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Getting ready to lose 15 yr 150mcg fentanyl Rx

Kjl1

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Mar 18, 2019
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My pain management Dr. has had me on 150mcg fentanyl patches for 15 yrs, for severe pain from a failed neck surgery. I have never abused or misused it! Now with the big opiate crisis, he insists the only way he will continue treating me is if I have an internal pain pump surgically implanted! It's a worker's comp case, and they have denied the surgery, so my long time Dr. is just going to dismiss me from his practice! Withdrawals from 150mcg patches, and I did nothing wrong! I'm 60 yrs. old! I'm trying to find a suboxone Dr. near me. I'm terrified! Has anyone been through this, or have advice? I'm not even sure about the suboxone! Please??? I don't have much time!!!
 
That's a tough place to be in. I'm not sure you have very many options at this point. Short of doing something drastic like buying heroin on the street, pretty much your only option is to prepare for opioid detox. I believe even if you go on opioid replacement therapy you'll have to wait at least a few days possibly up to a month or more.

You do have a choice about how and where you want to detox, although given your age going through opioid withdrawal at home might be out of the option. If you have other health concerns, like a heart condition or mobility problems then opioid detox alone at home isn't something I can recommend you do with a good conscious. It's not known to be fatal by itself, but can be with other health complications which is at increased risk if you are 60. If you do it at home be sure to stay hydrated and have someone to check up on you at least. But really you'd be so much more comfortable under the care of an addiction specialist who can treat the withdrawal symptoms.

Also, suboxone is actually a combination of two medications, buprenorphine and naloxone. Buprenorphine can be thought of as a mild opioid stimulator, and naloxone as an opioid blocker. The buprenorphine is what "stabilizes" you/serves as the replacement opioid. The naloxone is there to block any opioids of abuse that might get consumed. If you only took the medication as prescribed, you might consider either getting only buprenorphine or methadone, which is similar but a bit stronger than buprenorphine.


Do your best to stay calm and not panic, although I know it's probably really hard not to. The truth is that the worst case scenario you'll have about a week of acute withdrawal to deal with, which will be admittedly pretty terrible but things will start getting better after that. I know you'll have the pain to deal with the whole time as well, which other than things like yoga and chiropractor I'm not sure what you could do. You might be able to find support at your local NA meetings. Even though you didn't abuse it, you were still on pretty high doses of opioids and many people in those meetings are chronic pain patients who got their start in the doctors office, and who now have to deal with chronic pain without opioids.
 
Thank you Mafioso! I wonder if what this Dr. Is doing could be illegal and considered pt. abandonment? I have had a mild heart attack, and a stent placement over 10 years ago. I live in such a remote area in the Texas Panhandle, I'm just so scared! What I didn't tell you is that I've tapered myself to 75mcg, by steadily cutting small pieces off of one of the patches, so I'm just putting on one 75mcg patch! I wonder if this will help? Any ideas on meds to help get all the way thru withdrawals?
 
Kjl,

Something about that seems wrong. Completely unethical. And dangerous. Given you have a heart condition, weren't a problematic patient, etc.

Did you ask your Dr what he suggests you do at this point? You agreed to have the pump, but were denied by insurance.

Detoxing, when you're on high doses and for extended time, can be dangerous. You should be medically assisted, and your Dr should be helping to accomadate you.

I had seizures, from only opiates. I was on high doses for a few years. It was pretty traumatic. My story is different, I detoxed cold-turkey in jail.

If you're not getting anywhere with your Dr., I would go to the emergency room and talk with a social worker, or patient advocate. Make sure you get the help you need. You've done nothing wrong.
 
Tapering is probably one of the smarter things you can do. If you can get down to a low enough dose to where you barely feel it, then start spacing out time between doses more and more to the point where you are skipping days, you'll pretty much avoid all acute withdrawal. Probably will still experience some mild symptoms like indigestion, trouble sleeping, and a bit of depression, but nothing like you would stepping off 150mcg or 75mcg fent.

Even if you don't have enough to taper that smoothly, most any taper is better than none. And once you do go into withdrawals it's nice to have maybe a few 10-25% doses on hand. So if you step off at 50mcg, it might be wise to have a few 10-15mcg on hand for when things start getting really intense and you need a relief. Those few doses can be like having a bottle of water while going through the desert. They're great for when you are going on to maybe your 3rd or 4th day of less than 2hrs of sleep, you have diarrhea and restless leg syndrome so bad you can't sit still. That "relief dose", if you want to call it, will take most of the symptoms away and you'll be able to get some food, shower, and catch some sleep.

Make sure to stock up on food and supplies if you end up having to do it at home, and let someone know who can at least call to check in. Plan on being down with the worst flu of your life for about 2 weeks. Clean laundry, easy to prepare food, water bottles so you can drink laying down, extra toilet paper with a bin next to the toilet(you can imagine why), and easy to digest entertainment. Maybe some anti-diarrhea medication like immodium, and electrolyte drink like pedialyte. Dehydration is one of the bigger dangers. Melatonin can help with sleep cycles as well.

Oh and I have no idea about the whole legality issue with your doctor. My guess is that they are probably on the right side of the law, if not being mandated to do what they are doing by law. Even if they weren't it'd require expensive lawyers to do anything about, which if that's something you can afford then I guess go ahead and hire them and spend the money just don't expect anything to happen.
 
And yes, looking into methadone or Suboxone is a good idea. You said you live in a very remote area, so you may not have clinics and sub Dr's easily available.

You shouldn't be alone, in a remote area, detoxing off a 15yr, 150mcg fentynal dependence. You're going to have to get this figured out asap. Good Luck. I'm sorry you've been put in this position.
 
Mafioso -

Don't you think, at the very least the Dr. could recommend, and authorize him to a rehab given the situation?
 
Just for reference I'm a she. I sooo appreciate any and all advice! I don't know if I want to go to a rehab. I have some muscle relaxers and benzos that I hope will help! I don't know!!! I've called an office that claims the Dr. gives suboxone. I pray he knows what he's doing. I will see the Dr. who gives me the fentanyl, this week. I hope he will give me maybe 1 or 2 months more of fent. I see the suboxone Dr. next week I've heard I have to get really sick before I can start the suboxone! I need your support and advice!!!
 
My apologies Kjl! I'm also a she lol.

That's great that you made an appointment with a sub Dr. I'm not sure what the waiting period is when you're on patches, I think I read 36hrs, but please research that. I'm not sure.

There are things you can do to make the waiting period manageable. Taking Neurontin (gabapentin), Lyrica (Pregablin), some benzodiazipines (Xanax, valium, Klonopin, Temazepam), muscle relaxers can help. The waiting period is nothing compared to what you'd experience if you abruptly go off a a long term, high dose fentynal dependence.

I mentioned rehab due to your circumstances. I couldn't, in good conscience tell you to just tough it out. Not with the high dose, amount of time, having a heart issue, etc.

I never expected to have seizures and hallucinate when I detoxed. I didn't see that coming. I also lost my vision, and the complete use of my legs for about 3days. Also, never saw that coming either. As you can imagine, it was terrifying and traumatic. You're going to want and need medical advice and assistance.
Along with the above, stay hydrated, eat healthy, rest, etc. Physically and mentally prepare for the transition from patches to subs. Im on Subutex.
Mafioso gave great advice - stock up on Gatorade, Pedialyte, soups, pudding. You get the idea - easy to eat and prepare. Have your laundry done, straighten up, put everything you need either in a drawer right next to you, or on a tray.

You want everything stress-free, and ready. Maybe get some books you want to read, or movies you'd enjoy. Hard candy is also good to keep around. I like mints, they help my stomach. Also Coke. I usually drink Coke Zero, but when my stomach is sick, I drink regular Coke. It also helps with my stomach.

You're doing good! You have appointments scheduled. That's exactly what you needed. Well Done!
 
Mafioso -

Don't you think, at the very least the Dr. could recommend, and authorize him to a rehab given the situation?

Yeah, I'd think that making a referral is about the least that a dr could do with a patient in this situation. Unfortunately some might choose to do less, and I'm not sure they are required by law to do anything. Depending on the details of the situation it might be considered patient neglect or some sort of ethical violation, but it quickly becomes a legal matter about proof, which I can't really elaborate on.

But he hasn't even cut her off yet and she is still in her care, so there probably isn't a case for anything yet.

Just for reference I'm a she. I sooo appreciate any and all advice! I don't know if I want to go to a rehab. I have some muscle relaxers and benzos that I hope will help! I don't know!!! I've called an office that claims the Dr. gives suboxone. I pray he knows what he's doing. I will see the Dr. who gives me the fentanyl, this week. I hope he will give me maybe 1 or 2 months more of fent. I see the suboxone Dr. next week I've heard I have to get really sick before I can start the suboxone! I need your support and advice!!!

Just focus on keeping your taper going and you'll be alright. With a taper, muscle relaxers and benzos, the opioid withdrawal probably won't be that bad. Not much worse than a bad cold that lasts about a week or so. Make sure to keep working on a pain management plan with your current doctor and see what he thinks about suboxone.
 
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10 yrs gone, what you went through sounds like a horrible nightmare! May I ask what you were withdrawing from? Mafioso, your advice is awesome! I'm still sooo scared! I really am going to need all of the advice and support I can get! I guess there are a lot of people in my same position. Maybe they're just handling it better! I guess from the 75 mcg taper over a few months, I'm already having problems with nausea, and not wanting to eat. Or maybe it's from the constant stress about what is to come! I'm scared, y'all! Almost like a constant state of panic!
 
Mafioso, I don't think my pain management Dr. plans to work with me AT ALL! He did not suggest the taper I've done so far! Even after all this time, 15 years, I think he just wants me gone! I just don't understand, other than I think he wants to be distanced from the meds HE has had me on! This just doesn't seem right!!! Whatever it seems, I have to accept its coming.??
 
OMG!!!! I am so freaking mad after reading your post, that I can't even respond adequately. What is happening to you is so​ wrong on so many levels. You have my sympathy and your terror is palpable. I am so sorry.
 
That doctor can't legally do that. It's abandonment, especially at your age. I would ask him or another doctor for a referral to an addiction specialist because only they can legally write a Suboxone (spelling?) script, well in California anyway. He has to legally give you a referral. I'd get on the phone to some lawyers if he won't. Don't try to do this cold turkey because being on that drug for as long as you've been on it and at your age is risky and dangerous. There is a doctor that will help. Ask for a referral.
 
Mafioso, I don't think my pain management Dr. plans to work with me AT ALL! He did not suggest the taper I've done so far! Even after all this time, 15 years, I think he just wants me gone! I just don't understand, other than I think he wants to be distanced from the meds HE has had me on! This just doesn't seem right!!! Whatever it seems, I have to accept its coming.����

So what was the decision, if any, that your doctor made after your insurance denied the surgery for the implant? He just said sorry that's it?
 
Hi kjl!

How are you?

At the time, when I got locked up, I was taking 300mg of MS Contin (time- released morphine), and using a gram to a gram and a half (14 to 21 bags) a day of good quality IV heroin. I went from that to nothing. I think my body and brain were in shock.

I still feel something is wrong with how your Dr. (dickhead) is handling this situation, given the specifics of your situation.

I had a Dr do that to me too. The same one that prescribed me narcotics in the first place and told me they were non-addictive.

Fortunately, I found another Dr to write my scripts. If I could go back, I would've looked into things more regarding the Dr that abruptly, out of nowhere, wouldn't write my Rxs after a year and a half. Let alone 15yrs.

I keep thinking "patient advocate". I've heard of people getting assistance by talking to one.

I hope you come by to update us.
 
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