Opioids Unique situation for tapering/quitting opiates - how should I handle it?

[John_Burrows]

So, after a year of injecting dilaudid and 2 years of being on the stuff, I may finally need to quit.

Of course I've wanted to, but when you have a script and a legit reason to take the stuff, it's tough! I've been on it for back pain, but admittedly my current meds may be overkill.

But my pain doc is forcing my hand. He's out of town and won't be available to meet and refill me before I run out (when I explained I'd run out before next week, he said "you'll just have to tough it out." Is that a reasonable response from a pain specialist? It feels kind of unprofessional to me, but what do I know).

I'll have to taper down anyway to make it last, but if I can I'd like to try just stopping entirely by Tuesday (6 days from now).

I generally inject between 6 and 8 pills (8mg) a day. And before you tell me that's enough to knock out an elephant, my tolerance is much higher than your average elephant!

Here what I have to work with:

18 8mg hydromorphone pills
18 10mg methadone pills

I know that's not exactly slumming it, but obviously I'd like to quit and not go through withdrawals.

What pills should I use in what order/dosage over the next 6 days to best quit? My instincts tell me to take 3 methadones a day and only use the dilaudid if I get really really anxious, but I also don't want to be in a position next week where I now have to taper down off methadone. I'd like to be 100% drug free in six days.

Is it possible?

 

[effie]

I'm going to scoot this over to OD, as they are the experts on tapering and even have a tapering megathread in their directory (link in the header at the top of Other Drugs forum).

BDD > OD

 

[sekio]

Methadone has a long half-life (long duration of action) & is strong as fuck so keeping yourself suitably loaded on those would be best, using the hydro to stop any "breakthrough" symptoms.

Just remember that 'done takes a few hours to take full effect. 10mg 3x a day would probably keep you feeling groovy.

 

[bayhead415]

I am just going to say something on your docs attitude. While my doc may not have been as blatant as yours most pain docs, I imagine, would not have extreme sympathy or care for WD symptoms. I think it is not because they don't care, but it is because they are meant to manage the pain and not manage issues that are present because of the medication prescribed. In better words pain management is there not only to help make sure that you get a stable dose and don't withdraw, but that it also does not get to a point of extreme dependency. On their medication you should be able to go cold turkey without severe issues.

Also from someone I knew who had a bad heroin problem and is now working towards substance abuse counselling had once told me that a lot of methadone OD occur when people on MMT start mixing it with other opiates (this person specifically mentioned relapsing on heroin). Defiantly keep it in mind since you may think about combining the two as one does not seem to work. I also recommend finding a different ROA rather than injection as injecting pills is not a good habit... Or IMO repeated injections.

Also having people you trust to help you get through the time is always helpful even if you need them to stay away for a minute.Anyways good luck with getting off! I hope you succeed! Defiantly make sure you research and do it safely!

 

[John_Burrows]

Thanks for the responses, guys.

Seiko, at this point I'm not interested I'm feeling groovy anymore, just seeing if I can quit in the next 6 days and get out from under the meds and my pain doc.

Besides, nothing really gets me high anymore, no matter how much I take. And that's not glib, I've always had a resistance to opiates (which is why they put me on dilaudid in the first place) so at this point it's mostly just a bad, pointless habit. It still helps the pain, but I'd like to see how my pain is if I stop taking the drugs. It's been a while since I tested this.

Anyway, if I do as you suggest and just take the methadone 3 times a day, what happens 6 days from now when my methadone is gone? I've heard methadone withdrawals are worse than dilaudid, so I don't want to switch dependency from one drug to another.

I'd just like to be done with it.

I've read that it takes 3 days without dilaudid for my body to no longer crave it. Of that's true, should I use the methadone for 3 or 4 days then slowly taper off the methadone? I really don't know how I should or shouldn't use the small supply I have left to best effect.

 

[MoosejawSanders]

30mg methadone should get you by reasonably well... I'd start taking it when you feel bad and slow down your dosing when you're getting ready to go back to hydromorphone.

 

[bayhead415]

I forgot to mention cannabis can and would be your best friend to help you through this, but again there is that problem of trading one drug dependency for another. Plus it may be hard to access where you live. Still studies show it potentiates opiates and many people have lowered their use or even quit completely by using cannabis.

Also if you can talk to a doctor about prescribing clonidine (α2 adrenergic agonist) is a prescription medication that, which in my case, helped with some WD symptoms, although I would consider them minor and that I have never had major WD. For me it helped with the perceived temperature fluctuation, high heart rate, dilated eyes, and excessive sweating. If you can talk to your doctor about it afterwords it may be an option as it really does not have much recreational use if any at all. Although as I said talking to the doctor is important as you don't know what conditions you may have that interact.

Just thought it would be a good idea to add if you are really trying to get off without being on any drugs, or at least ones that create heavy physical and/or mental dependencies.

Edit: Keep in mind you may not have to use all your medication in the end. The less used the better!

 

[John_Burrows]

Moose jaw and anyone else: I though I was explaining my situation properly, maybe I didn't ... But I don't want to go back to dilaudid in 6 days when the methadone runs out - I want to be DRUG FREE. When I see my pain doc next week I want to tell him I'M DONE.

I'll worry about psychological withdrawals when I cross that bridge, for now I want to know how I should use the dilaudid and methadone I have left to QUIT THEM BOTH and avoid physical withdrawl symptoms.

 

[sekio]

Bear in mind that some malaise is going to be expected withdrawing from 64mg/day opf hydro in a week. You're not gonna feel great.

Ideally if you want to detox, get rid of the methadones/don't touch them, and use just enough hydro "as needed" to keep w/d symptoms manageable for a few days. (probably less than half your "normal" dose to start, reducing it by 10-20% a day) Since h/morphone is a short half life opioid the bulk of the withdrawals will be over in 5-6 days. Eventually (preferably before they run out) you should just jump off entirely.

The other option is to do the methadone as a "long acting" opioid instead. Apparently oral methadone is more or less equianalgesic to IV hydromorphone, milligram per milligram (but of course it lasts a fuck longer) so you could try taking ~5mg methadone in the morning and at night and just reduce that dose very gradually, again 10-20% a day. (note m/done takes a while to kick in) Here you could use the h/morphone to tide you over until you get the methadone working.

Basically, when you start to get intolerably sweaty, shaky, can't sleep, take enough opioid to make it suck a little less, and keep going about your daily business. Remaining active, eating well, and taking your vitamins will help.

Don't go back to the needle, either. If you are getting off narcotics it won't hurt you to take them as directed.

 

[T. Calderone]

Sekio is right, don't inject the hydro anymore. I'm glad you want to be drug-free. If this in your commitment why bother seeing your doctor anymore? I quit my pain management doctor abruptly a little more than 16 months ago. I miss him sometimes but don't miss being drug sick when I would run out early.

You can do a slow taper and limit yourself to 4 mg 4 times a day orally. Then work yourself down to 3 times and then twice afterwards gradually. If you start to feel ill, maybe take the methadone as a breakthrough medicine. You have enough to get you through. Wish you the best.

 

[TyLannister]

IMO
Dont touch methadone for UA.
Use hydro to get u to doc.
Tell Doc You feel better wanna taper.
Avoid all problems suggested above.

 

[Tommyboy]

I've read that it takes 3 days without dilaudid for my body to no longer crave it. Of that's true, should I use the methadone for 3 or 4 days then slowly taper off the methadone? I really don't know how I should or shouldn't use the small supply I have left to best effect.

I don't know what you mean about your body not craving dilaudid after 3 days without it. Withdrawals are your body craving (or rather needing) the drug to function normally, and that process lasts more than 3 days.

While most will agree that methadone withdrawals are worse than withdrawals from most other opioids, that if for people who have been taking methadone for a while. Using it to quickly taper or detox won't make the withdrawals worse. I think that you should utilize the methadone since going cold turkey would be pretty difficult after a two year habit, and if you make it too hard on yourself then you are setting yourself up for a relapse, or more likely not making it through acute withdrawals to begin with.

I think that most detox facilities give you a split dose of methadone for 3-4 days, and then one last single dose on the last day (so day 4 or 5). Your other option of course is a longer taper. Whichever you choose, I suggest tapering down your dilaudid as much as possible, and then switching to the methadone to either detox over the course of ~5 days, or use it more sparingly to taper longer.

 

[TyLannister]

As hes a legit pain patient, i really dont get all the methadone advice.
You have plenty of your contracted/prescribed med to get you thru 6 days for doc time.
As your a legit patient, just tell hin what youd like to do. Diff story if you went in sayin gimmie more.
But at any rate its what u (or me....u obamacare bastards TOTAL JOKE) pay him for.
Just seems like itd be the best solution

 

[John_Burrows]

I remember about 9 months ago there was a shortage of dilaudid and I literally could not find a pharmacy that had any. So the doc put me on methadone until I could get the dilaudid.

Now at that point I had NO dillies to help me switch. During the first few days I didnt experience wd per se, but I could def feel my body wanting it. If I had some I probably would have taken just 2 or 3 a day - if that many - to help me get through it.

But I didnt have any so I roughed it out. But after a week, I was free of dilaudid and wasn't feeling any need for it. If I was smart, at that point I should have just tapered off the methadone and I would have been drug free.

But like a fool as soon as the pharmacy had the dillies in stock I went back to them (that's why I still have some methadone left).

Still, it taught me that if I decided to quit for real, a week of methadone would get me through the worst of it.

I really don't want to just taper down the dillies - its too easy to keep going, especially if I know more are coming. Right now, I feel confident that if I can kick the habit in 6 days, when it's time for the pain doc to give me more I can just refuse. But if I'm still tapering down and need more, quitting will be harder.

That was a good point about needing to be on methadone longer before my body would suffer withdrawals from it.

If I take methadone, 3 10mg a day for the next 6 days, I'm confident i'll be over the dillies. The question is what will happen if I stop the methadone cold turkey after those 6 days? Is 6 days enough to develop even a small dependence or will i be able to just walk away from it?

I suppose if I can reduce my methadone to 2 pills a day, I'll still have some after those 6 days, maybe enough to taper? It just depends how shitty I'll feel if I go cold turkey after 30mgs a day for 6 days...

 

[TyLannister]

Thats silly tho, if u really want off TELL ur doc that, n not to offer you them anymore that u jus wana short taper off. If you tell him the meda are an issue for you n u wanna taper i promise you wont get more

 

[bayhead415]

/\Ty are you really trying to get him as a listed addiction and possible abusal risk? Freaking ridiculous/\

Just keep in mind you can not walk away from a withdrawel, but will have to face it when you want to get off. You can do things (such as methadone tapering) to make it less severe and even non-existent, but there will probably be some symptoms.

I highly recommend finding a doctor to talk to about clonidine as, in my case, it really helped easy some of the withdrawal symptoms without creating a "high" effect. It may be good to have on hand after stopping the methadone in case any w/d symptoms come up.

Just wanna say sounds like your really putting your mind to it and there is nothing you can not do if you put your mind to it. I wish you the best as you get off!

edit: \/The mod said it well, but clonidine is not very psychoactive at all..... It really just helps physical symptoms without creating a change in mental state that can be perceived as a high. Do not listen to this guy as you want to get off opiates and other drugs that create dependencies as you can NEVER get off all drugs (coffee with caffeine, chocolate with theobromine, tobbaccoo with cigarettes, alchohol, etc).\/

 

[TyLannister]

Huh??
He already HAS a Dr. to give him clonidine "n all other shit".
He said he wants to be done, what better way to tell the doc u just wanna be done and ask for some things thatll make the quuesiness for a few days bareable.
Pain Docs do it all the time, makes zero sense to go find a "clonodine dr"

 

[NeighborhoodThreat]

^This. Even regular GPs will prescribe clonidine. It has zero abuse potential and does a great job of helping with WD symptoms. Doctors are afraid of prescribing addictive drugs for various reasons...GPs, that is. Specialists are a different story.

And since you're seeing a specialist..

 

[Tommyboy]

If I take methadone, 3 10mg a day for the next 6 days, I'm confident i'll be over the dillies. The question is what will happen if I stop the methadone cold turkey after those 6 days? Is 6 days enough to develop even a small dependence or will i be able to just walk away from it?

I suppose if I can reduce my methadone to 2 pills a day, I'll still have some after those 6 days, maybe enough to taper? It just depends how shitty I'll feel if I go cold turkey after 30mgs a day for 6 days...

It seems like you are torn between just getting through the 6 days until your refill, or detoxing. If you are planning on detoxing then you shouldn't be taking the same dose of methadone for 6 days, and should be lowering your dose each day with it. So what is your actual plan, to get through the 6 days until your appointment or to detox?

 

[John_Burrows]

My plan is to be free of physical opiate dependence by Tuesday. I explained what meds I had left and asked how I could best use those meds to taper down and meet my goal, but many of the replies seem to be almost non sequiturs, going off in an entirely different direction. Ive read posts in the past from people who said they tapered down in 3 days; that seems really extreme, but if it's possible then 6 days should be almost easy!

Anyway, I'm only one day in and so far so good

I'm taking the methadone to ease withdrawals as I taper down the dilaudid. Hopefully by Sunday I 'll be done with the dillies and then I can start tapering the methadone. That gives me two days to see if it's working before I see my pain doctor. I guess if by then I've successfully started to cut my methadone dose with no ill effects, i'll be confident that I can finish and meet my goal.

I started this thread to see if that plan was a good way to go, but a lot of people are suggesting entirely different plans and different drugs. Maybe my plan isn't the best one in the world, but I've educated myself enough over the last 2 years to know my plan is at least possible, if not ideal. I was hoping for some advice on how to best pull off MY plan, not get new ones!

Right now my specific question is how dependent will I become on methadone after only taking it for 6 days? Is it a short enough period that I could stop cold turkey on day 7 without experiencing WD, or will my body physically crave it by then?

And no I am not just trying to get through until script day. I dont know how anyone could have drawn that conclusion of they read my entire post. But given a few of the responses I've gotten, I think that's the case!