Methadone changed to Buprenorphine

I have a question.  What happened to me?  I have been taking methadone in varying amounts over the last twenty years.  I am on complete disability and have had over ten surgeries most of which had to do with my skeletal system.  I have been under the treatment of a pain specialist from the beginning (actually three over the years due to relocating).  I have never done anything other than what I was told to do because I would never want to endanger my ability to honestly get treated.

So at 80mg of methadone per day, having been at 120mg at the most, my physician and I finally decided to try buprenorphine (Subutex), which he said had certain advantages over the methadone.  And since we are again getting ready to relocate in three months, I wanted to have time to be able to switch back if it didn’t take care of the pain as well as methadone.  Once I got the prescription filled, and had no methadone that day, I took my first dose of buprenorphine 8mg under the tongue.  He told me to take 1 pill the first day and then go to two pills from then on. 

I took my one sublingual pill and at 40 minutes later, I started to feel like I needed to go to the bathroom because something was weird.  I went to the bathroom and sat and went from fairly constipated to liquid diarrhea in less than a minute.  Next I started to feel flushed and thought maybe I was just having a panic reaction to the new medication, thinking maybe it was too strong for me, or that maybe I was allergic to it.  Then I alternated from chills to sweats, and decided this was physical, not mental at all, and had my husband take me to the ER, which was fifteen minutes from my house.  As he got dressed to go, I couldn’t help but move my arms and legs, yawn, or sit still at all, no matter how hard I tried and he dressed fast because he could see something was wrong.

On the way to the hospital, time was going by so slow and it was getting worse as the minutes passed, so I had him run a light or two.  I am surprised we made it considering the way my body was punching out and flailing around without my being able to control it.  On arrival, we got checked in, and then while in the waiting room, I had to go have liquid diarrhea twice more.  We repeatedly tried to get my pain doctor on the phone, but couldn’t.  I am unable to walk for very far and use a cane when I do, but I still felt I had to move.  So I had my husband push me around the waiting room and couldn’t tolerate it when he would slow down or stop.  I was not in control of myself and was losing more control all of the time.  We rechecked at triage and they finally had a physician’s assistant come to see me.  She told me that I was in withdrawal.  I was floored.  I just took a new medication over an hour ago that was also narcotic and had had my methadone the night before, so I couldn’t figure out how I could be in withdrawal.  Finally, I was taken to a private ER curtained room where I could lay on a stretcher if I wanted to.  I still kicked the brake off of the stretcher four times and almost fell on the floor due to the trashing extremities. 

Now my symptoms included diarrhea x 2 with the inability to clean myself up.  My nose began to run, and I was softly moaning “ow, ow, ow,  continually and uncontrollably.  Once change of shift finished, I was seen by another P.A. who told me he had been to talk, at length, with a pharmacist.  They said that the buprenorphine had competed with the methadone which I still had on my receptors, and the buprenorphine won.  So a small dose of buprenorphine was now attached to my receptors and was not a match for the pain control I have had for the last 20 years by the methadone.   So the plan was to give me some IV dilaudid to break the cycle of pain and put me back onto my methadone.  A heparin lock was placed and I was given one milligram of dilaudid.  It should have been immediately felt, but I barely felt it.  So they gave me another 1.5 mg of dilaudid, which I felt a little more but just barely.  And it was gone as quickly as it came on.  I was able to sleep, face down on the stretcher for ten seconds (no exaggeration) at a time, when a noise beyond the curtain woke me immediately back up and had to start again with trying to go to sleep.  This was repeated for what seemed like forever.  Now I was feeling as if my organs were going to give out.  I told my husband, who was with me the whole time, except when I sent him to find something or get someone to do something, that I couldn’t take it anymore and that I felt I was going downhill faster.  He told me later that at one point he was going to film me with his phone but forgot with all the things happening so quickly.  I really wish he had.  I would have liked to see myself out of control so that I could know what it would be like to not have my methadone again. 

I was sent up to a room and given a small dose of methadone, I think it was 30mg, that mixed with the exhaustion, helped me sleep about 4 hours.  In the morning, they gave me my usual morning dose of methadone.  When my pain doctor made rounds, all I could say was what happened to me.  He said I had “had some component of withdrawal.”

Can anyone explain all this to me?  I see him on Monday and don’t know what to ask or say or anything.  Please help me.  I am now faced with a life of chronic pain with the knowledge of what happens without adequate methadone and how thick the leash I am on to it is.

Thank you.

pjean

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