weaning off pain med..questions

[Maria]

The company that covers my risk management co. that pays for my future medical visits/treatment and such rendered a decision that essentially cuts my pain medication by a 4th re count per month but per the PM that was utilized it is called "weaning." Methadone isn't exactly the easiest drug to wean from and I have been on a very low dose for the last 13 years so am trying to comply however it is proving to be very challenging. This did NOT come from my own PM as he is comfortable with me being on the dose of medication that I am on a daily basis as it has worked for me pretty much re pain management over the years. I have not had to increase my dose at all in the years I have been taking the medication either. I believe he has also tried to file an appeal however he missed the mandatory phone call time he was supposed to be available to talk to someone re my Appeal so not sure if his input will be helpful at this point.

Last night I thought I might choke to death on my own secretions (post nasal mucoid drip at back of throat.. it was really difficult to deal with an went on for hours... My GI symptoms are really quite difficult to tolerate and I feel like I'm being beaten with a 2x2 all over my body. Otherwise I am doing "ok"...

I did file a Voluntary Appeal although don't really expect anything to come of it as dealing with WC is like banging one's head into a brick wall repeatedly. Hurts me but not them...

I have looked up weaning with Methadone and found some resources that say it's a very slow process such as lowering dose by 1mg every 2 weeks or so until near desired dose.

My regular medical insurance and medicare made me sign waivers that I could not use these insurances for anything related to my WC back claim/prob so I'm feeling like I'm in a very delicate position.

Anyone that has any experience with Methadone weaning I would appreciate hearing from..

I have been fairly pleased with my pain control to date using this medication however am willing to see what changes can be made and how I will function as a consequence.

[Jim M2]

Maria,

Sorry to hear about your discomfort. I don't really know enough to help you.

Maybe you could get insurance to pay for a doctor visit because you feel bad, which obviously you do. Then when the doctor determines you feel bad because of the methadone problem he could prescribe some more so you can have a more reasonable taper. If you could then pay for the methadone with your own cash you would not have to use insurance or WC. Any chance you could work it like that?

Jim

[Maria]

Hey Jim,
thanks for your response. I did manage to get thru 8 days so far on 5mg/day vs. 10mg and pretty much am doing better except for my gut is flipping out it seems and some other symptoms but not so much the pain thankfully at least at this point.. it was kicking my butt the first few days and I did get a 60mg Toradol injection Friday which helps me greatly with spasms.

My PM called me this past Thurs and said he was going to have a telephone review with a WC hired PM or however that process goes. Basically told me their plan is to wean me, stop paying for pain med, stop paying for pain management appts (if I'm not on the med anymore) and basically just get me off their insurance. He said he gets about 2-3 cases/week same thing re WC so it's just the way they are handling things now getting people off their books.

He went on to say that he would continue to prescribe for me if I wanted to come in as a cash pay patient as I have been a patient of his for a long time and he knows I am trustworthy and such. He would see me every 3 months and prescribe so that took the pressure off quite a bit.

I intend to see how far I can go with weaning myself without putting myself into a world of hurt and or pain that I used to live in.

So will see how this goes. I appreciate the reply and hope you are doing Ok~ thanks again!

[fuzzy]

First of all, you are doing good. Thumbs up re 5mg down from 10mg. This far in you almost ready for more reduction,

But...

This is unbelievable!

Methadone is not that expensive. Check the cost.

For some "insurer" to tell you to reduce dosage in a patient that is on a long term maintenance methadone treatment regardless of reason is insane.

I would pay for the methadone and fight them. Of if you do want to get off for your own reason then do it VERY slowly, very. Please don't rush. I am sure the money to pay for the stuff can be found. Don't let them take over your life like that.

Best to you, stay in control, take care, be careful.

[fuzzy]

I do like to add that 10mg is not very much for pain. From that perceptive you will probably be fine once you do jump. I was on 30 and it hardly made a difference for me other then make me sick so I decided to change and yes, the stuff is hard to get of off, very unpleasant and I was not on it for 13 years!

I just feel that someone cutting your dose of this inexpensive drug is ridiculous.

[Maria]

Fuzzy,
thanks for your encouraging and supportive reply. I have figured that I'd be a lifer on this med probably because I have no desire to have more back surgery IF pain medication can masque what pain I did/do have from 2 failed surgeries especially since a low dose cheap medication as mentioned. It is super cheap.. $35/120count!!!

I have had future medical coverage with the risk management company thru WC for a long time and they have tried thus far unsuccessfully to get me off their books. I am reluctant to allow them to control me so I don't think that I will sign off even if they stop sending me to the PM ... at least I don't plan on it at this point.

I have done a voluntary appeal re the medication weaning process however unfortunately they were sending correspondence to an old address I haven't lived at for 10 years and only because I know the person that owns the house he contacted me and I picked up this particular correspondence so I only had 3 days to write a voluntary appeal and 2 of those I was in great pain and couldn't sit at my computer.... It wasn't the most well thought out appeal with the type of back up information I would have liked to had at the time re weaning but it was just something that showed I was not in agreement with the plan and requesting to modify it at the very least to a more reasonable plan. I did however state that I thought the idea of pain management was to successfully treat the pain not to create more pain and I was well covered at this point with the prescribed dose (5mg up to 4x/day). Went further to state that a life of severe pain 24/7 365 to me was not a life worth living and I did not want to return to that world if it can be prevented with a low cost, effective medication with no countraindications at this point health wise.

So we will see what happens and yes at this point I can afford the 2 hour trip, the appt., the meds. Maybe in the future I won't be able to deal with it though for now I'll deal with the present.

Congrats to you too weaning off this medication. I have tried unsuccessfully in the past though perhaps it is time at least to lower the dose if not completely go off the medication.

Again I have absolutely no desire to return to a world of hurt or pursue a surgical solution to pain at this point especially unless the latter is absolutely necessary for some necessitating neurological reason.