Opioids In A Quandary & Could Really Use Some Help/Input!

[Emme80]

So, I will desperately make an attemp to make this as short as possible.
I've been on methadone( from a 80+ OxyContin addiction ) I very much wish I had I had ended this road on Methadone a couple years ago, as I have been...ready. But, that is as it is. Where I am at now- I have tapered down to 7.5mg. on my own. (I saved a little over 500mg. of Methadone from my take homes over the last 6-7..8months.. decreasing at home, as clinic would only allow 2/3mg every 4weeks... They thought I was on 34mg. when I up&left- never went back to clinic as of 3wks. ago.(of course they never called to see if I was ok... what happened... I will set my disappointment w/them aside though) So, the highest dose = maybe 140mg... That was a couple yrs.ago. I was at an average of... 45 for a good many moon. But, I'm now at 7.5. I've been reducing 1-2mg each week until I hit 8mg. Leveled out and now decreasing half a mg. or 1mg every 7 days(have room to wiggle if I need to "stabilize". I'm excited b/c I feel I'm at the home stretch. Handling minor wd's. On vitamins, have some(most) "comfort meds" I may need, etc. I have a plan I'm sticking to. I WILL end this chapter.
Now, The Quandary....!!!! In November of 2013, I had to "sit" at my dose due to a surgery. Well, I need the exact same surgery, again. It's an orthapedic surgery-basically, left&right foot, big toe separating from foot, due to "bursa sac" that gets infected inside & is pushing all toes to the right - my left foots been done already.Total success! I thought I could wait a year+ to do right foot, but it's...simply very bad. It's all very wrong looking, but I could give rats a** about that. But, with every step I take, I'm trying to avoid any pressure at all on inside if foot- or more so, my big toe. This "walk" is throwing hips off- domino affect.. It's painful as it is. Growing worse. I've known for long time how this progresses&it would need to be done before more permanent damage is done. It's imperitive now. Time to cut the bones&screw 'em back together. The last time, I was on bed rest for 2weeks. Those 2wks. Did require pain meds. Stronger pain meds. the first week, then .. Oxycodone(I think it was that)the 2nd week& the third week&on, it was Vicodin as needed. I never used all the Percocet-had my mom flush them w/me once Tylenol was perfect for the job. I'll be on crutches &surgical boot for 4wks. It's an ugly surgery . YUK!
So... I am in it. I'm continuing to taper-Won't be thwarted. Sometimes I think I should just jump now- but the surgery is scheduled for June 24th. And I don't know if that would be smart- esp. as I have 500+ mg. to finish this taper- I'm being very diligent with it. Not once have I up'd my dose due to minor wd's. I just don't know what's best to do. Keep doing what I'm doing... which is either 1-2mg every 7-10 days or just a 10% reduction if it gets harder. I'm wondering if I get down to much lower dose before surgery (4 or 3mg. At least) maybe I can switch to the shorter acting opiates&go off from there. Is that even possible to do? My mother will be holding my meds. (I'll be with her for a month, at least, as I will need help, esp. those 1st 2weeks- with a big fat black&blue foot, stitches all along the side of foot, bones cut & pieced together- ICK! It's... humbling when you need help in&out of shower.., etc.) Moms are so Wonderful, seriously! I digress... Already nervous about the surgery itself. Sorry. And I wrote way more than I intended. I'm super stressed about this...with the thought of ~
IS it possible to switch- at the last couple mgs. to a shorter acting opiate? If I then slip off from there, well, I will face what I have to face.
I'm quite determined to not be a slave to anything. I quit smoking 3months ago- (It was odd&sudden- one day, just fed up&done!)and even though I never took my Clonazepam daily( rx'd 1mg. a day as needed ),nor ever "ran out" or.. I don't know...I never took it unnecessarily- I was scared for that to be an issue, so haven't taken it in a couple months (tho I've read it can really help with wd's), but I cut that too. I guess I just met some kind of wall in my particular road?!? And I want Life back so badly-to continue what I was doing before this fork in the road. Close this chapter so I can write another!
Any thoughts, knowledge, ideas, would be greatly welcomed &appreciated. I know that there is a danger of switching to shorter acting. Either way- I'm ending this chapter... it's so long overdue.
I thank you all so kindly! (Esp. if you made it through this annoyingly long arse msg.!! I'm detailed and thorough to a fault!)
:/
Again, I truly thank you kindly- Emme80

 

[Emme80]

Has anybody had to have surgery when they are towards or at the end of a methadone taper? If so, how did that sort out?

 

[The Doc.]

Sorry I'vehad operations done while on suboxone (same idea as methadone) but I've never switched to another painkiller before for one I always used the suboxone for my pain just taking it 4-6 tines a day so its effective on pain more so than just once daily dosing.

So you want to know if you should switch to a shorter acting med, or if you should stay on methadone the dose your at while you are recovering, or if you should continue tapering the Meth while in pain?

 

[The Doc.]

you I suppose its your decision in the end how you want to do it. do you have a high tolerance to pain? if so you could stay at the dose your at or maybe split up your dosing to 3-4 times a day and take a little more than normal if you need it for pain. if you think your gonna be screaming in pain then I would go on oxycodone a timed release and fast acting ones as your body is used to having constant 24/7 opiates flowing through your veins meaning youll need oxy to do the same thing. or you could stay on the low dose methadone and take whatever fast acting meds you need when the time comes where the pain gets un bearable. if you decide to take any fast acting meds either way your gonna reset your taper back quite a bit cause your tolerance will be raised meaing if you go to take the same dose of methadone after its not gonna hold you over because you need more opiates. you could always do another taper afterwards though I would worry about getting healthy and staying pain free then worry about getting clean of methadone/opiates in general.

just my 2 cents

 

[Emme80]

Thx. Trainspotter. Indeed, I probably did not make my inquiry precisely clear. My head is swirling in thoughts that go sideways :/
So, I will taper as much as I can before surgery- I don't think wise to "jump" now(unless someone has an enlightening perspective on said "jump") What I had hoped:
* If I can get dose down reasonably lower, might the meds.- ranging from either Morophine / Oxymorophone(last time they were ER) for the 1st week ( I don't know if those 2meds. are relatively similar-I DO admit, I'm not well versed in the similarities of all opiates. I will look those facts up here on BL). The 2nd week- something a bit weaker & then the 3rd&4th weeks, it was Vicodin/Percocet. Could was hoping these could "take the place" of the 3/4mg. of methadone.
Last time, I did not take my methadone for the 1st week- by week 2, I did resume taking my methadone-that's when I started reducing on my own, with my take homes. I was at a dose of 34-40mg at that time(Mid-November) This time, I'm at a hair over 7(just a well, should be said 7mg.really)as of today. So yes, my quandary was just as you figured-if it's possible to switch out the methadone to short acting opioids & be "okay" without the methadone... ?

Again, I do have(saved up a lot) 500+mg. to taper off methadone slowly if the ol' switcharoo does not pan out. But I sure would like to switch to short acting for 3-4 weeks&then jump off those. Perhaps I've just been dreaming....
I do apologize if I'm still not making sense! Thank you kindly for your response & patience for trying to make sense of my.."quandary".
I'm scared... scared of debilitating wd's- I suppose I will just taper down as much as I can... and hope I won't end up on the floor, beyond sick. Maybe I will just take the meds. during the worst of it- the 1st week. Ugh! I SO wish to close this chapter ASAP & be able to start a new chapter of my story.
Thank You A&D Trainspotter, you're so helpful in so many threads! I hope I can be of help to others one day...if I can just get off this shite! I'm just SO scared of this surgery&my taper! *feeling sorry for myself*, I know...
SO many thanks Trainspotter, truly... and thank you for your honesty as well! You're rad...

 

[Emme80]

I don't know if I can rate my pain tolerance as I think the methadone has altered it a bit perhaps. Prior, yes. I AM willing to deal with moderate pain. Would rather put up with some pain that I know will be fleeting compared to jumping off methadone pain. I do believe it may not be wise to jump now, as I have no idea if I would be " well" by June 24th. Perhaps I will just take the meds. I will more than definitely need the first week, but stay with my current dose, and only take the Vicodin if absolutely necessary- like the kind of pain that would send you to hospital kind of pain. I REALLY don't want to go backwards. I do have the luxury of decreasing only 10% every 7-11days if I need to.(I'm sure glad I saved what I did...) Too bad I left my clinic a week before I found out how necessary&soon the surgery needed to be). Oh well, it is what it is. One would think I would be more knowledgeable of all things opiates..(i.e. equivalencies, splitting dose throughout day, etc.)
Trainspotter, you mentioned splitting dose throughout day... Did you do that? As I am on 7mg. a day (I plan on a 2mg. Reduction tomorrow... As I WILL try to get as low as I can before surgery- I'm already on leave from work, so I'm at home, don't have to worry about feeling a hit w/the reduction&managing any real responsibilities- other than myself& my big furry best friend.. My big ol' dog).
Will splitting up the dose while I'm recovering from surgery, help keep any slight to moderate wd's at bay a little more, as I would be "feeding" my body through the day? And would you recommend doing that thru the rest of my taper? That is something that I've read & has piqued my interest. I've never split my dose up- but perhaps a good idea towards the end if this taper as well as recovering from surgery?
(I had hoped that if I got my dose low enough before surgery, I could just take the meds. given- as last time I didn't need to take my dose while I was on the ER opiates the 1st week..but my dose was at 40/45 then. I thought maybe I could switch to the meds. given, and by 3rd week, taper off or just try going c/t from there... wherever I'm at, but I guess that's not ... Logical)
But I am interest in splitting my dose up.
Dang, I can't wait until these things are not an issue for me!
Many thanks, Emme80.

 

[The Doc.]

Lol no problem I know what you mean its frightening for us addicts to know we are gonna be in pain from surgery and knowing that it could set us back into our old ways if we choose to control our pain with doctor prescribed pain meds. But the thing is I think you will be fine judging from your character the way you took responsibility and told your mom to hang on to them. Yes you will probably screw up your taper a bit scrap that you will screw it up when taking pain meds so I suggest you go off the Meth save what you got for another taper then switch to the meds your doc gives you. Once you no longer need the meds then go back on a dose of methadone that holds you. What I would do is take the same as the last dose of methadone your took before switching over then see how that holds you if you can handle any alight discomfort then great stick with it and continue tapering when you want to if not which is more likely after surgery then up the dose 5mgs or so till it covers all your symptoms then you know where your tolerance is at and can continue tapering.

 

[The Doc.]

And yes splitting your dose works wonders on pain and keeps you at a steady level of methadone all day and night. When pain patients get methadone prescribed to them they usually take around 5-10mgs every 4-6 hours because its more effective on pain when taken that way.
It also helps to taper yes I split up my dose and it made it 10 tines easier to taper it.

 

[Emme80]

Ahhh... there comes great power & relief in decisions vs. juggling so many possibilities. As your plan stated above, is what I was leaning towards. I'm gonna tough it out and reduce all I can-anything short of full on 100% wd's-until a few days before the surgery. The the above mentioned plan. Once I can stand up on both feet, literally, I will stabalize asap, then taper taper taper. I figure, even after 3/4wk. mark, I will( my foot & leg )still swell a lot & will be on a bed or couch for a bit longer. So, perhaps never a better time to finish the taper! Uhhghhh...it will be a long hot summer, but it will be worth it all. I'm just gonna get through this surgery- use plan stated- and then work my way off methadone! And not read all the pure horror stories of people being on the floor, so sick it feels like death. I think those stories are causing me more anxiety , along with the thoughts I've been mulling over regarding the surgery&methadone.
It's odd, what an addict I am, yet in my old chifferrobe, there's Percocet from Dec. 2013, when I was put in hospital for very large bloodclot, which caused permanent damage..I sometimes remember it's there, but I never take out that skeleton key to open that door.
I really appreciate all the help&advise! Doctors can guide you as much as they want, with all their knowledge, family&friends can help all they can- but only someone who's been IN it can give some of the best advise !
Thank You Kindly Trainspotter! I hope all goes well. At least I have a plan, thanks for helping me hash it out!

 

[Emme80]

Splitting dose throughout day is very valuable info! I'm going to initiate operation split tomorrow!

 

[The Doc.]

right on keep in mind it will take a little while to adjust to split dosing if youve been taking it once a day for all this time beause when you take it in the morning you will feel like you need more because your used to taking the whole dose at once. to get past this you can give it a bit of time it won tbe long before you adjust on your own or you could up the dose a bit like say you took 15mg once a day then when you switch to split dosing you may need say 10 in morning and 10 at night to stay happy then you can taper down which will be easy with split dosing as you can take a mg or 2 off both doses you take everyday and you wont notice it as much as once daily dosing because night time you wont be tossing and turning waiting for the next morning to be able to dose.

 

[The Doc.]

and to answer your question morphine is weaker than oxymorphone quite a bit weaker actually the morphine may be your best bet for pain as it doesn't have quite as strong a rush/euphoria as other things such as oxycodone/percocet do. also Vicodin (hydrocodone) is another good one as it doesn't have a strong rush and all in all its very weak.

the ones you really got to watch for that could get you addicted or your tolerance raised real high are Percocet/oxycodone ( Percocet is oxycodone if you didn't know it just has acetaminophen mixed in with the oxy percs are actually more addictive than high dose oxycodone ER because the dose hits you all at once not over 12 hours) and opana (oxymorphone) also fentanyl is real intense that could get you right hooked or even dead if not used properly the skin patches are good and not too addictive IF used properly.

also I don't think youll be able to jump from your pain meds that will be every painful and you may as well use that methadone you have to tape rwith that's the whole point of your taper is to make the jumping part easy on you if you taper the meth to nothing stop then go on pain meds then try to jump off your gonna be pretty sick as youll still be dependant when you stop the meth and anytime opiates enter a former addict body even for legiminate use its almost certain there gonna be going through really rough withdrawl symtoms when they stop when normal people who have never had an opiate problem before would have no withdrawl symptoms. sometimes all it takes is one time and your addiction centre is fired up full force again so keep that in mind.

people bad mouth methadone all the time but in reality methadone is meant for easy tapering off other opiates and that's what it works good for due to the long half life. stopping painkillers/heroin cold turkey or trying to taper with either of those is a pain in the ass and way more difficult than tapering methadone and jumping off at a real low dose. the horror stories you hear are mostly people doing it wrong and jumping of doses like 120 mgs or people who thought it would be absolutely pain free when they stopped. although its not fun or symptom free when you taper down meth and jump off the right way its not too bad youll have some symptoms that arnt too horrible for a while but theres just no way around that you always gotta have some pain when detoxing its just the way it is we don't have a cure all pill for that but its certainly so much easier than doing it any other way like cold turkey so don't be scared by those stories .

 

[Emme80]

Wow! Thus might be perfect timing then! I'm currently stable & my body has adjusted from my last 2mg. reduction. I'm at 7mg. If I do 3.5 or 4bas split doses (5mg if I HAVE to- I'm still going to be stubborn girl & try to keep dose low&even still, taper as low as possible between now and the surgery). But it makes sense...and I do see why, when you start a split dose after doing a single dose for so long, that you might/would likely need to bump it up a little... But the benefit of being able to cut it down easier is great! I'm liking this method! Particularly with the upcoming surgery! So helpful Trainspotter! Too kind!
I will start this tomorrow. As ALWAYS, thank you kindly.

 

[Emme80]

Thank you for the reassurance that that tapering off methadone the way I've been doing it is not likely going to be the severe wd's horrors I hear. I expect discomfort, pain, ickies. I don't expect to get off Scott free. Gotta pay the price. Methadone certainly allowed me to make the necessary changes I made. I do wish that my counselor had said "hey, you've been in a stable, "clean" life fir a few yrs. it's time for you to move onto a new chapter". But, it is what it is & I'm closer to the finish line than I ever have been- on this long road. I will adjust dose due to surgery as needed then when I know my body can handle it, I'll resume taper. I've had a decent taper thus far- only hit a wall twice. I'm very grateful for all the info. and explanations. Indeed, the 1st week or week & a half, they'll give me an ER pain med. (I can't remember exactly what it was, but it was an ER) as well as a Percocet/Vicodin for breakthrough. I'm gonna try to stick with just the ER one. Only with "holy hell I can't breathe it hurts so bad b/c my bone was cut in half &screwedvback together" kind of pain will I take the breakthrough pain med. I know I can get through this w/I too much collateral damage I WILL! your advise& info has helped extremely. Odd, to be an opiate addict&not know these things!!! :/

 

[RTrain]

At 7.5 mg you shouldn't have much of an issue switching over to Suboxone and tapering off that, which will be much easier.

Also, you said your habit prior to starting methadone was 80+ of oxy, you mean 80+mg a day or what. Because using methadone for that is insane and I can't fathom how you ended up on a dose of 140 mg a day of the methadone unless you were taking a crazy large amount of oxy.

 

[The Doc.]

I think she's fine sticking with methadone she doesn't have any suboxone and suboxone is still a bad thing to come off. The OP seems to be doing real good tapering Methadone so why switch to suboxone? Also she's having surgery suboxne is the last thing you want to be on when having surgery.

 

[The Doc.]

At 7.5 mg you shouldn't have much of an issue switching over to Suboxone and tapering off that, which will be much easier.

Also, you said your habit prior to starting methadone was 80+ of oxy, you mean 80+mg a day or what. Because using methadone for that is insane and I can't fathom how you ended up on a dose of 140 mg a day of the methadone unless you were taking a crazy large amount of oxy.

It doesn't matter what she did in the past her tolerance is a lot different today. Lots of people go on methadone for oxy or painkiller addiction they don't need to be taking 500mgs of oxy a day to go on methadone to stop bad habits and save their liver I'd rather see someone on that than oxycodone.

 

[Emme80]

Hey RTrain, how are you? Indeed, my habit was dabbled with a Vicodin here or there in college to picking up OxyContin 80mg. a day average in my for 1year. Sorry I did not specify/forgot to put the "mg" in the said post. Agreed, it is insane. I admitted I had a problem to my Dr. & was sent to a methadone clinic. I did no research- I listened to what my Dr. said, and what the Clinic said & my Family said. And I thought it was my answer. And it DID do what it's meant to do. after my evaluation/intake. Everything said methadone was the way to go. Over 2-3 yrs. at clinic, I was always encouraged to increase, increase, increase. . So I did. Do I wish I'd done research online or such. Of course! But I've never been a huge internet girl. Even now, I don't own a computer...nothing. Just my iphone. (Admittedly, a bit of a Luddite) I know now that I never needed to be on that high if a dose really.
It was done gradually over 3+yrs. the "increase increase increase", I woke up and reduced reduced reduced. I believe methadone is a life saver. Where would I be now? Don't know. Sober? Maybe. Dug in deeper? Good chance. What I do know, is I'm here, Now. Woth life. Methadone is an incredible tool&life saver to some. And it allowed me to make necessary changes. But I do not believe I should have been at that dose or have been in this long. Even the last day that I went to get my take homes, I was on a plan of reduction&it was stated as so in my file there-but they always gave me reasons I should increase..which I have not increased over the last 2yrs.
I voiced my opinion about this exact matter in the methadone mega thread. I, (in way too many words)explained how I feel with people being taken into methadone clinics so easily&up'd on high doses.Mt opinion of this is there in the said mega thread, as well as what I would LOVE to see happen with methadone intakes.It is an...issue I have, yes. There are changes I would LOVE to see initiated & in place. But I AM an advocate of Methadone.
But, I cannot change where I was...I am where I am now- close to being out of this tunnel. Needless to say, I now am hyper-aware& wary of any medication suggested/prescribed. It may sound unfathomable or Insane, but it was certainly has been my world the last 6+yrs.
As for 7mg. & switching to subs, I considered it heavily & After research(on my ill' "computer " iPhone ). With the facts, I thought about it and w/my gut feeling, I firmly decided to stick with the beast I know. Methadone. I know how it works, and it's almost a personal vendetta now. So, no subs. for me. As insane as it may sound, I that is how my journey to here&now took place. I've learned a lot on the way and that's...my story.
Thx. Trainspotter- for knowin' my story while I was sleeping and supporting the fact that it is what it is right now! That's real support. You must help SO many here. From me &ISO many others, many thanks!

 

[The Doc.]

Your welcome
Always nice to hear I've helped somebody out and to know I'm appreciated.

I'm here to give you info not judge I'll advise you to do something different if I think it could benefit you but I try not to judge.

Your right but the thing is methadone clinics ate trying to help a lot of the time cause they would rather be sure your comfortable with enough meds rather than sick all the time and feeling shitty. I agree lots of doctors will push doses up real high for no apparent reason and even encourage then too in lots of cases but a lot of the problems cones from the patients chasing that high that never seems to cone on like you would hope. See methadone is very strong and effective on pain but doesn't have the make up of a very euphoric opiate meaning although you may be taking around the equilivent of 500 mgs of oxy on a dose like 120-140mgs of methadone but you won't feel nearly as high as you did if you took say 80mgs of oxy because the oxy holds more euphoria than methadone. Lots of patients want that high still so they keep raising their dose up and up chasing a high that never comes

 

[Emme80]

Oh yes.. I heard many patients in the clinic talking to each other in the "waiting room" about how much should they go up to try&catch a buzz.. that warm whizzy feeling. I do believe fully that they'd rather keep one stable and on enough meds. vs. chancing an OD due to a patient using to get "it". I simply wish- all I know is my experience- I played it all by the book, I'd been in a stable, "clean"(just the methadone&the 3surgeries=some pain meds., but mainly it was the foot one that was REAL pain), therapy, I had all the changes in place & was that way for over 3yrs. Once I signed to taper, they would never remind me - "hey, it's been four weeks, ready to go down again?"...not once. But I was always asked if I needed to increase. I just think that as much as they help people get their lives back, when they see that someone is in a good place in life, all sorted&stable, they should also be just the same kind of help to give life back. It's up to the patient to do so, completely. But I just wish they'd encouraged my taper once I was BEYOND ready to get on with my life instead of encouraging me to actually increase, when I was doing fine w/the taper, and still stable in "life". I will ALWAYS support Methadone. It saves many, including me. I suppose I just wish there were a second party to help the patient to see all sides, before, during and at the end of their treatment. That's all I wish, does that make sense?(I know I talk in circles 8) )