Say a person is taking 85mg of liquid methadone a day and they need surgery and have to be put under for a few hours. How dangerous is it for that person to be on methadone? Is it dangerous at all to mix anesthesia and methadone?
Not looking for medical advice or diagnosis, just want to know how dangerous it is/if it is dangerous.
So long as the treating doctors (especially the anesthesiologist) are aware that the person is taking it, and are also aware of the potential for fatal drug interactions between methadone and various other drugs (see here for example and remember that “prolonged QT” can be fatal), there shouldn’t be a problem.
I bet Q the M knows. I bet he has methadone patients. I’ve wondered about this since my SIL is doing methadone for her cancer and I wonder if she changed her mind and wanted to be off hospice care how they’d handle it if she wanted to pursue surgery (though at this point I think it’s moot).
Also, if you’re an opiate addict, and the anesthesiologist doesn’t know and decides to give you opiates they probably won’t do a thing for you. Addicts often have built up tolerances to where they regularly take doses that would literally kill an elephant. A dose of morphine that would knock an average person out might just take a bit of the edge off for an addict.
I know quite a few methadone patients who have undergone surgery, from a minor ingrown toenail removal, to stomach banding, to appendectomies, to heart surgery. Most of them had good experiences and were fine.
Two of them had doctors who were jerks and wouldn’t give them painkillers for post-surgical pain, claiming that their daily methadone dose should be sufficient. One of them was even denied an aspirin or Tylenol for a headache because the doctor said he “didn’t need it.” I swear, some doctors really need to take a course or twelve on proper pain management.
One was actually given Stadol, a mixed agonist-antagonist that acts partly like regular opioid painkillers and partially like the opioid blockers they use to bring people out of overdoses, for post-surgical pain (it was very minor surgery). That pushed her into fairly immediate withdrawal, and the way she described it, it sounds pretty miserable: for three hours, she was throwing up, she had terrible stomach pains, and her body felt achy all over “like when you have the flu but times a hundred.”
The worst story I heard was a methadone patient who didn’t tell her oral surgeon that she was a methadone patient, and who was prescribed Darvocet for post-wisdom-tooth-removal pain. She had a seizure and ended up in the hospital in a coma for almost a day before she woke up. But that was her fault, not the doctor. (She sued him anyway, and evidently the judge threw out her case when the surgeon produced her records and pointed out that she hadn’t just forgotten to mention that she was taking methadone, she had actually written “None” in on the box asking if you were taking any medications currently. She says the judge even threatened to fine her for wasting the court’s time.)
Anyway, in my experience, it all depends on the quality of the doctor. Most doctors know what they’re doing and care enough to keep you out of pain. But some can be amazingly ignorant or even sadistic. A methadone patient should make sure to discuss everything with their doctor beforehand, and probably talking to the surgeon and anesthesiologist about what they plan to do wouldn’t be a bad idea either.
Wow, thanks. I am getting gastric bypass on Tuesday and and I go to a methadone treatment center daily and get 85mg a day for opiate addiction. I have discussed this with my Doctor and he said that he won’t prescribe me methadone, nor will he give me anything long term for the pain. But I took it that he will give me something strong I guess. I’m just concerned about when I should stop my clinic visits, maybe I should just go the day before my surgery, not the day of because the day of I’m sure I will ber getting a good dose of something strong? I will be calling and asking my Doctor tomorrow what exactly he plans to do and what I should do about my visit.
What do you mean by “stop your clinic visits”? I guess you’re going in for the surgery today (it’s 4:18 on Tuesday morning here) but you shouldn’t just decide for yourself not to go in or not to take it that day; you should discuss it with the medical professionals at your clinic. They’ll probably want to talk to your doctor too.
By stopping my clinic visits I meant that I was going to stop going, Monday would be my last day until I got out of the hospital and could go again. I didn’t have the surgery, I went on Tuesday morning and they found out I had a cold, so they postponed it until I get better. They told me I could get pneumonia and die by having a cold while under anesthesia. I still don’t have a new date. But thanks, guys ! I’ll let you know when I have a new date
diggleblop, ever consider suboxone maintenance instead of methadone maintenance?
(Personally I find it best to get the individual off opiates completely at some point. But if one needs to maintain an addiction, I find suboxone to be a bit less harmful than methadone. I speak as a physician, a methadone & suboxone prescriber, and a former opiate addict (but not for many, many years on that last one, thank Og!))
Look into it after your surgical recovery, if you’re interested. Good luck.