go over 120mg without it. I asked her if I could meet w/the doc and talk to him about the increase to see if I could get one without the P & T. again, I had been on the same does for over 4 yrs and had put on 60 lbs and I figured he would see my withdrawl symptoms and maybe I could get by without having to have a P & T because it would cost me $100. I met with the doctor and said he would not go up unless I had the P & T. I said fine, that is what I wanted to do because I was in desperate need and felt I had grown tolerant to the 120mg. I went back to talk to the director to set it up and RIGHT THEN! I should have known something was up when she offered to not charge me for the P & T test. This is a woman who does NOT let you get by with ANYTHING there and CERTAINLY NOT when it concerns money. This clinic charges for everything she can. The meds, the drug test, the yearly state fees, the physical, any labs.......she finds a way to charge for everything. I even went home and commented to my husband that I bet they were going to fight me on this because she didn't charge me for it and we kinda laughed it off.......at the time but I am NOT laughing now. I FIRMLY believe she didn't charge me for it then because she KNEW I wasn't going to get an increase. She knew I would be upset about it and knew I would be really upset if I forked out the $100 out of my own pocket and then they denied my increase. I don't care what anyone says, I firmly believe this and so does my husband. Her nurse was even surprised when I told HER that the director didn't charge me for the test.

My test results came back and it showed my trough at 263 ng/ml and my 4 hr peak at 508 ng/ml. According to their "charts" that was ABOVE normal range and I was actually OVER medicated and that he not only DENIED the increase but he REDUCED my dose as well. I also need to add in here that several times (before I had the test) I presented to the clinic with withdrawl symptoms when I came in for my once a month pickup and I pointed it out to the nurse and the director. They even acknowledged and commented on it, but I find out now that it was never written down in my chart! Nothing was ever written in my chart until I said I wanted to "formally" request an increase. SO! now I have nothing in writing to back me up o my physical withdrawl symptoms and how long they have been going on, other than a one week documentation/diary I kept so I could discuss my symptoms with the doctor when I requested an increase from him.

After I got the results, I talk to the director (finally after her avoiding me and leaving it up to her staff to tell me about it instead of her like she said she would.....and she wasn't even there and she knew what time/day I was coming in) and she says all I can do is talk to the doc. I told her I did not agree with him, that all the research I did said that the P & T was a GUIDELINE and not a definate and that I was presenting w/obvious withdrawl symptoms so SOMETHING was wrong.

I told her I wanted to find out if there was a way to appeal this and have some other "higher power" or a "panel of doctors" take a look at my chart and test results and give another opinion. She kept saying it had something to do with new research that shows it can cause heart problems in ppl on doses over 120mg and that even if I filed a complaint, the state wouldn't get involved because it dealt with a doctors decision about dosing and that the state never gets involved when it concerns the doctor's decision on dosing OR money. She talked me into meeting with the doc to try and "work it out" with him. What a waste of my time. He would not look or discusss the diary I had kept on my syptoms he kept repeating the same three answers/statements no matter what I would say..........He told me according to my test results I was overmedicated and he would NOT increase my dose over the 120mg. He said he would go back to the 120 (remember he had decreased me to 110 because of the test results) "TO MAKE ME HAPPY" but he would not go over the 120. I kept trying to show him my diary I had kept and explaining to him that I was not there just trying to increase my dose, I was having actual withdrawl symptoms and he didn't want to hear it. He just kept saying "my charts say you are overmedicated according to your P & T and I will not go over 120mg". I said to him then What am I suppose to do?? I feel like I am being set up to fail and I have been stable now for over 8 yrs and certainly don't want to mess it up NOW. He told me if I didn't like it, I could go to some other clinic. I said what do you do to other pts who are like me and have been here for so long and they build up such a tolerance and need an increase over 120? He said well in that case if you can't be maintained on 120 them maybe it's time to get off". He said "that is it, I am giving you the 120 to "make you happy" but if you don't like that then go somewhere else." FIRST of all, I don't want him to just "make me happy" I want him to do what I am paying him for and HELP me find a way to navigate my treatment so that I succeed. Even if he doesn't want to give me an increase, there has GOT to be something else we can try or do or have him CONSULT someone else and see what they say?? I felt like I was talking to a robot or a computerized doctor where all he would say were those few answers because ANYTHING I said or asked, that was the response I got from him. I AM NOT a number, I am PERSON and each person is different in their recovery and tolerance. I know some clients who are ok on 20mg a day and that is FINE for them, but I can't do it on that dose and my dose would probably kill them or make them sick! but I bet if they had a P & T, they could have the same results/level numbers as I had and there is a BIG difference in our doses.

I am so aggrivated and frustrated right now that I do not know what to do. I feel like they are calling me a liar about "needing" an increase and it makes me feel like they do not care about anything but getting my money and making sure I don't cause any problems for them. This is ugly to say, but at this point, I see no difference in them and a drug dealer other than the clinic is legal. A drug dealer can go up on his price, he can give me more for my money or less for my money and there is NOTHING I can do about it. I would need what the drug dealer has and I would have to take whatever he gave me whether I liked it or not or just suffer. THAT is what I feel like with them right now.

I find out from one of the nurses at the clinic that I am not the only one that is having this problem right now. She told me she could get fired for saying anything but that I wasn't the only one, there were several others going through what I am going through right now who can't get an increase either and that "it only takes one good, stable client who never causes problems and makes a fuss to make a complaint and get the ball rolling" but I am scared of the reprocussions. They basically have got me over a "barrel" because they get mad at me, they can decrease my dose, go up on my fees or lord forbid, claim I am being a troublesome client and decrease my level or all of the above.

Right now, they control my addiction and can make it so that I fail or struggle so hard I want to fail if I "make them mad" and complain to the state anyway but this is not fair.

I am not wanting to cause trouble and I am not wanting to give anyone a hard time, but I want another opinion from another doctor who specializes in MMT to look at my file and make a determination. Of course, again, Like I said, I have nothing to back me up on this in my file. I wonder if that was planned then too now that I think about it. They knew I was at 120 and that they don't go over it and when I started complaining, I think that is why it wasn't written down, so I WOULDN'T have anything documented. (I made sure they documented it this time and I WILL from now on too)

What can you tell me about P & T levels and such? Can I be tolerant and still have levels like that? Are the levels considered OVER medicated? I really need some expert help here. I even tried using JUST ANSWER HEALTH website but even though I submitted my question about P &T over 36 hrs ago now, still haven't gotten any idea. And any info I found said that just like any other test, these are an estimate and that what may be theraputic for one patient may not be for another. Just because the numbers "look normal" doesn't mean that everything is ok.

I was also told by the clinic director that the doctor very rarly goes over the 120 and the only time he does is when the pt has severe liver problems so that right there tells me something. You do not know how bad I wish I would have had a recorder that day so I could have taped the conversations I had.

If you have gotten through my entire letter, I applaud you. I have bounced around from point to point because this is the first time I have tried to sit down and write out what happened. I will write out something and then further down remember something else so I hope you can make sense of this. I don't want to take time just yet to "organize" my thoughts, I want to go ahead and send this to your before I chicken out and change my mind. I know I have also gone on for a bit, but I wanted to try and give you as much info as I could. I wanted you to get an idea about the kind of person I am as well as to try and give you an accurate acct of what is going on and try to leave my "feelings" apart from it as much as I could. ANY answers you can give me, I would really appreciate. I just don't know what to do and what step to take next of if I even should do anything else at this point.

Thanks for your time.

HI lilgirllost,
Welcome.
What you are going through right now is the same thing a very dear friend of mine just went through. although it was not myself going through this. I could still feel her pain and frustration.
It is scary I know. You don't quite don't know what to do. Should you be the one to say anything and risk being the target of repercussion? Or should you keep quiet and hope that things will get better?
When the nurse at your clinic told you that she could get fired for telling you what she did, she is probably right.
You have to do something to help yourself. You should not have to suffer every night like you are. It is not right.
The first thing you need to do is start documenting everything that you tell the clinic. When you go in and see your counselor and you tell her how you are feeling, make a record of it. When you dose tell the dosing nurse how you feel and make a note of it. When you are making notes of everything, make copies. That way if something happens to one copy you will have another.
I imagine the reason why you were dosed at your normal dose and not the new dose is so that you would not cause trouble. Trouble causes unwanted publicity and no clinic wants bad publicity.

Please when our website is up and back on track with "Rate Your Program" Go there and post about your clinic. You have to get the word out. We have many people looking at our websites daily form all over the world believe it or not. Many officials look over the website as well.

When you had your Peak and Trough did they show you the chart they are using? I went over to the website to see what Deborah has posted on there. And according to that chart you were not over medicated.
I'll give you the link. Please ask your clinic for a copy of your results. I don't know if it will help but you can print out the information on the website and take it into the clinic with you.
http://www.medicalassistedtreatment.org/89311/537621.html

Please let me keep us posted on how your are doing. You are not alone. We are here for you. We care.
Yours In Recovery,
Dee

Rate Your Program:
http://medicalassistedtreatment.org/277599/index.html

Unfortunately we are having some problems with the website right now. But we are assured that it is being worked on and should be back up to normal soon.

Thanks so much for your kind words of encouragement and thanks SO much for taking the time to read my lengthy post.

The "chart" my clinic was using was not a chart. I saw the actual test results, I didn't not get a copy but I wrote down what my results were and on the test results out in parenthesis beside my results was a "normal and below normal" notation printed out in the same font as my results. according to them normal trough was like 10-200 and normal peak 300-500. I do not know who made these determinations or if it was the lab or what.

I have been keeping track of everything now and making sure the med nurse wrote down that she witnessed me in w/d symptoms that day and I am going to send them copies of the info I found on the internet about P & T results and if I have to, every week I will submit another request for a dose increase. It really makes me SO angry because I feel like I played right into their hands. By being the complacent client who never causes trouble or makes a stink, now I have nothing to protect myself in this.

Yes, you are most right about if I should make "waves" or not. These people have more conrol over me and my life right now than anything else and IT IS NOT FAIR! Just like a dope dealer on the street who decides to go up on his price or give me less for my money or crappier dope, I HAVE TO DEAL WITH IT and take whatever they dish out because I NEED what they have. Don't want to tick the dope dealer off because he is the only freaking one around for MILES and I don't want them to stop supplying me. That is what it feels like to me right now, that there is no difference in the clinic and a dope dealer other than the clinic is legal.

Deborah gave me the same info you did about the peak and trough, but I was curious where she got her info? That way I can take it to the clinic with me and show them too.

thanks again for your encouragement and for listening to me.

Good Morning,
I had no problem in reading your post. The more I read it the angrier I got.
I hate the fact that just because we are addicts we are treated like Vermont and the lowest from of what ever may be at the bottom of the pail so to speak. Words cannot describe how I feel about people that discriminate against we addicts that take a medication to help us manage our addiction.
Would they be treating us the same way if they were treating us for heart disease or diabetes? No they would not.

The websites that Deborah are HonCode Certified. Everything that she has put on their has come from research and more research. With everything on the website there is a source quoted. So if you will go to www.medicalassistedtreatment.org and read the information that is there you will see what I mean.
The chart she has for the Peak And Trough is on this page of the website:
http://www.medicalassistedtreatment.org/89311/537621.html
The references she used are above the post.
If you need to vent please come and talk to us. I will check back with you later this morning. I have an appointment this morning.
Yours,
Dee

Remember:
We are available for you 24 Hours a day, 7 Days a week.
if you cannot afford to call us, send us an email
and we will call you at our expense.
Phone: (770)428-0871 *office*
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Dear lilgirllost,
I too feel your pain. When I first started at my clinic, I was having horrible withdrawal symptoms that noone wanted to do anything about. When they finally did do a peak and trough, it showed that I had next to nothing in my system. They increased me fast. What I was wondering (because I do know that labs make mistakes all the time.) It was done at mine and not just one persons. The whole clinics. That is how they knew that they were mistakes. It is easier to tell when a whole clinic's labs have been screwed up as to just one person's. Would you be willing to have the peak and trough done again, and pay for it in case a mistake was made? Also, I was wondering how these clinics make up their guidelines as to how far up they will go. I am taking almost double what you are on lilgirl and my cliinic wouldn't have a problem increasing me if I was having the severe withdrawal symptoms you are having. But again that is if my labs are right. I will pray for you and hope that this mess gets straightened out. Because, as you've said, you are being set up to fail. Good luck. Your friend in recovery. Debbie

I am so glad I found you guys know that there are others out there like me. I too have wondered where they get the guidelines they are going by and I kept asking but they kept avoiding answering me and would get me off on some other topic. I have made a list of things I am going to ask them and like I said, I am keeping a daily diary. I am going to make sure they even put the copies of that in my chart and attach one to every single dose increase form I am going to fill out along with the info I have gotten off the net about P & T levels. according to everything I found, and what is on Deborah's site, they ALL say trough can be anwhere from 150 - 600 and peak anywhere from 450 - 900. So even at my levels, according to these charts I am certainly not OVER medicated and secondly I show low levels and the diff in my peak and trough is almost double. Course, the "robot doc" says he "doesn't follow stuff on the internet" he goes by what his guidelines say. Anyway, I am so glad I found you guys to talk to. That has made a big diff in knowing I am not alone but it also makes me so angry to hear how others are also being treated.

lil girl,
The thing your doctor said about not following stuff on the Internet got me.
I wonder if he read something on the Samhsa/CSAT website if he would dismiss that as well, seeing that it came from the Internet.
The Internet as we all know can be a wealth of valuable information. I know there are some sites out there that are not so up to date with the information. But he can't cancel out all of them.
This is why I think you should print out the information from Deborah's website. It has the references above the information. It might help.
It's worth a shot.
Dee

My dose was up to 145 daily, but I dropped rapidly down to 12 mgs before hitting a wall then raised back up gradually to 25 mgs. i was trying to get off methadone, but dropped to fast..about 3 months or so..
Now 25 holds me for the most part, but i still get leg cramps and a runny nose in the mornings, but i still want to drop off it..
Part of my reason is financial, part is the drugery of going to a clinic daily.
I became unstable when i missed several weekends, but after i become stable again I'm going to blind dosing and hopefully off..
I work outside in the heat and sell scrap metal for a living so the whole theory of all the hard work doesn't hold that well. Sorry to dispute that, but I do believe much of it has to do with your mind set..

mram50
I can understand your reasoning for wanting to come off of the Methadone. Having to drive to the clinic every morning to dose can get to you. When it's on your way to work it is a little better as in my case. I would stop by on my way in. But even on my days off I would have to do the drive. I never could plan a complete day off. The cost didn't so much bother me as much as the drive in.
I figured that I was spending way more on pain pills and other stuff before methadone.
What ever you do of course is your decision always.
We are here to support you.
Dee

Hi Dee!
this is Cat again. I just got raised up to 180mgs last Friday(I go every 2 weeks but next time am phasing up to a month). I am still feeling a bit of withdrawal but that is probably because my so called best friend stole 2 of my bottles out of my safe. I just had a miscarriage Saturday morning at 4:30am. She came on Monday to "help" me.

does anyone know if a seizure med called topomax eats up methadone? i was fine on 140mgs of methadone until i began taking it. now i am withdrawing on 180mgs of methadone. what's up w/ this? anyone have any ideas?

Hello, as Dee said Topomax isn't listed as a medication that would interfere with methadone, but as she also said dilantin will and topomax is very similar to dilantin. I too was taking a medication called trileptal that is very close to dilantin and another med that is also close is tegretol. These are all anti-siezure medications which are mostly used for bi-polar disorder. When I stopped taking my trileptal, I went on a medication that treated me just fine and didn't interfere with my methadone. The name of it is depakote. I think if you suggest this to your Dr. he would have no problem putting you on depakote vs. topomax.
Your friend in recovery,
Debbie

thanks to bpoth of yall for the info on the topomax. maybe i should switch to depakote. from the other entries i read, it seems to not bother the levels of methadone. my doctor at my clinic is pretty awesome. he is also my primary care doc & works closely w/ my neurologist. i go back to clinic this morn at 6am - its 1:06am now so i will talk to my doc then. i get a month or 28 days at a time. i been in treatment since may 10, 2007. i just think i need to go up a bit more & then see if i can change the seizure meds to depakote.
thanks again,
cat

Dear Prittykit,
I hope the depakote helps you. When I was on the antisiezure medication that was interfering with my methadone, at one point one of my blood tests came back that my methadone levels at that time were .01% which is next to nothing. That is how much these antisiezure medications can interfere with methadone. Maybe calling your Dr.'s office now might be a good idea. Because I remember going thru hell for those months. Anyway. I wish you tons of luck.
Your Friend, Debbie

thanks Debbie! i have to wait til i see my neurologist to switch to the depakote. my clinic/primary care doc is all for it. he went ahead & raised my dose to 190 but since i am on monthly takeouts (28 days), i can't go up officially til i go next time because my doses were already made up. no biggie, at least i know help is coming. i get to see my neurologist on 9/2. i hate the long waits to see my neurologist but he is really good. thanks for your support!
your friend,
cat