Opioids Need help with dilaudid taper during methadone

[kracked]

Hi guys, it's been a while I havent visited this forum but I've encountered a problem recently and I needed some help.

So, a short resume of my story.

I've had an opioid addiction to dilaudid and this led me to taking methadone 3 years ago. I started at around 75mg but even tho I was taking methadone, I'd still buy and use dilaudid on the first year. I understood that the effect were almost non-existant due to the block that the methadone offers but I'd still do it for the 10-15 seconds rush but even that was toned down by the methadone so after about 8 months I decided to delete everyone of my dealers from my phone and try to take the detox more seriously, and it worked well, until last month.

The goal was that if I don't have access to diladid then I won't have a problem, but I still though in my head that this was just ignorining the problem and putting it away, I wanted to be able to have access to dilaudid, even have them in my possession, and be able to not use them or at least not abuse them in a way that would cause me to become addicted (assuming I ever get out of this first addiction)

But last month my coed came back from surgery at the hospital and they had given him dilaudid 1mg for pain. I didn't know about it at that time but not long after that he came to me to ask me if he should keep them or throw them away since he didn't needed them so I offered to buy them from him. Shortly after, I tried dilaudid again with my usual method, IV and it didn't take long that I had finished all the pills he had given me. The effects were much better than what I remembered because I used to have 75mg methadone back then but it's been 3 years since that time and now my methadone has lowered to 22mg.

I ended up finishing them all quickly and getting more from a contact I remembered. I don't know exactly what I was thinking, probably just thinking about now and not later because I just though that I could simply stop at any time and the methadone would make this go smoothly. I took in total around 275mg of hydromorphone in the past 3 weeks and everytime I've tried to stop, I've felt withdrawals that were really uncomfortable. Sure the first 6 to 8 hours after taking methadone feels ok though I have sudden sweats that lasts around 10 minutes but the evenings, mornings and nights are a nightmare unless I take a pill. What scared me a bit is that yesterday, 8 hours after taking a 2mg injection I started shaking uncontrollably like it was freezing cold and I did feel a bit cold but putting on more clothes did not help and even taking another 2mg did not make the shaking stop. It ended up stoppig after 35-40 minutes.

When I understood just stoping would not work I started taking a bit less each day with what I had left but now I'm a bit scared because I have only 4 pills left (4mg ills) and I'm scared that I won't be able to go back to just taking methadone like before withough being really sick of that things like yesterday happen again and I'm not sure which option is the best for me.

Should I get more pills and try to plan ahead for a taper plan that would be stretched over a couple of weeks or should I ask my doctor to increase my dosage of methadone just to get rid of the pills I have and then go back down to what I was or should I try to taper off using the 4 pills I have with a better method ???

I've heard some people used anti-diharrea medecine to taper but I tried that 3-4 years ago and it didn't work at all for me. I also heard about bupe but I have no idea how to get it or even what it does. All I know is when I got into my clinic they asked me if I wanted to be on the methadone program or the suboxone program and I choose the methadone. If I remember correctly, they said that using both would not work and would actually cause precipitated w/ds.

Any help would be very welcome.

 

[kracked]

Please answer ?

I just read another thread on this forum and it seems what I've experienced was something called coton fever... it's weird because I've used new materials and a fresh cotton but I had pre-prepared the shot... maybe that caused a bacteria to form inside the solution ?

Is it safe to pre-prepare a syringe of water-dilaudid solution for injection? And if theres risks, can we minimize the risks by using the shot faster ? AKA: less than 12 hours after preparing it or something ? I had prepared mine about 36 hours in advance. (What I did is I cut my pills and mixed them with water and then I filled 8 syringes and put them in a container that I hid in my bag. Whenever I was feeling like I needed a hit, i'd take my bag to the nearest bathroom wherever I'm at and I can come out as quick as if I had just pee'd normally. But is it safe?

 

[Dr. Extract]

I don't have much to add as to the structure of your taper; most of my successful tapers came about as forced happy accidents. One thing I can comment on with certainty is that pre-preparing your shots is a bad idea. I understand your reasons and that to not pre-prepare would likely be an inconvenience but you're inviting microbes to grow when you leave (for an hour or more) a solution that has been in contact with any non sterile surface. That is almost certainly what happened to cause your "cotton fever" episode. It is called a foreign body response and can be quite violent depending on what the offending factor is.

 

[tacodude]

You need to say what your dose is for the dilaudid.... You should try using the dilaudid only once 12+ hours after the methadone then reduce the dose till none is as close to the best method you'll get. Do you use the methadone at the clinic or do you get take homes?

 

[Jabberwocky]

Please answer ?

I just read another thread on this forum and it seems what I've experienced was something called coton fever... it's weird because I've used new materials and a fresh cotton but I had pre-prepared the shot... maybe that caused a bacteria to form inside the solution ?

Is it safe to pre-prepare a syringe of water-dilaudid solution for injection? And if theres risks, can we minimize the risks by using the shot faster ? AKA: less than 12 hours after preparing it or something ? I had prepared mine about 36 hours in advance. (What I did is I cut my pills and mixed them with water and then I filled 8 syringes and put them in a container that I hid in my bag. Whenever I was feeling like I needed a hit, i'd take my bag to the nearest bathroom wherever I'm at and I can come out as quick as if I had just pee'd normally. But is it safe?

Nooooo!!! Do not inject pills without proper filtration!!!! Micron filter is necessary for them to even possibly be “safe” to inject. And you need bacostatic solution and proper container to store them approaching “safely”. I use quotes because it isn’t quite accurate to say injecting pills is safe even under the best of circumstances.

Unless you already know what your doing with it, no prepping a shot of hhydromorphone isn’t a great idea. How do you filter the pills? Cotton it seems... you will do serious damage using cotton to filter pills, if it hasn’t happened already it will happen sooner than later if you continue injecting pills using cotton as filter.

I wouldn’t be surprised if this is related to injecting pills more than anything else.

I highly recommend stopping the hydromorphone, letting your clinic know voluntarily (that goes over a lot better than missing a UA), and getting their help to up your methadone dose to deal with any potential withdrawal from hydromorphone.

If you want to try taping the hydro, go for it, but I’d really suggest you insulfate or plug it if you aren’t micron filtering it. Without proper filtration pills are really really dangerous.

What does if hydromorphone have you become habituated to? If it’s just a few mg, like ten or under, you shouldn’t have too hard a time just getting back to methadone only, especially if you increase the dose.

Another thing to consider is why you ended up using the hydro while still on methadone. That would indicate you haven’t done enough to deal with the issues underlying the opioid use issues. Therapists, CBT, RP, MBRP, MBCT and MBSR are a really good place to figure this out.

But yeah, strongly suggest you work with your methadone provider on dealing with this. Upping the methadone dose and stabilizing on that while you do the work necessary to meet your as of yet unmet needs will be good for you.

Imagine feelings like you don’t need to use opioids on top of your methadone? Getting to that point, then working on tapering off methadone (assuming that’s what you want)? Sounds pretty good, no?

After all, perhaps it would be a good time to reflect on why you decided to get on methadone in the first place. People don’t get on that stuff cause it’s fun, after all...

Hopefully you’ll work with your support group IRL to help overcome this hiccup/lapse/whatever you see it as. It won’t be super fun, as the clinic will probably test you more frequently and make you come in for dosing for three month before take homes become possible again (or they may make you rise daily for the foreseeable future if you’ve already missed a number of UAs).

But as much of a PItA that would be, it is probably along the lines of what you need. Do please try and take better advantage of the support of your clinic. It won’t be easy, but it may save your life.

Lemme know if you want help finding a good therapist/mindfulness based interventions. FWIW mindfulness based interventions tend to be a hell of a lot more effective than plain old CBT/RP. I can direct anyone to the research on this to learn just how siginificant the improve can be (like 31-62% more effective than traditional RP/CBT).

At the very least, see what happens if you stop taking hydromorphone as frequently. It would be helpful to know if you actually go into withdrawal from the hydromorphone while still taking methadone. Whether or not you’ve developed a hydromorphone dependency on top of methadone that leads you to withdrawal upon cessation of the hydro, we will be able to give you better advice with that info.

But please please find people to help you deal with this IRL. It’s an important skill to learn, how to rely on others for support when we need help, even when that support means you’ll have to put more effort into your recovery. Sounds like more effort would be helpful in any case.

There are also meds to help you deal with cravings that aren’t hard to get prescribed. Stuff like gabapentin, especially if you deal with anxiety, can be really helpful to have on hand for when you’re getting a strong craving for opioids. Ymmv, but the more resources you have in your tool kit the better off you’ll be.