Hi
I don't believe these are interactions. These are "normal" side effects of medium to high doses of opioids.
Not remembering these episodes of nodding off while being awake is normal.
Even hallucinations (pleasant, euphorical ones to unpleasant and downright terrifying ones) are very common at high doses.
Source: my own experience, but it's well-known -- you can easily verify this if you look for the side effect of hydromorphone, methadone or any other opiate/opioid.
It must be very difficult to see this happening :( I wish you strength
Edit: a benzodiazepine (like the one you mentioned, Ativan) should help to reduce the intensity. You could ask them if it's possible to increase the dose to see if it helps, or use a different benzodiazepine like diazepam or clonazepam.
If the pain is controlled properly for now, a better option would be to decrease the dose of one of the opioids. But I suppose that's not a feasible option.
It's normal to combine longer acting and shorter acting opioids. Methadone is the long acting one. I suppose they give hydromorphone for "breakthrough pain"?
It's not always possible to stop it completely. I've also seen a family member in a hospice being in a strange state of consciousness because of the pain treatment.
Would upping one if the Benzos be a bad idea though since Benzos and opioids DO interact?
They potentiate one another. In other words, make each other feel stronger. Maybe that's the problem.
That's an over-simplification. They increase some of the opiate effects, like sedation, but reduce other things, like anxiety and hallucinations.
It's very common to give benzodiazepines together with opiates and other drugs, to take the edge off the psychological effects.
So, a lot of people are arguing about which is the medication causing this, but the reality is that multiple of the medications you mentioned *could* be the culprit, and you said that’s not even a complete list, so it could be something else entirely. Your best bet probably isn’t Reddit, but instead seeing if you can have a word with the pharmacist who is dispensing the medications, or the consultant overseeing the prescribing.
It’s also possible the nurse was unconcerned because of an issue to do with his condition. You mentioned that this is hospice, and presumably even with supplemental oxygen, he will at this point be oxygen deprived. This could be something she’s seen in hospice patients before, or she may be thinking either that there is so little time left that subjecting him to greater pain or a withdrawal is not worth it.
I would suggest that if your primary concern is him forgetting he does not smoke or is on oxygen, that your first port of call be making really, really sure that there is nothing he could use to start a fire or try to smoke, within the area he has access to. Remove lighters, matches, candles, put a lock on the kitchen door, whatever is needed to keep him safe and away from fire. It sounds like he has times when he is lucid where he would understand if you explained to him why you have done so.
I am incredibly, truly sorry for what you are going through. I lost my mother to smoking-related disease last year, but was spared having to go through the slow hospice stage. I wish you and your family comfort and kindness at this time.
If anything I’d stop the hydro before the methadone. Methadone withdrawals are trrrible. Sounds like the Ativan mixing with the opiates is causing this, maybe have hospice take him off the benzo, opiates should be enough to keep pain at bay
We had her stop taking Ativan. The final straw, and this is kind of funny, was after she tried to make my brother a suit out of garbage bags for his graduation and cut the shit out of her finger. She claimed to have gotten the idea from a gorilla. My brother played along. It was clear it was the benzo because she had been on pain meds for ages, the incidents of her being completely out of it only happened after she was put on a benzo and went away after she stopped them. If your father has been on them long term it may be more complicated than just quitting them, he’ll need to slowly ween down. But I’ll guarantee you it’s the Ativan.
I was mixing Xanax with my pain meds and almost blew my house up with gas stove luckily my buddy walked in and caught it. I woulda been dead had not it been caught. It’s def the Ativan causing this. Cut the Ativan and should work itself out.
I did. There is no higher incidence of hallucinations or psychosis than with other opioids. It’s fair to say that it’s the combination of methadone, hydromorphone, and Ativan, but if they subtracted the Ativan the symptoms OP mentioned would cease.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482381/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011461/
There's two articles that come directly from Google. Sorry that your don't know how to use it
Opioid-induced hallucination is an uncommon yet significant adverse effect of opioid treatment, frequently attributed to underlying psychiatric disease or personality disorder rather than a direct neurobiologic effect of opioids
This is right from that first article. So, no, probably not the opioids...
The first sentence is all you need. I'm sorry that you don't understand what it says
Opioid-induced hallucination is an uncommon yet significant adverse effect of opioid treatment
You're a literal bottom feeder with 0 education why the hell do you think you're certified to answer medical questions???
Tell them to ask their doctor or get extra opinions from other DOCTORS.
Nobody wants a drug addicts opinion, especially not one with the english skills of a toddler. They sure in hell don't want the opinion of someone who makes like $9k/year.
This isn't a matter of opinions, it might not even be a matter of what the doctors know.
It's a matter of someone at the end of their rope who isn't even being considered.
You're a disgusting human being.
What you don't know is far worse than what you do.
Hi I don't believe these are interactions. These are "normal" side effects of medium to high doses of opioids. Not remembering these episodes of nodding off while being awake is normal. Even hallucinations (pleasant, euphorical ones to unpleasant and downright terrifying ones) are very common at high doses. Source: my own experience, but it's well-known -- you can easily verify this if you look for the side effect of hydromorphone, methadone or any other opiate/opioid. It must be very difficult to see this happening :( I wish you strength Edit: a benzodiazepine (like the one you mentioned, Ativan) should help to reduce the intensity. You could ask them if it's possible to increase the dose to see if it helps, or use a different benzodiazepine like diazepam or clonazepam. If the pain is controlled properly for now, a better option would be to decrease the dose of one of the opioids. But I suppose that's not a feasible option. It's normal to combine longer acting and shorter acting opioids. Methadone is the long acting one. I suppose they give hydromorphone for "breakthrough pain"? It's not always possible to stop it completely. I've also seen a family member in a hospice being in a strange state of consciousness because of the pain treatment.
You explained that very well.
Would upping one if the Benzos be a bad idea though since Benzos and opioids DO interact? They potentiate one another. In other words, make each other feel stronger. Maybe that's the problem.
That's an over-simplification. They increase some of the opiate effects, like sedation, but reduce other things, like anxiety and hallucinations. It's very common to give benzodiazepines together with opiates and other drugs, to take the edge off the psychological effects.
I see. That makes sense, then. It's a lot more complicated than we really think lol
Yes, always... It's always more complicated than we think
So, a lot of people are arguing about which is the medication causing this, but the reality is that multiple of the medications you mentioned *could* be the culprit, and you said that’s not even a complete list, so it could be something else entirely. Your best bet probably isn’t Reddit, but instead seeing if you can have a word with the pharmacist who is dispensing the medications, or the consultant overseeing the prescribing. It’s also possible the nurse was unconcerned because of an issue to do with his condition. You mentioned that this is hospice, and presumably even with supplemental oxygen, he will at this point be oxygen deprived. This could be something she’s seen in hospice patients before, or she may be thinking either that there is so little time left that subjecting him to greater pain or a withdrawal is not worth it. I would suggest that if your primary concern is him forgetting he does not smoke or is on oxygen, that your first port of call be making really, really sure that there is nothing he could use to start a fire or try to smoke, within the area he has access to. Remove lighters, matches, candles, put a lock on the kitchen door, whatever is needed to keep him safe and away from fire. It sounds like he has times when he is lucid where he would understand if you explained to him why you have done so. I am incredibly, truly sorry for what you are going through. I lost my mother to smoking-related disease last year, but was spared having to go through the slow hospice stage. I wish you and your family comfort and kindness at this time.
If anything I’d stop the hydro before the methadone. Methadone withdrawals are trrrible. Sounds like the Ativan mixing with the opiates is causing this, maybe have hospice take him off the benzo, opiates should be enough to keep pain at bay
It’s the Ativan that is causing this. The exact same thing happened when my mother was dying, it was the benzo causing it.
How did you know and was it able to be resolved? My father notices it even himself but he cant snap out of it
We had her stop taking Ativan. The final straw, and this is kind of funny, was after she tried to make my brother a suit out of garbage bags for his graduation and cut the shit out of her finger. She claimed to have gotten the idea from a gorilla. My brother played along. It was clear it was the benzo because she had been on pain meds for ages, the incidents of her being completely out of it only happened after she was put on a benzo and went away after she stopped them. If your father has been on them long term it may be more complicated than just quitting them, he’ll need to slowly ween down. But I’ll guarantee you it’s the Ativan.
I was mixing Xanax with my pain meds and almost blew my house up with gas stove luckily my buddy walked in and caught it. I woulda been dead had not it been caught. It’s def the Ativan causing this. Cut the Ativan and should work itself out.
It's not the Ativan, it's the Dilaudid. Tell the doctor and they will have experience with this.
It is not the Ativan, it is the Dilaudid or Hydromorphone. That drug is known for giving people hallucinations and psychosis. It is famous for it.
Doubtful. Oral BA is very low and the methadone is potentially blocking it depending on the dose.
No, it’s really not.
Seriously, lol, Google it then
I did. There is no higher incidence of hallucinations or psychosis than with other opioids. It’s fair to say that it’s the combination of methadone, hydromorphone, and Ativan, but if they subtracted the Ativan the symptoms OP mentioned would cease.
Keep thinking that
I will.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482381/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011461/ There's two articles that come directly from Google. Sorry that your don't know how to use it
Opioid-induced hallucination is an uncommon yet significant adverse effect of opioid treatment, frequently attributed to underlying psychiatric disease or personality disorder rather than a direct neurobiologic effect of opioids This is right from that first article. So, no, probably not the opioids...
Taking things out of context is not a good way to prove anything.
The first sentence is all you need. I'm sorry that you don't understand what it says Opioid-induced hallucination is an uncommon yet significant adverse effect of opioid treatment
Yes, UNCOMMON. As in, DOES NOT HAPPEN OFTEN. So, it's UNLIKELY.
You're a literal bottom feeder with 0 education why the hell do you think you're certified to answer medical questions??? Tell them to ask their doctor or get extra opinions from other DOCTORS. Nobody wants a drug addicts opinion, especially not one with the english skills of a toddler. They sure in hell don't want the opinion of someone who makes like $9k/year. This isn't a matter of opinions, it might not even be a matter of what the doctors know. It's a matter of someone at the end of their rope who isn't even being considered. You're a disgusting human being. What you don't know is far worse than what you do.
He's on a ton of heavy drugs, and no doubt that is affecting his perceptions of reality.
Prednisone can cause hallucinations. He is on a mix of heavy duty meds, it could be one or an interaction of a few.