The image included a rundown neighborhood, a mix of scraggly men and weary women lined along the corner of a building, and protestors with handmade signs (“Keep drugs away from our children!”). And maybe—if depicted by a Hollywood film—a black and white police car might cruise by on the street. Those in the line are lowlifes, misfits, and losers, addicted to a serious drug like heroin and now nursing their vile habits with a prescribed substitute.
What comes to your mind when you think about methadone?
But if you do have a thought, it’s probably based on a film, a story on the mean streets of New York with old Al Pacino or young Ryan Gosling as a loner cop. If your thoughts weren’t from a film, then it was in a newspaper article from the last century, a Law & Order rerun, or a hazy recollection when you were lost in the rundown side of chilly Milwaukee or sunburned Miami searching for a college roommate’s address. Regardless of the source of your piecemeal memory, you “know” about methadone: it’s for drug addicts. Sure, people may need a physician’s prescription to get a dose, but it’s not much different than the various illegal drugs that are ruining society.
So when a hospice nurse suggested that methadone was a good choice to manage your pain, you quickly said, “No way.” Or a family member equally quickly said, “No way.” Or, after the nurse invited you to consider methadone for part of your pain treatment and then left for her next patient, you and your spouse chat about the possibility for about 5 seconds and decided, “No way.”
As a narcotic, methadone is an undeniably potent drug; using it on a regular basis will lead to addiction. And that’s the truth.
But you are a hospice patient. If you’re in pain, you won’t enjoy a loving conversation with your kids. If you’re in pain, you won’t relax and get any decent sleep at night; at midday, you won’t admire the autumn leaves flickering in the wind through your living room window. When the grandkids visit, you’ll get angry with them or ignore them. With pain, the walls close in on us. When in pain, all that matters is not having pain. Methadone may not reduce the pain, but it’s worth a try. Methadone can be an effective, reliable medication.
No! Those mean street images linger. Those ne’er-do-wells snake around a derelict building. Methadone is not, not, not a medication! It’s . . . it’s what?
For some, methadone is a blunt reminder she or he is now a hospice patient, that doctors determined a cure for her or his illness is no longer possible, and that the length of life is limited. It’s no surprise that many patients resent and resist using methadone.
Methadone has practical and personal advantages. Frankly, it’s cheaper than morphine. In whatever form methadone is administered—liquid or pills—the typical patient takes fewer doses than many other pain medications. It’s longer acting and usually easier on the body. It’s also, like every drug, not perfect. I heard a nurse recently say, “It can make you loopy.” It simply won’t work for everyone. Nonetheless, methadone is frequently beneficial and effective.
But who cares about the upsides? Regardless of what you’ve read (whether my words, web searches, or those colorful pamphlets the nurses and doctors provided), methadone is like a neon sign flashing on your forehead: I am dying.
I would be scared. Methadone is not familiar and comfortable like aspirin and Ibuprofen. It’s never hyped on commercials with carefree (and “normal”) people walking dogs, strolling the perfect beach, or mowing lawns while a cheery voice-over describes a thousand complex, confusing side effects in 60 seconds.
But the positive side effect of methadone, for many hospice patients, is simple: better pain management. I believe (along with the scary feelings I’d have), that using methadone doesn’t mean “giving up,” but that you are prioritizing time with your loved ones. Instead of turning away in pain, you can more likely turn toward your loved ones and continue to create meaningful memories.
(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)by