The Taper Caper, pt III

[twotoomany]

Gonna be taking a break/quitting opes soon. Looking for some advice. Tolerance is currently 30mg of oxy to get highish. I have on hand:
2 30 mg oxy,
1 8mg dilaudid,
10 600mg gabapentin,
12 200 mg tramadol er,
one 8mg sub strip,
10 7.5/325 perks,
and a handful of .5mg kpins.
If you were me, what would you take, in what order, to taper as painlessly as possible. Bear in mind, there are two of us, and kpins work well for both of us.

 

[Tommyboy]

You have a pretty low tolerance so I would just take use half a suboxone (you said you had to split it between two people) taking 2mg the first day, 1mg the next, and 0.5 the last two days.

 

[hangyourhead]

Yeah, that's a rather large arsenal of opioids on deck for just a taper. Like Tommyboy said, you have a low tolerance (at least in comparison to my IV heroin habit) and really only the Suboxone, or rather, buprenorphine would be the most useful in terms of a taper. You could synergize the bupe with tramadol and/or the gabapentin.

Gabapentin alone can be helpful when in opiate WD; great for RLS (restless leg syndrome), tones down the anxiety, helps with the chills, and the aches.

 

[missmeyet?]

Hey twotoomany...you said you take oxy 30 to sort of get high. Is 30mg what u normally take per dose? And how often do you dose? I mean, what exactly have your doses been like and how often say over the past fews days or week?

That makes a big difference in how I would handle the taper, but that's just in my opinion. This is simply because I would have a hard time doing a 4 day taper with the bupe as suggested, especially with all those other meds lying around! But again, that's just me.

 

[twotoomany]

For the past few months between 15-45 mg oxy per day, until recently in the form of OP's. Usually dosed once in the evening. Sometimes twice on weekends. I've been mostly "on" for the better part of two years. I certainly have a habit, but I've been diligent in terms of keeping it in check.

 

[missmeyet?]

So do you think you could do the bupe taper as the others suggested?

 

[twotoomany]

I do. I've never tried bupe before, though. From what I've read, I'd imagine just 1mg might be enough to start, then we could taper down from there. At this point, we'll probably go a week on the 7.5's, since I have em, then jump on a quick bupe taper, followed by a few days with gabapentin and kpins. After that, I guess it's time to taper the kpins. Got that down to .125 mg right now with no WD effects so far.

Ps...the tramadol offers no temptation for me, so if I can get by without using those, I can just leave em in the drawer for a rainy day.

 

[hangyourhead]

Just make sure you wait until you're in WD from the full-agonist opioids, so you know that the full-agonist is out of your system and off your receptors, to guarantee you aren't going to throw yourself into precipitated WD's with the buprenorphine.

Might as well make your bupe taper quick, yet comfortable as possible. I was on bupe maintenance/ORT for over a year, just trying to delay the inevitable. When I went to an impatient rehab for about 20 days, the bupe taper only lasted 4 to 5 days. Some days were quite shitty and I had some awful, sleepless nights plagued by RLS, but I was expecting much worse... considering how long I was on the bupe. They definitely should've lowered the dose A LOT more; they made me hop off 2mgs! I would've preferred getting down to 0.25mg.

Since you have a fairly low tolerance and all that gabapentin and clonazepam on board, I think your taper will be rather painless. Best of luck! and just know that after the acute withdrawals the PAWS can really cause some depression, boredom, anxiety, fatigue and bring some strong cravings.

 

[twotoomany]

Yup. I'm familiar with PAWS. After Christmas we made it 21 days. Then the blues came in. It was supposed to be "just the blues", but it quickly turned in to a 5 month run. I think we'll go the quick taper route. I'm not sure why my tolerance hasn't gone up that much, but I'm sure happy it didn't. Perhaps because we've kept ourselves on a rather regimented dosing schedule.

 

[thesameoldfears]

If you're anything like me, you're gonna need to get rid of all the full agonists before you stand a chance of staying clean.

Now assuming of all the stuff you have listed you only have half available to you since it's split between two people, right? So I would try to go ahead and use up your opiates while tapering slightly. So I would do the 30mg oxycodone one day, the next do three percs, the next do two. Then the next day they hydromorphone since it has the shortest half life. Then when you're sick you should be able to jump on the sub. I'd try 1mg, 1mg, .5mg, .5mg, .5mg, .25mg, .25mg or something similar. If you need more the first day use it. I find a short taper on subs is almost completely physically painless as long as you can induce correctly. Then throughout this you can use the gabapentin, tramadol, and kpins to help ease any physical discomfort you have.

 

[twotoomany]

Thanks, TSOF. That was my plan, so it's good to have confirmation that my plan is sound. How long do you think I have to wait, after hydromorphone, to induce subs? I'm guessing by 4 pm the next day I'll be in full WDs. For some reason, WD doesn't seem to hit me till the evening of day one. Probably my dosing schedule. The receptors are used to being mostly empty during the day. Not being able to be high at work has probably saved me a bunch if pain. Another of the many benefits of working with behaviorally challenged children who like to punch and bite...

 

[hangyourhead]

Another combination I'd suggest is to combine <2mg bupe + low dose DXM or low dose bumps of Ketamine or MXE, whether insufflation ROA, IM/IV, or plugged. Dissociatives helped me beat some awful times during heroin/bupe WDs. Especially during PAWS, considering the high rate of depression

 

[Tommyboy]

If you're anything like me, you're gonna need to get rid of all the full agonists before you stand a chance of staying clean.

Now assuming of all the stuff you have listed you only have half available to you since it's split between two people, right? So I would try to go ahead and use up your opiates while tapering slightly. So I would do the 30mg oxycodone one day, the next do three percs, the next do two. Then the next day they hydromorphone since it has the shortest half life. Then when you're sick you should be able to jump on the sub. I'd try 1mg, 1mg, .5mg, .5mg, .5mg, .25mg, .25mg or something similar. If you need more the first day use it. I find a short taper on subs is almost completely physically painless as long as you can induce correctly. Then throughout this you can use the gabapentin, tramadol, and kpins to help ease any physical discomfort you have.

Or they can try to start on 0.5mg of suboxone (which really should hold them at their tolerance of they wait 36 hours after their last dose to start taking it) and do a bit of a longer taper, skipping days towards the end when they are on the 0.25mg. It's hard to take less than 0.25mg since it's a hard dose to eye out, so instead of going lower than that they can skip days to get similar results. 0.5mg of suboxone is about equal to 15mg of oxycodone so I doubt they will need more than that to hold them at first, especially if they wait 36 hours to start it and are in moderate withdrawal.

 

[twotoomany]

I waited about 20 hrs, then we jumped on 1 mg of sub. Way too much. I was pretty high. Did one mg yesterday, and today we cut to .5. Tomorrow will be .5 as well. After that, gonna go to .25 every other day for 4 days, then jumping off. I've been able to keep my kpin (also kicking that) use stable at .125 mg/day. Pretty psyched so far, but I know the hard part is still to come. Thanks for all the responses. I feel like I took a little piece of each one and came up with a sound plan. Lets hope I get more than 25 days outta this one!