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Opioids Fentanyl patch self taper?

oar9fi

oar9fi

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Apr 29, 2009
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"Stop, collaborate and listen" -Vanilla Ice
I have a friend who was in the hospital recently who had some problems likely related to a liver transplant years ago. She's normally prescribed just 90 5mg oxycodone every month but she doesn't have a real habit.

After her hospital stay they gave her 10 25mcg/hr fentanyl patches. I warned her that she might land herself in trouble if she stays on the patches for the whole 30 days. She agreed and really she's better off just using her pain meds if she needs them. After a full month of fentanyl her 5mg oxys would probably be useless- meaning higher doses & maybe having to go to a pain management specialist. She doesn't want that.

I think she's on her 3rd patch (maybe 4th- I didn't ask her.) My question is this: If she keeps the patch on longer than 3 days, will there be a smaller amount than 25mcg/hr being absorbed for a couple of days causing a sort of self taper? I don't think it would drop straight to zero. They are the Mylan (non-gel) type.
 
Sure it's possible there may be a small amount left in the patches. I've heard of people "overlapping" them, meaning put the next patch on with the old one still in place simply because it can take hours for the medication to kick in. This is where breakthrough meds come in handy though. But it's generally not recommended to leave them on for more than 72 hours.

What you're talking about is completely different though isn't it? If your friend wishes to taper off the fentanyl patches, she needs to get advice from her physician. Fentanyl is very potent and withdrawal can be brutal so it's good you are looking out for her. Especially since she has liver issues which any drugs can complicate.

I've known people who didn't react well to the mechanism of patches and gotten ill (like dopesick) after 36-48 hours. So it may appear to drop to zero, like you said much quicker but you just don't know for sure. Absorption can vary from person to person, these patches are tricky. She cannot wean off them alone! Have her see her doctor with any concerns!
 
It wasn't her regular doctor but the one in the hospital that prescribed it. I don't know when her next appointment is. Since she's only been on them for less than 2 weeks it might not be too bad. I suppose she could also cut the patch in half since it's the fabric type if she does have any WD. It's ok to cut the fabric patches but not the gel ones IIRC.

Yes, she really needs to talk to her regular doctor but until then she should try to take as little as possible or get off them.
 
IME fentanyl used even for very short periods of time (1 week +) leads to a very fast tolerance build up because it is so strong. I binged on hydrocodone (50mgs/day) and took 1 75mcg patch for just one week. When I stopped, I was hit with mild physical w/d's but HARSH anxiety, depression, dysphoria, and insomnia. I had my first panic attack which scared the shit out of me. Since then, I promised myself to stay the hell away from fentanyl and any other full synthetic opiates. It's bad news
 
Yes these type patches (non gel) can be cut to smaller pieces in order to taper and that may be her best bet. Do you think maybe the doc from the hospital planned on leaving her on these/having her regular doc continue them for awhile? They are specifically labeled not to be used afer surgery/short term so it is ridiculous that a doc put her on them for only a month.

Also, in theory they should still release a smaller amount of fent after the 3 days is over but they do not. As someone else said they abruptly stop releasing the medication and for some people this actually begins happening after only 48 hours not 72. So though there is still medication left in the patches after the designated time period for some reason they do not continue to release it.
 
Yes, in theory this could work. In practice it will not. I have tried. They stop releasing fent after 48+ hours for me and most of my friends. 72 hours is really pushing it if you are using it for pain and not getting high.

There is still fent left in the patches that can be extracted after you have removed them. But it won't work by putting them on.
 
^^ Yep, the patches seem to get much weaker approaching the 48 hour mark. When I'm using them, I can feel withdrawal starting to set in around the 60 hour mark. I'm wearing a patch right now and I can feel the initial symptoms of wd and it has been 57 hours since I put on this patch. Only one more to go and I will be in a world of hurt. I usually take them off around that 60 hour mark and cheek or smoke the gel. If it is the matrix patch, I will cut them into smaller pieces (4 pieces if it is a 75mcg) and cheek each piece for about 6-8 hours just to fight off withdrawal. I'd much rather have the matrix patches because you can cut them.
 
I tried to call her a few days ago to see how she was doing and I found out she was back in the hospital. This time in the ICU with encephalopathy due to high blood ammonia levels. They said today that she probably won't survive another day. She developed a bowel obstruction which in addition to her liver problems means death. I don't know if the patches contributed to her problems. Her brother mentioned there were more patches missing than she should have used. I think it's just the end of her second chance.

They said she has no hope of recovering and are just keeping her comfortable until the end. So sad...
 
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Excerpt from PubMed article "Pain Management in the Cirrhotic Patient: The Clinical Challenge"

"If opiates are required for pain control, lower doses and/or longer intervals between doses are needed to minimize risks. Hydromorphone and fentanyl may be the better choices. Careful follow-up is required to check for signs of sedation, constipation (a risk for precipitating encephalopathy), and early encephalopathy. Any sign of these complications necessitates immediate discontinuation of the opiate."

After reading this, I think the fentanyl was the triggering factor. Constipation due to the fent precipitated the encephalopathy. She's still alive but is comatose and is definitely dying. Her BP is 50/20. I'm going to miss Jessica... I already miss her. She is/was only 32 years old

EDIT: I just have to say this... FUCK ALCOHOLISM!!!
 
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She's dead. Her kidneys stopped last night and she died at 12:30 this afternoon. Only 32 years old.

I realize I've derailed this thread but I hope you can understand I've just lost a very dear friend.

To keep it a little on topic, If you are reading this please be aware of the danger of bowel obstruction when using patches- even properly. Especially if you have liver issues. And if you are a heavy drinker, please get help.

RIP Jessica. I love you and will never forget you.
 
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