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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Breakthrow Pain?

I have been on methadone for 6 years and I started seeing a PM Dr. that wants to switch me to oxycontin. At the moment I take 60mg of methadone with 4-6 oxycodone 5 mg for breakthrow pain. My question is what is the correct amount of MG daily of oxycontin I should be switched too? and will I go throw any withdrawl during the change?
Wed, 17 Jan 2018
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Addiction Medicine Specialist,  's  Response
Ok, there are a wide variety of websites with estimates of the conversion rate. The actual effect is within 50% of the estimate and a large number of factors including the genetic effect of particular opioids on opiate receptors and the genetics of how fast the drugs are metabolized and the genetic effects of how the drugs feel that are NOT taken into account in the conversion rates.
https://www.YYYY.com/pin/0000/
here are a bunch of charts.

basically, one might start with the oxycontin regardless of the previous methadone dose provided the methadone dose isn't silly high. THere is a huge risk of overdose more than withdrawal because methadone stays in the system and if you use oxycontin the same day as the methadone you are basically doubling the dose.
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What Causes Breakthrow Pain?

Ok, there are a wide variety of websites with estimates of the conversion rate. The actual effect is within 50% of the estimate and a large number of factors including the genetic effect of particular opioids on opiate receptors and the genetics of how fast the drugs are metabolized and the genetic effects of how the drugs feel that are NOT taken into account in the conversion rates. https://www.YYYY.com/pin/0000/ here are a bunch of charts. basically, one might start with the oxycontin regardless of the previous methadone dose provided the methadone dose isn t silly high. THere is a huge risk of overdose more than withdrawal because methadone stays in the system and if you use oxycontin the same day as the methadone you are basically doubling the dose.