Opioids Question for those who are good with equivalencies

[Emme80]

I'll try to make this short. I've been on a methadone taper...down to 4mg. Was doing a split dose-2@morning-2@night.
I had a gnarly foot surgery on Tuesday. Sucked. Big toe cut in 1/2 , a wedge taken out, twisted, lower down-following the to bone, same thing-then bunch if screws , staples, pins, etc. to keep this poor sad foot together.
So, the Dr. rx'd me:
(by the way- last time I took methadone was 2mg . on Monday)
* 15mg. Morphine ER -to be taken 1 every 12hrs.
* 2mg. Dilauded- to be taken every 3-5 hours.
I realllly don't want to go completely backwards on my 4mg. Of methadone.SOO much progress has/had been made. I'm NO good with conversions, no math girl am I. Is all progress lost? I took the 15mg.ER Morphine for...4 days.(2x's a day... Tues. - Fri.) Am I just totally fucked? Shall I take just the 2mg. dilauded ? I know he will giver something "less" at next follow up.( i.e. vicodin/perc's ) I'm on day 5(5&1/2) if no methadone. Any suggestions of how to perhaps NOT go UP on methadone? Shall I split up the ER morophine?or JUST take the dilauded? I know I can/will get a less strong med.
My goals: (and indeed, they may be unlikely ...just hopin '& prayin' there's a way)to be able to go with scripted pills&taper off them, leaving the methadone behind. Or stop all meds.(pills) and go back to g. Methadone. Like I said , I'm on day 5 of no methadone- day 4 out if surgery (for which I've been on above meds).
Lorne??? Your a spot on with these things... Any takers to my lilttle big problem?? I hope there's still hope!
Thx for any help offered( and to you my Trainspotter!)
I'm realllly hoping there's a way I can either switch to meds. rx'd for this surgery( med's , along w/ the shorter acting I'll recv. In next week)...a month on such meds-while methadone is pushed out of my body or..ask for different meds... OR say fukitall & cease pain meds.& go back to methadone-no matter the pain. Don't know what go do. Just want to be done with Methadone. And my foot to stop screaming. It IS gnarly looking though...Frankenstein Foot !
Again thx for any help seeing this thru.
(P.S....I still have at least 400mg. Of methadone left)
Hope this made sense, as I am not breathing-holding breath through the pain.

 

[The Doc.]

Hey Lorne may be able to convert it he seems to know more about the Methadone/conversions than I do but in my opinion you should take the meds you get prescribed then go back to a methadone taper or taper your use of the meds before going back to your methadone taper I mean 400mgs is a lot and if you only need mabye 10 or so at most you will be able to do a good slow taper still even if you have to raise your dose.
I read that 2mg diladid taken orally is about the same as 5mgs methadone but diladid when taken orally has A very un predictable Bioavailability meaning it most likely is a little less than 5mgs methadone when converted since methadone has a very high B/A when taken orally.

I think if your in pain keep taking what you need but if you feel you don't need them don't take any. The easier one to come off of the two drugs your on is morphine it is the weaker of the two drugs by far and being extended release makes it not nearly as addictive(when taken orally) as drugs such as percocet/vicodin or diladid since all those drugs are quick release.

 

[QUARE]

http://en.wikipedia.org/wiki/Equianalgesic

Here is a chart for Analgesic equicalencies.

 

[Pill__Head]

If I were in your position, this is what I would do:
1) Keep tappering your methadone as you have been, dont change anything there, keep this all the same. ( OR as a second option keep your methadone dose right where its at during this whole recovery time period, and continue with your tapering once your totally recovered and out of pain.)
2) If you are in pain on-top of you low methadone tappering dose, then dose the absolutely least amount necessary of the Dillies. BUT THATS IT. JUST TAKE IF ABSOLUTELY NEEDED FOR PAIN.

Yes no matter what you do taking more of any opiate is going to prolong your methadone taper, because you aren't just tapering off "methadone" its the "opiate effect" that you are tapering off, so if you take any more opiates it will just be moving backwards in taping and getting clean ( if thats what youre trying to do).

But don't let the fact that you will be prolonging/ possibly worsening your comming off of all opiates cause you to not take your pain meds if you are TRUELY in pain.Once you have healed enough to you no longer need your pain meds, just finish your methadone taper, and you should be golden !

GL!

 

[The Doc.]

^^^exactly I say worry about tapering methadone after I mean the worst you could possibly do with those meds is mabye up your tolerance to 15mgs methadone whivhbisnt much considering you have 400mgs to taper with and you will be down to 4mgs before you know it if you continue splitting your dose.

 

[Emme80]

Ugh

Thank you all .. QUARE,Pill_Head & as always, my trainspotter !! I have been methadone free for 5days. The Dr.'s plan- in just about 2wks.
(Feeling fucked & as if I lost the game b/c I feel I'm trapped again, my plan apparently appears un-feasible .down& at square 1)
I go down from theses "stronger" meds to less punch= Vicodin/Percocet. The current meds(the Morphine ER...have taken it every 12 hours as of Wednesday. I've taken 1 Morphine ER today(at 3am) nothing since. I if I were to stop the rx'd meds from this pain in the foot surgery, today ... As of today, drop all rx'd pain meds, jump back on my 4mg.of Methadone(how much higher dose would I HAVE to be on... Considering the 4days of taking 15mg Morphine ER every 12 hrs . As well as Tylenol & the .2mg of Hydromorphone, every "3-5" hrs-(which has been on a non-"rx'd/prescribed as . Meaning less. What if I chopped the 15mg.morphine into smaller bits ( yes, that would ruin the time release...but would that be better than....I dunno...just wish I could get through this w /I upping my methadone intake ( dose ) or if possible to switch to these pain meds .& taper off them. Wouldn't methadone be at least partially removed from my body in 2&1/2-3weeks ?
Confused , sad, mad, let down & frustrated. Damn foot . And yes , as Trainspotter said, perhaps the almighty at equivalencies guru Lorne!?? might have, insight / opinion??
Thx . again you lovely peeps !
Any way to make possible... If I can go 1month on rx'd pills, isn't the m.done nearly out if my system? Ugh..sorry-so many questions that may not be answerable.
Many thanks & thank you kindly!
^Indeed train... I think I'd rather lay here in pain than fall back into a methadone trap tho , ya know? :'(

 

[Pill__Head]

Thank you all .. QUARE,Pill_Head & as always, my trainspotter !! I have been methadone free for 5days. The Dr.'s plan- in just about 2wks.
(Feeling fucked & as if I lost the game b/c I feel I'm trapped again, my plan apparently appears un-feasible .down& at square 1)
I go down from theses "stronger" meds to less punch= Vicodin/Percocet. The current meds(the Morphine ER...have taken it every 12 hours as of Wednesday. I've taken 1 Morphine ER today(at 3am) nothing since. I if I were to stop the rx'd meds from this pain in the foot surgery, today ... As of today, drop all rx'd pain meds, jump back on my 4mg.of Methadone(how much higher dose would I HAVE to be on... Considering the 4days of taking 15mg Morphine ER every 12 hrs . As well as Tylenol & the .2mg of Hydromorphone, every "3-5" hrs-(which has been on a non-"rx'd/prescribed as . Meaning less. What if I chopped the 15mg.morphine into smaller bits ( yes, that would ruin the time release...but would that be better than....I dunno...just wish I could get through this w /I upping my methadone intake ( dose ) or if possible to switch to these pain meds .& taper off them. Wouldn't methadone be at least partially removed from my body in 2&1/2-3weeks ?
Confused , sad, mad, let down & frustrated. Damn foot . And yes , as Trainspotter said, perhaps the almighty at equivalencies guru Lorne!?? might have, insight / opinion??
Thx . again you lovely peeps !
Any way to make possible... If I can go 1month on rx'd pills, isn't the m.done nearly out if my system? Ugh..sorry-so many questions that may not be answerable.
Many thanks & thank you kindly!

Okay it looks like you may need 7.5mg methadone daily to cover your morphine...{http://www.sfhp.org/files/providers/Best_Practices/Opioid_Dosing_Guidelines.pdf}

Im sorry you're in such a hard position, I always hated being fucked...but who doesnt?

Unfortunately this conversion site for your dillie use seems a little high, but IDK it could be acuurate; it states you'd need 13.3mg of methdone/day to cover your dillie use. { http://www.medcalc.com/narcotics.html}

So from these conversion it looks like you would need 7.5mg + 13.3mg = grand daily total of 20.8mg or personally, I'd just call it 21mgs.

anyways thats whatd you'd need for methadone, im kinda of confused by your post.. not sure if you DO or DON'T want to use Methadone.. but anyways, if you have any more questions,,feel free and, Good Luck!

EDIT: after reading TP's post, ANouther thought is that if you do want to just stick to the methadone, and use it for everything, your painkiller for recovery, MMT(if thats wut its actaully for), and I gave you the dose above you would need to start at, that should kill all you pain, keep you well, and once your totally healed/recovered start tapering down from there and be DONE!

 

[The Doc.]

Well the methadone will be out of your body but then your addicted to the pain meds and jumping off those cold turkey totally defeats your whole methadone taper cause you may as well have jumped off 20mgs of methadone instead of tapering slowly down to nothing I mean why don't you want to taper it? Is it cause your scared of the methadone withdrawal and how people make them out to be horror stories. Your addicted to opiates and in my opinion tapering and coming off a long acting drug is not as horrible as dropping off painkillers. I mean why not use the Methadone you have and taper it what's so bad about using this tool to help you get off the drugs some more surley you couldn't have expected to just stop yourbtaper go on pain meds then just stop I mean think of it this way you spend all this time tapering meticulously and thoughtfully down to this extremely low dose of 4 mgs then when you have 400 mgs still left you start taking 20-30mgs for a bit then you decide you don't want to taper back down and just quit. I don't know just don't make sense to me but if you want to make it quite a bit harder on your self that's up to you I just don't see what's wrong with that plan I mean go back to 4 mgs of methadone then see how that feels it may hold you if your taking vicodin as that's weaker than most opiates such as percocet or hydromorphone vicodin is almost like codeine so that bit of Meth may hold you.

I just hate to see you putting all this un nessesary stress on yourself and making coming off opiates so much harder when you have the tools to do it right.

Just my 2cents nothing but you know that Emme.:D

 

[The Doc.]

And we will never really find an exact dose of methadone equivalent to what your taking now there are too many variables and people process drugs so differently especially methadone. You'll just have to start low and work up. Looks like I was pretty dam close according to pill heads link by saying around 20-30mgs of methadone but by the time your down to vicodin (choose vicodin not percocet if you want a lower tolerance) it should be half that amount so really your only really going up by 5 -10 mgs of methadone by having this surgery which I think is well worth it.

 

[Pill__Head]

And we will never really find an exact dose of methadone equivalent to what your taking now there are too many variables and people process drugs so differently especially methadone. You'll just have to start low and work up

well of couse but we can give her pretty good ideas of where to start at, you can't deny that..

 

[Lorne???]

Well if you do go back to methadone, you'll need way more than 2ng initially. Remember that "acute" methadone is half as strong as chronic methadone, and the duration is shorter.
But if you haven't taken too many dillies, you won't be to bad off. 15mg PO morphine= 1.75-2.5mg chronic oral methadone, dosed BID.

2mg hydro= about 1.5mg chronic oral, but a lot of people say it's more than that.

You might be better off tapering from these short acting agonists. If not, you need to stack a little bit of methadone in you're system before you restart your taper.

But as you can see, the methadone dose really won't be much higher, it's just a matter of getting it back in your system.
Of course, these figures are variable, and at these low doses, methadone tends to be less potent in relation to other opioids(at high doses, methadone can be 10-20x stronger than morphine).

Either way, you can't suffer through pain,(much less a "Frankenstein foot", yikes!) so this is an unavoidable hurdle with opioid dependence.

 

[crzydiamond]

^^ was going to say exactly what Lorne?? mentioned above, that you might be better tapering from short acting opiates.

Yes after several weeks the methadone would no longer be built up in your system, in the long term the surgery might do youths favor of coming off short lasting opiates rather than methadone at the end...

As Lorne mentioned, the stacking effect of methadone is needed for its efficacy in maintenance. But then again, ridding yourself of that stacking is necessary to get off of it... Would be much easier to taper from Vicodin or oxy. If you have that control to taper and not go for the buzz...

Good luck. And whatever else, take enough to make yourself comfortable until you are out of pain. Then go from there on the dependence

 

[The Doc.]

well of couse but we can give her pretty good ideas of where to start at, you can't deny that..

Yea I know I already did but what I'm saying is we can't say for sure. That's why I said EXACT

 

[Lorne???]

Ok, I'm back.

30mg (chronic) oral morphine=
roughly 10mg (acute) methadone, range 7.5-15. Chronic is twice as potent, so 3.75-7.5 is pretty much you're dose range.

IDK how many dillies you take, you said 3-5 hours, so lets say... 6-8mg?

7.5mg hydromorphone= roughly 30mg chronic oral morphine.
T

That would essentially double you're dose, if you're taking 4 a day.

So 15-30 acute, 7.5-15 chronic. BUT methadone has a much longer duration. Thus, the above estimate is overestimated. I'd say start with half of the recommended dose.

Methadone conversion is complex, as it's not only variable(and dose dependent) but methadone's longer half-life/duration mean that an "equivelant" dose lasts longer than the comparable dose, therefore reducing total daily opioid consumption.

As an example, it only takes 1.25-2.5mg CHRONIC methadone to equal 2mg hydromorphone; however, methadone lasts MUCH longer; so you'll need 3-5 doses per day of the dilaudid, but only 2 doses of the methadone.

If you switch to methadone, I would start with just 7.5mg. You could even take the 7.5mg in the morning, and 2.5-5mg later. People underestimate methadone potency.

I would also highly suggest getting some WGJ/cimetidine, not to make the dose stronger, but last longer, helping to stack it back in your system to continue your taper.

Anyway, good luck and tell us what you decide to do, and feel free to ask any questions

(PS: it might help, IF you intend on going back to methadone, is to go ahead and start stacking small doses back into you're system now. You could take just 2-4mg a day a few days, while you still have the dillies for "breakthrough", and once you go back to methadone, you'll only need half the dose I mentioned above, so 4-6mg per day.

So so, you're really not any worse off

 

[Emme80]

Will continue taper as soon as I'm not in deathly a screams.!suks.!Disappointed.!Sad.! Didn't wantto have to go up in methadone.!
But it is what it is. Does suk. Should a jumped ship earlier. Oh well. I'll muscle my way thru this pain for the next week& go back onto methadone. Sad. Just a wanna cry...so I will.

 

[Lorne???]

Like I said, you really won't have to. 4mg(chronic) methadone is actually equal to 20-30mg oral morphine, but with a longer duration. I think you'll be suprised at how low of a dose will still work, I highly doubt you would need much more than 7.5mg once it's back in your system.

 

[Emme80]

Thank you for alllll the factors.!and Lorne??? You are a conversion hero. I'm going to have to read that better when my eyes aren't full of tears. You be awesome. I'm feeling 1000% emotional. So, I'm gonna have to pardon myself as the only thing I can do right now is ....cry.
Trainspotter- I adore ya
Pill_Head...many thanks
crzydiamond.... Your help does NOT go unnoticed. You rock.
Lorne??? ....hero of conversions.
I'll respond when I'm not a cying mess.
Beyond d thank you all!

 

[Emme80]

Ok...hello my helpful friends. So, it's been one LONG night..woke in pain about every hour&a 1/2. I did take the ER tablet...2hours of writhing pain did me in.. no fun feeling like all the screws and pins were in the midst of an epic battle inside your foot. It helped reducing the oh-so classic bone splitting pain (I forget how it was last time...
Considering I've been up since 4am , I've given long hard thought.
@trainspotter.... I don't fear the wd ( well of course I do but far from reason I'm .. Sucha worried girl. Ima worried girl...always. But this, I suppose it had confused me. And with all the progress I made-going from 145mg(approx....sikewhere between 140mg&150mg)
Even this last haul from 34 mg. to .4mg. ...being so excited ...yea, it was/is disappointing.
BUT, you guys gave me a lot of good things to think about .
*Yesterday, I felt destroyed...scared b/c whatever methadone I have left...a good bit over 400mg. is all I have. I'm hoping that's enough to
finish a taper.
*Indeed, there was a good part of me that HOPED (as I've read of people doing so) of switch to the shorter acting opiates&go taper off those.
* My plan.... Well, I suppose I cannot " predict " and make a plan when I don't have the cards in my hand.
I plan on taking as little as possible...as I've already done . Maybe he WILL give me 60 Vicodin like last time. But whatever... I need to not NOT take ANY pain meds- as I was warned- this procedure is very painful & 12+months to get foot back to semi-normal. I'll be switching to the Vicodin for about 2weeks. I have not taken ANY methadone in ... 6&1/2 days. I suppose I'll just "play it by ear".... To know when my body's gonna start yelling at me. Right now-I must must must take care if foot. I can deal w /pain- but not the screaming type if pain. So, I will only take meds . if it's the screaming pain...
Trainspotter-invaluable you are! Thx. Many times over !
Lorne???- Master if conversions-a wealth of knowledge!
Pill_Head-you as well were there, with straight up facts-rad
abracadabra-thanks for confirming&lending a hand....
We shall see how it all goes down. And thank you Trainspotter- I don't want to make this harder on myself
-not now... good point to bring up! Thx. Truly.
As of now, I will not beat myself up( already feel that way as is
!!! HarHar). Towards end if this week , I will evaluate myself from there . Apparently, I've more options that I previously asked!
Question though~ been off methadone for nearly 1week: is it"out" of my body(beyond fat cells, etc.)?
Also, the 15mgMorpine ER, would it be better to cut that up( I know it'd ruin the ER issue) and the same with the Dilauded? ( it's 2mg...would be hard to cut-it's tiny tiny ) ugh...spacing out tired Zzz is needed.
I'm dreaming that
A) maybe... Just MAYBE, I can get on w/shorter actings& taper from there
B) I can switch Back to Methadone at not TOO high a dose.
I will keep up on my "progress". Now, it's time to elevate foot,Ice the hell out of my foot(the icing it is KILLING ME this time around-last time the ice was a godsend - this time... It's a nightmare. I dread the ice
Thank you all Always& Forever!
.

 

[crzydiamond]

^^ on the question about methadone being "out" of your body after a week+ , I cold turkey wd one time from methadone (ugh) and it took about 30-32 days to feel normal again. The first 2-2.5 weeks were the worst, with small improvements daily after that. Thankfully I ds not know then how long wd would be. I was used to heroin wd. So after 3-4 days I'm wondering every morning "why don't I feel better"?? Little did I know! I ate no solid food for 10 days. The wd strangely wasn't quite as viciously intense as heroin wd but it was soooo drawn out and the weakness was unbelievable.

But I'm off the track--my point was I think the methadone is not quite out yet. In another week/week and a half most should be though. In my experience.

And idk about you, but when I'm legitimately in pain and take meds for some reason my tolerance
Doesn't skyrocket. Relax n play it by ear. Keep out of pain and see where you're at. You just may be surprised...if the methadone has cleared your system and you only have a low level short acting opiate wd to taper from...

 

[Lorne???]

^^^ Those long WD'd are because of how damn strong it is, and of course, the way it lingers in your body.
In terms of dosing, though, it's pretty much out, to the point it is definitely "acute" dosing, which means it will take a couple days of loading to get you're body saturated enough to switch to "chronic" mode so to speak.

I personally would grind the morphing into a fine powder, but it's all personal preference.

Emme, Hun, if you can just keep the dose under control(I know with pain that might be impossible) but if so, you haven't lost. Much footing.

With you're resolve to quit, 400mg will be more than enough

(Think about it in terms that it would roughly 3 grams of morphine to equal that much methadone!)