Oxymorphone withdrawal is a whole different beast than Oxycodone withdrawal.
Not to mention it's so much stronger. Your 250mg a day of Oxymorphone isn't the same as 250mg a day of Oxycodone.
250mg of Oxymorphone IV = 5000mg Oxycodone Oral. Oral Oxycodone is slightly weaker than IV but not by much.
As such your tolerance is obviously much higher than it was & withdrawals would be exponentially worse.
Sadly enough most people don't realize that 10mg IV Oxymorphone is like approx 200mg Oxycodone Oral.
With a tolerance level as high as you speak of I'd say do a taper. I find tapering with Oxymorphone difficult though.
Due to the intensity of the withdrawals & how quick they hit IV Oxymorphone is hard to taper IMHO.
Well tapering with Oxymorphone itself that is. Switching & tapering is much easier.
Also with this taper are you plannin on taperin with IV route? Or trying to get off IV? That will make a difference.
Please post that information as possible as it will affect the answers given.
Also an idea as to whether you plan on tapering with the Oxymorphone or trying one of the other proposed methods.
Personally I would do a quick methadone taper & jump or quick methadone taper to short acting to jump.
It would be much less painful than tapering with the Oxymorphone from my experience.
Though my tolerance was slightly different when I tapered I was wearing 100mcg/hr Fentanyl Patches.
I would IV various opiates on top of this for example 40mg Oxymorphone IV per shot on top of said patches.
I tapered down using methadone with little discomfort. Though after switching off the Methadone to shorter acting meds
before jumping has me at a bit of a stand still. This is likely due to my longer usage 3+ years of high dosages.
Once I took a 2 month break after cold turkey off of 120-150mg Oxymorphone Nasally a day.
That was rough but doable. Since then withdrawals are much worse. It seems the longer your on opiates the worse they get.
So even though your dosages are high the short time frame will likely be to your advantage.
You could consider Suboxone but you'd likely want to taper first. As with Suboxone's ceiling dose it may not cover your current tolerance.
So you could always taper down then switch to Suboxone & taper with that. There are plenty of options.
The clonodine & benzo's & such will definitively come in handy.
They will help alleviate some withdrawal symptoms & all some sleep if your lucky.
I can't help but say that I disagree on cold turkey. With your dosage levels cold turkey would be extremely difficult.
Cold turkey from 120-150mg Oxymorphone intra-nasal though with a longer time frame was brutal.
Coming off IV Oxymorphone is even more brutal. Well it was for me even with doses of 100mg IV or so total per day.
My main issue became that as tolerance to Oxymorphone grew the time to withdrawal's shrank.
It was like I was either high or sick or hella sick. No real in between from feeling good to negative 10 in a couple hours.
I ended up having to dose halfway through the night just to sleep for a full 8 hours, was ridiculous.
Hopefully you 2 haven't run into those issues yet. As I remember it being some of the worst times I've dealt with.
That's one of the reasons I suggest the Methadone. You can stabilize & start cutting doses quite quickly in most cases.
It also allows for much less frequent dosing & a chance to get one's head straight & a taper plan in place.
I recommend figuring an exact taper & going so far as to document your plans & progress.
Doing so has always helped me to stick to said taper & to keep track of progress.
If you go the methadone route you may be surprised as to how low a dose will hold you.
Though considering it's Oxymorphone you may need a decently high dose to begin with.
Cutting the Methadone once stabilized for a few days can be relatively painless.
For example at one point I tapered using methadone. I got lucky & 40mg was enough to hold me.
I did 40mg for 3 days, then 30mg for 3, then 20mg for 3, then cut 5mg every 3 days till down to 10.
Below 20 it started getting a little worse at 10 it became much more noticeable.
Thus at 10 I cut 2.5mg every 3 days & then switched to short acting.
As methadone is great but it's long half-life means long withdrawals as such I usually taper with methadone
then switch to something short acting till the methadone is out of system so I can withdraw from a short acting med.
I find that to be the best of both worlds. The methadone makes the taper less painful & easier to do.
Then the short acting switch at the end reduces the duration of withdrawals by avoiding the methadone withdrawals.
If your considering tapering, using methadone to taper, tapering to suboxone, or anything of the like the following threads may help.
Suboxone & Buprenorphine Mega Thread & FAQ-v13.0
Methadone Mega Thread & FAQ-v-2.0
Progress Mega Thread
Also if you happen to need a dosage converter to help figure tapering dosages you can try the following.
Global RPH's Opioid - Narcotic Converter
If there's anything else I can do to help or any more questions I can help answer please feel free to ask.
Hope the information I posted is of use to you & I wish you 2 the best of luck with your situation.
