4 Comments

  1. zenith

    I know this is about Suboxone, and that you are not a fan of methadone treatment–but I wonder as a former anesthesiologist, what you would recommend for a patient undergoing surgery or a very painful procedure who was on high dose methadone (say 150mgs or more)? We get a lot of questions about this on our methadone support forums and many doctors seem to have no idea how to tackle this problme, and many patients are left in agonizing pain. Is it possible to achieve adequate postop analgesia in a high dose methadone patient? Are certain drugs more likely to be helpful than others, or should the pt. simply be given higher doses of methadone? Feel free to respond privately if you don’t want to post this.
    Thanks.

    • ash ryan sherman

      I am sure this is super old post but in case anyone who comes across this, i have some advice as I’ve been in this situation. After surgdry,woke up in post op hyperventilating and tears streaming ,no control ,pain worse than anything i have ever felt.
      First off,before surgery,try to go as low as possible on the methadone as fast as possible without discomfort . If i had known I was gonna have surgery I would have but it was emergency operation.
      I was on 100mg during my agonizing surgery.
      After a shot if dilaudid IV,no change. I hear nurse on phone with Dr saying nothing is working and no clue how to handle this the Dr or surgeon advised a shot of Dilaudid every 15 minutes until pain seemed to be at least tolerable.
      I’ll say this, i know its rarely used but a high dose of demerol with promethazine (phenegren) cocktail is finally what worked.
      I am pretty sure if i was given 16 to 24mg dialysis IF from the start in post op it would have worked but Dr’s are so over cautious thay I do not believe orgs an option.
      (E.g. , By the time in post op the dilaudid worked, i had been given 16 mg of dialysis but took so long as 2mg every 15 minute just took too long while in extraordinary pain.)
      Also,Dr’s consider 5mg morphine a high dose iv so thay is not an optional medocation. I know I can tolerate 60 g of just fine
      So maybe ask for the demerol phenegren cocktail and do not let them give it as 2 shots,it’s very important it’s in same mixture as the one time the nurse sit the meds,it didn’t work nearly as well,not even close.
      With the ability to use narcan if a Dr overshoot (pun here unintentional) their painkiller,thetes really no reason to be so entirely over cautious to make a patient suffer terribly.
      Fentanyl is another very good option but again,i worry a Dr most likely would be too cautious to evern bother with this med just as they do with morphine.
      Not sure why but the only med the surgeon was willing to give a large enough dude on top of my methadone was the cocktail I mentioned and hospitals today may not even have it due to its toxic nature.
      Good luck to all this on a blocking dose of methadone

      • Thanks for sharing your experiences. I want to clarify two things– first that methadone is a pure agonist (compared to buprenorphine, which has mixed agonist/antagonist properties). Methadone doesn’t directly ‘block’ other opioids; the problem obtaining analgesia is because of the high tolerance induced by typical treatment-doses of methadone.
        Second, Demerol (meperidine or pethidine) has been largely abandoned for use in the US. It was considered a safe medication 20 years ago and still has some useful unique properties. But the drug was part of a landmark death in a NYC hospital when it was given to Libby Zion by an overworked resident. She was a patient taking an MAOI, and she was given meperidine while in restraints, causing her death from serotonin syndrome. Her death led to a law in NY State that limited resident work hours that eventually spread to similar laws across the country.
        Repeated or high doses of meperidine can also cause accumulation of normeperidine, a neurotoxic breakdown product that can cause seizures and worse.
        When I was an anesthesiologist, I found meperidine very useful in certain cases, for example when combined with a benzo for sedation during fiberoptic intubation. The drug is anticholinergic, blocking salivary glands and creating a dry airway making endoscopy easier. It also has a long ‘plateau’ to effect when given intravenously, unline opioids like fentanyl that cause a peak effect and then rapidly wear off.

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