Opioids How to properly taper off opioids?

[Azmodon]

I'm new here, just an FYI.

I'll start with the situation: I've been under the care of a pain specialist for over a decade now and been prescribed the fentanyl patch and oral hydrocodone. I was called today and informed he lost his license this week and they are closing up shop. I had been slowly reducing my dosage over time but what I was taking worked so I wasn't especially inclined to change things (I have many significant chronic illnesses, but no mental health issues or previous or current addiction issues).



So, this question is for those of you with experience here. I'll probably be needing to start tapering even if my PCP or Gastroenterologist come to my rescue (i've seen both of them for 10+ years as well, but they likely won't be able to fill those scripts for more than a couple months, if they are allowed/willing to do so). Lets have 3 scenarios, to work from, scenario 1 I have enough to continue my current dosages for a month and then I'd run out, scenario 2 I have enough to do that for 2 months and scenario 3 I have enough to keep going for 3 months. giving those options, how would the experienced among you go about tapering in those 3 scenarios (in scenario 4 one of my doctors swoops in and fills the scripts until I can get seen by a new pain specialist or another doctor willing to deal with this mess).

Hopefully one of my doctors comes to the rescue but just I'd like to plan for worse case.

Also, My PCP is likely to be willing to prescribe other schedule 3/4 medications if there is a medically accepted use for it in tapering from opiates, even if he isn't willing to prescribe schedule 2 stuff.

Thanks

 

[Robi]

Welcome Az! i know you will get great advice, i was a cold turkey fool. so id give ill advice, best of luck

 

[Las Veghost grower]

The truth is tapering requires self control, and let’s face it as addicts we have no self control when it comes to out drug of choice..I’m not saying it’s impossible…but eventually you’ll prolly have to bite the bullet and cold turkey it with some comfort meds, good luck

 

[SummerWinter]

Late, but how did it go?

 

[plumbus-nine]

Use dissociatives, memantine's the best option and saved my ass more than once in that it is able to essentially skip opioid withdrawal. Needs a doc willing to prescribe but then it's almost too easy.

 

[SummerWinter]

I’m glad it went well for you!

 

[plumbus-nine]

I'm not sure how well it went actually because the addiction, the cravings and inner restlessness, are still here and why I'm using again - 'just' kratom because I don't have access to morphine anymore, and that fucked my sleep but if I had access I'd do it again ... still, from all I know and have seen I'd expected much worse withdrawal, with high dose memantine it was really just the opioid effects being replaced with memantine's dissociation and sleeplessness. If you still get restless legs or remaining withdrawal I'd consider adding pregabalin but with caution because this one can induce dependency by itself as well. Or for the shits use loperamide (in regular dosages, no megadoses required)

 

[Azmodon]

Late, but how did it go?

Fine so far. Ive got a good PCP and a solid medical reason for taking what I take. We will lower the dose as much as possible since most likely ill have to raise it up again as I get closer to needing a transplant.

Some people on high doses were just left without care and had withdrawals, etc. It was a mess. What needs to happen is the government (the DEA, ATF, etc) need to have mechanisms in place to manage the gap care for patients effected by their enforcement actions. The supposed goal of DEA enforcement is to reduce harm to the citizens of the country, and leaving patients without care and essentially saying "its not our problem" isn't acceptable.