Opioids Opioid use frequency and withdrawal duration

[veggies]

Hi BL. I am looking for information or experiences on the effect of different daily dosing schedules on the duration, specifically (vs. intensity), of opioid withdrawal. For example, given a total daily dosage of 100mg/day of a given opioid, would a single 100mg dose/day have any noticeably shorter or longer withdrawal effects compared to 2x 50mg/day or 4x 25mg/day, etc?

 

[thismighthurtabit]

This is kind of debatable. There are tons of variables as well. It's going to be harder to come off a dose of 100mg of something, as compared to weening down to four 25mg doses. But if all of those doses are in the same day, so close to each other, it may not make a difference. It would also depend on how the doses are usually administered, how often, for how long etc.

 

[veggies]

Absolutely. I wonder if it may interact with the half-life of the specific drug in question also. As far as split doses, although I didn't state explicitly, I mean having them split across (more or less) even intervals throughout each day (e.g., 6AM/1PM/6PM/11PM). That being said, I am interested in any general rules of thumb that anyone may have read a paper on or experienced.

 

[suessmayr]

All addiction therapy and tapering plans aim to get the patient onto the smallest possible doses. If you're taking 50mg at 8am and 50mg at 8pm, almost no opioid will last in your system long enough for the two doses to 'double up' and combine to produce a high equivalent to 100mg; rather, you will only feel the effects of consecutive 50mg doses and will therefore not be trying to leave behind more intense feeling doses, and it would be easier to get clean - irrespective of how long it took.

 

[amapola]

^Indeed. Without a doubt it is better to maintain a much lower steady level when a habitual user than to have peaks of highs alternating with valleys of withdrawal. That being said the OP specifically asked about duration of withdrawal, which even if slightly irrelevant to most people who just want off, could have a slightly different answer. For example using 100mg of hydrocodone once a week on Saturday night for a year probably won't even lead to any dependence, but 15mg/day for year would result in a few flu like days.

If you are only taking about at least daily use OP then I would agree with minimizing maximum drug levels by splitting your dose into as many small administartions as possible.

 

[veggies]

Thanks for the replies, everyone. Just to clarify my question a bit, I think you hit it at the end of your post pretty well, amapola. I am especially interested here in the duration of acute withdrawal after quitting daily use specifically, split into either less or more doses/day. To put into perspective, generally longer half-life -> longer withdrawal, not considering intensity (e.g., fentanyl vs. methadone). Now repeatedly dosing a short acting opioid over the course of a day does not lead to a withdrawal duration of a long acting opioid (e.g., bear with my hypothetical math here...but dosing fentanyl split into 10 doses/day does not produce a later withdrawal close to as long lasting as methadone). But what I am trying to get at, carrying from this example, is would dosing 1/10th of a dose, 10 times a day of fentanyl, produce a longer lasting withdrawal (i.e. resembling a longer acting opioid) than a full dose one time / day, regardless of the treatment efficacy / "prognosis" of this type of dosing schedule?

I don't mean to quantify this too much, but really am just looking for any general rules of thumb that people may have read about or experienced personally. Thanks, all!