Need help with reducing opiate my opiate usage. Taking alot.

[whippa craka]

This is for a dear old friend of mine. He is always in heavy pain. Here is what he is prescribed to take everyday.

Methadone 10mg x18 per day (yes, 180mg).
Oxycodone 30mg x5 per day (MAX,4 generally)
Valium 5mg x5 per day (MAX, 3-4 generally)

He has a lot of issues reducing the meds he takes, the pain is too much. What are some good OTC solutions for reducing the amount of opiate he needs to take and get the same pain management? Currently I am helping him explore the realm of medical marijuana. For an example, here are some things I am thinking of.

• DXM has been shown to reduce opiate tolerance by as much as 20%.
• Any use in taking loperamide or something to help with reduced opiate intake and make a lower dose effective?

What are some viable solutions aside from other opiates (like kratom), to help him take less pain meds?
All help is appreciated, thanks.

 

[opi8]

Nothing will work for pain like opiods.

 

[whippa craka]

Obviously. He is still taking opioids.... but he want's to take a lower dose.
There are ways to make opiates more effective. I am trying to find the best solution.

 

[RTrain]

Why did you say "my" in the title and then try to hide that it is you (which is obvious and not worth hiding) in the post?

The best bet to lower tolerance is obviously abstinence, a tolerance break as many call it. Obviously is it is being taken for pain then its more than just sucking it up and dealing with the withdrawal. But it is really the only way to make it happen. AFAIK the DXM thing only prevents increases in tolerance, it will not lower the tolerance. But if you can get it back down then maybe it will provide some help in slowing down your tolerance from re-growing. With your current tolerance I doubt any doses of kratom will effect you. You could try using Suboxone for a while to drop tolerance but it is very difficult to switch over to suboxone form methadone, especially with a dose that large. A doctor typically won't let you switch over unless you are down to 30 mg of methadone per day. You would probably have to wait a minimum of 96 hours from the last dose of methadone to dose Suboxone without getting precipitated withdrawal. There really isn't much else to do to drop one's opiate toelerance.... otherwise it'd be well known about and everyone would be doing it.

 

[whippa craka]

Im not asking how to lower tolerance. I am asking the best way to make a dose more effective. Still waiting for a helpful answer.

 

[WantToBeReborn]

You are asking something very dangerous at these doses. Speaking as a pain med patient currently detoxing from massive doses of medical opiates, I know what pain is. Anything you do to "potentiate" medical opiates at these doses carries risks of not only respiratory depression/arresting/bowel obstruction, etc., but will also alter tolerance quickly, leaving you needing bigger doses.

There is a phenomenon called opioid induced hyperalgesia whereby increasing doses of opiate pain meds over a long time cause increased levels of pain. The only way to reduce this is to taper the opiates and reduce tolerance.

Your situation requires an urgent review with a pain management doctor.

The doses will become less and less effective as you are finding out and no amount of booting other stuff to make the doses hit harder will work in time. Tolerance is inevitable with opiates.

The piper must be paid sometime. The payment gets bigger, the longer we wait.

 

[OC80IOWA]

Up the benzo dose, and in turn, lower the Oxycodone and Methadone doses. Benzos potentate opiates like crazy, thus the reason doctor's usually pair the two together in pain management clinics. (For serious pain, that is.)

 

[WantToBeReborn]

^^ Poor advice.

If you think opiate withdrawal is bad, you haven't tried benzo withdrawal.

Upping the benzos is a terrible idea since the memory loss makes it far too risky that you'll redose both benzos and opiates again after forgetting when you last did so. Benzo tolerance also increases swiftly when used regularly.

One cannot simply "lower the opiate doses" when at these dose levels, without consequences, indeed any reductions should be done with medical supervision. Once someone is at beyond a certain threshold on opiates, reducing can cause severe issues, for example, massively elevated blood pressure, heart rate, etc. (tachycardia) amongst other serious complications.

I've experienced memory loss and redosing on benzo and opiate combo and know many others that did so too.

This combination of drugs at these considerable doses along with benzos is not usually prescribed just for pain, but indeed for end of life palliative care or severe intractable pain in impending terminal illness. Benzos are not prescribed in severe pain to potentiate opiates, but to suppress anxiety and agitation and sometimes memory and to increase sedation in extremely ill patients.

When not expedited under medical supervision, this combination of drugs along with benzos above a certain threshold is a road to certain death - it is only a matter of time.

 

[Altered Perception]

I've been on Oxycodone everyday for 6 years for chronic pain and unfortunately tolerance and pain relief are intertwined. You can't separate one from the other once tolerance gets a hold.

The best method is to wait until your having a good week when your pains levels are at its lowest and take advantage of that opportunity to reduce your dose rapidly as possible so that when your pain increases again you are well equipped to manage it with a moderate dose.

But other less useful options are using "paracetamol" with the Oxycodone to boost pain relief.

And even worse options are using other substances for potentiating the opiates such as grapefruit juice, foods with high fat content or drugs like gabapentin or pregabalin.

But as I learnt the hard way there is no difference between "increasing your opiate dose" and using a "potentiater" . Your tolerance increases just as quickly when you try to potentiate opiates so not recommended.

Personally I have currently chosen the option to reduce my oxycodone dose after trying everything else

 

[entertaining.a]

I haven't been here for awhile and wasn't much of a posted more of a reader/learned. It sounds like a high dose around the clock medicine would be a start but the methadone would need to be adjusted to a safe level if it is to continue but maybe replacing the oxycodone with something longer acting would help too like hydromorphone. In a control setting would be ideal but it all depends on the persons doctors. If they could get inpatient pain management while adjusting that would be good.

 

[Felonious Monk]

Cannabis. It's been shown to decrease the levels of opiates PM patients need to take by 50-80%.

 

[whippa craka]

With this persons current prescription, he says he is at a constant 7/10 on the pain scale about. It is a 9.5 without them.

I am currently helping him explore marijuana. We found a good strong indica strain that didn't mess with him in the head too much, but was a strong relaxer. Every other strain he didn't like. This one is also the most expensive. NY is a crappy state to be in right now for anything truly medicinal for someone like a pain patient. Most good stuff here is sativa. It was hard to find a good strong semi-pure indica. He has traveled to boston to research getting an intrathecal pain pump. He is looking like a good candidate. His pain clinic has noticed the Marijuana in his system lately, he also told them himself he started doing it. They were perfectly fine with it as long as it was helping it with the pain. Now there is a strong chance he may have to quit, with pressure on the pain clinic from some agency with it not being legal in new york right now for 99.999% of people.

Lucky he has a friend who knows his marijuana (me). Any TIPS are appreciated. He has been cutting back on oxycodone use because of the marijuana but he is withdrawing slightly (nothing serious), but it is hard to say how much it is helping. He will hardly smoke, only smoking 1-3 days out of the week taking 1-2 hits. I tell him if he sticks with it, the high will change and become more medicinal. It takes hard work (lol).