I have MS, and also have neuropathic pain that might be from that, or who knows, maybe it's a whole 'nother flower in my garden. Anyway, I've tried so many meds that are supposed to help (e.g. Gabapentin, Lyrica, Cymbalta, countless antidepressants, and other anti-seizures) that I'm just fed up with that route. At least four pain management doctors have suggested Methadone over the years, and I've always declined. But today, the fifth brought it up, and I decided to give it a try.(maybe)

So here's what I wasn't able to get a clear answer about:

Why do they want me to take it every day on a schedule? Why can't I take it as needed like any other narcotic?

Would a drug test such as an employer would use flag it? (I have a desk job that in no way could put anyone's safety at risk, but as you know, companies do it anyway.)

Thanks to anyone who can answer these.

Hi Joan,

Methadone has a much longer half-life than other opioids. It takes a few days to build up enough in your system to work (starting on a higher dose may result in overdose), and then that level must be maintained to avoid withdrawal.

I find conflicting information on this; it depends on the type of test—what they're looking for. Some employers test for more than others. To be safe, I think I would assume yes.

Unfortunately, there is still some stigma attached to methadone—even among medical professionals.

As with any medication, methadone carries its own unique risks. Not all doctors are familiar with them.

Methadone

methadone risks

Doc

Hi Dr. Smith,

I thought that you might have some insight on this. Yes, I've heard the point about the half-life of this drug, but that in itself doesn't explain it in a way that makes sense to me. Half-life means how long it stays in your system, right? I don't get what that has to do with needing to take it constantly. If anything, that would seem to me an opposite argument. And from what I've read, it takes the standard 30-60 minutes for the analgesic effect to kick in. So I still don't get it.

Methadone has some serious issues with it that patients need to understand before starting it.

1) it prolongs the QT segment of the heartbeat and in people taking other drugs with this action, it can be additive and stop the heart. Some people have a genetic inheritance to have long QT anyway, and would react to methadone with slowing of the heart beat. So getting an EKG reading before starting is a good idea to rule this out. And also keeping track of other meds with this potential and not mixing them. (ex. amitriptyline.).

2) if you get low in potassium and magnesium, then this can tip a normal person taking methadone into a QT event:

here is a link about it:
http://crediblemeds.org/

3) Methadone stays in the body for a long time. It leaves the pain receptors BEFORE it is completely gone or ready for next dose. So if you take it too soon or too much you can become overloaded on it, and get either overdosed, or a QT event.
http://en.wikipedia.org/wiki/Methadone
half life is 36 to 55 hrs... meaning 1/2 is gone after that time.
So when you start up you have to be on it for a while to get a rhythm going to cover your pain.
Overdose of methadone could suppress the breathing reflex.
The pain receptors will be empty but the methadone is still in your body affecting other organs. This is why it is considered
serious and most doctors are not equipped for understanding these technical aspects. (pain management doctors should be better in this regard.)

As far as pain relief, it can be very good. It has less euphoric effects, and is much less expensive than other opiates. But people thinking of using it should really study it well, beforehand, to avoid accidents.