Opioids Question for those who are good with equivalencies

[Emme80]

Hello my kind &knowledgeable friends-well, this bitch of a right foot hurts as if it was crushed by a hammer. But, as of today, one week down that I won't have to relive again. Thank freaking God !
Tho, yesterday I'd to go to the Emergency Department b/c there was bleeding...and more bleeding. Had a look at the freshly cut flesh. Uck! It's a fairly straight slice-Goes from top if big toe to heel. The ER Dr. Said "oh that's beautiful"... Nurse said " oh that's a beauty". I thought they were joking-but apparently, it IS beautiful for the location, length,type & degree of difficulty of surgery-as they explained to me. All the blood was just due to the blood thinners I'm on-Blood is TOO thin. So, adjustments made. X-rays look good & that is GOOD to know... screws, pins, etc. are all in place.
Today seems a LITTLE less of the "fuck!shit!damn!shit!fuck!" of the bone splitting type pain-but holy hell, it's still breathless. I SO want this to be over. Ice felt great -great relief- on the operation on left foot...but right foot...w/ice ..it's like an exorcism of sorts! This foot wants nothing to do with ice. It's... Crazy!
So, anyways, to the important, ACTUAL matter at hand~the pain meds&methadone, etc. I was trying so desperately NOT to take anything-but up until today it was simply beyond the word "pain". Even so, I'm not taking the pain meds as directed(taking much less)than directed. I just had to take some-as I could barely breathe from the pain. Screaming pain. But, I've gotten away w/less than directed. Pain lifting a tiny bit today.
So, as I said in last post , I am figuring I can only play it by ear....which completely goes against my over analytical, all-controlling ways. But, I have to let it go. Listen to my body. But I might need to plan ahead a bit if it's the methadone I go back onto&taper,( I'd need to start building it up in system yes?)Until today, I've taken (avg .daily) 1 of the 15mg ER Morphine (versus the 2 every 12hrs.-as rx'd)and approx. 4-8mg per day (tho rx'd as every 3 hrs) I probably wouldn't have had as much pain if I'd followed directions. But I just can't bare being so rather close to the methadone "Finish Line" , being within grasp yet still so unattainable!
SO...1 week&1day w/o methadone. ( I like this idea of no methadone) Just the painkillers. Too bad that couldn't be the "end" of the road, eh? Too easy though! But, I think I've gotten by on the least ammt. of the Pain Meds.(Loads of Tylenol though!) My next Dr. appt. is July 9th.
Wondering...should I start "building up"/"stacking up" the methadone in my system now ? I've loads of Tramadol I never took..(dr. used to think it was FINE to take w/methadone ..she wouldn't rx me a Tylenol 3, but hey ... All the Tramadol you want! Crazy!) I can't say exactly what he will give me-tho thus far it's all been exactly the same as last time, as well as he did say we'd "step down " to Vic/ Perc. just like last time. I'll go Vicodin route, as was suggested. So as of today,(haven't taken anything yet) should I back off-stop the painkillers-go back to methadone? Start w/3mg.in morning&3mg.@night (I do just hate putting the methadone back into my body..but oh well...seems like that's the way I'll havta go, yes?(finish line is finish line no matter how I get there! And I WILL) I imagine if I jumped now, from everything, it'd be not so pretty...yes?(especially w/a still fucked up foot&pain) But,if I had Vicodin, would that be an adequate "step down" or would the Morphine& Dilauded have been TOO "big"? The longer I take the Morphine/Dilauded , the deeper hole I dig right? Such is why I'm done taking those as of today. So...wait&see? Cut those lil dillys in half...wean off? Possible? Or best be start stacking up on methadone&get back to the tapering. Don't quite know where to go from here.(obviously).
Lorne??? My God your knowledge of the equivalencies, doses , etc. is absolutely impeccable! As there IS a science to all of this. Thank you..trainspotter, crzydiamond, pill_head...all of you. Thank you! Hope this msg. Isn't TOO scattered. Took me over an hour or more to write ... Breaks to breath thru intermittent pain.
Hope I wasn't UN-clear . & hope all is well for y'all!

 

[Emme80]

I'd be happy girl if I could keep dose under 10...like the 7.5! Way ok. After years of pills & methadone, I AM certainly naïve -admittedly. So, Lorne??! "acute" meaning an efficient dose to hold? as in starting/stabilizing on a dose? & "chronic" meaning...the dose needed to "hold" once stabilized-for daily "chronic" habitual use? Is that correct?
I suppose, in short, to go from here, I could possibly get the Vicodin (last time it was 7.5..I think)-but would that even be enough to hold me from the week of 15mg. ER Morphine w/ average of daily 4-8mg of the Dilauded..? If not, then Methadone I go. Right? I still have about about 25-30 of the 2mg. Dilauded... Don't know if that would go against /for me.

 

[crzydiamond]

my honest opinion?

Don't restart the methadone. If you are not having wd then stick with the pain meds you are taking now, lessen as needed, step down to Vicodin and taper those as needed. Will be much much much more comfortable than going back to methadone and tapering. I did it once cold turkey and once a long slow taper on methadone and with the residual wd after you jump, well, it'll be a shorter one off the pain pills.

And take deep breath and relax... You sound so stressed!!

 

[Emme80]

Ok...short&sweet update....leaving back stories behind-I'll refrain&get to my update, facts and my major question(Lorne???? You know your shite when it comes to the equivalencies...might you lend your mind?)anyone else who knows such equivalencies-help!?!?
As of today, I am 12days with NO methadone .
I stopped taking the Morphine 15mg. ER two days ago- 2days prior to that, I was only taking 1 a day(vs.the 2rxd)
Yesterday, I discontinued the any & all of the "breakthrough" Dilauded 2 mg. in the 1st 4-5 days the meds were godsend. Now, manageable yet foot screams in pain still-just not as often & maybe 25% less pain. I was using those...average of...4-8mg per day for ...1 week? 8 days? About there.
As of today, I am on hydrocodone 5-325. Rx'd 1-2 tablets every 4-6hrs. 50 tablets. ( I turned down Percocet)
So, given the situation as it stands now...were I to take say...4 tablets a day, would that hold me? Is it at all fee single to go this way off (staying off) the methadone? 12days w/no methadone..I know it lingers in your body for an ungodly amt. of time...
So will the sky come crashing down on me if I taper off from here / was the week-10days of heavier meds. set me way off. I'm not feeeeling any different-other than emotional, frustrated&pain.. As I am forced to rely on others for 80% of daily life duties.
I realize the "answer" may be exactly the same as above answers. I am curious how the equivalency of hydrocodone 5-325 vs. 2mg. Dilauded is....
I won't be asking much more of this-as I imagine I'll know "what's up" with my body in a few days...it'll tell me yay/nay.
Thank you kindly for any input-much appreciated ! (Btw , I've looked at the opiate equivalency charts...still confused. Especially w/the cross tolerance ratio /% . I'm stuck in the charts .)
Again, many thanks .

 

[Emme80]

crzydiamond...If I've held off from the methadone (4mg)& am on these said pain meds for 3, more likely 4weeks-as it was 4wks. last time/surgery..(my methadone dose was much higher last surgery&made it virtually unfeasible to attempt then), now stepped down to 5-325 hydrocodone- I know I can get another refill if need be. Some are put on morphine drips for this procedure-so I'm actually going "light" on this...full recovery is 9-12 months(ugh!) you do think it would be an easier "jump" than methadone?

 

[Lorne???]

On general, 2mg PO hydromorphone = roughly 8mg hydrocodone, range probably, 6-12mg. But both of the "hydro's" tend to be variable, due to variable metabolism/BA. So the best I can do there is tell you morphone is generally 4x stronger, though it could be anywhere from 3-5x stronger, or even 6x in some cases. The duration is similar, though hydrocodone's half-life is a bit longer.

But will 20mg hold you? Only you can know that, by trying it. It won't make you feel great, but it should hold you.

I'd actually try 7.5-10mg TID, whether than 5mg QID, then drop to 5mg, then nothing.

You're pain will be you're main obstacle here, as having dropped from such a high dose you're still better off than you were, but I know from experience getting analgesia after having such a high tolerance.

 

[Emme80]

Thank you Lorne???...! I'll be listening to my body. Is it odd/perfectly normal that as of right now...through this& to this moment, I feel completely fine. Not experiencing any kind of wd symptom?

 

[Lorne???]

I'd call it damn lucky

Nah, it makes sense, I mean the very minor WD'd from low doses are nothing compared to you're previous methadone habit.

I mean you got down to 4mg; not that CT'ing even that would be fun, but it just doesn't compare to being at the typical 80-120ng at an MMT clinic.

I'm sure the pain you're in is far worse. If you feel fine otherwise, though, I'd stick to whatever dose of hydro you're on, and to be safe, cut that in half before dropping(after your pain is dealt with obviously).

Don't be afraid to take rescue medication, just don't take a single large dose; that, or dosing 4-5 times a day is what jacks up tolerance, since the receptors don't get any downtime, to recover.

Glad it is working out for you, though.

 

[Emme80]

Right on .... I'm hoping that any acute methadone wd would be...somehow skipped over. I don't know how that works...but today being 13days w/no methadone(having switched over to surgery strength pain meds) the methadone is leaving my body I'd imagine...true, other opioids taking it's place. Indeed, I took less of rx'd pain meds & it certainly would've been less painful but I just didn't care-some relief was a-ok .... if it meant I could work this on my favor. Just gonna keep doing what I'm doing...listen to my body ... and I'm a already in pain .. Soaybe my body is distracted. If anything , I've got my 400mg+ of methadone. Would be cool to not have to use it. I suppose I'll know if this is "too good to be true" once I taper off the Vicodin... once I'm on NOTHING for a week+ will I believe I made it through the eye of the needle. Thx. Lorne- for putting up with my worried neurotic ass!
Will listen to my body.