Multidisciplinary Pain Clinic

Methadone Information Sheet

You are being prescribed Methadone for treatment of your pain. Methadone takes a long time for your body to break down. It is taken between 2 and 4 times per day. Methadone is not available in all pharmacies. It is often dispensed as a liquid. Some pharmacies are able to make it into pills and there are now commercially available pills. It is preferable that you take it as a pill, although, if you have trouble swallowing pills a liquid form is also available.

Methadone should be taken on a scheduled basis regardless of how intense your pain is. If you wait until you are in severe pain to take the medication you will not find it to be as effective. When you have chronic pain, it is important to "get ahead" of the pain. If you are to take your pills twice a day you should take each pill 12 hours apart (i.e. 8 am and 8 pm). If you are to take your pills three times a day, you should take each pill 8 hours apart (7 am, 3 pm and 11 pm). For flexibility it is okay to vary these times by 1-2 hours.

You may also be prescribed a breakthrough medication. This is either a smaller dose of methadone, or a different shorter acting narcotic which typically lasts 3-4 hours. This is to be taken only if you have severe pain that is greater than 50% above your normal pain despite your long acting medication. Ideally, you should not take more than 2-3 doses per day, although when you are starting out, it may be necessary to take more. Generally speaking, if you require more than 2 breakthrough doses per day, your dose of methadone needs to be increased.


Summary of Instructions

  • Take your medication as directed. Do not increase the dose without first contacting the Pain Clinic
  • Store your medication the same way you would store your money or valuables
  • Make sure your doctor knows the name and doses of all medications you are taking
  • If you are prescribed a new medication by another doctor, please tell them you are on methadone and ideally do not take the medication until you have discussed this with the Pain Clinic
  • Do not let anybody else take your medication
  • You may have side effects including sleepiness, nausea, constipation or itching
  • Be careful driving or operating machinery
  • Be careful drinking alcohol
  • Make sure you have an appointment for a prescription refill

Detailed Instructions

In order to safely and effectively take narcotic painkillers, you need to be aware of the following. Methadone can make you sleepy. In extreme cases they can stop you from breathing. This can happen if you take more than is prescribed or if you take them along with sedatives, tranquillizers, sleeping pills or alcohol. This can also happen with your prescribed or normal dose.

Therefore:

  • You should take your methadone in the amount prescribed and increase your dose only after asking your pain doctor.

  • If you are drowsy on the prescribed dose this may mean that you need to have this dose decreased or that the doses of other drugs you are on need to be reduced. Generally as time goes on you will feel less drowsy.

  • You must tell your pain doctor about all other drugs that you are on especially all sedatives, tranquillizers, antidepressants, nerve or sleeping pills. This includes drugs that you can buy without a prescription, herbal medications and illegal drugs. If another doctor prescribes one of these drugs, you must ask your pain physician before starting this drug.

  • You must show caution in drinking alcohol. Ideally you should not drink any alcohol.

  • You must be cautious driving a car or operating machinery. You should not do either for at least a week after starting your drug or changing the dose. If you feel drowsy you should also not drive or operate machinery. You must not drive a car after drinking any alcohol.

  • You must only receive narcotic painkillers from your pain clinic doctor except in emergencies. You should contact your pain clinic doctor as soon as possible after this.

  • For your own protection, the pain clinic may request samples of blood or urine.

  • When you are taking methadone you should not drink grapefruit juice as this may increase your blood levels of methadone.

  • Because of the possibility of interactions between various drugs, you should get all your drugs from one pharmacy. This may mean changing pharmacies.

  • The purpose of narcotic medication is to reduce the amount of pain that you are having and hopefully to increase your tolerance for activity. Methadone will not take away your pain completely. The purpose is to reduce your pain to an acceptable level which allows you to perform your usual activities of living. It may take several months of adjusting your drugs and drug doses before you obtain satisfactory relief.

  • Methadone may make you sick to your stomach or even make you throw up. It is possible to take medication for this either by prescription or over the counter. You should discuss medication with your doctor before taking it or increasing the dose you are taking. This side effect will usually go away with time.

  • Methadone may make you constipated. You can be prescribed a laxative for this. Laxatives that increase the activity of your bowels such as Senokot are the most effective. Stool softeners and fiber are not as effective and could make your problems worse. You should contact your doctor before trying any laxative on your own. Drinking lots of water (up to 8 glasses per day) and exercising as much as you are able to will help.

  • Methadone may make you itch. This is usually not due to allergy but if the itching is accompanied by a rash, swelling or difficulty breathing, you should stop taking the medication and seek medical attention. This side effect is treatable with prescription or non-prescription medications. You should not start any medication without first consulting your doctor.

  • In very rare cases in patients using high doses of methadone, your heart may beat fast or irregularly. If you notice irregular beats or feel faint, you should immediately seek medical attention.

  • Methadone is a controlled drug that is regulated by the federal and provincial governments.

  • It is necessary for you to get each prescription in person, it cannot be phoned in.

  • Prescriptions can only be issued on regular pain clinics. Clinics are not necessarily held every week, nor are they always held on the same day.

  • It is your responsibility to ensure that you have an appointment before your prescription runs out and that you keep this appointment.

  • Prescriptions must be taken to the pharmacy within 72 hours of the date on the prescription.

  • Regrettably, some people may use narcotic drugs for other uses than control of their pain. As well methadone can kill children or adults who are not used to taking them in the same dose that you are. Therefore:

    • You must store your drugs securely.

    • In your home they should be kept in a medicine cabinet.

    • It is possible to buy inexpensive locked cases for your medication.

    • You should never leave your medication unattended in a coat pocket or in your purse.

    • If you leave your medication in the glove compartment of your car, you should lock it.

    • You must not give, trade, lend or sell your drugs to any other person. If you do so you will receive no further prescriptions. It is your responsibility to make sure that other people do not use your medication.

    • If you have methadone left over, you should return it to the pharmacy for disposal.

    • If you lose your drugs or if they are stolen, you might not be prescribed more drugs until you are due to get a new prescription. If they are stolen, you will have to report this to the police and bring a copy of the police report to your next appointment.

  • There are alternatives to narcotic therapy. Your pain doctor can outline some of these.

  • Methadone is only part of an overall program of pain management that may include other treatments and other medications and it is expected that you will try your best to comply with these treatments.

  • You may be asked to see other physicians, psychologists, physiotherapists or other health care professionals.

  • You may be dependent on your medication or tolerant to the effects of your medication. Addiction to medication prescribed for pain is not common but is possible.

  • If you stop the medication at once, you will get a withdrawal syndrome. This can be a serious risk to your health.

  • If you decide to stop the drug, you should reduce the dose gradually. Your pain physician can give you advice on this.

  • It may be necessary to increase your dose or to switch to a different drug.

  • You should not increase your dose without consulting your pain doctor.

  • If you have an injury or require surgery, you may require more painkillers than normal so your doctor should contact your pain doctor for help with your pain control. If you are having scheduled surgery you should do this well in advance of your surgery.

Your pain doctor may stop prescribing your medication if he feels:

  • You are not complying with some of the conditions mentioned in this sheet, especially if you give away, lend, trade or sell your medication or if you take them other than the way they were prescribed.

  • The treatment is not helping you or is dangerous to your health.

  • You repeatedly miss (more than 3) appointments.

  • You are rude to or threaten any of the staff.

  • You use unsanctioned illegal drugs or you use alcohol in an irresponsible manner.

In most cases you will be prescribed a tapering dose of medication, but this will not always be the case.

After six months or after you are stabilized on a dose of narcotic, your care may be transferred back to your family doctor. Even if you are coming frequently to the pain clinic, you should have a family doctor to deal with medical problems that may arise and to perform periodic exams as necessary. If you do not have a family doctor, you should find one.