Well OP, I'm about to join you on the journey of tramadol cessation. Or so i hope...you never know. Looks like its been a few weeks since you started coming off so I'm interested in a status report if you're so inclined.
Here's my deal: I have been taking daily doses of 1.5 to 2 grams for about 2 months and lower, escalating doses prior to this for about 4 months. I think I probably have about my current daily dose of the drug left to taper with. From all I have read on tramadol, ironically mostly when I had no intention of trying to quit, these are some withdrawal aids: Loperamide (imodium), benzos, low dose SSRIs. There are others, as stated above and elsewhere, but these are substances I have access to.
Question: I have access to Carisoprodol and Fioricet. Would these offer any relief if taken responsibly? I do not wish to trade one shitty drug for another and these two would be worthless for daily abuse IMO. (Sorry bro, don't mean to hijack your thread but this question didn't seem worthy of its own post).
I wish you all the best. There is a lot of good advice here on BL (and elsewhere) and some have great success with 12-step programs, I know dozens that have many years clean - others detest these programs. I feel that when you're miserable anything, within reason, is worth a shot. You can always change your mind.
Hi,
I see you are online so I am going to provide some help, as much as I can offer (I have also abused tramadol). However, I am not a doctor although I have knowledge on psychopharmacology, so ALWAYS consult with a doctor first. I only want to help and give some interesting text to read and open up ideas. Now that the whole legal stuff is covered, let's move on.
You have a good arsenal although I am missing some form of NRI there and possibly some pregabalin or oxcarbamazepine. Bupropion is an excellent aid in detoxifying from low dose dependence (e.g 200mgs for months), tried and tested, plus it makes sense from a theoretical point of view. The problem that I can see is that you are at risk of seizures from withdrawing from such a high dose, paradoxical since normally when detoxifying from a substance, you experience the opposite effects that it initially yielded. Thus, using bupropion is risky although I would throw in 150mgs once you have the whole WD strategy sorted, which is outlined below.
I would personally start loading on the benzodiazepines. I dont know your tolerance nor which ones you have but I would certainly opt for one with a long half-life and strong anticonvulstant properties. Diazepam and clonazepam are the best for this, alprazolam can be used on top to provide a mild, as it can, antidepressant effect (dopamine agonism and less of a sedative effect). You will, however, need to base the benzo strategy upon either diazepam or clonazepam (maybe lorazepam but it has a shorter half life). I personally vouch for clonazepam, with some alprazolam used as convenient.
Now that you have zapped away the seizures, you need to be aware that you are withdrawing from both an antidepressant (AD) and an opioid. Many people comment that the AD withdrawal is much hellish than the opioid WD, so the goal here should be to comfortably titrate down the dose to 400mgs (maximum therapeutical and approved dose). Your goal should be to go down to a dose which is medically approved, whilst using different tools to ease the going down. Once you are stabilised at 400mgs, you can drop down easy and even stop the medication in a fast manner (I personally think 300mgs is a good dose to drop the tramadol using the rest of the tools which will be outlined further into this text).
How do you titrate down? As fast as possible without causing too much uncomfort. I would ask around for I have never withdrawn from such a high dose, but I think you can safely go down by 100mgs every 3 days until you are at 400mgs. Thus, it would take you 2 weeks to be there and the benzodiazepines will be making life easier. 400 mgs is still a high dose and should be providing plenty of brain acitivity without dropping you into full WD. Of course, you should be gauging how you are feeling, drop more or less according to your response but bear in mind, you need to get off these fuckers fast, so suck it up as much as needed.
As mentioned, you will be withdrawing from two drugs, a pseudo-SSRI (as much as I hate to use the term SSRI to describe tramadol's pro-serotonin effects) and an opiod (I dont care how hardcore heroin junkies put down tramadol's opiod effect, at your doses it rivals the stronger opiods). Lets go by parts.
Anti-Depressant WD
Most of the antidepressant WD from tramadol comes from the constant serotonin release, akin to MDMA, albeit in a not-so-easy-to compare form. Expect depression, fatigue, anxiety, insomnia and irregular electrical impulses known as brain zaps. It should not be sugar coated, it will not be easy. You mention you have SSRIs, and these have been used to ease the WD in the past. However, you must be careful to not take both tramadol and SSRI's concomitantly, especially at the doses of tramadol which you use. You should use the SSRI once you drop the tramadol completely, leaving about 4x the half-life of the parent drug to introduce the SSRI so as to avoid any serotonin interaction. I believe tramadol's half-life is 6 hours so leave at least a day to wash it out before introducing the SSRI. Whilst the benefits of SSRIs take time to be felt when dosed for depression, they start acting in the brain immediately. I dont know which SSRI you have but one with a long half-life is the best choice (i.e fluoxetine aka Prozac). Dose as indicated for depression and maintain for as long as desired, 2-4 weeks should suffice unless you want to stay on the AD (which I don't recommend unless prescribed and supervised by a mental health specialist). By the way, use SSRIs and not SNRIs, as am writing this approach with an SSRI in mind (since this is what you have). Using a SNRI changes the approach to an extent.
Caffeine will also be your best ally. Caffeine potentiates tramadol's stimulant effect, so dose on it as much as required as you titrate down. One of the main WD symptons is fatigue, and at the doses you are taking, adding caffeine will synergistically work with the tramadol to unleash any untapped stimulant benefit as the dose drops down. In my experience, caffeine halves the amount of tramadol needed to provide the ever-so-nice stimulation that tramadol gives and which has gotten me hooked on it before. Caffeine is also a safe stimulant although it decreases the half-life of benzos in high doses (+200mgs). Be aware and add a little bit more of the benzos if you think the caffeine is interfering with their effect.
I would personally use a small dose of bupropion once you totally drop the tramadol but I am assuming you only have access to the drugs mentioned in your post. Small doses of amphetamine would also help as so would methylphenidate. Read, SMALL doses. These stimulants are used together with SSRIs for treatment-resistance depression and they do not produce any major interactions. Do NOT use street drugs such as speed or cocaine.
Opioid WD
This one is your usual heroin detox approach. Loperamide helps with the gastrointestinal side effects but it doesn't cross the brain-barrier. In any case, using another opiate/opiod to detox (I am assuming you think loperamide could yield any opiate effect) would be even worse so the goal here is to ease the pain. Unfortunately you don't have a good arsenal here. Clonidine, oxcarbamazepine and pregabalin should be tools which you should have if you want to play hard with opioids. They are readily available online (pregabalin is expensive though) and they are god-sends to opiate users. By the way, use the loperamide as needed although I cannot predict when, in the timeline, you will experience GI effects such as diarrhea. You may experience none, for diarrhea is mostly seen when abruptly discontinuing an opiate.
I dont think the opioid WD should be that harsh as you drop down. Perhaps it would be a good idea to take some days off matching the weekend so as to have plenty of days to recover. There will be a point when it will get a bit harsh, and that time should mostly spent passed out. Dyphendhidramine is reported to be useful in opiate WD, and would aid in passing out with the benzos. DPH is easy to obtain OTC, so load up on it. Hydroxyzine (Atarax) is also a good antihistamine that will knock you out cold. It is not OTC but easy to get from a GP.
With regards to carisoprodol, it is a muscle relaxant but in high doses it produces paradoxical convulsions (which I personally suffered on 2.5 grams). The benzos should be providing enough muscle relaxation but there may be times when the restless leg syndrome may kick in, so keep the carisoprodol and use it as needed (starting slowly as it increases anticonvulsant effects with benzos).
Conclusions
It will not be easy but it certainly is doable. Your goal is to be tramadol free rapidly and then drop the rest of the tools used. I think one month should be enough to get off the tramadol. Do remember, however, that you may still be having physical WD effects (albeit mild) down the line. If you stay positive, however, you will be done with it in comfort and still being able to keep up with the rest of your life, and in some weeks you can be substance free. I do, in any case, stress visiting a mental health specialist then (and also before embarking on your weaning off).
In essence, here is what you should do:
- Drop the tramadol as fast as possible (100mgs per 3days)
- Introduce benzos as soon as starting to tritate down. Use as little as needed so as to avoid tolerance and future dependence.
- Use loperamide as needed.
- Use caffeine as needed. On empty stomach, caffeine takes minutes to kick in. Before breakfast is a sure way to get stimulated for the day.
- If there are nights you cannot sleep, use DPH or HDX to knock yourself out (try not to increase benzo dose so as to induce sleep, we are trying to keep benzo dose as low as possible)
- Get to 400mgs of tramadol (continue with aforementioned drug regimen)
- Get to 300mgs of tramadol (continue with aforementioned drug regimen). I think you can do this in 3 or 4 days once at 400mgs.
- Drop the tramadol completely in the morning. Go to bed, tomorrow is your big day.
- Next morning start SSRI.
- Increase caffeine dose or introduce low doses of: bupropion, methylphenidate or amphetamine.
- Increase benzos as needed.
- Wait one week and assess. Are you still uncomfortable?
- Wait another week and asses again.
- Start dropping the benzos and SSRI slowly. If using fluoxetine, you can stop taking it the same day, although I suggest using it for one or two more weeks.
- Remain positive, you should now be getting out of the hole.
- Total time: on tramadol 4-6 weeks, on parallel drug regime 6-8 weeks.
Try and order online both clonidine and pregabalin (plus oxcarbamazepine). They are easy to get, unscheduled and will be of much use with regards to the opioid WD. If you get these, get back to me and I will outline a regime to use these drugs. Pregabalin is a wonder drug, use it as it will also reduce your need for benzos.
Overall, it is not as bad as you may think. You need to remain positive, this is what will get you through. It is imperative to get your head distracted with activities that you may be able to do. Social interaction can help a lot, even if it is on Bluelight, although I recommend conversing with other people whom are not related to drug use (family, friends, etc). Moreover, it would be a good idea to talk to a specialised professional or even a GP about what you are about to do. You can even mention some of the stuff I put, so he can prescribe some of the medications and supervise your use.
I sincerely hope that my words are of help you.
All the best.
P.D: Anyone feel free to comment or debate my weaning off approach. Do also feel free to debate my approach elsewhere although please reference my post and username so I can provide and be provided feedback.
