Need help getting off IV Dilaudid

[KJ_Namaste]

It's been a long time since i've posted here but I supposevthe time has come that I am ready to reach out for help. I've been using opiates on and off for over 10 years, and ive been a daily user for the last year and a half after a 1 year break that ended in relapse due to mental health issues and PAWS.
I picked up the needle for the first time about 8 monthes ago, went from snorting dilaudid to shooting. My dose has been constant at 8 mg between 5 and 8 times a day (40-64 mg IV) daily.

On top of that I have been also taking 100 SR morphine daily, though i find I can go without it.
Now, i'm at a point where I am sick and tired of dealing with doctors visits, IV, and the list goes on...my goal is to escape the cycle, but i don't know what strategy to employ.

I do know one thing for sure and that is I dont want to go cold turkey because last time I did that I ended up suffering from PAWS for a year before relapsing.
Now, it seems like my options are such....

1. Suboxone microdose
2. Methadone
3. 24/hr release Morphine

I'm inclined to go with the suboxone route as my doctor suggests, but the question is how long should i stay on it...and will it be able to stop me from wanting to inject Dilaudid?

 

[axe battler]

To be honest I don't think the subs will stop you wanting to inject dillies. They should however help quite a bit with the cravings, but after a while you may still want to get high. The subs will block the ability to get high from other opioids whilst you work on what's causing you to wanna take them with therapy, meetings, whatever.

It's good you have choices though. If it were me I would start taking the ER morphine orally and to gradually take less dillies - orally too if you can but plugging or snorting are apparently good compromises as long as you're able to reduce your dosing!

 

[KJ_Namaste]

To be honest I don't think the subs will stop you wanting to inject dillies. They should however help quite a bit with the cravings, but after a while you may still want to get high. The subs will block the ability to get high from other opioids whilst you work on what's causing you to wanna take them with therapy, meetings, whatever.

It's good you have choices though. If it were me I would start taking the ER morphine orally and to gradually take less dillies (orally too if you can!)

Thank you for the reply Axe Battler, I am happy to be back here and lucky to have a community like bluelight to consult during this difficult period. Being in BC Canada i'm also aware how lucky I am in terms of having access to harm reduction resources and a progressive minded policies surrounding OAT.
I just experienced first hand how different the scene is in the states where i'm originally from. Went to my home state over Christmas not realizing how much things have changed in the last 10 years...if it werent for my family doctor there I would have probably been screwed.
I travelled there for a month long trip with only a week supply of my meds thinking it would be no problem getting my weekly scripts. Turns out getting my script was the easy part,albeit expensive since I had to pay out of pocket....but it turned out that the Pharmacists were the issue.
My script is 5 x 8 mg dilaudid tablets
6 x 10 mg methylphenidate
100 mg SR Morphine (Kadian)

Now, I literally called/visited every pharmacy on the island with that script to no avail....got plenty of dirty looks and lectures about DEA quotas, and that they don't carry the formulations or quantities etc.
Took me almost a week with the help of my doctor to get Costco to eventually fill the script, after changing the script from 8mg to 4mg dilaudids....long story short it was a nightmare and part of the reason I want to get off these meds, and not to mention the needle (also was a nightmare trying to purchase syringes OTC).

I digress, so back to your reply...you reckon that Suboxone won't really get me off the needle? I've been taking the stuff since Thursday but just realized that I have been using the medication wrong.....the doc forgot to mention that it is not designed to be swallowed like evefy other pill haha, so i've been swallowing the damn things the whole time!
Funny thing is...yesterday I swallowed the 1 mg halves twice daily and even at that low level of bioavailability I can feel that it's reducing the effectiveness of all the drugs i take, including the methylphenidate.
My fear is that im just going to keep increasing my dosage of opioids out of frustration if i keep taking the suboxone...because if im swallowing such low doses and getting this shitty feeling already then will upping the dose help?

Im going to visit the doc tmmrw, im thinking ill suggest that she write me a script for 1 12hr release 100 mg m-eslon, and double my daily kadian dosage to 2 x 100 mg SR....so 300mg total.
Does this sound like an amount that will satiate me? In my experience, when i have been sufficiently opiated with oral opioids I wont even want to shoot up dilaudid because then its just too much...anyone relate?

Sorry for the rant, since i started taking that suboxone (albeit the wrong way) i just feel lime my brain is scfambled and im really fiendy...is this drug like that even when you reach a stable dose?

 

[axe battler]

It does kill cravings for sure. It's hard to say exactly how well it'll work for you, but subs are normally only super effective if someone really really wants to quit. At a dose of 6mg or 8mg+ then you pretty much can't get high anymore.

I like your morphine idea, wish I had that option as I quite like oral morphine. Better than methadone anyway!

It really depends what you wanna do. If you wanna taper and get off everything then the suboxone at an effective dose - wait until you're fully in withdrawal - 24hrs at least after your last dose but probably more like 36 with an ER pill.

If you wanna maintain a while I would go for the extra ER morphine (you lucky ducky).

 

[KJ_Namaste]

It does kill cravings for sure. It's hard to say exactly how well it'll work for you, but subs are normally only super effective if someone really really wants to quit. At a dose of 6mg or 8mg+ then you pretty much can't get high anymore.

I like your morphine idea, wish I had that option as I quite like oral morphine. Better than methadone anyway!

It really depends what you wanna do. If you wanna taper and get off everything then the suboxone at an effective dose - wait until you're fully in withdrawal - 24hrs at least after your last dose but probably more like 36 with an ER pill.

If you wanna maintain a while I would go for the extra ER morphine (you lucky ducky).

That's what i figured, I jumped into the suboxone thing thinking that it was some kind of miracle drug....but from what my research tells me, and like you mention...you need to have the intention to really want to quit for this stuff to work it seems.
Now, of course I want to get off the needle...but i guess im not quite as motivated as I need to be because im not willing to sacrifice the good feelings that dilaudid gives me, and it sounds like Suboxone wont give me those feings that I desire.
Im pretty confused as to how a drug like suboxone which doesnt produce euphoria is supposed to be an effective replacement? Methadone makes sense...its a long acting opioids replacing a short acting one...same idea with Morphine.

Wow i guess i'm really lucky to have the morphine option haha. Where are you located if you dont mind me asking?
Morphine is used here in BC in OAT but only as a 3rd line treatment i believe....meaning they normally start you on Suboxone, then they try Methadone, and finally Morphine.

Now i hope the doctor allows me to bypass the methadone option, its just silly if you ask me though....they write me a script for Dilaudid take homes easily but seems like morphine they want you to take it at the pharmacy just like methadone...thats the issue i see arising, because i want to take my script home. Lol im spoiled i know!

 

[Opi_Kid_Rock]

It's been a long time since i've posted here but I supposevthe time has come that I am ready to reach out for help. I've been using opiates on and off for over 10 years, and ive been a daily user for the last year and a half after a 1 year break that ended in relapse due to mental health issues and PAWS.
I picked up the needle for the first time about 8 monthes ago, went from snorting dilaudid to shooting. My dose has been constant at 8 mg between 5 and 8 times a day (40-64 mg IV) daily.

On top of that I have been also taking 100 SR morphine daily, though i find I can go without it.
Now, i'm at a point where I am sick and tired of dealing with doctors visits, IV, and the list goes on...my goal is to escape the cycle, but i don't know what strategy to employ.

I do know one thing for sure and that is I dont want to go cold turkey because last time I did that I ended up suffering from PAWS for a year before relapsing.
Now, it seems like my options are such....

1. Suboxone microdose
2. Methadone
3. 24/hr release Morphine

I'm inclined to go with the suboxone route as my doctor suggests, but the question is how long should i stay on it...and will it be able to stop me from wanting to inject Dilaudid?

Combining Opioid Replacement Therapy with support group meetings of some kind would be a good try to get clean and to test your ability to refrain from using. SMART Recovery is CBT for addiction and how to deal with cravings, Lifering , or NA all serve to reinforce restraint. It’s a lot cheaper than private rehab but some people need and can afford private rehab.

Ten years of using isn’t easy but the good news is that you haven’t been IVing the whole time.

I hope you find the right solution that fits you and that you can be free from addiction and begin to achieve your hidden potential.

Cheers.

 

[axe battler]

I think a lot of places see it as a miracle drug as using other opiates on top is futile and most don't bother. With methadone many do use on top, but there is little point in that either.

I'm in UK @KJ_Namaste

 

[KJ_Namaste]

I think a lot of places see it as a miracle drug as using other opiates on top is futile and most don't bother. With methadone many do use on top, but there is little point in that either.

I'm in UK @KJ_Namaste

I suppose this whole Bernese approach is relatively uncommon outside of Canada and Switzerland? It seems that the majority of suboxone induction accounts I read online are people employing the old school way where you go into withdrawals before starting the suboxone....not sure why anyone would want to put themselves through that and risk PWD.

So good news!!! I just got back from the doctor and boy am i lucky to have her, she fully supports my suggestion of giving the morphine a go!!! Thank you for your suggestion @axe battler ...she put me on 300 mg kadian, a 24 hr release formulation.
We'll see how well that dosage works for me, might have to increase but if it gets me off the needle ill be a happy camper.

Do they not offer Morphine as an option for OAT in the UK? What are your options over there?

 

[KJ_Namaste]

Combining Opioid Replacement Therapy with support group meetings of some kind would be a good try to get clean and to test your ability to refrain from using. SMART Recovery is CBT for addiction and how to deal with cravings, Lifering , or NA all serve to reinforce restraint. It’s a lot cheaper than private rehab but some people need and can afford private rehab.

Ten years of using isn’t easy but the good news is that you haven’t been IVing the whole time.

I hope you find the right solution that fits you and that you can be free from addiction and begin to achieve your hidden potential.

Cheers.

I may be open to therapy or meetings down the road but that is something i've been very suspicious of. Who knows, maybe im in denial or ignorant but I have a mentality where I don't want to accept the mainstream views towards substance abuse where its either im sober or im failing...is it foolish to treat opioids as angidepressants? Thats sort of where i'm at...i tried SSRIs and sobriety and i hated it, but being on opioids seems to work for me.
I will admit though i have very progressive views when it comes to drugs...i am a proponent of drug legalization and involved in local groups fighting for legalization.

 

[Opi_Kid_Rock]

SMART (CBT) isn’t as dogmatic as NA.

 

[axe battler]

@KJ_Namaste we basically have methadone or subutex (think suboxone is very rarely if ever used).

You do hear of diactylmorphine being prescribed but I think that was years ago.

Think you'd have to go private over here for the kind of treatment you're getting and even then you'd have to be very lucky.

 

[KJ_Namaste]

SMART (CBT) isn’t as dogmatic as NA.

I believe it! Will ask my doctor about that tomorrow! Is that something typically covered by health insurance?

 

[KJ_Namaste]

@KJ_Namaste we basically have methadone or subutex (think suboxone is very rarely if ever used).

You do hear of diactylmorphine being prescribed but I think that was years ago.

Think you'd have to go private over here for the kind of treatment you're getting and even then you'd have to be very lucky.

When you say suboxone is hardley used, do you mean specifically in regards to long term maintenance of opioid dependence disorder or that suboxone for all applications is uncommon in the UK?
Regarding diacetylmorphine....the program is still operational here in Vancouver, i believe it is limited to a few hundred patients. There is a waiting list to get in as they can only have so many participants...the only time spots open up is when patients pass away or volunteer to leave the program ( from talking to patients I have learned that no one voluntarily leaves the program LOL! ).
As you can imagine, that is a program that you'd only want to be part of if you plan to use for the rest of your life...most if the participants are old timer 'veteran junkies', residents of the DTES.
Besides that, I have never used diacetylmorphine (at least not verified) mainly because I don't trust most street drugs, hence why I use Hydromorphone tablets.

UPDATE... So the 300 mg morphine SR 24hr release is working quite well for me so far. I have gone from shooting 6-8 tablets of Hydromorphone 8mg per day to now between 2 and 3 tablets per day.
I think i'll increase my dose to 400 mg morphine per day and see if I can stop to Hydromorphone all together now as that is the goal of this (want to get off the needle).

Now my dilemma is how will I eventually go about quitting opioids completely? My buddy who is a former user tells me to just go cold turkey and I know where hes coming from but I also think he just has a bigger ego to blame for that thinking.
Then again, I thinking tapering will be tough given my addictive nature so maybe I will give the suboxone a shot once i stabilize on the morphine and kick the IV habit.

The big question is what method of detox will be most effective at reducing PAWS and preventing me from relapsing in the future? I want to be able to go travelling/backpacking with my girlfriend next year without needing to rely on medication.

 

[Opi_Kid_Rock]

I believe it! Will ask my doctor about that tomorrow! Is that something typically covered by health insurance?

SMART recovery group meetings are just local support-groups organized by individuals or groups of individuals. SMART is based on the current evidence on addiction and is one of the main alternatives to Narcotics Anonymous or AA as there’s no requirement to believe in a higher power and they don’t hold addiction necessarily as a “disease.” SMART, like the contemporary evidence shows, that -relapse is a part of the recovery process.

 

[axe battler]

I mean subOXONE the brand is something you never see but I have heard of people talking about it.

Subutex is used all the time for both maintenance and quick tapers.

Yeah I think when you're ready to quit for good buprenorphine is the best and easiest medication to get off. Good luck!

 

[nznity]

Your body is a temple man, stop damaging it. IV drug use is slow suicide. Btw, I'd go with the morphine if I had those choices....suboxone I'd just idk....I've never liked it, same with methadone. Well every person is diff maybe one of those will help ya but srsly quit the needle, thst shit just ravages your body qq.

 

[Hm22312]

KJ_namaste I would love to chat with you and pique your brain about how Canadian drug treatment vs America! even the fact you can go to your doctor sns present your Situation is amazing to me, in America you would be looked at like an and maybe banned from getting narcotics in that area again! at most you would be able to get suboxone or methadone at a clinic. I do know Canada has decided they care more about their citizens being alive than fighting a war on drugs by enacting safe supply laws. how hard is it for you to get those meds? ask for increase in dosage?

 

[KJ_Namaste]

KJ_namaste I would love to chat with you and pique your brain about how Canadian drug treatment vs America! even the fact you can go to your doctor sns present your Situation is amazing to me, in America you would be looked at like an and maybe banned from getting narcotics in that area again! at most you would be able to get suboxone or methadone at a clinic. I do know Canada has decided they care more about their citizens being alive than fighting a war on drugs by enacting safe supply laws. how hard is it for you to get those meds? ask for increase in dosage?

Gladly! As an American who has lived in Canada for over a decade now I am in a unique position to have experienced the unfolding "opioid epidemic" of the last two decades from both sides of the border.
It was in the mid/late 2000s that I first became introduced to opioid medications as an American teenager, during a time that it seemed like everyone and their mom were getting scripts to percocets and norcos...pills were suddenly everywhere, at school...parties...my parents medicine cabinet!
Fast forward to my college freshman year, albeit having experimented with a variety of drugs I had never used anything regularly besides marijuana. It was around the age of 18 that I moved to Canada for school and to my surprise the drug scene in University was very tame in comparison to what I was used to back in the states. Perscription pill abuse was practically unheard of in that demographic of young college students, the opioid epidemic that I witnessed in the states prior to leaving was no where to be seen amongst people my age.
Vancouver of course had it's own reputation for opioid use, but that was contained in a specific region called DTES and something that had always existed but seemed to have affected an older demographic of primarily homeless inner city types....not something that seemed to have spilled over into the younger college age demographic, and not a prescription drug scene like i had witnessed in the states.

Now, it wasn't until around 2015 that I began wandering into the DTES on a more regular basis, seeking to score drugs....i soon figured out that it was easy to score drugs there, both prescription and street drugs. However, at that time the prices for prescription pills was quite high, on par with the prices I had been used to when aquiring pills in the states.

It wasn't until 2018 or 2019 that I noticed a significant drop in prices for certain medications, and this was directly related to a increase in prescribing of opioids due to a great paradigm shift amongst the medical community in regards to how substance abuse issues should be adressed.
Namely, i believe it was a response fmto a dramatic rise in fentanyl related death...at some point the heroin started getting practically replaced with fentanyl, doctors started prescribing hydromorphone in an attempt to get IV users a safer alternative.
My introduction to OAT wasn't until very recently, there were further policy changes that led to the current philosophy of treatment which has led to the opening a more clinics that specialize in addiction. The philosophy of harm reduction is taken to a new level that for the average person might seem extreme or crazy...the practice of basically providing substance users with access to safe supply, a practice that hasn't seemed to have caught on yet in the states.

There are clinics that will provide injectable Hydromorphone USP, and others that will give daily or weekly prescriptions in the form of tablets....but the idea being that by providing usera with a safe supply they can prevent overdose and toxic drug supply.
The added benefit of these programs is that they halp users financially as well but also work with users to help them get access to the resources they need...at our own pace. The medical community here is much more conscious of the fact that no one can force us to quit, but they are there to help us regardless of what stage in addiction we are in. It is a much more compassionate approach, as opposed to the punitive approaches that most of the world sadly utilize.