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.