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Fast methadone taper help

Sorry I haven't been on here but I had to put my beloved dog of 15 years to sleep today. So I'm a wreck. Add the taper on top of that and well, I'm just not doing good. But I'm hanging in there. Today was the day I dropped another mg so I'm now at 8mg. As for the taper, my main issue is pain. I'm having to take the oxy every 4 hours and my pain level is still around a 7-8. So the sooner I can get off this methadone I can have the first surgery to correct what's causing me pain. Im just ready for this to be over with.

I'm sorry I'm sounding so negative it's just been a long day. I hope you're doing well Somni. I really do appreciate all your help and you checking in on me really means a lot.

?Barb
 
That's rough. Sorry about your dog. If you think your ready for surgery go ahead and start scheduling it. Under 10mg of methadone isn't going to make a difference with pain control post surgery. At this point I would be more worried about your tolerance in relation to surgical pain then the tiny bit of methadone. Your doctor didn't want to do surgery while you where on a semi blocking dose of mdone because it's impossible to control pain many people are on low dose methadone with short acting opiates for breakthrough pain. Which if I where you is something I would discuss with pain management. But yeah start getting the ball rolling on surgery.
 
My neurosurgeon said he wouldn't do surgery until I was off completely or I would go ahead and see him to schedule. They did a ua before I even got to talk to him and that was the first thing he brought up when he walked into the room. I didn't even have a chance to tell him I was on it. So I have to come completely off. And he won't schedule the surgery until he sees me again and I have a negative urine for methadone. His comment about "not being able to treat my pain without using ridiculous amounts of meds and refusing to do that" was just a bunch of crap I believe. I'm pretty sure he just was being judgmental without even hearing anything I had to say. But he is the best neurosurgeon in this area (3 hour drive) and I've been cut on by the worst which is part of my problems. So I have to follow his rules if I want his help. If there was an easier route I'd take it. It sucks that he's not willing to budge on the issue but he made it clear as a bell that if I want him to help me I have to be off of it and long enough where theres no traces of it in my body.

So, I'm seeing this to the end. I'm doing ok with the taper. My pain is bad but I'm going to try to see my dr sooner than my appt time. I'm goin to call Monday and ask if they have a cancellation like before. I'll beg if I have to but I need something else to help my pain. I'm a rapid metabolizer so these short acting oxy just aren't cutting it for pain. Which that's not why he prescribed them. It was to come off the methadone and then he was going to switch me over to a long acting with the oxy for breakthrough.

Sorry for such a long post I just wanted to explain why I wasn't scheduling the surgery yet. Doctors can be really crappy sometimes.
 
Damn your getting screwed six ways to Sunday. Doctors can be such pricks. On that note be careful trying to get an early appointment some people think that is drug seeking behavior. Which is stupid because your going there for drugs but you know how little common sense is used some times
 
Oh yeah I didn't think about that. Thanks CJ. I wouldn't think my primary dr would think that way about me but since I went early last time he just might if I go early this month too. So yeah I better just wait until my appt. If the pain gets too severe I'll just go to the ER. They are familiar with me. In June I went and I had a kidney stone a lil bigger than half inch. My urologist called it Monster. It couldn't pass obviously and was blocking and caused hydronephrosis. Anyway I had surgery for that while on methadone and basically suffered because he prescribed hydrocodone 5mg and it didn't even touch the pain. Doctors don't seem to know much about methadone. Maybe it's just the ones in my area. Or maybe it's everywhere. Regardless, it sucks how we are treated.
 
Barbie, tell me how you know you are a rapid metabolizer and of what enzymes.
 
When I was a patient of the pain dr who skipped town he did some kind of test. It's been so long ago I don't remember what it was called. I just remember he said it was a new test that helped pain Dr's determine what meds work best. He swabbed my cheek and sent it off. He told me I was a rapid metabolizer and that's why the meds he had me on wasn't helping. He then changed me to the long acting opana er with Oxycodone for breakthrough. After the change in meds my pain was finally under control. As for what enzymes I'm not sure he ever explained that to me. If he did it was so long ago I don't remember. When I go back to my primary dr I can ask if he can get that information somehow. If knowing that information would help with the tapering plan I'll gladly try to find out.
 
It may help you with your pain but its debatable. Oxycodone itself seems to be the main agent that provides analgesia as slow metabolizers of CYP2D6 havent been shown to get less pain relief than normal metabolizers. It may be argued that fast metabolizers may have decreased analgesia for that opposite reason. This, to my knowledge is not proved however.
 
So I should stick with Oxycodone then? I don't know anything about enzymes and metabolizing. I just thought when he said I was a rapid metabolizer it meant I used up my meds too fast. Like how someone with a high metabolism burns up calories.
 
Actually barbie I think the time and place for this is after you secure that surgery date. There very well may be better options but there would still be trial and error even if you knew exactly what you were a rapid metabolizer of as its not the only factor that effects drug outcomes, especially with pain.
 
Ok kitty, thanks. Right now I'll just focus on finishing my taper and then I'll discuss the metabolism stuff with the dr when I am off the methadone.
 
I!m so sorry to hear about your dog. It seems to pour when it rains. To say it is challenging is an understatement. I wanted to say hello Barb and you continue to be in my prayers. You're getting closer every minute. <3.
 
Sorry to hear about your dog barb.
The pain of Losing my last two dogs a month apart from each other is why I don't have another dog now. (Besides being barely able to take care of myself) I get too attached and it's like losing a child. Mine were fourteen and twelve.
I'm still struggling with wht avenue to take. Its a Consant battle in my brain.
I'm praying for you and you are doing great!!
 
I'm doing ok CJ. Sorry I haven't been posting my progress. My mom ran over the cable thing that connects the sattelite internet to the house with the lawnmower. Exceed just came to fix it this morning.I don't have cellular service when I'm at home. Well sometimes I get a little bit of a signal. I got on here a few times but my service would go out and I never got to finish a post.

Anyway, I'm doing ok. I saw my dr early again because I have staph infection from a tick bite. He told me to just stop the methadone and prescribed morphine & said it would take the methadones place. I haven't filled the script because I wanted to post here and see what you guys think. I'm down to 7mg on the methadone. I really didn't want to just stop since I'm sick already and taking antibiotics that make me very nauseated. I've had morphine before but it's been about 15 years and I think they made me feel like my heart was beating out of my chest and I only took them a couple days. My dr said 15mg was more than enough to replace 7mg methadone but I looked at a post on here and that's way off. Should I just continue the taper to zero or do the switch?

Hope everyone is having a good weekend!

?Barb
 
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The morphine will make a big difference, but no surprise your doctor isn’t exactly right about the dose conversion. The equanalgesic dose of oral morphine to methadone is 30mg morphine to 5-10mg of methadone. So a more appropriate dose of morphine to replace 8mg methadone, you’d need 24-32mg of morphine.

Now, 15mg morphine isn’t far off from that all things considered, so it shouldn’t be too painful. If you can continue tapering your methadone before beginning the morphine @15mg, it would be best. But you should be able to manage the transition right now without terrible discomfort.

Other than the dosage issue, morphine is a great replacement for methadone. Is this going to be an ongoing treatment or something you’re going to be prescribe just short term to get off methadone? Also, is it an extended release formulation of morphine or instant release?
 
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Go ahead and get the morphine filled. You don't want to wait too long because it will raise red flags plus you want to stay on schedule for your next refill. Your doctor is an idiot but we already knew that. I agree that 15mg will be mostly good enough but you may have to dose a couple mg of methodone to stay well. I would try his dosing schedule and see what happens then you can add small amounts of methadone as needed. That'll be beneficial because it may end your taper in a satisfactory conclusion or if that doesn't work it will stretch the methadone left and a longer taper is always better.

Congrats btw your basically done. I am really really impressed you pulled this off. I thought you would end up back at the clinic for sure when I first read this.
 
TPD, CJ, you always have great advice! The only pharmacy here is closed on Sunday so I will take it tomorrow. As for whether it's extended release I'm not sure. I can't read the script because his handwriting is terrible. He did not give me another script for the oxy tho. I'm worried about that. He said the morphine was temporary and only for getting me off methadone. Once it's no longer in my system he's referring me to a pain specialist. I don't know if he's planning on giving me the oxy again once the methadone is out of my system or what he's going to do. I'd like to try not taking the methadone once I get the script filled and see what happens with just taking the morphine. If I can jump to the morphine now instead of going another 6 weeks of tapering I'd rather do that. But if that doesn't work I'll just continue tapering and try another time. Thanks guys

?Barb
 
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