Opiates. Tolerance question

[UpInFlames]

OK, this is really about a friend.

My best friend was recently hospitalized with intestinal issues. She is a chronic pain patient. Her inteestinal issues were very painful, so she was put on a Fentanyl patch while in the hospital.

She was in the hospital and on the patch for 5 days during which she also received several injections of dilaudid.

Her normal PM meds are 10mg oxy 3x daily and 30mg morphine 2x daily.

The fentanyl and dilaudid she got in the hospital blew her tolerance sky-high and now her regular PM meds aren't working for her.

Her PM doctor refuses to raise her dosages or change her meds. She is 72 years old with multiple health issues and severe chronic pain.

Short of going into withdrawal to "reset" her tolerance, is there anything to do to bring it down? Does anyone have any idea how long it should take for it to return to what it was before she was given the stronger drugs?

She can't take more of her maintenance meds than prescribed as she'll be kicked off of PM, and she is terrified of running out and going into flat-out withdrawal.

To me, she seems to be showing signs of withdrawal already. This is the same woman who's admitting physician for an earlier hospital stay refused to write for her pain meds, throwing her into withdrawal, which was a nightmare as incapacitated as she was already.

She has sworn she'll kill herself before going through that again.

She refuses to take "street" drugs. I think I could talk her into taking loperamide, if the experts here think that would be safe for a 72 year old woman with severely impaired mobility due to multiple sclerosis.

Any ideas would be appreciated.

TIA

 

[placid space]

It drops fast and I dont think its really going to be that terrible. Its not actually a true withdrawl, she has her meds theyre just not quite enough. Im not suggesting anything but if I had a friend like that and "street" drugs were out of the question I would maybe get them some oxy, tell them its from a friend that was left from a surgery and maybe soften the blow of the taper by giving her an extra pill per day for a week or so,slowly lowering the dosage to get to her normal one, so the forced tolerance drop is not that brutal.
But before all this I would go to a REASONABLE doctor, not a complete tool, and explain exactly like you did here and tell them to help her with lowering her tolerance, even if it takes going there every day or so, so that they can be sure she wont abuse it.

 

[UpInFlames]

Thanks, Placid Space.

As it turns out, she was readmitted to the hospital for pain control. They found out there that she has a urinary tract infection and that the intestinal infection has gotten worse and may require surgery to remove some or all of her colon.

Right now she is being heavily medicated for pain, so this is back-burnered for the time being. I have some oxy 5s leftover from dental work, and today found out that there is a local source for opioids of various kinds, so will go that route if needed, though I would much prefer to stick with pharmaceutical meds as opposed to street meds for her.

With all her other health problems and all the other meds she is on, it would be better to know exactly what she is getting and how much of it.

According to her wife, she is back on the Fentanyl patch and IV Dilaudid,which thankfully is controlling her pain, though she's not making much sense as of the last time I spoke with her.

Her wife, also a close friend, plans to talk to her PCP to see about getting a referral to a different PM doc who will work with her in a more "whole body" fashion.

This one just throws pills at problems, and we think she could benefit from physical therapy and the like as well. The current doc also treats her "like she's a junkie" which she doesn't appreciate.

Thanks again for your advice. I'm a bit nervous about possibly having ot turn to the street for meds for my friend, but I did it to get MJ for my late husband when he was dying, so he could eat and to help his pain meds work better.

According to the friend who told me about this contact, he himself is a pain mgmt patient who sells his pills so he can keep a roof over his head and food on his table.

All of which makes me hate society even more.