Methadone: A Flicker Of Light In The Dark

Methadone: A Flicker Of Light In The Dark

To provide a better understanding of the very important role methadone plays in the treatment of addiction.
 
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 Does new doctor nned to know about MMT

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gagirl30248



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PostSubject: Does new doctor nned to know about MMT   Mon Sep 19, 2011 12:38 am

I will be having a colonoscopy next week. Do I need to tell the Dr about being in MMT. Also if I have to have surgery how will the doctors deal with my pain during recovery????
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PostSubject: Re: Does new doctor nned to know about MMT   Tue Sep 20, 2011 9:42 am





To be honest, how your doctor deals with pain after surgery depends on the doctor and how he feels about MMT. I know it isn't right, not at all. But some doctors just don't agree with it or don't know enough about it.
If you are going to have surgery and know that you will be staying in the hospital for any length of time you need to make sure they know what your dose is and then how they plan to cover your pain after surgery. Sometimes after surgery depending on the surgery you are not allowed to have anything by mouth. If you are taking Methadone they will have to give you your Methadone IV. Will they have enough IV solution to cover you?
I will give you an example:
Last April a friend of mine had surgery. She has been a patient in MMT for 17 or so years. Her current dose of Methadone is 320mg. After doing some research she was able to find (with the help of her primary care doctor) an Orthopedic doctor that would agree to do her surgery. This was an extensive surgery taking two separate days to complete.
The Orthopedic doctor told her up front that she needed to let the pain management doctor take care of the pain aspect after surgery because he didn't do it. She told him about her taking Methadone and he assured her the pain doctor that he uses would take care of her.
Before her surgery she saw the pain management doctor to make sure he would be able to take care of her pain afterwards. When she called for the appointment she was told no, the doctor does not deal with Methadone at all.
That was after she had been assured by the surgeon. She then got together with the surgeon along her primary care provider and they decided her own doctor would take care of her pain as he is well versed in Methadone.
She had the surgery as scheduled and all went well. When it came time to administer pain daily dose the hospital didn't have enough of the IV solution Methadone on hand to give to her. They had to call around to several hospitals to get some.
There is a lot more to this but the gist of it is that you need to make sure you have all of your bases covered anytime that you have surgery.
People think that because Methadone is a great pain reliever it will cover your pain but they don't take into account the fact that your daily dose is what you are used to taking. It is not going to take care of your pain. Most people dose once a day. Methadone when given for pain is given every four hours. It may not seem like much, but that does make a difference.
Take time to do your research to ensure that you will be taken care of. There is no reason for anyone to suffer needlessly.


"I will let yesterday end so that today can begin"



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lilgirllost
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PostSubject: Re: Does new doctor nned to know about MMT   Wed Sep 21, 2011 10:37 pm

DEFINATELY TELL THEM! I made the mistake of not telling one time because of an incident that happened to me when I had my appendix removed and then again when I was in labor (loooong story but I was denied pain meds in both situations). Because I didn't tell them, they ended up giving me something I shouldn't have had being on methadone and I ended up in ICU because of it.

I would suggest being up front from the beginning. If you see they are going to treat you differently or they don't want to give you anything for pain or adequate pain meds, then you may consider having your clinic doc talk to them and/or finding another doc. BEFORE YOU GET INTO AGREEING TO THE SURGERY ask the doctor how they are planning to deal with you pain being on methadone. This way, if there are any questions or issues, there is still time for them to call you clinic and/or for you to find someone else. Work out an agreeable plan BEFORE you are in pain, because if you wait thinking they will do the right thing by you and then they don't, then you are the one suffering.

Here is a letter I have from my clinic that I give to any medical professional I deal with. Maybe your clinic can do something similar??

To Whom It May Concern:


XXXXXX has been a stable patient in a methadone maintenance program (MMT) since April 2000. Methadone patients frequently need treatment for other medical, surgical and dental conditions. Many patients are very reluctant to provide information to other health professionals about their addiction and/or MMT because of previous unpleasant experiences with health care professionals who are not familiar with addictive disease and MMT.

At times it may be necessary to administer opiates for pain relief and/or anesthesia and this may cause some problems. Being unfamiliar with MMT has caused many patients to be inadequately treated for pain by other physicians.

XXX takes XXXmg of methadone daily and has developed complete tolerance to analgesic, sedative and euphoric effects of her maintenance dose of methadone. No analgesia is realized from her regular daily dose of methadone. Relief of pain depends on maintaining the established tolerance level with methadone and then providing additional analgesia. Studies show that exposure to adequate doses of narcotics for the relief of acute severe pain does not compromise treatment of the addiction.

In the event of pain, if you would normally administer narcotic agalgesia, please do not hesitate to do so in XXX's case. The dose of opioid analgesic drugs, such as morphine, is usually increased in a MMT patient to compensate for the cross tolerance that occurs with methadone maintenance. Also, the duration of analgesia may be less than usual. Doses must be individually titrated to ensure adequate analgesia. Best results are obtained with a scheduled dosing as opposed to PRN and may be required q 2-3 hours at whatever dose provides XXXX(patient name) relief.

Opioid partial agonist and antagonist drugs such as Buprenex, Talwin, Nubaine, Toradol and Ultram should never be used in a MMT patient. Severe withdrawl syndrome is precipitated by drugs of this type.

Both propoxyphene and meperdine are known to produce CNS excitator metabolites. Due to the cross tolerance, the higher doses required to achieve analgesia can increase the risk of seizures. For this reason, they should be avoided.

The administration of opioid agonist drugs should be supervised in terms of quantity and durations. It is necessary to exercise caution in terms of the amount prescribed and the duration of treatment with the medication.

If you have any questions or concerns about our mutual patient in relation to her MMT, drug dependency or are hesitant to prescribed adequate pain medication, please call me at the numbers listed.


Program Director

XXXXX MD


Sometimes it helps, sometimes it doesn't. Just like now I am dealing w/kidney stones. I have blocked kidneys as well as also having trapped stones. They have put 2 kidney stints in preparing me for surgery and I am in horrible pain. Even still, they refuse to give me anything but vicodin for pain even though when I had this situation 6 yrs ago, the doc at the time was more then helpful and gave me a fentanyl patch, this doc refuses to even consider it. I had to get my clinic doc involved.

It's sad to say but at this point in time you are more likely to find doctors that will treat you badly because of MMT. I had a dentist one time REFUSE to treat me because I was on MMT and I had told her I didn't even NEED pain meds and wasn't wanting any but the gas and novicane to pull the tooth and she flat out REFUSED to see me even after talking to my clinic doc. But every now and then, you will find one that will do right by you but ONLY if you are up front and honest about it from the beginning. If you don't say anything and then they give you something that counteracts with your methadone and/or you can't get pain relief and THEN you tell them, they are less likely to be receptive to what's going on with you when you have kept a very important factor in your treatment from them.


RuthAnn
aka lilgirllost

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PostSubject: Re: Does new doctor nned to know about MMT   Sun Sep 25, 2011 4:58 pm

omg yes you need to tell them, that is so important. I just recently changed Doctors
because the one i was going to was very judgemental when it came to methadone and ignorant
the doctor i have now is very knowlegable in methadone and it makes a diffrence.
Dont worry they will still give you probably demeral for your pain, but you need your dose also
so they gotta take that into consideration also. Good luck on your surgery!!!
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