I'm not sure where this post should be planted, and I'm sorry if I guessed wrong.
Here's the background: I'm basically sober now, but until a few years ago I was a poly-drug addicted, IV-opting, rehab/hospital-hopping, liar to and betrayer of friends and family, daily participant in felonious activities, constantly over-dosing but somehow never arrested, victim of a myriad of somatic ailments related to my drug use (ranging from cellulitis and a pulmonary embolism to repeated "mystery traumas", which ranged from mild and embarassing to life-threatening and embarassing)... My drugs of choice were heroin and - to a lesser extent - cocaine, but I would and did do whatever was available. I also suffer from bipolar disorder, type one (rapid cycling, with psychotic features) and for most of my life I refused to take my meds with any consistency. Drug abuse and a tendency towards mania go together like taking a piss on high tension wires.
Anyhow, all that was just to give you some sense of the brand of baggage I'm lugging around... My question - the reason I'm posting - is really more about narcotics in the context of pain management. I was in a bad car accident a few years ago... the specifics of my injury and current problem(s) don't matter. The problem is that because of X, I'm in the position of having to go to a new pain doc tomorrow and try to convince him to help me get off methadone and back on the dilaudid regimen that I used to take (and know is effective).
Doesn't sound that difficult, but experience has proven to me that I'd be an idiot to assume that - any - doctor (and especially a pain doc) is going to listen to me and take me on as a patient. So, I've the last few days constructing a plan for getting from 110 mg of methadone a day to the correct and effective dose of dilaudid.
Here's what I've come up with:
Current Medications:
Pain Control
Methadone 110 mg q AM
Psychiatric (Bipolar Disorder)& ADHD
Lithium 900 mg bid
Lamictal 25 mg q bedtime
Clonazepam 1 mg 1 to 3 X daily
Temazepam 30 mg q bedtime
Focalin 5 mg bid
Serequel 600 mg q bedtime
Misc.
Synthroid (forget the dose; not sure where the bottle is)
Zyprexa ODT 10 mg PRN (agitation)
Soma 350 mg PRN (pain, muscle spasm)
Lyrica PRN (pain/adjunct mood stabilization)
Depo-Provera IM (contraception)
Apparently, 110 mg of oral methadone is equivalent to approx. 240 mg of oral hydromorphone (source(s) for that came from the internet and an opioid equivalency calculater app on my tablet).
Goal: transition to effective pain management that does not include methadone with minimal withdrawal side effects that could potentially exascerbate psych symptoms and significantly worsen current pain situation. [Note: it is well-documented that opioid withdrawal –esp. methadone withdrawal – almost invariably causes my mental illness to derail very quickly, with affective instability and psychotic symptoms that frequently end up requiring inpatient treatment either in response to extremely dangerous actions and/or thoughts or as a pre-emptive attempt to prevent a potentially lethal incident resulting from psychiatric symptomology precipitated by the physical and emotional pain of withdrawal.
DAY ONE: 40 MG OF DOLOPHINE BID & 2 MG HYDROMORPHONE TID
DAY TWO: 35 MG OF DOLOPHINE BID & 4 MG HYDROMORPHONE TID
DAY THREE: 30 MG OF DOLOPHINE BID & 4 MG OF HYDROMORPHONE TID
DAY FOUR: 20 MG OF DOLOPHINE BID & 8 MG HYDROMORPHONE TID
DAY FIVE: [REPEAT DAY FOUR]
DAY SIX: 10 MG OF DOLOPHINE BID & 16-8-16 MG HYDROMORPHONE
DAY SEVEN: [REPEAT DAY SIX]
DAY EIGHT: 5 MG OF DOLOPHINE BID & 16 MG OF HYDROMORPHONE TID
DAYS EIGHT – TWELVE: [REPEAT DAY EIGHT]
DAYS THIRTEEN & FOURTEEN: 16 MG OF HYDROMORPHONE TID
AT TWO WEEK MARK, BOTH PAIN AND PSYCH SYMPTOM SEVERITY ASSESSED AND – PENDING RESULTS OF ASSESSMENT – MEDICATION REGIMEN ESTABLISHED.
Does this sound like a realistic plan? (all that build up, just for that… heh, even I have to laugh)
If you read this far, well, you deserve a cash prize, or at least a new kitchen appliance. I know this has been long, and not particularly interesting. I wouldn’t even post it at all – mostly because I’m a coward and I know people are going to make remarks that will make me feel stupid, if they even bother to respond – but I’ve been reading this forum for a long time, and I respect the collective wisdom and analytical prowess I’ve come to expect from the majority of the serious posters/responders. And I need help with this… I don’t want to be even more boring than I already obviously am, but this pain problem has reduced the quality of my life to the point where I frequently seriously consider taking myself out. The thought of either having to go through every day in agony or ending up instutionalized for god knows how long… Well, I’d rather put a gun in my mouth.
Any feedback would help. Thanks.
X = involuntary and lengthy psych hospitalization that, through a circuitous route, managed to disrupt the care I was receiving for my chronic pain issues and when I no longer had a doctor to prescribe the extremely large amount of hydromorphone I had become accustomed to and legitametely needed, I panicked, and ended up a patient in a methadone clinic (which was entirely innapropriate, as my problem was pain -- not opioid abuse).
Here's the background: I'm basically sober now, but until a few years ago I was a poly-drug addicted, IV-opting, rehab/hospital-hopping, liar to and betrayer of friends and family, daily participant in felonious activities, constantly over-dosing but somehow never arrested, victim of a myriad of somatic ailments related to my drug use (ranging from cellulitis and a pulmonary embolism to repeated "mystery traumas", which ranged from mild and embarassing to life-threatening and embarassing)... My drugs of choice were heroin and - to a lesser extent - cocaine, but I would and did do whatever was available. I also suffer from bipolar disorder, type one (rapid cycling, with psychotic features) and for most of my life I refused to take my meds with any consistency. Drug abuse and a tendency towards mania go together like taking a piss on high tension wires.
Anyhow, all that was just to give you some sense of the brand of baggage I'm lugging around... My question - the reason I'm posting - is really more about narcotics in the context of pain management. I was in a bad car accident a few years ago... the specifics of my injury and current problem(s) don't matter. The problem is that because of X, I'm in the position of having to go to a new pain doc tomorrow and try to convince him to help me get off methadone and back on the dilaudid regimen that I used to take (and know is effective).
Doesn't sound that difficult, but experience has proven to me that I'd be an idiot to assume that - any - doctor (and especially a pain doc) is going to listen to me and take me on as a patient. So, I've the last few days constructing a plan for getting from 110 mg of methadone a day to the correct and effective dose of dilaudid.
Here's what I've come up with:
Current Medications:
Pain Control
Methadone 110 mg q AM
Psychiatric (Bipolar Disorder)& ADHD
Lithium 900 mg bid
Lamictal 25 mg q bedtime
Clonazepam 1 mg 1 to 3 X daily
Temazepam 30 mg q bedtime
Focalin 5 mg bid
Serequel 600 mg q bedtime
Misc.
Synthroid (forget the dose; not sure where the bottle is)
Zyprexa ODT 10 mg PRN (agitation)
Soma 350 mg PRN (pain, muscle spasm)
Lyrica PRN (pain/adjunct mood stabilization)
Depo-Provera IM (contraception)
Apparently, 110 mg of oral methadone is equivalent to approx. 240 mg of oral hydromorphone (source(s) for that came from the internet and an opioid equivalency calculater app on my tablet).
Goal: transition to effective pain management that does not include methadone with minimal withdrawal side effects that could potentially exascerbate psych symptoms and significantly worsen current pain situation. [Note: it is well-documented that opioid withdrawal –esp. methadone withdrawal – almost invariably causes my mental illness to derail very quickly, with affective instability and psychotic symptoms that frequently end up requiring inpatient treatment either in response to extremely dangerous actions and/or thoughts or as a pre-emptive attempt to prevent a potentially lethal incident resulting from psychiatric symptomology precipitated by the physical and emotional pain of withdrawal.
DAY ONE: 40 MG OF DOLOPHINE BID & 2 MG HYDROMORPHONE TID
DAY TWO: 35 MG OF DOLOPHINE BID & 4 MG HYDROMORPHONE TID
DAY THREE: 30 MG OF DOLOPHINE BID & 4 MG OF HYDROMORPHONE TID
DAY FOUR: 20 MG OF DOLOPHINE BID & 8 MG HYDROMORPHONE TID
DAY FIVE: [REPEAT DAY FOUR]
DAY SIX: 10 MG OF DOLOPHINE BID & 16-8-16 MG HYDROMORPHONE
DAY SEVEN: [REPEAT DAY SIX]
DAY EIGHT: 5 MG OF DOLOPHINE BID & 16 MG OF HYDROMORPHONE TID
DAYS EIGHT – TWELVE: [REPEAT DAY EIGHT]
DAYS THIRTEEN & FOURTEEN: 16 MG OF HYDROMORPHONE TID
AT TWO WEEK MARK, BOTH PAIN AND PSYCH SYMPTOM SEVERITY ASSESSED AND – PENDING RESULTS OF ASSESSMENT – MEDICATION REGIMEN ESTABLISHED.
Does this sound like a realistic plan? (all that build up, just for that… heh, even I have to laugh)
If you read this far, well, you deserve a cash prize, or at least a new kitchen appliance. I know this has been long, and not particularly interesting. I wouldn’t even post it at all – mostly because I’m a coward and I know people are going to make remarks that will make me feel stupid, if they even bother to respond – but I’ve been reading this forum for a long time, and I respect the collective wisdom and analytical prowess I’ve come to expect from the majority of the serious posters/responders. And I need help with this… I don’t want to be even more boring than I already obviously am, but this pain problem has reduced the quality of my life to the point where I frequently seriously consider taking myself out. The thought of either having to go through every day in agony or ending up instutionalized for god knows how long… Well, I’d rather put a gun in my mouth.
Any feedback would help. Thanks.
X = involuntary and lengthy psych hospitalization that, through a circuitous route, managed to disrupt the care I was receiving for my chronic pain issues and when I no longer had a doctor to prescribe the extremely large amount of hydromorphone I had become accustomed to and legitametely needed, I panicked, and ended up a patient in a methadone clinic (which was entirely innapropriate, as my problem was pain -- not opioid abuse).
