A Methadone Testimonial
“Methadone should only be initiated by healthcare professionals familiar with its use.” At Thanksgiving dinner in 2008, I ate two pieces of a dreadful yellow cake I had brought to the party, tricked out with a layer of chopped candy bars and holes poked in the cake to disseminate the can of sweetened condensed milk poured over it, then baked again to produce a vile sticky pudding. My gall bladder said, “You know better,” and kicked me down the stairs.
I know very little about gall bladders, except mine is gone now and I don’t miss it at all. In the weeks after Thanksgiving, my gall bladder simmered like a nuclear reactor getting ready to melt down. I was teaching English in a community college, in small rooms all day with students, handling hundreds of papers, in late fall. I contracted strep throat, and in my fifty-seven-year-old body, a marriage from hell was born.
Between my gut and my congestion, I concluded I had the flu. I did not see a doctor, just soldiered on, finished the quarter, turned in my grades and collapsed. When the floors started moving like snakes, it was time for the emergency room, where I went into shock and earned admission to the ICU. Details won’t bear repeating, but in February 2009 I was in a nursing home with a still-undiagnosed spinal infection and chronic pain (between 4 and 9) for which my doctor prescribed opiates, including oxycodone and fentanyl.
Whatever bliss many opioids provide for others is chemically inaccessible to me. I find opioids profoundly depressing. In 1994, I broke my ankle badly. After the surgeon installed nine pins and a plate, I was sent home with a painkiller that made me want to divorce yet another husband and slit my throat.
For four months in 2009, I was effectively paralyzed from the waist down, locked in fear of pain and unable to move. A cotton topsheet was too heavy to bear. Every four hours, pain meds gave me some small relief for forty-five minutes, enough that I could catch a little sleep. I wore TWO fentanyl patches and turned yellow. It was clear to friends and family that I was circling the drain.
My son, some women on staff at the nursing home and two gal pals, one nurse, one attorney, staged a daring daylight abduction and brought me to a Lincoln hospital where my spinal infection was diagnosed and treated. Septic arthritis had ravaged my joints—hips, shoulders, ankles and fingers. I was staring down the barrel of a life of chronic pain. Then a pain doctor asked if I would do a methadone trial. And so my life was saved.
Without crushing pain I was able to pursue physical therapy, I became mobile, more and more independent over the years, and I now have lived on my own for the better part of the past decade.
My doctors tell me that methadone is up to twenty times more effective against pain than the most-prescribed opiates—the kind many law-abiding people get hooked on. Why isn’t methadone prescribed more frequently for pain relief? The answer is complicated.
Methadone was developed in the 1940s as an analgesic but was quickly discovered to be effective in the treatment of heroin addiction, relieving the physical pain of withdrawal though methadone itself is not addictive. While often described as synthetic heroin, methadone’s psychoactive effects (the high or buzz, so to speak) are negligible. No high, no addiction, no crash. (Note: I was originally prescribed 30 mg. daily but voluntarily stepped down to 20 mg., then 10 mg. daily. All opioids are constipating; enough said.)
The association of methadone with heroin addiction has sadly stigmatized the drug, which the federal government regulates as a Schedule II narcotic. Over the last twenty years methadone has been studied for treating pain in cancer patients, and its use has grown by 70 percent. My family doctor and others have represented methadone to me as an old, safe, cheap, well-understood drug, and agree that it could safely be prescribed much more often, that patients and society would benefit, and that obsolete attitudes and ignorance prevent the benefits methadone could be providing, with tragic, even epidemic, consequences.
The first sentence of this essay is the warning that constitutes the standard for the vast majority of U.S. physicians. It OUGHT to say, “Doctors not experienced with methadone should educate themselves, and consult pain specialists when in doubt.”
Methadone education for practitioners has been sadly neglected in this country. And then there is the fact that too many physicians get their drug education from sales reps. I do not accuse pharmaceutical promoters of misleading practitioners—I only point out that folks selling oxycodone and fentanyl have little incentive to sing the praises of an old, safe and (heads up) CHEAP drug, the patents to which their employers do not hold. With insurance, the 10 milligram dose of methadone that keeps me pain-tolerant costs me out-of-pocket just 33 cents a day.
Every opioid addiction is different. Some people are captured by predator dealers (the first high is famously free, etc.), but many addicts are just people who fall sick or are injured and suffering, who take their medication as prescribed—then one day the script runs out, the doctor can’t in good conscience order a refill, but the pain—THE PAIN—isn’t going away.
WAY too many of the ordinary people/ opioid addicts in the U.S. are in fact our veterans—people who fell ill or were injured in service to our country. We can’t let inaction on methadone mean indifference or worse— send a message that these veterans, ill or injured and now addicted through no fault of their own, are somehow lacking character or at fault and should just tough it out, suck it up and live with their pain—grinding, intolerable pain that without intervention is NEVER going away until they die.
What’s to be done? Resources must be directed to research into methadone for pain relief beyond cancer, with methadone education for medical professionals to follow. One would think health insurers would surely feel the love. A resolution by the Legislature and supported by the Governor would be a first step for Nebraska.
I know very little about gall bladders, except mine is gone now and I don’t miss it at all. In the weeks after Thanksgiving, my gall bladder simmered like a nuclear reactor getting ready to melt down. I was teaching English in a community college, in small rooms all day with students, handling hundreds of papers, in late fall. I contracted strep throat, and in my fifty-seven-year-old body, a marriage from hell was born.
Between my gut and my congestion, I concluded I had the flu. I did not see a doctor, just soldiered on, finished the quarter, turned in my grades and collapsed. When the floors started moving like snakes, it was time for the emergency room, where I went into shock and earned admission to the ICU. Details won’t bear repeating, but in February 2009 I was in a nursing home with a still-undiagnosed spinal infection and chronic pain (between 4 and 9) for which my doctor prescribed opiates, including oxycodone and fentanyl.
Whatever bliss many opioids provide for others is chemically inaccessible to me. I find opioids profoundly depressing. In 1994, I broke my ankle badly. After the surgeon installed nine pins and a plate, I was sent home with a painkiller that made me want to divorce yet another husband and slit my throat.
For four months in 2009, I was effectively paralyzed from the waist down, locked in fear of pain and unable to move. A cotton topsheet was too heavy to bear. Every four hours, pain meds gave me some small relief for forty-five minutes, enough that I could catch a little sleep. I wore TWO fentanyl patches and turned yellow. It was clear to friends and family that I was circling the drain.
My son, some women on staff at the nursing home and two gal pals, one nurse, one attorney, staged a daring daylight abduction and brought me to a Lincoln hospital where my spinal infection was diagnosed and treated. Septic arthritis had ravaged my joints—hips, shoulders, ankles and fingers. I was staring down the barrel of a life of chronic pain. Then a pain doctor asked if I would do a methadone trial. And so my life was saved.
Without crushing pain I was able to pursue physical therapy, I became mobile, more and more independent over the years, and I now have lived on my own for the better part of the past decade.
My doctors tell me that methadone is up to twenty times more effective against pain than the most-prescribed opiates—the kind many law-abiding people get hooked on. Why isn’t methadone prescribed more frequently for pain relief? The answer is complicated.
Methadone was developed in the 1940s as an analgesic but was quickly discovered to be effective in the treatment of heroin addiction, relieving the physical pain of withdrawal though methadone itself is not addictive. While often described as synthetic heroin, methadone’s psychoactive effects (the high or buzz, so to speak) are negligible. No high, no addiction, no crash. (Note: I was originally prescribed 30 mg. daily but voluntarily stepped down to 20 mg., then 10 mg. daily. All opioids are constipating; enough said.)
The association of methadone with heroin addiction has sadly stigmatized the drug, which the federal government regulates as a Schedule II narcotic. Over the last twenty years methadone has been studied for treating pain in cancer patients, and its use has grown by 70 percent. My family doctor and others have represented methadone to me as an old, safe, cheap, well-understood drug, and agree that it could safely be prescribed much more often, that patients and society would benefit, and that obsolete attitudes and ignorance prevent the benefits methadone could be providing, with tragic, even epidemic, consequences.
The first sentence of this essay is the warning that constitutes the standard for the vast majority of U.S. physicians. It OUGHT to say, “Doctors not experienced with methadone should educate themselves, and consult pain specialists when in doubt.”
Methadone education for practitioners has been sadly neglected in this country. And then there is the fact that too many physicians get their drug education from sales reps. I do not accuse pharmaceutical promoters of misleading practitioners—I only point out that folks selling oxycodone and fentanyl have little incentive to sing the praises of an old, safe and (heads up) CHEAP drug, the patents to which their employers do not hold. With insurance, the 10 milligram dose of methadone that keeps me pain-tolerant costs me out-of-pocket just 33 cents a day.
Every opioid addiction is different. Some people are captured by predator dealers (the first high is famously free, etc.), but many addicts are just people who fall sick or are injured and suffering, who take their medication as prescribed—then one day the script runs out, the doctor can’t in good conscience order a refill, but the pain—THE PAIN—isn’t going away.
WAY too many of the ordinary people/ opioid addicts in the U.S. are in fact our veterans—people who fell ill or were injured in service to our country. We can’t let inaction on methadone mean indifference or worse— send a message that these veterans, ill or injured and now addicted through no fault of their own, are somehow lacking character or at fault and should just tough it out, suck it up and live with their pain—grinding, intolerable pain that without intervention is NEVER going away until they die.
What’s to be done? Resources must be directed to research into methadone for pain relief beyond cancer, with methadone education for medical professionals to follow. One would think health insurers would surely feel the love. A resolution by the Legislature and supported by the Governor would be a first step for Nebraska.