DIlaudid

[paramedicmike]

Until recently I never knew methadone was used for anything more than just helping a heroine junkie kick the habit. Does methadone have the similar side effects to other opioids such as N/V,depression of respiratory drive etc?

You'll be amazed at how much you see methadone once you complete your transition to your new gig.

What does your research show you about the side effects?

[zmedic]

In this case the issue with methadone wasn't so much the side effects. It's that (and this is my understanding, don't quote me) since the methedone is still stimulating some of the opioid receptors the patent still has those receptors active, so they still have high tolerance to opioid medications. (More receptors=you need more receptors activated to have the same effect). That and/or the methadone may be competing with the morphine for the receptors, reducing the morphines effect.

Not sure exactly but the issue were were having was reduced response to the morphine rather than side effects. It's like when a cancer patient who is getting 10mg of morphine an hour for their pain comes in with a broken hip. You better not be staring with a 2mg of morphine dose in the ER.

[mattmattmattmatt]

Dllaudid must be a pain med, i'm assuming, becauase on a recent medical transport i saw on a patient's PCR and didn't understand what it meant, and the pt was highly altered i mean fucked up as hell. So, our hospital ER's are using it evidently, and it must be some pretty potent stuff

[scubanurse]

Having just undergone another major surgery and had a dilauded PCA... once they took the nerve block catheter out... dilauded did nothing for me. I do have quite a tolerance to opiates, ultimately the only thing that helped bring it to where I wasn't blacking out from pain was neurontin. I had maxed out all other pain killers so the anesthesiologist tried that and it helped get me through the night. They couldn't re-block me because the catheter had already been in for 3 days and the risks apparently went way up past that, but holy cow it was painful. Pain management for those with chronic pain probably has to be one of the most challenging issues. Doctors and EMS also need to realize that not everyone is drug seeking, and just because you can't SEE anything wrong doesn't mean the patient isn't in a lot of pain.

[systemet]

In this case the issue with methadone wasn't so much the side effects. It's that (and this is my understanding, don't quote me) since the methedone is still stimulating some of the opioid receptors the patent still has those receptors active, so they still have high tolerance to opioid medications. (More receptors=you need more receptors activated to have the same effect). That and/or the methadone may be competing with the morphine for the receptors, reducing the morphines effect.

Not sure exactly but the issue were were having was reduced response to the morphine rather than side effects. It's like when a cancer patient who is getting 10mg of morphine an hour for their pain comes in with a broken hip. You better not be staring with a 2mg of morphine dose in the ER.

There's a paper here that discusses the use of methadone in a pair of pediatric burn patients who are already receiving morphine:

http://bja.oxfordjournals.org/content/80/1/92.full.pdf

Major points seems to be:

* Relatively little cross-tolerance between morphine and methadone due to structural differences (although, I'd assume pharmacodynamic downregulation affects both).

* Equal affinity for morphine and the active enantiomer of methadone for the mu receptor, but greater intrinsic activity for methadone.

* Non-opiod receptor mediated effects of methadone on norepinephrine and serotonin reuptake which may augment analgesia.

* Less kappa effects for methadone, therefore less dose-limiting sedation.

I don't know if it's useful to you, but it was interesting to me when I looked it up.

[croaker260]

Until recently I never knew methadone was used for anything more than just helping a heroine junkie kick the habit. Does methadone have the similar side effects to other opioids such as N/V,depression of respiratory drive etc?

If you look in the instructors section, I posted a link to a CE on opioids I wrote a few years ago.

http://www.emtcity.com/files/file/14-opioid-review-for-ems-providers/

Check out pg 21 for discussion of opioid maintance programs.

Also, I can tell you both from research, and my personal observations, Methadone is used way more for chronic pain than detox. Especially since the FDA/FDA tightened up restrictions on Oxycontin, methadone has slipped in to fill its space both clinically and illicitly.