Opioids A little bit worried here...[Morphine Sulfate/Tramadol]

I've been a lurker for a little while here, and have been browsing OD for a little while to try and educate myself.

I was on long-term pain management previously, taking Talwin NX, and did fairly well on it. Then my insurance coverage lapsed and I could no longer afford it. Cue nasty withdrawals, multiple trips to the ER for various pain (and withdrawal, I'm not going to bullshit myself, I have an addiction to this shit) related issues, and now I am back on my state's Medicaid, which gives me access to my pain management clinic. Yay, right?

Well, in the meantime, because my records state pretty much the truth (I have been seen at way too many healthcare providers looking for something stronger than Tylenol), I found that tramadol, being an unscheduled drug in the US, can be bought over the internet with a contrived prescription and about a hundred and fifty bucks. This has fed my tramadol habit quite handily, allowing me to get pretty much as much as I wanted. Consequently, I have been taking about 900mg a day. I tried to cold turkey off this crap about a week and a half ago, which did not end well- I ended up in the ER for a Xanax overdose in a half-assed attempt to off myself. The crash was that bad.

Cue finally getting into pain management, who did some MRIs and determined that medically, I am entitled to some of what I have been seeking. The doctor gave me 60 15mg IR morphine sulfate tabs (wtf doc), a. Rx for gabapentin (which I told him I did not want for several reasons), and a muscle relaxer. He is, of course, unaware of my huge Tramadol habit. Now, when I got the morphine, I quit taking the Tramadol, thinking it would kill the WD symptoms. I didn't think about the OTHER effects of tramadol, mainly the fact that it's essentially an extremely fast-acting antidepressant due to its effects with seritonin and some other brain chemical I can't recall at the moment.

For the past two days, I have not been able to sleep well, and when I do, I get the oddest dreams I have ever had in my life. While awake I have been getting muscle twitches that zing across my body like an electrical zap, but the same thing is happening in my head. It's like somebody just shocked me with a low-grade zap, and it happens at least twice an hour.

I broke down and took a tramadol (50mg) and no more zaps, so I assume that this is related.

The reason I don't want the gabapentin is the fact that I take Prozac and tramadol already...taking another SSRI is probably a bad idea, right?

What I'm trying to ask, I guess, is the easiest way to taper myself from the tramadol. I assume the morphine will help with the physical symptoms of WD but what will help with these neurological symptoms?

Well, I would first stop the morphine, get back to taking the tramadol, and do a slow taper off of that. OR you could look into getting Effexor rx'd in lieu of the tramadol, which has very similar SNRI properties to tramadol, and take the morphine with the Effexor. In fact, that might work nicely. Neurontin (gabapentin) is not an SSRI, but I wouldn't touch that or the muscle relaxant until you are stabilized on a good regimen of meds, as we don't want seizures to occur. A lot of muscle relaxants do lower the seizure threshold, and I think gabapentin might too, but I am not sure about that. You say you have access to Xanax, so I wouldn't be afraid to use that as needed for anxiety or insomnia when coming off the tramadol. It is tricky because you want to keep both the symptoms of SNRI wd away and the symptoms of opioid wd away, while not increasing the likelyhood (sp?) of a seizure. If you can handle coming off the tramadol cold turkey while continuing to take the morphine and Prozac, that might be best, but since you did become somewhat suicidal during your last tram wd, I am hesitant to suggest this. Also you don't want these "zaps" to cause you any danger, like when driving or something like that. I wish you the best, and hope you get off the tramadol safely and comfortably.

I would not recommend adding Xanax to the cocktail you're already on, and I would recommend discussing your tramadol use with your physician. I really don't understand why people aren't truthful with their doctors, and then they're confused and searching for help when their experimentation fails. You need to come clean with your doctor.

900mg habit a day of Tramadol is a serious habit. You should taper down if you have anymore Tramadol & do it over a 2 to 3 week period. Just save your Morphine until you are ready & can come off Tramadol safely.........

Alex000 said:

Well, I would first stop the morphine, get back to taking the tramadol, and do a slow taper off of that. OR you could look into getting Effexor rx'd in lieu of the tramadol, which has very similar SNRI properties to tramadol, and take the morphine with the Effexor. In fact, that might work nicely. Neurontin (gabapentin) is not an SSRI, but I wouldn't touch that or the muscle relaxant until you are stabilized on a good regimen of meds, as we don't want seizures to occur. A lot of muscle relaxants do lower the seizure threshold, and I think gabapentin might too, but I am not sure about that. You say you have access to Xanax, so I wouldn't be afraid to use that as needed for anxiety or insomnia when coming off the tramadol. It is tricky because you want to keep both the symptoms of SNRI wd away and the symptoms of opioid wd away, while not increasing the likelyhood (sp?) of a seizure. If you can handle coming off the tramadol cold turkey while continuing to take the morphine and Prozac, that might be best, but since you did become somewhat suicidal during your last tram wd, I am hesitant to suggest this. Also you don't want these "zaps" to cause you any danger, like when driving or something like that. I wish you the best, and hope you get off the tramadol safely and comfortably.

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Thank you very much for your good wishes; I was worried that I might be experiencing what some people have termed "miniseizures", which are apparently not uncommon with tramadol usage, especially in high doses. I no longer have access to Xanax, though, and don't particularly want it, either, because of my stupid stunt and the hospital's threat of an involuntary stay. Yeahno, I'll pass.

Missykins said:

I would not recommend adding Xanax to the cocktail you're already on, and I would recommend discussing your tramadol use with your physician. I really don't understand why people aren't truthful with their doctors, and then they're confused and searching for help when their experimentation fails. You need to come clean with your doctor.

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Why am I untruthful with my doctor? Because, frankly, I'm afraid to tell him. It's not out of a desire to get more dope out of him; it's because I'm freaking ashamd of what I'm doing and don't want to tell him. I can tell y'all; you don't know anything about me other than a username on the other side of the screen. Him, I have to look in the eye and tell him I'm an addict. And that is fucking hard.

Child of Night said:

Why am I untruthful with my doctor? Because, frankly, I'm afraid to tell him. It's not out of a desire to get more dope out of him; it's because I'm freaking ashamd of what I'm doing and don't want to tell him. I can tell y'all; you don't know anything about me other than a username on the other side of the screen. Him, I have to look in the eye and tell him I'm an addict. And that is fucking hard.

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I get it. But you're taking morphine and you're worried about telling him about a tramadol habit? Tramadol is the work of the devil, much worse than morphine or any pure mu agonist in my book. It's not controlled so that makes it easier to get. Uninformed doctors think because it's not controlled somehow it's "safer" and has a lesser potential for abuse which isn't the case for some people. Add to that its effects upon serotonin and its potential to lower the seizure threshold in certain individuals and I think the drug is a recipe for a disaster. You're the classic example, it was cheap and you could get it with a fake script. But now you have a doctor and you have insurance. So tell your doctor the truth--tell him that you started taking tramadol before you became his patient, but you're not certain if it's the best medication for you, or, if it is, you'd like to learn how to use it safely. He's a doctor. He's not God, not your father, and he's certainly not a cop. And whatever you tell him will not shock or appall him. But he can't help you if you're not honest with him. It's great that you've come to a forum seeking advice where most of the participants sincerely want to help you, but at the end of the day, we are not your treating physician, and THAT is the person you need to talk to.

I have had extensive use of both these drugs,tramadol/tramal and morphine oxycontin....I agree with the posted who suggested " leave the morphine out of the picture for a while and taper off the tramal "...at least down to 200mg if you can..Then start using the oxycontin/morphine "SLOWLY"..