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Tapering Someone who knows fentanyl/mega opiate withdrawal - please help me.

C

CindyinCR

Bluelighter
Joined
Apr 14, 2015
Messages
23
After more than a week, I got zero help from 'Basic Drug Discussion' and so I am reaching out here, because I really need help with this withdrawal. I have read the other fentanyl withdrawal threads and they aren't giving me the support I need. So someone who knows fentanyl/mega-opiate withdrawal - please help me.

I have a damaged spine from a slip & fall accident that happened four years ago. I still have great pain, but I am pretty sure that after three years I have built tolerance to my 25 mcgs. of fentanyl and am getting by okay. And so given that my injury pain seems better I want to withdraw. Also, the only PM that I found here in Costa Rica who would prescribe opiates at all, just closed his practice last week without any referrals, so I really don't have any choice! I appreciate any help you may lend.

After going from 25mcgs to 12.5 mcgs in a week things are getting really tough. Last night was really bad, so I ended up using a precious 12.5 twelve hours to early. So now my taper will have to be even faster.

The worst part of my opiate withdrawals is the what I call the 'boiling blood', the oppressive system buzzing that I feel. I guess it's overall system stress, but it is very scary - I feel like I am going to die. The second worst part is lots of vomiting - sorry.

Last night I had to use a 12.5 patch twelve hours early, or I was going to 'boil over'. Any fixes for this, besides using more fentanyl? I don't want to use up my last patches now, and be left with jumping off with nothing.

Everything I read says it gets worse the lower you go, so I am thinking I will need to strictly ration my dimishing patches for towards the end and do that taper very slowly. Is this even true, that if I am down to 5mcgs for 2 days and jump off, it will it be as bad as last night?

So dear Bluelighters, I am hoping to get advice on my worst problems, so I wont break down like last night, ultimately making this taper more aggressive than it already is. Please help me.

Current meds : fentanyl 25mcgs every 48 hours, gapapentin 600 3xs, soma 3xs, clonopin .5 2xs, NSAIDs 1xs. Other meds include synthroid, and HCTZ (so I can't use clonodine)

Supplies: fentanyl 25mcgs 4.5 patches, Valium 2, tamazapan 2, OTC codeine (30mgs), and the above meds (tolerant to all).

thank you
 
So you only have two pills of Valium/diazepam and two pills of temazepam?

Basically fent withdrawal is really tough for about 4-7 days. Tapering will help, but tapering short acting opioids like fent tends to be very difficult.

The gabapentin and some of your other meds should help, but if you're already tolerant you may need to increase the dose while you withdrawal from fent.

I'd suggest jumping on codeine (if it has any other ingredients like APAP, do a CWE) for a week as the fent gets out of your system. You may need to dose 300mg once to three times a day (do not ever take more than 400mg at once, and do not redose until you absolutely need to, as codeine OD is very uncomfortable and can lead to a life threatening histamine reaction). How tolerant are you to codeine (how much do you normally use)?

Now, given where you are located, can you get any tramadol? That would probably work as well if not better than codeine to get you through the acute withdrawal.

How are you going to manage your pain/condition(s) post fent?

Good luck OP!
 
Toothpastedog,

Thank you for being here! I had seen your support in other threads and was hoping (praying) to hear from you. You are correct regarding the number of benzos that I have. I also have my prescribed klonopin, which I've been taking for 30 years for nostagmus. When I was bad last night, I took my gabapentin, klonopin and soma as usual, but because I am tolerant, they didn't help at all, so I put my patch on early.

I never use codeine, but it is over the counter here. I will look at CWE, since the pills have a strong NSAID in them and so dosing only one a day is possible - so only 30mgs of codeine is available.

I will manage my pain with NSAIDs, as needed. I have a home practice of yoga which has helped to strengthen my lower back where the spondolysthesis and fracture is and so the pain is manageable. Although I can't really know that the pain is tolerable, until I am off this last 12.5 msg of fentanyl.

I have a questions regarding your comment that fentanyl withdrawal is really rough for 4-7 days. And that tapering it is difficult. Do you mean that with each taper, I can expect 4-7 days of hell? Or did you mean at the end of the taper or both. If it's with each taper, I should probably consider just going cold turkey or jumping, since I will increase my days of suffering with a taper. I can and have cut my patches, so the idea to get to 0 was to cut them in pieces eliminating some every two days. Currently I am on 12.5mcgs, and so by Monday I would be on 11.5mcgs and so on.

i like the idea of increasing my gabapentin (and probably somas), I should have done that earlier yesterday, then maybe I wouldn't have been so bad last night, leading to me putting another 12.5 on 12 hours early. I hope I didn't set myself back too far in this process.

We have tramadol here, but I am a seizure person, so I am afraid to take it. I didn't mention that I have 30 5mg tablets of methadone (not refillable), that a Dr gave me down here to jump off fentanyl. I have had syncope in my lifetime so I am afraid of those too, because of what I've read about the long QT interval issue. Maybe at a dose of 5mgs I would be safe. Do you know about this? And if so, what would the dosing be?

I appreciate your input more than words can say. I have felt very alone in this, and as you know it ain't easy! With great warmth and gratitude, Cindy
 
Oh nice you have methadone. That supply will basically see you through the acute detox pretty darn comfortable, and you can avoid taking large/CWE codeine, which can be kinda problematic. Super glad to hear you have access to something more appropriate like methadone.

I will report back when I have the time to write a proper reply. Just wanted to reassure you that you're pretty, all things considered.

and to quickly answer your question about tapering with fent, it will take 4-7 days for your body to adjust to "normal" with each dose reduction you make (well, it could happen in as little as 2-3 days given fent's super short half life, but as a general rule dose reductions shouldn't be made faster than once every seven days unless it's absolutely necessary). The 4-7 days I mentioned was more in terms of the acute opioid withdrawal you'll experience during your detoxification.

If you have a seizure disorder, definitely talk to your doctor about increasing your gabapentin and clonazepam for a few weeks once you are about to begin your detox.
 
Toothpastedog, I got out my cardiac halter report. With my ventricular arrhythmia, methadone if off the menu. So please disregard questions about methadone.
 
Ha, I thought I had begun my detox! Does detox mean the day my last patch goes on? And are you saying that with seizure disorder the gabapentin and klonopin would be helpful or harmful? I have no Doctor to talk to, unless I show up at a cash only ER.

I have some old, enhanced gold kratom. I used it before to withdraw, but had hell to pay to get off of it.

Also, I was wondering what that all over crushing 'boiling blood' feeling is? Is that simply withdrawal and it won't kill me? I mean, if I knew what it was, maybe I would feel safer to just ride it out.

And finally, what is the difficulty in tapering a short lived opiate like fentanyl? If I knew the problem, maybe I could manage my taper more effectively.

For various reasons, mostly due to moving from CA to Costa Rica, I have had to withdraw before. Maybe it's because I am older (63) now, but that short taste last night terrified me. Nonetheless, I must continue.

Thank you again for writing when you can.
 
Last edited:
I wanted to give an update. I think I have stabilized at 12.5 mcgs. I added 1200mgs of gabapentin to my usual 1800mgs. And it helped me and my 'boiling blood'. I also took over the past three nights a half of one of my Valiums so
I got a little sleep too - it's amazing that that tiny amount did anything! My pain is 'there' but it was the same as on my usual fentanyl dose. So I plan to continue dropping tomorrow - I will go down to 11.5 mcgs, by cutting a 10th of my 25mcgs off. I am hoping it won't be as intense as my jump from 25 to 12.5.

I hope you are having a great weekend, and that when you return to Bluelight you will help me with my questions above. Oh, as an aside, I did two capsules of the old gold reserve that I had on Saturday. I am not sure, because my withdrawal was so bad that day, but Ian pretty sure there is still 'kick' to it. However, it didn't make me feel very good, it just added more intensity to the day. Maybe if I had taken more it would have helped, but because of my age, I am weary of adding more to the mix. The increased dose of gaba definitely helped, and since yesterday and today are much better I am back to my normal 1800 dose, so that when I need an increase I can feel the effects.

ok, that's it for the weekend report!
 
Keep up the great work OP! It's not going to be easy, but that which is worth doing rarely is (love might be an exception to this). Anyways, please let us know if/how else we can help support you in your efforts with this. I'm looking forward to hearing how this progresses for you <3

And when the going gets hard, I will always suggest the kinder, gentler route. This might be hard, but there isn't any reason your pain should have to mean suffering. With the right information (which is really what we are hear to provide) and a little creativity on your part, anything is possible. Highly recommended :)
 
I value your time and encouragement! But when you have time, would you answer my three questions that were in the message just before my last 'update'.

1) what does 'detox' mean? Is that the time that follows my last .10mcg patch or am I in it now? When you mentioned it above, it sounded like something beyond what is happening now.
2) what is that boiling blood feeling when the WDs are strong? Can it kill me? Managing my fear will help me make better decisions, like slowing the taper or getting though it because it's just a 'feeling'.
3) what is it about short lived fentanyl that makes tapering hard? You mentioned this above, but I don't know exactly what you meant and knowing, might help my taper strategy.

grateful as always
 
CindyinCR said:
I value your time and encouragement! But when you have time, would you answer my three questions that were in the message just before my last 'update'.
Click to expand...

  1. what does 'detox' mean? Is that the time that follows my last .10mcg patch or am I in it now? When you mentioned it above, it sounded like something beyond what is happening now.

    The detoxification refers to the period of time it takes for a substance one is dependent on to go through the period of acute withdrawal following cessation. In your case this involves fent and coming off that.

    So yes, the detox (aka acute withdrawal) refers to the period you will enter once you have moved into cessation of fent use (please not that the detoxification phase can be treated with appropriate ORT medication to keep the symptoms of acute withdrawal from getting to out of control, so it isn't necessarily total abstience from all opioids, at least not if they are used only to treat symptoms of acute withdrawal.

    Right now you are in the tapering phase. It often will involve a degree of symptoms essentially the same as you'd experience during acute withdrawal, but they won't be as pronounced as they will probably get once you enter the cessation/detox/acute withdrawal phase. So yeah, in short detox begins once you stop taking fent.

  2. what is that boiling blood feeling when the WDs are strong? Can it kill me? Managing my fear will help me make better decisions, like slowing the taper or getting though it because it's just a 'feeling'.

    Is it like hot/cold flashes, the chills, getting hot and nasty even in a cool room, or something like that? That is I believe you endocrine system acting up as you taper and experience a little bit of symptoms of withdrawal. Medication such a clonidine is prescribe to treat this particular symptoms and is highly effective.

    This could also be a symptoms akin to RLS. Clonidine will also help with that, although gabapentin is a bit more effective for it.

  3. what is it about short lived fentanyl that makes tapering hard? You mentioned this above, but I don't know exactly what you meant and knowing, might help my taper strategy.

    Shorter acting opioids like fent are more difficult than longer acting ones like buprenorphine and methadone because it wears off quickly. Basically, long acting opioids are preferred because they leave you system relatively slowly compared to their shorter acting counterparts like fent. That allows for your body and brain to adjust to dosage reductions with less discomfort. Basically you can think of the body's reaction to trying to find a kind of homeostasis without the input of exogenous endorphins (opioids), and as your body begins to produce its own endogenous endorphins again the withdrawal subsides. Short acting opioids leave your system quickly, so your body doesn't have as much time to adjust, meaning there is more shock to the system as your body is constantly ramping up and down to produce endogenous endorphins as it leaves you system, and then when you take more of a short acting opioids your body compensates by reducing the production of endogenous endorphins.

    Basically, withdrawal is all about your body finding balance. The more time it has to adjust between doses, the slower the dose leaves you system, the less intense the withdrawal will be. That is essentially the lay persons explaination as to why longer acting opioids are preferred for tapering and detoxification. They make it a bit easier on your system and allow you to recover faster/with less suffering.

Please feel free to clarify anything. This isn't the best explaination of some of the concepts, but it's a start.
 
I have written and lost my reply to you three times!

Oh wow thank you for your thorough explanation!

The boiling blood feeling is not a temperature change, it's like I am vibrating internally. Can you have RLS everywhere? On the night I caved and put another patch on there was also unbelievable pain. My eye sockets even hurt! It was like my eyeballs were going to fall out!

Thank god I found my PM Dr. He prescribed more patches, so I can take this taper more slowly. However, I want off the fentanyl, as I don't think I need it for my injury anymore. I can't know this, until I get past detox, but this is my hunch at this time.

So today I drop from 12.5 to 11.5. Hopefully my eyeballs will stay put!
 
Yes, the restlessness can become rather generalized. Gabapentin will help a lot with that symptom.

Glad to hear you are able to continue working with your doctor on this. At a certain point it would probably be helpful to switch to an extended release oxycodone or morphine based medication.

Without the pain meds, do you have a sense for how you'll manage you pain/condition(s)?
 
Restless is maybe what people say, but it's more like tremors to my core with a fast heartbeat. It seems to be worse in the evening, but when I take my gaba, klonopin and soma it lessons or goes away.

They won't prescribe that stuff unless I can go in weekly to pick it up. It's just the law here. I am hoping the over the counter codeine will help, but if not a tiny slice of a 25patch would probably work. Ideally I could manage to slice off 50mgs of morphine from a 25mcg patch. I have looked at converters, done the percent of the patch needed, and got out my ruler to measure the cut. It's a tiny slice - too tiny to be very accurate! Hopefully it's doable. If you have advice on that please let me know.

Last night was a bit sleepless, but tonight is when my cut yesterday will start bugging me. It was 10% of 1/2 a 25mcg patch, so hopefully it won't amount to many symptoms.

I am am very grateful to you for helping me. Information is power!
 
That is why we do what we do (and trust me, we love to do it :)). Keep up the good work! Dealing with overcoming withdrawal is a process. Getting creative and trying different approaches will be very helpful.
 
Hi Cindy... I was pain management for years and lost insurance and meds. Had to break a 300mg a day morphine habit. Advice is from a pain management perspective. First off its going to suck alot. The taper was bad but nothing like the drop off. Once I dropped off my body turned all the pain sensors to maximum. Pain level was extreme in all my bad areas. Now here is the good news... Your brain will reset the pain level! Just hang in there and it will happen.

I'm about 2 and a half months clean right now and doing well. Supplements like fish oil and tumeric will help with inflammation. Exercise helped me more than anything. Get those endorphins going.

Lastly TPD is awesome he helped me alot and will help you. Hang in there and it will get better... Promise!!!

R13
 
Hi R13,

Thank you for your insight regarding the drop off pain, after the taper. I can't wait - Not. But I will preserver, because that's who I am. I dropped another 10% today. Felt WDs, so I took a bath, gabapentin and did a lot of yoga. Now I am okay.

I trust the process and path that I am on. I think the fentanyl was making things worse and I now am having less pain at my injury sites, so this has been very encouraging.

TPD,

You are the best! I am coasting okay for now, but will be officially dropping around the 17th. I sure hope you and R13 will be around then. Hopefully it will be a non-event.

Huge gratitude!
 
Always <3

Getting sober is never a small thing, so hopefully it will be a good kind of event :) it's all how we relate to our experiences. Even with some of the most difficult and unpleasant of situations, it is always possible to overcome suffering. It just take practice.

May you preserve and prosper my friend. I get the resiliency vibe from you, and that's what getting healthy is all about!

No matter what happens, BL and SL are here for you. Without judgement. Unconditionally. That's way I love this community so.
 
When I jump off the fentanyl completely, in about 10 days, I am thinking about trying Sam-e along with my other tools. Does anyone know whether I can try Sam-e now, to help me with the adrenaline rushes? Or am I at risk to have serotonin syndrome, if I take it while on my tapered dose of fentanyl which equals about 70mgs of morphine? It was wondering if I should be taking Sam-e now to build neurotransmitters up in preparation for my 'jump' in about 10 days - but I certainly don't want to induce serotonin syndrome!
 
I wouldn't get your hopes up about that supplement.

There shouldn't be any serious issues combing it with fent though. Seratonin syndrome isn't really an issue with most opioids (the exception primarily being tramadol).
 
Thank you! It's so great to have a knowledable person to talk to. I should have clarified that in order to get something like long acting morphine, we would have to do a long mountainous drive to San Jose, which would trigger loads of back pain. And I have no clue if he would write the script. So it's going to be primarily these tiny slices of fentanyl and gabapentin. I also have those few benzos and OTC codeine for when things get really rough.

So far the nights are the worst, with sleeplessness and fast heart rate. It took 1800 mgs of gabapentin last night to even begin to settle. It was my 3rd day at my lower dose, so I am hoping tonight is easier. It could be the same or worse though, I haven't notice whether my system feels better at a new dose on day 3 or 4. I will watch for that this round, as knowing the end point may be helpful in the hard times.
 
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