• 💊 OTHER DRUGS 💊 Welcome Guest
    Posting Rules Bluelight Rules
    Notable Threads 1 Notable Threads 2
    Dangerous Combos Addiction Support
    Emergency Services Benzo Guide v.1
    Addiction Stories Scary Case Studies
    Biology, Pharmacology & Drugs 101
  • Select Your Topic Then Scroll Down
    Alcohol Bupe Benzos
    Cocaine Heroin Opioids
    RCs Stimulants Misc
    Harm Reduction All Topics Gabapentinoids
    Tired of your habit? Struggling to cope?
    Want to regain control or get sober?
    Visit our Recovery Support Forums

Opioids Worried about drug user.

That's a fuckton of opioid. IME nodding on opiates (especially when combinede with beznos) kinda makes you pop in and out of a dream_state, and I've come out of nods thinking I was talking to a friend who wasn't even in the room

Nobody needs half that much dope for pain managment, just increasing the habit to where detox is gonna ruin mind/body

Tell your friend his habit would put some of the most hardened heroin junkies in a coma, cuz seriously, that's enough to kill a herd of buffalo
 
^
Sorry I just checked again and saw the clonazepam at the bottom. Im in the uk, land of generic medicines, so I dont always click first time with brand names.lol that seems like a massive dose of clonazepam for a daily regimen and along with all those strong opiates I think your right to be worried for your friend. How does your friend feel about all these meds? have you mentioned your concerns? also benzos shouldnt be prescribed for depression, it can be an accident waiting to happen. Although im guessing the tapentadol is being prescribed off-label for the depression as a side benefit. It sounds like like the doctor is a maverick....but not the good kind!
 
Last edited:
My vote defo goes for the doctor being a psycho because I cant see any doctor, even if they got their MD off a cornflakes packet, being stupid enough to prescribe in such a dangerous manner. Having said that my fathers GP prescribed him diclofenac despite the dact hes got a stomach ulcer the size of a 50p piece. In fact there should a thread titled 'stupid things that GPs do' maybe with an annual nominations for dumbest prescription and worst diaganosis!lol
 
Absolutley agreed! The storys ive got about moronic GPs are as shocking as they are amusing. Saying that, the diclofenac story wasnt amusing, it resulted in internal bleeding and hospitalization. Same GP after the hospital incident when my dad went for a checkup, got my fathers medical records mixed up with another patient and asked to see his scar from a removed pancreas. My father informed him he was mistaken and had got him mixed up with someone else. To which the GP retorted 'would you mind lifting your shirt and proving it?! Now that was funny!
 
Hi - this is a reply to questions and comments that have come up in the replies to the original post. The level of medications taken daily are correct, although I did see an error on the Nucynta it says 2 x 75mg per day, but it is actually 4 x 75 mg per day; The Clonopine are 1 mg tabs and they are taken TID/1, 3x/day. These meds have been built up over the course of several years, and yes I do know that if anyone tried to take these meds they would OD and die. The clonopine is one of my major concerns as I know the danger of mixing with the opiods, but he appears more addicted to the clonopine than the opiods - saying he does not get high any more from the opiods, but the clonopine puts him to sleep so he can "deal with his life." He is a failed back surgery patient (surgery occurred 8 years ago when he was 41) who had a screw that pierced through the nerve root - left in for a month before the Doc would believe the pain was not in his head - had to go through our primary and emergency room CT scans for an emergency admit. Anyway the damage was done at the initial surgery, worsened by reverse screw out of the offending screw and a shard of metal was left sticking out of the vertebrae into the nerve bundles (L5-S1); He is in pain all the time no matter what the level of meds - the meds with the clonopine make sleep the object of release. Anyway, appreciate the comments but felt that some background may help in the discussion -- how to get off all these meds? how to even cut down on these meds. Also, the clonopine is prescribed by a psych. Not the "pain doctor" Thanks for any further discussion or comments.
 
Username69 said:
Opana ER 40 mg twice daily
Opana ER 30 mg twice daily
Methadone 75mg twice daily
Nucynta 75mg twice daily
Roxycodone 50mg three times daily
Clonopine 3mg three times daily

Sorry... my bad.
Click to expand...

So your friend is taking in total:
- 150mg methadone/day
- 140 mg ER oxymorphone/day
- correction: 300mg tapentadol/day (according to the last post where you said "it is actually 4 x 75 mg per day")
- 150mg oxycodone/day
- 9mg clonazepam/day *Wait are you now saying the clonazepam is 1mg 3x a day for a total of 3mg?
?!?!?

All that would be enough to make most people crazy (well obviously that would kill non-tolerant people of course). Is your friend dying? I know people dying of cancer who are not prescribed that much drugs. IF your friend is even legitimately prescribed all this stuff?? Is it from multiple doctors who are not in contact with each other or something? I don't know a single doctor who would prescribe that combination and those doses. If your friend is NOT legitimately prescribed all these drugs and is self-medicating &/or addicted that's one thing, but you said prescribed so I'm really shocked about that. Why are 4 opioids necessary? Normally one would just get one long-acting opioid and one short-acting opioid for breakthrough pain. And 3mg of clonazepam 3x a day is a lot. How long has your friend been on all these drugs?

Cannabis can affect different people very differently. For me it seems to make everything worse, especially my mental state, but also my pain, insomnia, etc, and the effects can be quite long-lasting, while others find it extremely beneficial and are able to drastically lower their doses of pharmaceutical painkillers. If your friend feels like the cannabis triggered his/her mental issues then it may not be a good idea for them to use cannabis.

Not sure what else I can say without more info. EDIT: I see you posted while I was typing this. Will add some more thoughts in a sec.

EDIT:
Ok I think your friend seriously needs to find a GOOD pain management doctor who is responsible for all prescriptions and is supportive of and knowledgeable about non-opioid treatments and non-drug treatments. A great doctor can be hard to find but is really worth the effort. Secondly, I would ask about switching to a smaller number of opioid drugs, even if the doses of the remaining drugs need to go up at first to compensate. One shouldn't need 4 different opioids. Perhaps his doctor will have some suggestions for more effective pain management using opioids that have less side effects. There may be some options like switching to one strong long-acting opioid like fentanyl patches plus one short-acting opioid for breakthrough.

I can see the point of the tapentadol if it provides effective antidepressant effects or perhaps gives some pain relieving properties that the other opioids don't, because it is a norepinephrine reuptake inhibitor in addition to being an opioid, but it's also possible it could be causing side effects. If your friend decides to quit the tapentadol it would be best to taper off it instead of stopping abruptly due to its aforementioned mechanism of action.

Perhaps instead of the methadone + oxymorphone your friend could consider switching to a single long-acting opioid?

Both oxycodone and tapentadol can be stimulating, so maybe trying to not take them very late in the day would be a good idea. Perhaps if your friend can get his opioid usage under control he wouldn't need the clonazepam in order to sleep.

Has your friend talked to his/her doctors about the mental issues he/she is experiencing??
 
Last edited:
Hi - One physician prescribes on a 28-day cycle ALL of the medications except for the Clonopine - this is prescribed by a psychiatrist for anxiety/depression; He is taking both Opana ER 30 and Opana ER 40 as the doc wanted him to take a total of 70 mg at a time, but this medication does not come in that dosage (thus combining the two). I will go check on the oxy/roxycodone - he was on 10 mg Opana instant acting but that became unavailable and backordered on the market so was switched over to roxy/oxy - this is for breakthru pain. Thank you.
 
From the wiki on tapentadol

"A relative high incidence of hallucinations have been reported, especially among patients on anti-depressants, possibly due to its pro-adrenergic properties. [27] [26]"
 
Username69 said:
Hi - One physician prescribes on a 28-day cycle ALL of the medications except for the Clonopine - this is prescribed by a psychiatrist for anxiety/depression; He is taking both Opana ER 30 and Opana ER 40 as the doc wanted him to take a total of 70 mg at a time, but this medication does not come in that dosage (thus combining the two). I will go check on the oxy/roxycodone - he was on 10 mg Opana instant acting but that became unavailable and backordered on the market so was switched over to roxy/oxy - this is for breakthru pain. Thank you.
Click to expand...

That seems so weird to me. Honestly I think if I were him I would try to find a new doctor. Do you know if the psychiatrist and pain doc are in communication with each other? I think it's important. I added a bunch of stuff to my last post above.

Fig said:
"A relative high incidence of hallucinations have been reported, especially among patients on anti-depressants, possibly due to its pro-adrenergic properties. [27] [26]"
Click to expand...
Yep, that is my concern with the tapentadol too. Unfortunately it shouldn't be abruptly discontinued if someone has been taking it for a long period of time, one should taper off it gradually. The friend really needs to discuss his mental health issues with his doctors if he's not already doing that.
 
Thank you all for your insight and recommendations. The psychiatrist does know all of the medications that he is taking, the pain management doc only knows about the meds he is prescribing. Thinking about cutting down, which has been discussed numerous times with the psych. gives him panic attacks, when he actually tries to cut down he seems to need them more. I have taken to doling out the clonopine on a daily basis as if he has control of the med bottle he will take 6 to 10 in a day - thus shorting himself on other days - it is not a pretty scene. His friends and family all are trying to get him to go to detox/rehab to get off the pain meds and reset himself. But he will not go unless as he says "they knock me out for the time it takes to detox." This will not change learned behaviors though - and it would not be long until he is back on medication again. The Clonopine he has been on for over 2 years. The other meds for years, with the nuycenta in the last 8-10 months. Thanks again for all comments.
 
I would really look for a GOOD doctor who has experience with this kind of thing. It IS possible to greatly reduce one's opioid intake, or even stop completely, even when one has serious chronic pain, but the person has to want to do it and be ready, and it's certainly not easy. It sounds like there is definitely mental addiction going on here as well. You are right that detox on it's own is not a real or lasting solution. But if his doctor could at the very least streamline his drug intake would be very beneficial. 3 drugs would be better than 5. And would help to get him out of the habit of taking so many pills all the time. Maybe like a fentanyl patch or something, with just one short-acting opioid. He should definitely talk to his doctor about reducing the number of different opioids he takes, even if he will still be taking the same total in analgesic strength. Does that make sense?

And I think he really needs to get some non-drug therapies going if he doesn't already, both to work on his pain and to work on his addiction and mental health issues. There are a lot of options: various types of counseling, meetings, mindfulness techniques, yoga, meditation, acupuncture, massage, physio, self-help, hypnosis, and so on. He may have some other health issues from being on so many drugs that need to be dealt with as well. I certainly have health issues after being on methadone for years. It's important to take small steps at a time, and do things (like I mentioned above) other than just try to reduce the doses of the meds he's on while getting no other help. He could start, for example, by trying to switch to one long-acting opioid instead of 2 (even if that has to be a higher dose of the one), trying a couple of non-drug treatments for his pain and anxiety, and adding some vitamins and supplements. Something like that would be a lot less overwhelming than the idea of quitting.
 
Thank you Swimmingdancer for all your ideas and suggestions - I know it is a long road to go down, but will try and sway the way things go. Can only hope for the best. Thank you again
 
So we have one possibility for the cause of the hallucinations, and that's the Nucynta. It is hard to diagnose a mental disorder when the patient is on so many meds, and as much as I recommend they cut down on these meds, it's best for them to get a second opinion from another doctor so that they can do this in a medically supervised manner.

Also, did we straighten out the confusion on the klonopin/clonazepam dosage? Do they take 3 1mg pills a day totaling 3mg daily, or do they take 3 of the 1mg pills 3x a day, making it a total of 9mg daily?
 
The Clonazepam are 1mg tablets that are taken 3 x a day for a total of 3 mg a day / that is how they are prescribed. On occasion when he is able to find the hidden bottle he has taken 6 to 10 1 mg tablets in a day; emotional distress dramatically increases with an increase in the prescribed amount.
 
I am still puzzled as to why they are prescribed that high of a dose of methadone along with the other medications, when the dose of methadone that they are on is definitely in the blockage range. The only thing that I can think of is that it's because methadone's blockade effect is different than that of buprenorphine in that it doesn't block due to a higher affinity, but rather because having a high dose of a potent opioid in a persons system 24/7 will greatly limit the affect of other opioids since they are so used to having a large amount of opioids in their system that adding more to the system won't produce much change. My analysis for this is that it's like an alcoholic that drinks a few liters of hard alcohol everyday (which I am comparing to daily dosing of a high dose of methadone) drinking a few beers on top of it (other opioids). Obviously the two beers wouldn't make a difference to a person who is constantly under the influence of something stronger.

But if they have been taking these other opioids along with the methadone then I supposed that they are all having an affect on the person compared to if they were just taking a high dose of methadone for a while and then taking another opioid at times to try to get high. Much like the alcoholic, if they are mixing the alcohol with beers from the start, then they will all have an affect on the user and they will be able to get drunker when taking them together all the time.

So in that respect, the methadone might not be blocking the other opioids, but I still think that they should get a second opinion since the methadone is usually taken as the long acting pain killer (it's not an extended release medication but it acts as one due to its long half-life), and they are taking Opana ER which also serves that purpose, so it's odd that they are taking both of them along with the roxicodone for breakthough pain. Usually a pain patient will take either Opana ER and roxicodone aka oxy IR, or methadone and roxicodone, but not both. Throw in the Nucynta and it's like the doctor is breaking all of the rules.

They really need to be careful mixing the clonazepam in with this. The methadone/benzo combo is a very dangerous one, and all it may take is a few extra pills and they can fatally overdose from it. The line becomes very thin when dealing with such a large amount of opioids, especially when methadone is one of them. The difference between nodding out and dying is only a matter of a few pills, so you really need to drive this idea home with them so they know the severity of their situation.

This is just a random article I pulled up, but it shows how fatal the combo is;
Combining Methadone and Benzodiazepines is such a lethal combination that states all over the country are investigating this epidemic. In Tuscaloosa, Alabama, 28 of the 41 drug overdoses in 2008 involved Methadone and Benzos (source).
Click to expand...

Here is another article about the number of fatalities from these drugs;
Among opioid analgesic–related deaths, those involving methadone increased the most during the study period.

"Methadone is a long-acting opioid and requires a complex dosing schedule. Methadone relieves pain for 4 to 8 hours but remains in the body for up to 59 hours. A lack of knowledge about the unique properties of methadone was identified as contributing to some deaths," the authors write.

In addition, the researchers found that the number of poisoning deaths involving methadone increased nearly 7-fold from 790 in 1999 to 5420 in 2006.

The report also shows that in about 50% of deaths involving opioid overdose, more than 1 type of drug contributed to the death. Involved in 17% of deaths, a combination of benzodiazepines and opioids was specified most frequently. This was followed by cocaine or heroin in 15% of deaths and benzodiazepines with cocaine or heroin in 3% of deaths.

"The involvement of benzodiazepines — sedatives used to treat anxiety, insomnia and seizures — is particularly troubling as previous studies have shown that people who were prescribed both methadone and benzodiazepines were at greater risk of overdose than those prescribed only 1 of these drugs," the authors write (source).
Click to expand...
 
Last edited:
The methadone just seems massively counter-productive for pain relief. At those doses it must blockcade the receptors to some degree and with pain relief only lasting around 4hrs with methadone it would leave the patient in pain while impairing the action of his other pain meds. Does anyone know which of thee opiate meds has the greater affinity for the receptors? Because I maybe well off the mark here but wouldnt the patient get better pain relief if he dropped the dose of methadone or stopped it entirely?
 
bunge said:
The methadone just seems massively counter-productive for pain relief. At those doses it must blockcade the receptors to some degree and with pain relief only lasting around 4hrs with methadone it would leave the patient in pain while impairing the action of his other pain meds. Does anyone know which of thee opiate meds has the greater affinity for the receptors? Because I maybe well off the mark here but wouldnt the patient get better pain relief if he dropped the dose of methadone or stopped it entirely?
Click to expand...

I can't honestly say I know the details of the receptors working or impairing the other opiods but really think you're barking up the right tree. I think what you've written seems to be speaking to this problem. Hopefully, someone here with more technical knowledge that I can help this fellow out and provide a better understanding of what the doc is doing right and what he's doing wrong. Good Luck out there everyone!
 
You must log in or register to reply here.
Top