Tapering Ready to give up my addiction. Seeking advice

[Structure87]

Three years ago I had never touched an opioid and was diagnosed with UC and nothing helped me. Without insurance I couldn't afford the Biological Meds and the doctors answer was give to give me a shot of HM and send me home with a script of oxycodone. This went on for about a year until we found a medication that helped me and I no longer needed the oxy. When I tried to give it up it was complete hell, I couldn't do it and I had a strong urge to use. I knew at some point along the way that I was addicted but figured I could just stop.
Fast forward 2 years and I've managed to keep my habit at 60mg of oral oxy a day. I'm ready to give it up and either begin a taper ( which i'd like to know what you all would recommend ) maybe cut back by 10mg every week?
Should I consider suboxone? Can I simply schedule an appointment with a doctor and tell them my situation? Would that be worse than just tapering off?
I quit once before cold turkey, I felt like shit for just 36hours it wasn't to bad. It was the mental aspect of the WD that absolutely tortured me until I picked back up a week later.
I've done the math and this shit is costing me 24k a year, how stupid of me to have kept it up this long.
I'm so ready to quit, I know I can do this, just looking for some direction. Any advice is appreciated.

 

[Jabberwocky]

Generally tapering off opioids is harder with short acting medications like oxycodone. I have heard folks have success tapering off morphine more so than oxycodone, although it would be easier to taper using a longer acting opioid like buprenorphine or methadone.

I'm curious though, what are your goals with this? You want to come off opioids, that much is clear. If you've been using opioids for pain management, you'll need to find effective strategies to work with you physical discomfort. If you've been using it for mood regulation/stability (to address anxiety, depression, etc), you'll need to find ways of addressing that without opioid use. Likely, you'll need to find a combination of strategies addressing your medical condition and how you've come to rely on opioid use (I'm guessing) to give your mood stability (and in any case, coming off a long period of opioid use is highly destabilizing, so you'll need to address this regardless).

Basically you have a couple options in terms of coming off opioids in particular (detox/withdrawal):

You can work with you doctor to get the right comfort meds (gabapentin, diazepam, clonidine) and detox with those (which shouldn't be so bad given your experience coming off opioids before). Alternatively, you can work with a doctor who can prescribe you a week or two of buprenorphine (ideally in addition to comfort meds - buprenorphine when used this was is itself a comfort med). You can also use a methadone clinic's month long detox program.

However, those three options only deal with the detoxification. The large issues surround how you'll manage your medical condition and mood without using opioids (this is your goal, correct?). This is probably one of the biggest reasons a term of maintenance on ORT (buprenorphine or methadone) can work well, because it helps to give you time to stabilize in terms of how they'll manage their medical condition and psychology without their opioid of choice.

With buprenorphine you can work with a doctor in a private office to determine a plan that works for you, although it won't work as well for pain as methadone and is not nearly as structured as an ORT clinic. Methadone has a specific six month extended detox program (basically switching to methadone and slowly tapering off it over five to six months), which I think would be ideal for your needs. The clinic staff can help you manage your medical conditions, coordinating with your other doctor(s) and provide you with a highly structured environment for your detox. It is a much larger commitment than buprenorphine is, but this is your life we're talking about.

I'm curious to hear more about your reasons for wanting to get off opioids. Financial reasons are important and highly motivating, but for most people it isn't nearly enough of a reason to at first achieve lasting recovery. Or perhaps your financial situation is affecting your life in other more interpersonal ways. Basically I'd like to explore your reasons for wanting to address how your opioid use has become problematic or maladaptive, more in terms of your relationships with other people in your life, especially those important to you.

Coming off opioids often requires a pretty dramatic restructuring of our lifestyle and daily habit patterns. It never, for no one, happens overnight. This might sound like bad news, as we so often want to just get over our problems already or find some quick fix, but it's actually quite liberating. Namely, that there is no rush - that rushing into this is actually makes things more difficult, confusing the issues most important to you in the first place. And especially this reality belies the insight that great things are accomplished by small, consistent steps. Goals become much more achievable themselves when once they're broken down into achievable steps that are most relevant to you, your situation, your goals, etc.

 

[Structure87]

The main reason I want to quit is my family. My wife has absolutely no idea about my situation, as far as she knows my UC is under control and I put the pain killers down after we found a medication that can keep it that way. My kids are both under the age of 6 and I don't want them to grow up with a father as an addict, 60mg oral use a day isn't a ton compared to the horror storys I've read on here, but I'm sure it could get much worse unintentionally. I'm spending almost half of my salary on Oxy ( wife has no idea how much money I actually make) and we get by alright, but I often day dream about all the great things I could do for my family if I could just kick this habit.
I love this drug. Its the first thing I think about when I wake up. It makes me feel good and it makes me ultra efficient at work. I suppose I do use it mainly for my mood now.
However, i'm slowly seeing things around me get worse. I know I cant keep this up or things will start to fall apart. I'm not willing to lose my family over this shit.
Whatever I do to kick this, I have to do it in secrecy. A Sub doctor is sounding like the way I need go. Do you have any idea the cost of doing that without insurance? Eh, I'm sure I cant be any worse than the $400-500 a week I'm spending now.

 

[Jabberwocky]

Different doctors have difference pricing strategies - so it largely depends on the doctor. With insurance you can probably find someone who is covered, although depending there may be a bit of a wait list for the cheapest options.

If money is a problem, you can get it from a clinics for less than doctors. Methadone is generally significantly less expensive than buprenorphine, unless your prescribed a generic and your doctor is reasonably priced/you have insurance coverage. Always talk to doctors and administrators about pricing discounts based on your situation, as many places are willing to work with their patients financial needs.

What jumped out at me in your post is where you state "I love this drug." That tells me you have a good idea why you use and how you can work from the place you find yourself to one where, while you might still love the drug, you have a more responsible, mature, balanced relationship with opioids and how it impacts your life. Sounds like you want that relationship to be one of abstinence, where you're not using them at all.

Buprenorphine based ORT can be a fantastic stepping stone to that place you ultimately wish to inhabit, a great "training" tool if you will, where you can figure out what non-pharmacotheraputic tools (as well as non-opioid based pharmacotherapies) work for best for you.

 

[Structure87]

Money is never the problem now so I'm not going to make it a problem when selecting a doctor. I'm going to read some reviews of the places in my area and make an appointment. Thanks man. Its nice to have someone to talk to about this, I've been hiding it from everyone in my life for such a long time.

 

[Structure87]

I found what seems to be a great place and scheduled an appointment. I spoke at length with someone who really seems the care about what I was saying.
My only remaining concerns are: I've heard bupe is harder to get off than Oxy, I don't want to substitute one drug I cant get off of for another.
And also I've heard that it can really rock you the first time you take it. That's not my MO. I don't take huge doses, ever.
I hope they start me off low and find exactly how much I need to stay well.

 

[Jabberwocky]

When done right coming off longer acting ORT meds like buprenorphine is actually markedly easier than coming off a potent short acting full agonist. For a variety of reasons buprenorphine is often over prescribed, but once spend a little while taking it finding the right dose for you is pretty easy. Also, when used properly buprenorphine is in no way trading one addiction or dependency for another - the difference can truly be night and day. Of course, it can also be misused, but that isn't the medication's fault and whether someone does that is ultimately up to them.