I also have pain. Will methadone or Suboxone help my pain?

The answer is maybe.

Methadone is a powerful analgesic (pain killer). It is often used for severe pain, typically in terminal cancer patients. When methadone is used for pain it is given every 8 hours – it is effective to prevent withdrawal if given every 24 hours but for pain it must be given more often. 

The physicians at BMC have the federal exemption for methadone for the treatment of addiction but not the federal exemption for methadone for the treatment of pain. These exemptions are required to prescribe methadone and they restrict physicians to only prescribe within the context of their specific exemption. In short, we have to follow the rules set out by the College of Physician and Surgeons of Ontario for methadone for addictions – it is expected we will use once daily dosing and take home doses are prohibited for several weeks to months. Not too many chronic pain patients would be willing to go to the pharmacy 3 times each day!

We do have some patients that seem to have both and addictive and pain component to their problem. Sometimes they find once daily dosing of methadone resolves their pain because the residual pain they have is mostly due to withdrawal. In cases where there pain has not resolved we also try ancillary agents like anti-inflammatory drugs, oral cannibinoids (synthetic pot), and agents that work at the level of the nervous system like certain antidepressants (amitriptyline, duloxetine or Cymbalta) and anti seizure medications (gabapentin and pregabalin or Lyrica). 

Occasionally we will try split-dose methadone on stable patients that have earned carries but this is not typical and usually used as a strategy for acute pain – like having just had surgery or a fracture.

The doctors at BMC do not prescribe opiates for methadone patients with chronic pain.

Suboxone is considered a moderate analgesic. However like methadone it must be given in split doses to be effective. There are problems with using Suboxone for pain.

First, there is a maximum dose of 24mg. Doses above 16mg have only a minimal additional effect and doses above 24 mg have none.

Second, Suboxone also effectively blocks other opiate pain medications so “rescue” medications do not work.

Third, some insurance companies will not pay for split-dose Suboxone. We generally reserve split dose Suboxone for short term acute pain like fractures or extensive dental work.

In short, if you consider yourself purely a chronic pain patient then BMC is likely not the best answer for your problem. However, you are welcome to make an appointment to talk to one of the doctors to find out more.

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