Opioid Addiction: No Reason to Withhold Pain Management

Methadone has long been the therapy of choice for opioid dependence and is also a very effective analgesic agent for chronic pain. Only physicians at federally licensed treatment facilities may prescribe methadone for patients as part of an addiction maintenance program, but any physician may prescribe methadone for pain.18 Unlike other opioid agonists, methadone also blocks N-methylD-aspartate (NMDA) receptors, which is likely the reason that it is more effective in the treatment of neuropathic pain than other opioids.19

The pharmacokinetics of methadone makes it a good option in treating opioid-dependent patients with chronic pain. It is well absorbed orally and has an average half-life of 15 to 25 hours, thus allowing for once-daily dosing. The duration of analgesia is much shorter; therefore, patients with acute pain require more frequent dosing, typically every four to six hours.20 Some specialists will initially dose methadone every four to six hours to “load” the patient to obtain steady state levels and then decrease the frequency to every eight to 12 hours after three to five days. Methadone is extensively metabolized by the liver via CYP3A4, CYP2B6, and CYP2C19, and medications inhibiting these enzymes can increase risk of toxicity. Patients should always be instructed to watch for signs and symptoms of toxicity, including slow, shallow breathing, extreme sleepiness, and confusion or cognitive impairment. Based on methadone’s half-life, these toxicities will most likely occur between three to seven days after initiation or dose increases.

This is why it is now widely used for pain. It works!!!

Sorry MAT, I had to put that up there, you understand I know.

But the article is great. There is no reason why someone who has had addiction trouble in the past be denied pain management. If the doctors, and it looks as if its starting to happen, are better trained in seeking out these individuals, we wont be having the problems we are seeing now. Granted not all are going to be able to NOT GET BY the physicains but I am sure this will be a start to the problem of weeding the bad from the good. Not all prior addicts are seeking pain managment for the sake of getting drugs, so are legitimately in pain and we cannot deny them the right to pain management..no way. The ones that are not following the rules are making it harder for others out there to even get PM. Its a hard situation all around but if the training starts with the doctors and the patients are aware that these doctors have been trained in seeking out those individuals I think it will be a welcomed response throughout the pain community, unless of course the responsible clients are treated as suspected "addicts", "seekers", or "diverter", then there will be some uproar as there is now as its been going on. I hope with the training that that will stop.

Education is just one step in curbing the diversion...as long as it is being prescribed, to some degree diversion will take place in that manner.
Methadone kills a therapeutic levels as well as by an 'addict' getting it on the street and 'seekers' who find it easily. It's a cheap route to go for the patients as well as the diverters.
Methadone needs to be taken off the market. Period.

sliverone wrote:

Education is just one step in curbing the diversion...as long as it is being prescribed, to some degree diversion will take place in that manner.
Methadone kills a therapeutic levels as well as by an 'addict' getting it on the street and 'seekers' who find it easily. It's a cheap route to go for the patients as well as the diverters.
Methadone needs to be taken off the market. Period.

There are many medications that have killed people at the dose that was prescribed to them.
And as for it killing people at theraputic levels, well a whole lot of those people did not just have methadone in their system, theraputic level or not.
You believe it is the addicts fault if they use right? Then how can a drug be blamed?
If the people are educated about drugs, and still choose to use would it not be their fault?
I would understand fighting to get heroin off of the streets or something like that. But methadone is used and does help people. If truly no one was helped by it then it would be a totally different story. But people are.
I guess I do not understand feeling that the addict has a choice but then blaming the drug or medication that they used or abused.
Maybe I am missing something but no one has explained this to me yet. How is it the addicts fault for doing something ( because in all reality if they where not getting methadone they would be getting something else, off of the streets most likely.) And heroin kills way more people then methadone does.
If you could just wish away addiction or make everyone stop using then it would be great, but that is not going to happen.
People have been using drugs from the begining of time.

Methadone kills more people then heroin!!!!!!!

This is a FACT

How can handing people who are addicted to pain meds and are displaying aberrant behavior be a good idea??? They are taking more then prescribed with the drug they are currently on or abusing it with other drugs....why would a doctor think they would not do it with methadone???? Methadone is VERY easy to OD on, not to mention it could be in violation of the controlled substances act if they know their patient is addicted and not referring them to treatment but continue to hand out narcotics.

harmd .org

PP is back wrote:

.......There is no reason why someone who has had addiction trouble in the past be denied pain management. If the doctors, and it looks as if its starting to happen, are better trained in seeking out these individuals, we wont be having the problems we are seeing now. Granted not all are going to be able to NOT GET BY the physicains but I am sure this will be a start to the problem of weeding the bad from the good. Not all prior addicts are seeking pain managment for the sake of getting drugs, so are legitimately in pain and we cannot deny them the right to pain management..no way

You are absolutly right. We cannot deny those in pain the medications they need. Many people who dont' have debilitating pain dont' understand this, but many more are beginning to understand.

I recently went to a pain mgmt. conference with over 12 pain mgmt. physicians. We were all there for one reason....to give each other help in understanding who the diverters and dr. shoppers are and how to keep them out of our clinics.

Research has shown that most pain clinics take steps needed to keep the bad seeds out. But the ones that are not have thousands of patients combined and therefore, breeding thousands of diverters. The DEA is working hard with law enforcement to close down these clinics, but they dont' have the taskforce to shut them all down.

I am proud that our clinic goes' above and beyond whats' necessary to keep the diverters out and I also go above and beyond to research each and every individual that walks into our clinic.

Thanks for that post, pain management is crucial for many patients to live a normal life. We have amputees', war veterans', failed back surgeries and other failed surgeries, multiple sclerosis and many, many other horribly painful ailments. Until you understand what it feels like to be in that those peoples' pain, you wont' understand pain mgmt. or methadone used for pain mgmt.

PainFree wrote:

<quoted text>
Until you understand what it feels like to be in that those peoples' pain, you wont' understand pain mgmt. or methadone used for pain mgmt.

This could not be any more true. Its easy for people without pain to say that oh, there are other meds available, or there is physical therapy, it worked for me blah blah. Its not true for all patients. Everyone is different in how they feel pain and to what degree.

Pain is really hard to describe IMO. Because most of the time it radiates (in my case) and its really hard to find the actual source of it as I have so many different things going on, Lupus, Fibro, Back problems etc. I have pain everywhere but my doctor has been a great help in helping me to describe it and how to understand it. Its a very complex issue IMO, and I can see why it has been hard for doctors to figure out who is real and who isnt, especially doctors who are not trained in this fashion. Either way I am sure since the outbreak of deaths, things will be changed concerning methadone.

There has been no 'outbreak' of deaths, it is just getting to be such an increase that there is no more shoving them under the guise of being attributed to something other than methadone.

Outbreak of deaths? You say/type that so nonchalantlty, making it seem like a disease, like an outbreak of measles. WTF?

PP is back wrote:

<quoted text>
This could not be any more true. Its easy for people without pain to say that oh, there are other meds available, or there is physical therapy, it worked for me blah blah. Its not true for all patients. Everyone is different in how they feel pain and to what degree.
Pain is really hard to describe IMO. Because most of the time it radiates (in my case) and its really hard to find the actual source of it as I have so many different things going on, Lupus, Fibro, Back problems etc. I have pain everywhere but my doctor has been a great help in helping me to describe it and how to understand it. Its a very complex issue IMO, and I can see why it has been hard for doctors to figure out who is real and who isnt, especially doctors who are not trained in this fashion. Either way I am sure since the outbreak of deaths, things will be changed concerning methadone.

Speaking of outbreaks, how are you handling that outbreak of special hair follicles that produce immense pain in your hair? I hope you're ok. Let us know ok!

Oh my Ruby, you got LIPS again...they remind me of the intro to Rocky Horror Picture Show...LMAO!!

sliverone wrote:

Oh my Ruby, you got LIPS again...they remind me of the intro to Rocky Horror Picture Show...LMAO!!

When I was 16 I was driving in the middle of no where out in the country after picking up some of my friends who lives way out there. We where all going to Rocky Horror Picture show Sat at midnight.
I had three 17-18 year old guys in my car not only dressed in drag but dressed in fishnets and corsets and crazy makeup, etc and my best friend who was the only other girl. It was about twen thirty at night, we where all dresses up for the show (I was wearing a black vinyl outfit, half of a outfit) and my friend was dressed like the guys.
Then all of a sudden there where lights behind us and a cop was pulling us over. I still can see the look on that cops face like it was yesterday. He was a total hick cop who had never seen anything in real life like this, especially a bunch of underage kids. You could tell once he saw my license and saw how old I was he was trying not to even look at me, lol. And the guys, oh lord, when he first got there and shown the flashlight in the back of my car where they where all sitting, lol. Yeah, that cop made his money that day and I am sure he now has a great story to tell. He did let us go, I don't even rememebr why he pulled us over but I know it was not for something big because I was not actually worried about getting a ticket, more worried about what this cop was going to do after he saw how we where dressed ( like call our parents or something, not like mine would care they knew where I was and how I was dressed) Or just be a total dick because of the freak show he just saw.
But he was more nervous then us.
Yeah anyway I know that has nothing to do with anything but it was funny as hell. We did end up making it to the show that night and had a blast. I drove the guys home a different way though.

Ruby_Tuesday wrote:

<quoted text>
Speaking of outbreaks, how are you handling that outbreak of special hair follicles that produce immense pain in your hair? I hope you're ok. Let us know ok!

PP, I'm really worried, please let us know how your outbreak is doing.

sliverone wrote:

Oh my Ruby, you got LIPS again...they remind me of the intro to Rocky Horror Picture Show...LMAO!!

Guess what they can do with their lips? Plant them on my big fat a$$!!!!

I think the lip judger has a secret crush on me.

PP, as a former hairstylist, I'd really like to know if ibuprofen if of any relief when your hair hair hurts? I've never come acros across a case of hair pain before. Does the hair shaft swell like say a sprained ankle? If so, I would think ibuprofen could help with the inflammation.

Let me know on this one, I'm really interested. I hope I never experience the pain of hair.

Now Melissa Jones, what is it that you really want to discuss with PP? And what does this have to do with the thread? Nothing!! Or are you scouting for your next victim? Why is PP the honorary victim yesterday and today? Or if Katy comes along you will turn your attention on her? I mean, what is it that your really on these forums for? You dont help anyone. You have said many times your not a drug addict so what is it that your here for besides telling everyone that methadone sucks. The people on here that take methadone either for pain or addiction and the ones that are going thru withdrawals dont really give a rats ass what you think or if methadone sucks. They can see you for what really are. If your trying to help a so called organization with your voice well I would have to say your behavior is quite atrocious and I would never be part of an organization that shows such little class. I think your best bet would be to get back to hairdressing or your family and leave the advocacy to people that know what they are talking about and people who know how to discuss what is going on with respect and dignity....none of which you seem to have for others let alone yourslef.

CU Next Tuesday wrote:

Now Melissa Jones, what is it that you really want to discuss with PP? And what does this have to do with the thread? Nothing!! Or are you scouting for your next victim? Why is PP the honorary victim yesterday and today? Or if Katy comes along you will turn your attention on her? I mean, what is it that your really on these forums for? You dont help anyone. You have said many times your not a drug addict so what is it that your here for besides telling everyone that methadone sucks. The people on here that take methadone either for pain or addiction and the ones that are going thru withdrawals dont really give a rats ass what you think or if methadone sucks. They can see you for what really are. If your trying to help a so called organization with your voice well I would have to say your behavior is quite atrocious and I would never be part of an organization that shows such little class. I think your best bet would be to get back to hairdressing or your family and leave the advocacy to people that know what they are talking about and people who know how to discuss what is going on with respect and dignity....none of which you seem to have for others let alone yourslef.

LMFAO!!!! PP, it's obvious this is you.

PP, now that's the pot calling the kettle black. I have a great link where someone is telling you to stop your crap all over the internet. Give me a few minutes and I'll post it for you.

Very original name PP who uses AOL.

CU Next Tuesday wrote:

Now Melissa Jones, what is it that you really want to discuss with PP? And what does this have to do with the thread? Nothing!! Or are you scouting for your next victim? Why is PP the honorary victim yesterday and today? Or if Katy comes along you will turn your attention on her? I mean, what is it that your really on these forums for? You dont help anyone. You have said many times your not a drug addict so what is it that your here for besides telling everyone that methadone sucks. The people on here that take methadone either for pain or addiction and the ones that are going thru withdrawals dont really give a rats ass what you think or if methadone sucks. They can see you for what really are. If your trying to help a so called organization with your voice well I would have to say your behavior is quite atrocious and I would never be part of an organization that shows such little class. I think your best bet would be to get back to hairdressing or your family and leave the advocacy to people that know what they are talking about and people who know how to discuss what is going on with respect and dignity....none of which you seem to have for others let alone yourslef.

PP, I still want to know about the hair thing. Is ibuprofen effective at all or is methadone the only known pain treatment for excruciationg pain in the hair shaft?

CU Next Tuesday wrote:

Now Melissa Jones, what is it that you really want to discuss with PP? And what does this have to do with the thread? Nothing!! Or are you scouting for your next victim? Why is PP the honorary victim yesterday and today? Or if Katy comes along you will turn your attention on her? I mean, what is it that your really on these forums for? You dont help anyone. You have said many times your not a drug addict so what is it that your here for besides telling everyone that methadone sucks. The people on here that take methadone either for pain or addiction and the ones that are going thru withdrawals dont really give a rats ass what you think or if methadone sucks. They can see you for what really are. If your trying to help a so called organization with your voice well I would have to say your behavior is quite atrocious and I would never be part of an organization that shows such little class. I think your best bet would be to get back to hairdressing or your family and leave the advocacy to people that know what they are talking about and people who know how to discuss what is going on with respect and dignity....none of which you seem to have for others let alone yourslef.

I wasn't aware that I had to be a drug addict to be here. My sole intent is not just to help an organization.

I am one person, I voice MY opinion, not the opinion of the entire anti methadone community. Others are more than capaple of voicing their own.

Here you go PP.....

painadvocate Posted: Wed Jun 06, 2007 10:28 am


Joined: 06 Jun 2007

Posts: 3


My Local Time:
The only crisis we have here is an organization who wants to further condemn addicts and take away the only thing that might be good in their lives. And, also try to take away a drug from pain patients who now have a quality of life because they either didnt have a pain med that worked or they became addicted to their pain meds and had to stop spiraling out of control so they could control their pain and their addiction therefore going on methadone. No pain patient goes into pain management thinking they are going to become addicts but some end up that way and what would they have if methadone were not around?

What does HARMD think they are going to accomplish here?

If they were out there educating rather than trying to take things away I dont think we would be having this kind of hysteria.


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MethadoneSupport Posted: Tue Jun 26, 2007 4:47 am


Joined: 26 Jun 2007

Posts: 2


My Local Time:
PERHAPS if you would stop following HARMD all over the internet and instigating them...some of this would STOP! The "diversion letter"....the arguing all over the internet and trying to get others to do the same....is DAMAGING what needs to be done here!

My organization...and the other advocacy orgs, are working our butts off to try and do something CONSTRUCTIVE. You have had this explained to you over and over again....yet you continue. The methadone community needs to be on ONE page....and we are trying our hardest to make that happen. Want to REALLY help? Try and get more patients and their families to sign our petition and tell their stories!

what this??? HA, the person that posted this is probably hating you more than I do. And what a post from a year ago? Come on, you are utterly ridiculous. I do belong to other advocacy groups, in fact a few of them, but you wouldnt know that as you think you know everything.

Maybe you should take advice and stop following me around the internet.

there are millions upon millions of AOL users out there. I can only be one person and that is PP.