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Opioids new here :) need help with tapering...w/d etc

sarajenni88

sarajenni88

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Joined
Mar 27, 2014
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*i never really wanted u to see the screwed up sid
HHello all! I apologize in advance if I am doing something incorrectly. First new thread.
So basically I have been in a pain management for close to three year's due to early onset osteoarthritis. I've been prescribed exalgo ER 2/day tramadol 4/day SOMA 3/day. Recently my medication was changed due to insurance reasons from exalgo to opana. Well the opana ER came no where close to the exalgo and I spent four days in pretty nasty w/d. During this time I upped my dose of tramadol from 4xday to 6xday to help with the w/d. When I finally got a hold of my doctor I explained the situation and she agreed I should go back on the exalgo. When I met with said Dr she abrutply informed me she was stopping my tramadol completely and decreasing my dose of exalgo to only one per day. For my honesty I was rewarded with this HARSH change. Since then I have been plugging my exalgo in order to get the most from that one pill. I am looking for advice and support concerning a tapering schedule... potentiating my doses...and whether or not I should be requesting comfort meds...clonodine...benzos...etc. after my last interaction with my Dr I am afraid to ask but feel as though I will not be successful without them. I have young children so being pill sick is not a viable option. Thank u <3.
 
Ask your Dr. if they think what they are doing is honestly actually helping you.
If they respond with the bullshit excuse of "I'm just trying to save you from addiction/dependence" tell them it's too late for that and you have a legit need for the medications.
Tell them your in pain, be open to other meds besides the ones you're on.. maybe they would be more open to switching to a less powerful med a couple more times a day.
I can't really tell you how to "play" your doctor even though you're being completely honest. I've learned that when I tell a doctor a med is helping me that they wanna take me off it because of it "helping me" they interpret as it feels good and assume you are abusing it.
They just try to cover their own asses, but really if you were in their shoes wouldn't you wanna do the same?
Tell them what their doing isn't working and you're worse than before the med switch.
DO NOT bring up medications you'd like to go on, they will know you looked up info on them and that's a way of a Dr. seeing you are trying to get to "feel good" which is only human nature. They just don't see it the same way as we (us suffering) do though.

BUT be aware of other meds and if they ask if you would like to try a medicine just ask if it will help as much and make you comfortable even if you know it will/wont and see if there are any other ideas they have and sit and think and say what you would like to try.

Honestly is always the best policy I've been told, but with Drs it has done nothing but kick me in the ass.
I'm honest to a fault literally.
Good luck.


EDIT: When you say tapering do you mean taper to a lower dose or completely get off the meds?
What meds do you have access to, what doses, how many, etc.
We can help more with a tapering schedule after knowing that info.
 
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So at this point I have 20ish exalgo 32mg to last 20 days. I'm withdrawing if I don't orally take 2 pills a day or 1.5 pill plugged. But I am also without my tramadol and I don't care what anyone says tramadol will give anyone with an opiate dependence w/d symptoms. So I'd like to ask my doctor to provide me with clonodine for the slight chills and I find it helps with anxiety as well...I doubt she will prescribe a benzo but who knows. I'm really not the type to scam a doctor...that's the reason I was honest with her. I live in a very small community where there is an incredible amount of presceiption pill abuse...not to mention im in my mid twenties
Honestly I feel betrayed. Lol. Its true tho. I'm looking to completely wean myself off the ...mind u not in the next 20 days. But I am sick of feeling like my life stops and starts around my drs say....thank u for answering with good advice!!!! I'm glad I joined: ) <3

I am also still prescribed the soma while its not an opiate it helps with w/d symptoms.
 
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I agree tramadol can cause wd symptoms but since you are still on a pretty strong opiate still, i wouldn't expect it to be 100% opiate type of wds from it.
Tramadol is a weird drug, its related to tricylic antidepressants and works on other receptors than just opiate.. maybe you're experiencing wds from the other actions it had besides its weak mu agonism. Just a thought.
Have you ever tried a med like amitryptaline (sp?) to help with pain? It's a tricyclic but is often prescribed along with narcotic pain meds to help potentiate it's effects as well as work on pain in other ways too.. look it up on wiki if you'd like, i really don't think your Dr would be worried about prescribing that, they're always pushing meds like that on people. Plus i think it would alleviate the symptoms of stopping the tramadol you're experiencing.

Yes clonidine helps, tremendously for wds and I find that with it and hydroxyzine it is just as efficient as a benzo with anxiety without the risk of dependence and looking like a "drug seeker" asking your dr for benzos.

Soma works much like benzos in the way it relaxes muscles, bad thing is it doesn't seem to last too long in effects. The effect on the GABA from the soma may be why it helps with opiate wds in a way benzos would too.

I'll leave the tapering advice with exalgo to someone with experience with the drug, I have never taken it personally. I've done dilaudid but never in extended release form.
I could tell you equivalent doses of meds i have used and tapered with but Im not sure what type of extended release mechanism it has so I wouldn't know how to break it down to lesser doses to taper with unfortunately..
Would your dr be willing to prescribe you just plain hydromorphone without the extended release? That way you could actually taper doses?
 
I have been using exalgo by breaking down the time release for a couple years now...which is why I had no luck with the opana ER. So I can technically break my doses down...as I plug I can approximate the doses. I know how much I'm taking by how much liquid I use to dissolve etc. I wish I had never started doing it but there were pain and tolerance issues involved.

I find that even with using my regular dose...stopping the tramadol has given me w/d. Strange...but I'm sure it has to do with the different make up of the two drugs.

I have been prescribe amitripiline (sp sorry) in the past but I found it made me incredibly tired. It might be a good suggestion to try for sleep and RLS as my exalgo dose decreases.

I would THINK that prescibing me IR dilaudid would be a sensible method for tapering...I will def. Ask but again I feel as tho I would be seen as a drug seeker. From what I've read IR dilaudid is very abuseable and ppl usually bang it. I've never done that but I would be afraid my Dr would believe that was my plan.

I just feel so set up in a way. I've always been honest...I've only failed one piss test because of an emergency procedure and I've never been in any position to be cut off...in addition I have an honest to god reason to be on these meds. If I was a regular 25 year old instead of having children to care four I would be tempted to buy off the streets. My w/d are hell and they scare me. I feel as though my Dr is not to concerned about HR. I understand her positionubut there is no communication. Sorry for the rant!!! I appreciate all the help I am receiving. I don't have many ppl in my life that I can talk to about this...ty
 
I can't imagine your doc is going to write any new opiate scrips unless were talking about something silly weak. Now is the time to go for either comfort meds or a new doc because this one has already flagged you (and considering the habits you describe, as a shrink I can't blame em).

To most Docs IR means more abusable, so that might be a topic to avoid. You've already told your doc whats up, now is time to say "you got me to this point, you need to help me get back to normal". I generally belive that when docs cut meds too quickly its perfectly ok to evoke the "I took nothing but what you scripted me, you need to give me a taper, this wasn't my mistake. you made an oath to do no harm, forcing w/d after scripting the addiction harms my life very much."
 
^ the good old "hippocratic oath" lol, ive yet to see a dr actually follow it.

But good point on the IR hydromorphone, but i figured if they told their dr they wanted to taper along with comfort meds.. how do you taper an extended release form of a short acting drug?
 
If you use the right wording, you can scare them into doing a proper taper, sometimes.
I've seen it work for my friends, and on my co-workers.

They won't want to use Dilly IR even if it's logical, prolly another opiate they are more comfortable with. Dillys just have an awful rep in the medical world as the addicts pill of choice. Many of my coworkers use any mention of Ds as a reason to label a new client drug seeking ( an example of the rep).

I'd like to believe my fellow shrinks and I follow our oath to do no harm quite well (I'm no MD though). It's the ones with the script pads you gotta watch out for :D.
 
I do understand what my doc wants to do...I'm on board with her. Like I said I'm sick of living my life around a pharmacy doc etc...but I do agree I've been prescribed these meds by the same doc. Have been honest with her and I'm just hoping she'll think about my best interest and work with me to get off these meds...not just stop and expect me to deal. Like I said I'm a busy good mother who can't spend three days incredibly sick. My babies Ned me there. I'm just thinking... if I were to start decreasing my dose by say .25% every 4 days if I can get some appropriate w/d meds...would this be a reasonable taper? Too quick? I have no experience in this as my physical dependence started when these meds were prescribed. I've gone thru CT w/d before and it's not something I'm looking to repeat. <3

I meant 25%: )
 
How about getting comfort meds and cutting it by 50% the day after you start the comfort meds,
Then decrease it by 25% every 3 days, and when you get to the lowest dosage before jumping off it, try to stabilize on that dose for a week or so and CT the low dose while continuing or maybe increasing the comfort meds?
 
Flaga121 said:
If you use the right wording, you can scare them into doing a proper taper, sometimes.
I've seen it work for my friends, and on my co-workers.

They won't want to use Dilly IR even if it's logical, prolly another opiate they are more comfortable with. Dillys just have an awful rep in the medical world as the addicts pill of choice. Many of my coworkers use any mention of Ds as a reason to label a new client drug seeking ( an example of the rep).

I'd like to believe my fellow shrinks and I follow our oath to do no harm quite well (I'm no MD though). It's the ones with the script pads you gotta watch out for :D.
Click to expand...

Thank you for the relevant advise. I hope ur right...I had the same idea about the dilaudid as I've known and heard of many many ppl iving these
 
HdoubleODeezy said:
How about getting comfort meds and cutting it by 50% the day after you start the comfort meds,
Then decrease it by 25% every 3 days, and when you get to the lowest dosage before jumping off it, try to stabilize on that dose for a week or so and CT the low dose while continuing or maybe increasing the comfort meds?
Click to expand...

Excellent advice: ) ty. I'm hoping to have an honest and productive talk with my Dr next week. I'm hoping that if she sees I'm ready and willing to taper she will see me as myself and not a young drug seeker. Its hard tho...I'm scared. But I think u are right.
 
I used kratom to help with buprenorphine wds and PAWS and it helped but it just delays the wds.. you're gonna feel them no matter what eventually.
 
IR Dilaudid is a horrible drug to taper with imo due to its short life span. On the plus side, D's have a shorter withdraw time, and since you arent stopping, just cutting down, it will be nowhere near as bad. That and you dont inject, just eat/plug will also make w/d considerably less sucky. I wouldnt ask for benzos either, many docs wont prescribe opiates and benzos together due to potentiation. and definitely do not take any street drugs or non-prescribed pills to compensate for your meds - if you fail a piss test, which is probably under your pain mgmt agreement (piss at any time), you will likely be dropped altogether, and flagged as well. dont be tempted to go for IV route, dilaudid is very addictive this way, and docs can spot track marks a mile away.

The reason your insurance probably changed is that 32mg Exalgo are HIDEOUSLY expensive, we've had two pharmacies deny my fiance's script for them because they cannot afford to fill them. 2 16's a day are the same as a 32, and would cost less than half of what 1 32 a day costs. They also make 12mg and 8mg strengths

Also, a maybe relevant note: exalgos time release is via a pin-sized hole on the white side, not a chemical/mechanical method. They do not gel up and arent crap like TRF Opana and OPs are. You should try swallowing one whole, it will dose better over the course of a day than breaking the time release altogether.
 
^ so the time release is like OROS?

how long is one exalgo supposed to last? half a day or a whole day?
if it is OROS than yeah just swallow it and let it last how long it's supposed to and see if the dr will just lower the mg of the pill as you drop down on dosage.
 
Kratom actually helped make my w/d very tolerable. I kicked a chemical dependency on opiates and went to semi regular Kratom use with far more ease then I could have cut out the Bupe on its own. I can't explain how or why it worked so well for me but it did. After a week of mild w/d that were easy to ignore because the Kratom made me feel good in ways unrelated to opiates, I was good. And not just on Kratom, I was good sober. Just keep the dose low and use it to ease the sickness, not get rid of it and make you feel amazing because then your not helping yourself lol.
 
HdoubleODeezy said:
^ so the time release is like OROS?

how long is one exalgo supposed to last? half a day or a whole day?
if it is OROS than yeah just swallow it and let it last how long it's supposed to and see if the dr will just lower the mg of the pill as you drop down on dosage.
Click to expand...
Good idea...I could ask to go own the lower doses as I taper!!
Cant believe I didn't think of that...lol o well guess that's y I'm here.. ty
 
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