Bupe Chronic pain patient switched from morphine to subs. Confused about timeline, any advice appreciated

[_Somethingintheway]

I have trigeminal neuralgia and have been taking 120mg of morphine for the last 6 years and before that I was on oxy for several more. I have never been able to taper because of severity of my physical w/ds. I was in the seizure monitoring unit this week and they offered me access to the toxicology team where they basically told me I could stay on my morphine, switch to methadone or switch to subs. My current dose of narcotics is not sustainable for my condition, I need to reset my opiate tolerance, and it was clear Suboxone was the right answer if my goal was truly to get to zero.

It's been 72 hours since I last took morphine and have been prescribed 4mg Suboxone in the morning with an additional 4mg to take as needed if I feel withdrawal symptoms. I want to stay on as low a dose as possible but I don't really understand the sort of timeline I can expect with the physical withdrawal symptoms as I'm not at all familiar with this process. I took 4mg this morning and was hit with a bunch of w/ds later so I took 2mg more.

From your own experience had I just toughed it out today at 4mg is that something that resolves/balances in a couple days? Or is this the sort of thing that I should really get myself to wtv amount I need (5-8mg) to experience no w/ds before trying to slow taper down from there? I'm just so fed up with this entire process already and don't want to end up on higher dose than is necessary. I can take up to 500mg of lyrica a day and have access to a valium rx. I know subs are notoriously hard to get off of but I was never getting down from that morphine dose alone. I just want to be done with all of this and don't want to trade one problem for another. I've only been on subs 5 days. Any advice appreciated, thanks.

 

[Them Witches]

Sorry to hear you are going through that awful nerve condition. I hope at some point soon it will change for the better.

120mg Morphine is the same as 85mg Oxycodone. I wouldn't go up on the Subs too high because you have a reset goal.

I would try to stablize on the current 4mg Sub dose and take Clonidine 0.2mg-0.4mg daily, Lyrica 500mg, Valium 30mg-40mg, and Promethazine 50mg daily. If you still have too much anxiety, stress, etc add Vistaril PAM 200mg daily. Stick with this medication list until you are comfortable into your transition. At that time evaluate which ones of these meds for best for you and stick with it.

When you start to taper the Subs, add some of these meds back into your daily schedule until comfortable.

You have a very painful condition, is it okay to ask you - "Why not increase your morphine dose or add a breakthru opioid ?" A 120 MME is relativity low by chronic pain syndrome standards.

 

[_Somethingintheway]

Sorry to hear you are going through that awful nerve condition. I hope at some point soon it will change for the better.

120mg Morphine is the same as 85mg Oxycodone. I wouldn't go up on the Subs too high because you have a reset goal.

I would try to stablize on the current 4mg Sub dose and take Clonidine 0.2mg-0.4mg daily, Lyrica 500mg, Valium 30mg-40mg, and Promethazine 50mg daily. If you still have too much anxiety, stress, etc add Vistaril PAM 200mg daily. Stick with this medication list until you are comfortable into your transition. At that time evaluate which ones of these meds for best for you and stick with it.

When you start to taper the Subs, add some of these meds back into your daily schedule until comfortable.

You have a very painful condition, is it okay to ask you - "Why not increase your morphine dose or add a breakthru opioid ?" A 120 MME is relativity low by chronic pain syndrome standards.

Thanks so much for the info! Honestly I had access to 160mg a day but oral morphine being a bit shit paired with my tolerance meant it was hardly working anymore. I have a handful of pills I held onto from my last bottle for if I was going to kill myself from pain but my understanding is it won't work with the Suboxone in my system? I'm sure methadone would have probably been a better choice for pain management but I knew I'd never get off of that either. I'm definitely regretting starting this process now with the amount of pain I'm in. They basically said there was no doubt the prolonged opiate use had given me opiate induced hyperalgesia and that the morphine could be provoking my seizures. Thanks again for the info, I will follow what you said and hopefully I can hack it with the lyrica and valium :/

 

[LucidSDreamr]

I have trigeminal neuralgia and have been taking 120mg of morphine for the last 6 years and before that I was on oxy for several more. I have never been able to taper because of severity of my physical w/ds. I was in the seizure monitoring unit this week and they offered me access to the toxicology team where they basically told me I could stay on my morphine, switch to methadone or switch to subs. My current dose of narcotics is not sustainable for my condition, I need to reset my opiate tolerance, and it was clear Suboxone was the right answer if my goal was truly to get to zero.

It's been 72 hours since I last took morphine and have been prescribed 4mg Suboxone in the morning with an additional 4mg to take as needed if I feel withdrawal symptoms. I want to stay on as low a dose as possible but I don't really understand the sort of timeline I can expect with the physical withdrawal symptoms as I'm not at all familiar with this process. I took 4mg this morning and was hit with a bunch of w/ds later so I took 2mg more.

From your own experience had I just toughed it out today at 4mg is that something that resolves/balances in a couple days? Or is this the sort of thing that I should really get myself to wtv amount I need (5-8mg) to experience no w/ds before trying to slow taper down from there? I'm just so fed up with this entire process already and don't want to end up on higher dose than is necessary. I can take up to 500mg of lyrica a day and have access to a valium rx. I know subs are notoriously hard to get off of but I was never getting down from that morphine dose alone. I just want to be done with all of this and don't want to trade one problem for another. I've only been on subs 5 days. Any advice appreciated, thanks.

If your pain is still significant and you intend to stay on opioids I would’ve gone with methadone over Suboxone. Subs and methadone are the hardest to withdrawl from so I’m not sure what you’re expecting having it be easier than tapering off morphine.

Suboxone is worthless for moderate to severe pain and every bit as dependency causing as methadone. Methadone has good analgesia.

What they did here was force you from a schedule 2 to a schedule 3 so that the dea gets off their ass. This has zero to do with what’s best for you

At that high of a morphine dose it’s not surprising your feel like shit on subs. It’s should last a week I would say before you adjust to subs. Methadone would’ve been a seamless transition

 

[Them Witches]

Bring up Clonidine with your doctor to help ease transition withdrawals. It will also help with sleep and provide some brain relaxant effects. The Clonidine will also strengthen the effects of the Valium.

With your condition no doctor should be pushing you away from opioids. As mentioned above in the last post, Methadone would be a better option than Suboxone in many ways.

I would also suggest Vistaril PAM for it's mild sedative effects and relaxation. Promethazine would also be another helpful medication for discomfort and sleep. Clonidine with both of these medications would strengthen the effects of them and would help significantly offer sleep and relaxation benefits.

 

[abdnlad]

First thing to do is don’t listen to the doctor, I was on morphine for years, 120mg sevredol, 90mg MST. I asked if I could get some help with withdrawal (diazepam) he sent me to a government clinic where they wanted me to get registered as an addict and with the local police force. This I bluntly refused, I wanted help not to go on a police database.
Anyway, I took it in my own hands, by reducing 10mg per week NOT PER DAY. And change to a different day to reduce each week,
Took me best part of 9 months to get clean, without any problems. I still have pain everyday, can’t stand for longer than 5 mins, but I have come to terms with it, it was my fault that I am in this situation. Fell asleep at the wheel after been awake for 5 days straight