Tolerance gaps/How to bridge the gap when you run out of an rx early

[R0Y]

Note: I changed the title as it was misleading

Hi Im 55 and have had chronic intractable headaches since 1987. They wrecked my life, even before I was ever prescribed opiates.

After 13 years of neurologists making things worse, I went to pain management. I was finally able to work, have a life, travel etc. Of course I was on an ever increasing dose of short acting opiates. Changed doctors and he put me on methadone, at times the patch, I was on a lot of stuff.

In 2009 he died and I found a local doctor and he had me on methadone and meds for breakthru. I was on huge amounts of methadone and prescribed enormous numbers of breakthru meds. I gradually decreased the methadone and in 2015 wo telling anyone I quit. I quit at too high a dose, it was awful. Had to use suboxone to get off. I was off opiates for a year but was incapacitated with headaches a lot of the time.

Went back to pain mgmt and have been on short acting meds since, and also using a lot of sumatriptan. Botox for migraines too.

Last few years my tolerance has gone thru the roof, and I have been using 120 x 10mg of oxycodone a month and often run out early. Last appt I asked him to change me to something else for a while and he prescribed a lesser amount of dilaudid for next month with a refill date a week from Wednesday, which is fine.

I ran out of my oxycodone on Friday. Like i said tolerance is thru the roof and I absolutely don’t want to ask my doctor for more because it will only get worse. My fill date isn’t until a week from Wednesday. I’ve gotten withdrawal down to a science. I take one 100mg capsule of Lyrica a day for 3 or 4 days. NyQuil as needed for runny nose. I have clonidine I take twice a day. And Valium if needed. I don’t feel so bad, even the first few days, just tired and irritable and COLD. It’s a terrible time of year to go thru this. I don’t feel like doing much though and what really suffers are my appetite and desire to drink liquids. I’m dehydrated and it’s not from stomach problems it’s just that I have no desire to drink. Everything I eat or drink leaves a terrible aftertaste in my mouth. Tomorrow Im going to have to buy a bunch of pedialyte.

I’ve done this many times before so I know I’m not going to die but how do you people who need to take these things get thru times when you’re running short or out or decide to take tolerance breaks? The only opiates/opioids in the house are methadone (still have lots left over) and suboxone (same). I’m leery to take either but this is going to drag out for another week and a half. I know how hard it was to get off of them. If I were to take 5 or 10mg methadone once or twice a day until my refill date and then switch to the prescribed dilaudid would it be seamless or would there be major issues bc of the methadone? I seem to recall that while in methadone wd I could take my opana breakthru med and see relief. I’ll get thru it either way. I can gut it out but I don’t want to touch either one of those drugs if the cessation of them are going to present an issue when I resume my rx. And if I gut it out I don’t know how to deal with the cold. It’s horrendous.

Thanks.

 

[someguyontheinternet]

I don't think that methadone would cause an issue when you get back on your regular prescription, I think taking the small amount is a good idea to avoid withdrawals. Suboxone probably won't cause an issue either, dilaudid has a higher affinity for the opioid receptors than suboxone, suboxone is usually higher but not in this case.

 

[brokedownpalace10]

It's high dose Methadone which will block other opiates. If you keep the Methadone doses at a level to just prevent withdrawal and don't try to get high on it, I think you'll be OK. Be aware that it lasts forever and that higher levels can build up.

High-dose methadone produces superior opioid blockade and comparable withdrawal suppression to lower doses in opioid-dependent humans - PubMed

Heroin use may persist during methadone treatment because low to moderate doses of methadone suppress withdrawal, but fail to eliminate the effects of heroin. These results provide a mechanism for the clinical observation that higher methadone doses are more effective at reducing heroin use.

pubmed.ncbi.nlm.nih.gov

 

[R0Y]

Thanks for both of your replies. I took 5mg and when I was still cold and had a runny nose after an hour I took another 5mg. Anyway I feel better, no longer freezing cold despite the heat on and with several layers of clothing. I feel normal. Not messed up and I don’t want to get that way. I don’t want there to be issues when I get my script filled next week, don’t want to have to unnecessarily use a bunch of it to prevent methadone wd. So I will use the bare minimum. When I got off of it in 2016 I made a spreadsheet of how the half lives of each dose stacks up, so I’d know exactly when it was out of my system. So yeah it does last a long time. I think I’ll try to cut it back to 5mg twice a day after today and see how I do and maybe next week try to skip a day or take it once a day instead of twice. Try to minimize the amount of it stacked up in my system. Make the transition back to a short acting med go smoother. Thanks again.

 

[tryptakid]

I've had friends with headache issues that have found success with micro-mezzo doses of psilocybin (0.3g -0.75g). Since headaches and migraines are connected to serotonin activity (particularly when it's a chronic disorder vs. a reaction to something) activating that system in a more direct way can be useful. Sumitriptan is actually a cousin of LSD and Psilocybin.

 

[someguyontheinternet]

I think only specific types of headaches can be solved with serotonergics because of the role of the trigeminal nerve in only some headaches. 1b agonism drives vasoconstriction and presynaptic 1d agonism inhibits the release of neuropeptides from the trigeminal nerve such as CGRP, NKA, and substance p

Sumitriptan does have a similar pharmacophore to LSD and psilocybin though, I believe sumitriptan is based on ergotamine which is also (rarely now) used for migraine treatment

 

[R0Y]

I've had friends with headache issues that have found success with micro-mezzo doses of psilocybin (0.3g -0.75g). Since headaches and migraines are connected to serotonin activity (particularly when it's a chronic disorder vs. a reaction to something) activating that system in a more direct way can be useful. Sumitriptan is actually a cousin of LSD and Psilocybin.

Thanks. From 1987 - 2001 I had 2-3 3 month long cluster headache cycles a year and they were what really screwed me up. I’d have one per day for 3 months straight. Awful. They disappeared in 2001 and thats the one victory against headaches that I’ve had.

This summer for the first time since 2001 I had a cluster cycle and they were awful. Instead of one per day I was having 2-4 a day, usually at night. They wrecked me, totally brutal.

Even though the oxycodone doesn’t work quickly enough, since they happened at night I could take some at night and it would help a little. They are why my tolerance shot up.

Anyway I tried psilocybin 3x and I thjnk it helped break the cycle. There’s a website that deals with it, teaches people how to do it. My main fear was making them worse.

Sumatriptan injections were lifesavers, killed them within a few minutes.

 

[tryptakid]

I've heard absolutely awful things regarding the experience of cluster headaches. I'm sorry you have to deal with that. You might find that semi-consistent microdosing could have some preventative benefit. There's a very simple way to grow plenty for personal of use using the uncle bens method (though there are a ton of different ways to approach this and I would advocate for the hobby in general!).

You could also look into the drug memantine (it's a long-acting NMDA antagonist, somewhat like ketamine though not nearly as impairing in therapeutic doses). There's a fair amount of data showing that using memantine alongside opioids can increase effectiveness while helping to minimize tolerance development. It won't get rid of tolerance, but helps to maintain it. There is also an analgesic synergy between opioids and NMDA antagonists that is well documented.

Again, sorry to hear about the cluster headaches and I hope you are able to continue to manage them.

 

[R0Y]

Hi everyone,

This is an update and a question. I have been taking roughly 10mg methadone 2x a day for the last week. A few of the days I took 25mg total. A few days I took 15mg total.

My rx refill date is Wednesday and since there’s a shortage of dilaudid, I was switched back to oxycodone 10mg.

I’ve only been taking methadone for a week and have been taking a relatively small dose.
Am i better off waiting for my oxycodone rx to be filled and just switching to it, or should I reduce the methadone from 20mg to 10 or 15mg a day for the next two days? Can I use lyrica like i do when getting off of short acting opioids? I guess im trying to gauge what to do. I have plenty of methadone left but would like to take it as few days as possible. I’d like to start to reduce now but wondering what I’m going to face.
thanks.

 

[Juicewrldfan]

I don't think that methadone would cause an issue when you get back on your regular prescription, I think taking the small amount is a good idea to avoid withdrawals. Suboxone probably won't cause an issue either, dilaudid has a higher affinity for the opioid receptors than suboxone, suboxone is usually higher but not in this case.

So that’s why they use it if I have to go to ER. Stilll didn’t feel it iv…they even used fentanyl once but again a dose I didn’t feel iv. And I never was big into fent.

 

[R0Y]

Last time im going to ask, so I hope someone responds. I think I’ve made a bad mistake here. Ive only taken the methadone for a week or so and usually 20mg a day.

How awful Is this going to be when I switch back to my short acting rx opioid, oxycodone on Wednesday?

I get headaches, will the oxycodone work at all and if not how long will it take? If they don’t help with the headache ie if I won’t feel it, that’s fine. Worse comes to worse I can take sumatriptan. Even if they don’t help with pain, will the oxycodone stop withdrawal?

And I have Lyrica. clonidine and Valium. Will they help mitigate the withdrawal at all?

When I used to be on methadone I was once on an enormous dose, maybe 200-300mg a day, and then on my own slowly reduced it. I stopped at 80mg and then after a few weeks of awful withdrawal took suboxone and that was a long taper. However, I had been on enormous doses of methadone for at least 15 years. This is a small but still potent dose for a week.

What do you suggest? I am not staying on methadone. Not at all. My last dose will likely be sometime today. Im also not going on suboxone again.

I should have sucked it up and tolerated the awful cold. Instead I took the easy way out and now will pay the price.

Im prescribed 10mg oxycodone up to 4x a day. So 120 tablets a month. I don’t want to run out again.

Anyone have any ideas on how best to handle this? I’d appreciate any responses. I’m going to stretch out the time before I take my next and hopefully last dose of methadone as long as possible and I’m only going to take 5mg.

I know from a rational perspective that this is not the same as when I did withdrawal after 15 years of extremely high dose methadone, but it’s still such a powerful drug that 20-30mg a day is still nothing to be trifled with.

I’m just worried, stressed.

Thanks.

 

[Juicewrldfan]

so Oxy will very likely keep your withdrawl away if you take it as prescribed. Methadone is ten times stronger than morphine if I remember correctly and Oxy is 1.5-2x stronger.

And if it doesn’t work kratom will. I jumped off a 8mg sub maintenance dose and used kratom. And it’s 7-10 times more powerful than morphine so should be close to methadone unless I’m remembering wrong. Worked pretty well for awhile just got tired of taking it so frequently but my tolerance is likely much higher than yours when it comes to opioids because oxy is like eating a sugar pill for me…methadone never got me high. Never. Even if I skunked my dose. Think I even tripled it once when I was getting take homes. No high to speak of.

But that’s my tolerance for you. It’s a gift and a curse but mostly a curse. It’s a gift because opioids were destroying my life so when dent replaced heroin it set me free ironically. Heroin was my love. fent is garbage.

I digress

 

[Señor Moreno]

I don't think you will have a problem switching to oxy. You only have been taking 20 mg max andi only for a week. In fact, you took it the exact amount of time to avoid the methadone's accumulative effect. 20 mg of acute methadone usage won't block your meds dramatically. I honestly think that you will be fine. I have read that you use 120 pills of 10 mg oxycodone monthly, is that right? So 40mg oxy a day? Well, I can't tell about the headache issue (I feel bad for you, it has to be horrible), but regarding to avoid wd, I wouldn't worry too much.
If I were you, I probably would use my normal amount of oxy, and, if needed, I would add 100mg Lyrica at morning and also at evening for say 3 days, then the next 2 only 100mg at night and then land on my regular oxy schedulle. Or you can try a smaller dose of Lyrica and use clonidine if you feel the hot/ cold flashes.
But you should be mostly fine all in all, I reckon.

 

[R0Y]

Thanks for replying. So maybe I won’t be totally screwed?

I used to have monster tolerance like you do, but ever since I got off of methadone the first time I’ve stuck to relatively small prescriptions of short acting meds. I actually feel 10mg oxycodone now (before taking the methadone).

Thanks again. I know I can do it, I have to, just want to do it the most painless way possible.

Would you recommend tapering more or just getting this over with? I’m of the opinion that the quicker Im off of the methadone and the sooner I start the withdrawal process the better.

 

[Señor Moreno]

Nah, as soon as you get your oxy forget the mdone, don't give the fucker the chance to accumulate. Do your regular oxy, add Lyrica if needed the first days and you should be fine

 

[Juicewrldfan]

Thanks for replying. So maybe I won’t be totally screwed?

I used to have monster tolerance like you do, but ever since I got off of methadone the first time I’ve stuck to relatively small prescriptions of short acting meds. I actually feel 10mg oxycodone now (before taking the methadone).

Thanks again. I know I can do it, I have to, just want to do it the most painless way possible.

Would you recommend tapering more or just getting this over with? I’m of the opinion that the quicker Im off of the methadone and the sooner I start the withdrawal process the better.

You will not likely need anything more than the oxy to manage withdrawal. It may be slightly uncomfortable at times but not much if at all…

lyrica is excellent for RLS and if you can’t sleep at night but really just would take it as prescribed if it’s prescribed which it sounds like.

 

[R0Y]

Thanks everyone for your replies. I’ve been through wd a bunch of times, obviously the methadone and suboxone withdrawals were the worst, by far. However, the times I’ve run out of my pain rx early and have had to use Lyrica and clonidine really havent been a big deal. But there is a major mental aspect to it, and overnight I was looking through threads and my fear got the best of me. After reading the replies this morning I could feel my blood pressure start to go down, feel more relaxed about this. I’ll get through this. Once again, I appreciate everyone’s help and sorry I panicked. It’s been a while since I’ve had to deal with methadone and the other time sucked. This time will be different. Take it easy!

 

[Juicewrldfan]

Thanks everyone for your replies. I’ve been through wd a bunch of times, obviously the methadone and suboxone withdrawals were the worst, by far. However, the times I’ve run out of my pain rx early and have had to use Lyrica and clonidine really havent been a big deal. But there is a major mental aspect to it, and overnight I was looking through threads and my fear got the best of me. After reading the replies this morning I could feel my blood pressure start to go down, feel more relaxed about this. I’ll get through this. Once again, I appreciate everyone’s help and sorry I panicked. It’s been a while since I’ve had to deal with methadone and the other time sucked. This time will be different. Take it easy!

No need to apologize. As you are aware there is a strong mental aspect to WD and you are more likely to worry. Thing is MOST of the withdrawls are much worse than they would be if people didn’t hear horror stories of withdrawl experiences and cause psychosomatic Symptoms. What I mean is if you have a toothache that won’t go away and you are on your way to work. You get to work nd get busy and forget all about your toothache.

Don’t focus on it more than necessary to strategize and plan.