Opioids Oxycodone - I'm pretty much fucked in NJ

[rules]

god damn...i wish i found a doctor like that. that is INSANITY. i'd be surprised if he isn't already behind bars.

 

[Paulington]

I genuinely cannot believe a legitimate doctor prescribed 700mg of Oxycodone per day, that is a TREMENDOUS dosage. PLENTY of studies have shown that after 100mg of morphine per day, analgesia doesn't really change, it's just a case of placebo effect and tolerance.

For comparison, you were taking ~14x that amount! You would likely have been just fine on (assuming you were opiate-naive prior to this) 2x 10mg OxyContin and 2x OxyNorm 5mg IR per day, MAXIMUM, if I was your Doctor I wouldn't even give you the 5mg OxyNorm IR as the OxyContin really should have been enough, for most people, 'breakthrough pain' is total bull. Heck, even if you were on an opiate beforehand, I'd likely have just given you a similar (probably less equianalgesic) dosage. The long-acting OxyContin leads to a constant serum level of oxycodone for fantastic pain relief with a much lower capacity for addiction.

What to do now? Either check yourself into something like a rehab/clinic or take the doctor willing to give you 150mg a day (that is still a HUGE amount for anyone and far beyond guidelines, in the UK at least) and prepare to suffer from a little withdrawal for a while.

As for what he said, coming down from 700-150mg leading to next to no withdrawal, he is right in a way. Since your opiate receptors are not going to be totally deprived of oxycodone, only a reduced amount, you will feel relatively okay, mild withdrawal symptoms for a little while including an increase in pain levels, but that should resolve itself in a week or so.

For comparison, in the UK, to get oxycodone legitimately in any form, you have to be in absolutely severe (we're talking 8-10 on the pain scale) pain for a long time, over six months with no other method of treatment, and even then it will be at very, VERY low doses. Opiates are very easy to access in the USA, despite what people may say about DEA crackdowns etc. If you were in the UK, you'd be given:

4x 1g Paracetamol + 30-60mg Codeine (Combined as co-codamol)
4x Ibuprofen (or some type of salicyclic acid cream)
MAYBE some Gabapentin/Pregabalin/Amitriptyline depending on whether they suspect any nerve damage.

If that didn't work, you would get low dose tramadol, if that didn't work, you'd be sent to a pain clinic and thoroughly examined and have a huge report done on you before you'd get morphine in any form, as for oxycodone, not many take it and those that do tend to be chronic pain patients (like me) or people with severe terminal cancer.

You should have said no right from the beginning, asking for a reduced dose. Best of luck.

 

[Tommyboy]

As for what he said, coming down from 700-150mg leading to next to no withdrawal, he is right in a way. Since your opiate receptors are not going to be totally deprived of oxycodone, only a reduced amount, you will feel relatively okay, mild withdrawal symptoms for a little while including an increase in pain levels, but that should resolve itself in a week or so.

This is true. If you can manage to get down to 150mg/day then you can just continue seeing the new doctor that is willing to prescribe you that. It's usually only when you taper down to lower doses that you feel bad withdrawals, but since 150mg isn't a low dose you should be alright, although uncomfortable for a short time. It's when you get below 40mg or so that it gets bad, or below 20mg if your tolerance had not been that high.

I know someone that takes over 300mg of oxycodone along with some morphine to get high for a few weeks from his script, and he gets by just fine on 60mg of oxycodone with 30mg of morphine as well.

So basically if you can get down to around 200mg you should be able to get by on the script for 150mg/day oxycodone instead of going the methadone or suboxone route. You can take more than prescribed for the first few days and then taper down to below 150mg to compensate for the extras that you took, but it's going to be a little rough.

 

[helium-4]

I think the worst part of dropping down so much will be the hyperanalgesia, which I'm surprised didn't eventually show its face after being on such a high dose anyway. No matter what your pain is going to get worse for a while and hopefully with a decrease in dose comes a decrease in tolerance, along with the ability to actually start getting pain relief again.

 

[Tommyboy]

^ I know that everbody is different, but I know a number of people with herniated disks (same as the OP) that got by alright after stopping their pain meds, or lowered the dose a lot. One thing that seems to help them a lot is losing weight, considering they are somewhat overweight to begin with, and can afford to lost a few pounds without looking ill.

 

[helium-4]

I can see the pain decreasing with a decreased dose if the high dose was causing hyper-analgesia, which makes a lot of sense. So who knows, it could be beneficial if this is the case.

 

[Paulington]

This is true. If you can manage to get down to 150mg/day then you can just continue seeing the new doctor that is willing to prescribe you that. It's usually only when you taper down to lower doses that you feel bad withdrawals, but since 150mg isn't a low dose you should be alright, although uncomfortable for a short time. It's when you get below 40mg or so that it gets bad, or below 20mg if your tolerance had not been that high.

I know someone that takes over 300mg of oxycodone along with some morphine to get high for a few weeks from his script, and he gets by just fine on 60mg of oxycodone with 30mg of morphine as well.

So basically if you can get down to around 200mg you should be able to get by on the script for 150mg/day oxycodone instead of going the methadone or suboxone route. You can take more than prescribed for the first few days and then taper down to below 150mg to compensate for the extras that you took, but it's going to be a little rough.

Hey.

As stated, when you start tapering to incredibly low doses (double digits) that is when you will likely begin to suffer noticeable withdrawal symptoms as this tends to be the general trend with people on tremendously high doses such as you.

For example, I know a patient who was happy on 600mg of Oxycodone a day, cut down to 300mg, bit more pain, nothing much. Cut down to 100mg, bit more pain and a bit jittery, but that went away after a week or two.

This patient even dropped down to 40mg and all adverse effects (besides a tad bit more pain) settled down within a fortnight.

However, as my pain consultant and I have discussed, in almost all people taking a strong opiate, there is a level at which most people find it completely intolerable to drop lower than. For this patient it was 40mg. If he dropped to even 35mg his pain SKYROCKETED and suffered all types of withdrawal symptoms. Once you reach that level is when the serious withdrawals start. This is why tapering is called tapering. With that patient, they got to 40mg, stopped and then transferred him to 10mg methadone for a few weeks and then continued his care.

However, with yourself, going from 700mg --> 150mg will be fine, especially if you take TommyBoy's recommendation and cut down to ~200mg a day, given your medication I would suggest:

2x 85mg Oxycodone MR (One every TWELVE hours).
1x 30mg Oxycodone IR. Figure out when your pain tends to be at it's worst and take it then, or take it before bed to help you sleep.

If you can get to that level, then moving down to 150mg should be, essentially, no sweat for you. For you taper, I would recommend:

Day 1: Full 700mg as normal.
Day 3: Cut down to 4x 85mg Oxycodone MR + 3x 30mg Oxycodone IR. This is 430mg.
Day 7: Cut down to the above level, roughly ~200mg a day.

That should give your body adequate time to adjust, you could do it all in one go but if you taper it as above it should give you an easier ride, make sure not to worry. If you worry excessively you'll just make it worse. Keep yourself busy to keep your mind off the increased pain level and I guess that you're probably going to be A-Okay.

As for the post below me, Cloudy likely means hyperalgesia. This means that on your lower doses as you taper, you will find not only will your pain level increase slightly, but you will find yourself hypersensitive to other forms of pain, such as pricking yourself on a pin, standing on a plug or accidentally touching something hot. This may happen, it may not.

Reducing your opioid load as soon as possible is a good idea, it reduces the risk of nasty side effects such as opioid-induced hyperalgesia and (more rarely) allodynia.

My final note, and this is very important as it is a crux of most pain management programmes is as follows:

"The most effective dosage of analgesics is the LOWEST DOSE POSSIBLE that makes your pain TOLERABLE so that you can function as NORMALLY AS POSSIBLE".

Make sure you discuss this with your new Doctor because, as the quote above says, you may be able to do just fine on 100mg of Oxycodone daily, if that is the case, you do not want to be on ~200mg a day, ask if the both of you can work out a programme to achieve the best pain relief you can for the lowest dose, it will likely be helpful in the long run.

As for opioid-induced hyperalgesia, what Cloudy is talking about, I doubt that is much of an issue here. Most people with OIH tend to be in severe pain, far beyond their original pain levels and the only thing that helps is cutting down on medication significantly. Given the fact that you haven't mentioned anything about a lower dose helping or whether your pain levels are increasing I doubt that is going to be much of a factor here, your pain will increase when you cut down, guaranteed, but that won't be OIH as if you were suffering from OIH your pain would decrease when you cut down, if that is the case, just mention it to your new Doctor.

Also, why not try alternative pain management methods? There are plenty out there, such as:

Losing weight.
Trying to do light exercise, "get fitter" for lack of a better phrase.
Massage/sports massage.
Rub-in anti-inflammatory creams.
Cold sprays, such as Deep Freeze type stuff.
Acupuncture, it works FANTASTICALLY for some people, so definitely worth trying!

What I am trying to get across is that, especially nowadays, people in pain just want to pop to the Doctors, ask for a pill and hope it will go away instantly, whilst this is doable for most people and great that we can do it nowadays, there are other ways to try, don't just rely on your medication, there are other pain control methods.

Cheers!

 

[boostemente]

Good advice all around. I really appreciate it guys.

I'm not going to sit here and act like I can't tolerate the pain without the meds. I certainly can, it wasn't that bad to begin with. I'm actually more sensitive to pain now than I was before I started with this. What it boils down to is that I used my mild back condition to score. While the first few months seeing this doc was amazing, its scary to say that the past 2 years I pretty much took the meds for a *slight* buzz here and there, and to not get sick. Oxy tolerance builds up fast and it's all relative. If this was really all about pain management I'm sure I could have started out with less than a tenth my original dose and went up from there very slowly as the tolerance built up. Most of my friends don't believe that on my dose I haven't achieved a nod in 2 years but it's true. My first 10mg percocet blew away any high I've achieved in years. I'm just entirely too tolerant to oxy. That's what really scared me about the drop to 150, but now that I've got down to 400 and I'm not feeling sick, I'm convincing myself that it's really more a psychological addiction; like one of the previous posts said, as long as I have something in my body to feed the receptors, I shouldn't go into full blown withdrawals.

 

[beavis71cox]

Look, I was on 25 80mg OC's per day. Got them on the street. Always chasing the pill, and the constant partial withdrawals in between was horrible. Then I found methadone, which turned out to be a lot stronger and longer lasting than the OC's. It was a godsend for me. Cheap, effective, no more lower back pain, and I don't have to worry about not being able to find more and go into withdrawals. The methadone dose for me ended up being 160mg a day. I split it in two 12 hour doses and have never looked back.

10 years later, and I'm still on it. Couldn't be happier. I suggest you at least give it a try. After all, if anything, it will keep the OC withdrawals away, until you figure out what to do. And you may find that you actually end up preferring it more than the OC's, like I did.

 

[helium-4]

To Paulington, for the doses he was on hyperanalgesia isn't some weird uncommon side-effect. I mean it is seen all the time for users WDing from most opioids as well those who are using them for pain maintenance. One of the reasons why methadone is seen to have some advantages over more tradition opioids like morphine and the like is because there is a smaller chance of inducing hyperanalgesia. Sure there will be increased pain due to the original pain source, but the body will have increased the signal perception of the pain.

 

[muskolo]

As far as my predicament, methadone seems to be the best idea being kicked around. I would hate to have to go to a clinic and be labeled an "addict" for the rest of my life, but thats a decision I'm going to have to make now. .

Just to let you know, I don't think you will be 'black listed' or 'flagged' if you're paying without insurance at a methadone/suboxone clinic. I'm not entirely sure of this, I just know that when I was taking suboxone I didn't have insurance. I don't know how I could be flagged if my MP didn't know about it and no insurance was involved.

Like you already said though, you gotta do it but I just thought that may calm any fears you have of everyone knowing about your addiction.

Hopefully, more knowledgeable folks on this area could chime in. Best of luck to you! Keep us updated.

 

[BiggDirty01]

Look, I was on 25 80mg OC's per day..

Please tell me this was a typo or something....2000mg of OC a day is incomprehensible and sounds like a disaster waiting to happen.

OP, I think you need to decide what the pro's and cons are of going to a methadone clinic. If you decide to go that route, you really need to have a mindset of not chasing a methadone high. As others have already said, the methadone high is fleeting and short lived and not worth chasing because when it comes time that you want off, you're in for a hellish detox that could take a LONG time. It may be worth it to try the 150mg oxycodone per day as a short acting opioid is a helluva lot easier to kick than a high dose, long lasting methadone addiction.

 

[boostemente]

I guess the one question I have about a methadone clinic is this. Do you have to go to the clinic EVERY day to get the meds? I've heard people say a doctor will give you a lower dose but at least a few weeks worth, but a clinic requires a daily visit. If it's a daily visit, it's out of the question. Or does it vary clinic to clinic?

 

[beavis71cox]

Sorry, but that was no typo. I had a serious habit.

As far as being labeled, or blacklisted, going to a clinic doesn't put u on some list, or carry a large sign around. Nobody but u will even know. It's all just a mental game. As with any clinic, you have to go everyday, but it gets less and less, to the point that you only have to go once a month. After awhile, I just switched to a regular doctor, and now I get my script from my family practitioner. And if it ever DID come out that you were taking methadone, u can easily prove the pain management part of it.

I myself have a government job with certain clearances needed, and I've never had a problem with ANY job, and my methadone. Not only that, but methadone does not show up on standard 5 or 7 panel drug tests. It has to be specifically tested for. And once you are on it, you fall under the Americans with disabilities act, and cannot be fired or discriminated against for it.

 

[beavis71cox]

Federal law states you have to start at 30mg minimum, and go everyday, but you can also up your dose everyday. Clinics vary on the maximum dose they will give you. After a couple months, you go every other day, then after a couple more, it's every three days, and so on. And most clinics open at 3,4 or 5 am and some even close late at night.

OR, you can just ask your doc to prescribe it for u, and just skip the clinic. A lot of doctors nowadays, are prescribing methadone for pain, because of its strength, it's long lasting, and only needs to be taken just once a day for most.

 

[Paulington]

To Paulington, for the doses he was on hyperanalgesia isn't some weird uncommon side-effect. I mean it is seen all the time for users WDing from most opioids as well those who are using them for pain maintenance. One of the reasons why methadone is seen to have some advantages over more tradition opioids like morphine and the like is because there is a smaller chance of inducing hyperanalgesia. Sure there will be increased pain due to the original pain source, but the body will have increased the signal perception of the pain.

Hey Cloudy.

First off, I don't mean to be patronising or condescending, but, "hyperanalgesia" doesn't exist, there is no such thing, it's hyperalgesia.

It is a side effect, and it doesn't occur in everyone, sure some people reducing their dose will become hyperalgesic, but most of the time it is near impossible to differentiate withdrawal symptoms and hyperalgesia. As for it being seen in those using opiates for pain tolerance, once again, almost impossible to differentiate tolerance and OIH. I take ~350mg of oxycodone a day and when I stop taking it, my pain levels go up, but if I increase my dose, my pain levels do not go up, therefore I do not suffer from OIH.

Methadone does not have a "smaller chance of inducing a hyperalgesic state", methadone is used to prevent hyperalgesia if it is suspected, this is because it is an NMDAR antagonist.

Most people who seem hyperalgesic when going through withdrawal are just that, going through withdrawal, sure they are hyperalgesic in the sense that they are suffering from increased pain levels and have a heightened sensitivity to pain, but true OIH (which is what you are referring to) manifests when pain levels increase upon an increase of opiate dosage and lower when lowering opiate dosage.

"Hyperalgesia" is a blanket term for "increased sensitivity to pain", which means that some people coming off opiates will go through some period of being hyperalgesic, but not all will, however, this is generally termed withdrawal as true hyperalgesia is caused by damage to peripheral nerves or nociceptors which isn't the case. I guess I can explain it like this, people who are going through withdrawal are experiencing more pain, but the increased pain levels are caused by the withdrawal, not damage to nerves or nociceptors.

Whereas opioid-induced hyperalgesia is caused by chronic opiate use and is characterised by an increased sensitivity to pain or allodynia AND the phenomenon where increased dosage of the opiate = increased pain. Once again, a side effect and not everyone gets it, and the dosage really is irrelevant, in fact, OIH has been shown to occur after one dose of opiates, I believe the dosage was around 30-40mg of morphine equivalent with various drugs.

Given the post after mine above this, I would hypothesize that the OP is suffering from moderate OIH, but that will disappear once he starts cutting down properly.

Cheers!

 

[helium-4]

I am not slightly confused it is well documented side-effect for both WD and during opioid use. Sorry I spelled it wrong, I'm not a very proficient speller, but my point still stands as I never implied it is seen with everyone. Maybe "all the time" is a little misleading but it is seen more often with users WDing than say with users still taking opioids. Yeah the cause of it may also be slightly different, but they are still resulting from use of opioids be it previously or concurrently.

And your wrong about methadone, it is used as an alternative to other opioids because it does have a lower risk of the condition. It isn't used to prevent it, as it still can cause it being an mu-opioid agonist. Or well I wouldn't use the word prevent, due to the posibility still existing. You'll see a lower risk of it due to its NMDAr Antagonism as well as it's SNRI activity. Now it can be used to "treat" hyperalgesia in those with OIH and still needing adequate pain relief. I see that as not so much treating it but offering an alternative with a lower chance of producing the same effect. But I guess the word "treating" still can be used

I really don't understand your post as it just says the same thing I was posting about and doesn't refute anything I said. You said exactly what I posted "I would hypothesize that the OP is suffering from moderate OIH, but that will disappear once he starts cutting down properly."

 

[Paulington]

You said exactly what I posted "I would hypothesize that the OP is suffering from moderate OIH, but that will disappear once he starts cutting down properly."

Hey there.

Yeah I did, but only after he posted this:

"I'm actually more sensitive to pain now than I was before I started with this."

Before then I couldn't see any reason to think about/mention it, but after he posted that then he could well be. .

Methadone is used as an alternative to other opioids, sure, but no Doctor prescribes it for the main reason of "to prevent OIH" unless the patient is suffering from severe OIH for some reason, even if this did occur, I'd think they'd just give you a small dosage of methadone, say 5mg to go with your usual opiate if safe to do so, and only if that didn't work would they swap you. But like I said, only an alternative if the patient is suffering from severe OIH for some reason. Also, I thought methadone was an SRI, not an SNRI? May well be wrong.

Cheers!

 

[helium-4]

Of course they wouldn't necessarily prescribe it for the fact it has lower risk of hyperalgesia unless there is reason to do so for that reason. I don't think anyone is refuting that. If a doctor is concerned about a patient potentially producing the nasty side-effect, like one who has been on a pain maintenance program for an extended period of time or using high doses of opioids, methadone is considered as a good alternative or even a holiday drug, like we both said. When hyperalgesia is seen a common thing to do is switch opioids rather than trying to add say 5mg of methadone on top. Even if oxycodone is producing the effect, morphine might not, or fentanyl might not. If the doctor isn't afraid of methadone sure it may be the first choice of the doctor, but not all docs like to script methadone due to its stigma. I'm lucky my neurologist acknowledges the potential of methadone and scripted it to me.

The reason why I came to the conclusion it might be something to think about is because of his ridiculously high dose prescribed. I think most doctors would start to be concerned with the fact that they need 700mg a day to get relief, knowing side-effects are extremely common at that dose.

From every article, book, and doctor handout I've read discussing the pharmacology of methadone it shows it has SNRI effects, with the S isomer the NMDA antagonism as well as serotonin and norepinephrine reuptake inhibition is a lot stronger than the R isomer which is primarily just mu-agonism.

I think we both are on the same page.

 

[DayNod]

I too have had severed chronic pain..while switching doctors becauselps we they were too afraid of the DEA left me in minor wighdrawls..anyways i heard fom BL i believe about Gabapentin (brand name neurontin) helps w/ withdrawls.. idk if itll help u but its not scheduald and maybe youll get lickuy and itll td pake the edge off or make a quick dose drop less unpleasant..
Prayin for u bro. Keep your head up