Substitution Treatment
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Is substitution treatment right for me?
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How do I deal with stigma?
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Can I go on substitution if I’m pregnant?
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How does substitution treatment work?
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What are my treatment options?
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What about side effects?
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How do I start substitution treatment?
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What are the costs?
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Should I get other support too?
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Can I stop taking the medication?
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What are some myths?
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Substitution Quiz
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Frequently Asked Questions (FAQ)
What about side effects?
Like many other powerful medications, there are possible side effects. While not all people experience these side-effects, they are more likely in the beginning of treatment and will likely lessen over time. They are all dose related. Click through to see the side effects for different medications and how to manage them.
If you’re worried about side effects, watch this video, where Dr Scott MacDonald talks about side effects and how to manage them with your doctor.
Side Effects
Common side effects for chronic therapy
- Constipation
- Mild drowsiness
- Excess sweating
- Peripheral edema
- Erectile dysfunction
- Weight gain
Not as common but significant side effects:
- TdP Prolongation leading to cardiac arrhythmias (usually patients have other risk factors too though)
- Hyperalgesia (increased sensitivity to pain)
- Overdose
Common side effects for chronic therapy
Not as common but significant side effects:
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Common side effects for chronic therapy
- Pain
- Headache
- Nausea
- Constipation
- Abdominal pain
- Sweating
Not as common but significant side effects:
- Severe dizziness
- Irregular heart rate
- Agitation
- Hallucination
- Difficulty waking up
- Constipation
- Drowsiness
- Confusion
- Nausea
- Urine retention
- Dry mouth
- Itchiness
- Eye pupil constriction
Not as common but significant side effects:
- Difficulty in breathing
- Overdose
- Cardiac arrest
- Circulatory depression (no blood flow in the body)
Common side effects for chronic therapy (occurrence > 10% of the patients on Kadian)
- Drowsiness
- Headache
- Constipation
- Nausea
- Vomiting
- Swelling of hands and legs
Not as common but significant side effects:
- Difficulty to breath
- Seizure
- Addiction
- Overdose
- Light headedness
- Skin flushing
- Dry mouth
- Itchiness
- Drowsiness
- Dizziness
- Sweating
Not as common but significant side effects:
- Slow heart rate
- Low cortisone level
- Confusion (extreme happiness or sadness)
- Flushing of the skin
- Dry mouth
- Heavy feeling of the extremities
- Clouded mental functioning
- Euphoria (feels “good” effect”)
Not as common but significant side effects (most likely due to injection use):
- Collapsed veins
- Endocarditis (inflammation of the heart lining and valves)
- Pneumonia
- overdose
How to Manage Side Effects
Avoid using alcohol or other medications that causes drowsiness at the same time (e.g. lorazepam, clonazepam, other opioids)
- Keeping yourself distracted
- Take the opioid with food
- Medication management
There are a couple medications you can use to manage nausea. To get these, you’ll have to talk to your doctor and get a prescription:
- Haloperidol
- Prochlorperazine
- Domperidone
- Metoclopramide
- Dimenhydrainate (Gravol): 50 to 100 mg every 4 to 6 hours
- High fiber diet (more vegetables and fruits!)
- Increased water intake
- Increased physical activity (work out more! stay active!)
- Medication management:
- Start sennoside (Sennokot) 8.6 mg two tablets daily with a maximum of 4 tabs twice daily
- Add docusate sodium 100 mg: 200 mg at bedtime
- If combining the first two medications still doesn’t work: add polyethylene glycol (PEG 3350) (Restoralax/Laxaday): 17g powder dissolve it in a glass of water (250mL) and drink it once daily
- Methynaltrexone (Relistor): is a prescription medication which you need to see the doctor for
- Keeping yourself distracted
- Meditation, relaxing therapy
- Medication management
There are a couple medications you can use to manage agitation and anxiety. To get these, you’ll have to talk to your doctor and get a prescription:
- Diazepam
- Clonazepam
- Lorazepam
- Meditation and relaxation exercises
- Gently massaging your temples and neck
- Medication management (make sure to double check these with a physician or pharmacist to ensure they are right for you):
- Acetaminophen (Tylenol) 325 mg to 500 mg every 4 to 6 hours when needed (maximum 4 g/day)
- Ibuprofen (Advil) 200 to 400 mg every 6 to 8 hours when needed (max 1200 mg/day)
- Naproxen (Aleve) 220 mg every 12 hours when needed (440 mg/day)
- Maintain good hydration (drink more water!)
- Avoid oral desiccants (coffee, alcohol, tobacco, cannabis use)
- Avoid low-humidity environment (e.g. air-conditioned stores, centrally heated houses)
- Use humidifier
- Medication management (make sure to double check these with a physician or pharmacist to ensure they are right for you):
- Artificial saliva (Biotene, Aquoral): Swish and spit 3 to 4 times daily
- These symptoms may be due to pseudoallergy related to histamine release within your body! Histamine is a substance that causes itchy and red rashes in your body, it also causes seasonal allergy symptoms such as teary eyes and runny nose
- Medication management (make sure to double check these with a physician or pharmacist to ensure they are right for you):
- Diphenhydramine (Benadryl): 25 mg every 4 to 6 hours when needed or 50 mg every 6 to 8 hours when needed
- Ranitidine (Zantac) 150 mg twice daily
Everyone will experience the medication differently. Discuss your side effects being experienced with your doctor to figure out how to best alleviate them.
You can also go to the withdrawal management module to learn more about what withdrawal is and how to manage it.
For serious and sudden side effects such as chest pain, shallow breathing, abnormal heartbeat, fainting feeling, confusion or hallucinations: CALL 911 IMMEDIATELY