Opioids Coming off Oramorph

[LittleTalia]

Hopefully posted this in the right place if not, please redirect me.

I am 9 weeks pregnant and I am currently taking 24mg of oramorph a day over 4h increments. I need to gradually come down off this and my GP has given me a list of dosing to go down from 4mg to 3.5mg, 3mg, 2.5mg, 2mg, 1.5mg, 1mg. He only wrote these down as four doses a day, however said I had to take it four hourly so didn't go into shock and didnt send my baby into shock and kill it.

So as far as I know it's 3 days on 4mg every 4 hours, then 3 days on 3.5mg then 3 days on 3mg... ect.

Does this sound right to anyone else?

I am so confused and not sure if I am doing this right, I can't get hold of my doctor for a few days so hoping it's alright.

 

[Backfromthebrink]

Hopefully posted this in the right place if not, please redirect me.

I am 9 weeks pregnant and I am currently taking 24mg of oramorph a day over 4h increments. I need to gradually come down off this and my GP has given me a list of dosing to go down from 4mg to 3.5mg, 3mg, 2.5mg, 2mg, 1.5mg, 1mg. He only wrote these down as four doses a day, however said I had to take it four hourly so didn't go into shock and didnt send my baby into shock and kill it.

So as far as I know it's 3 days on 4mg every 4 hours, then 3 days on 3.5mg then 3 days on 3mg... ect.

Does this sound right to anyone else?

I am so confused and not sure if I am doing this right, I can't get hold of my doctor for a few days so hoping it's alright.

The amounts your reducing seem spot on. I always recommend going down in the smallest increments possible. The only thinng that sounds a bit off is reducing evey 3 days...I would have made it every 7 days to allow your body to get used to each dose reduction.

However 24mg oramoroh per day is a fairly small amount, so the reduction shouldn't be too painful.

Why don't you follow the reduction he's give you and see how you feel...If you feel that as the doseage gets lower, you are really struggling and you need more time to adjust to each drop, speak to your doctor about only reducing every 7 dsys instead...Don't change anything without getting your doctors approval first though as it will lead to you using more medication than he has given you and could cause problems..Reducing too fast may well cause the baby distresss but the odd of it actually killing it are pretty small....That's very much worst case scenario and probably to shock you. If a person is on a very high amount of opiates them they usually recommend staying on it and then weaning the baby off when it is born as cold turkey can cause the baby distress...but your dose is small and youre only 9 weeks pregnant so probably safe to taper off

The reduction you outlined sounds about right though all things considered

 

[LittleTalia]

The amounts your reducing seem spot on. I always recommend going down in the smallest increments possible. The only thinng that sounds a bit off is reducing evey 3 days...I would have made it every 7 days to allow your body to get used to each dose reduction.

However 24mg oramoroh per day is a fairly small amount, so the reduction shouldn't be too painful.

Why don't you follow the reduction he's give you and see how you feel...If you feel that as the doseage gets lower, you are really struggling and you need more time to adjust to each drop, speak to your doctor about only reducing every 7 dsys instead...Don't change anything without getting your doctors approval first though as it will lead to you using more medication than he has given you and could cause problems..Reducing too fast may well cause the baby distresss but the odd of it actually killing it are pretty small....That's very much worst case scenario and probably to shock you. If a person is on a very high amount of opiates them they usually recommend staying on it and then weaning the baby off when it is born as cold turkey can cause the baby distress...but your dose is small and youre only 9 weeks pregnant so probably safe to taper off

The reduction you outlined sounds about right though all things considered

Thanks for the response, it's super settling. I think the reason I am weirded out about it was because I was on extended release morning and afternoon and only on 10mg to start with and I've had to go up in dose before I can come down, which I thought was odd but if it makes sense then I'll follow it.

I really appreciate your reassurance, I've never had to come off morphine gradually before. I did a cold turkey rehab once and hated every living moment of it and I was on 80mg a day then so this so far has been a breeze.

 

[Backfromthebrink]

Thanks for the response, it's super settling. I think the reason I am weirded out about it was because I was on extended release morning and afternoon and only on 10mg to start with and I've had to go up in dose before I can come down, which I thought was odd but if it makes sense then I'll follow it.

I really appreciate your reassurance, I've never had to come off morphine gradually before. I did a cold turkey rehab once and hated every living moment of it and I was on 80mg a day then so this so far has been a breeze.

Yeah, when switching from extended release to immediate release (oramorph) it's not always ad simple as switching to the exact dose and always better when tapering to start at a slightly higher dose and make sure you've comfortable first. Reducing from a dose that doesn't hold you in the first place is a recipe for failure.

Like I say, 24 mg isn't a lot but the taper he's given you makes sense and will be much easier and both you and the baby to taper rather than cold turkey.

You're doing great and although you might have a little discomfort st the end it will be so much easier than cold turkey.

Let me know how you do and if you have any problems...good luck and congratulations on the baby!!

 

[Scrofula]

You can always ask the pharmacist if any instructions aren't clear--they're the ones who had to translate it anyway. Proper dosing is also their entire raison d'etre, after double-checking that the technicians counted to 30 correctly. OK, it's probably making sure insurance claims are filed correctly; but deep down inside beats the heart of a detailed drug catalog, just begging to be consulted.

 

[speedballs_over]

Excuse me for busting into this conversation, in the name of harm reduction I felt compelled to chime in.

Edit: I agree with the post below. I fired too quickly. I read it as the mother being deeper in dependency than 24-mg oral morphine. Agreed that's too low to justify a switch to methadone.

My bad for confusing the issue. I'll leave the below for others who find this thread via search or interest.

So, this is for others... Pregnancy and *serious* opioid dependence:

A switch to methadone is sometimes indicated for opioid dependent pregnancies.

At birth the new born is treated with opium tincture or morphine, and tapered in hospital?

Why - withdrawal can be problematic for pregnancies.

Here's a link for a search on SAMHSA's website re: opioid dependence and pregnancy:

https://search.samhsa.gov/search?q=...eta_Drupal|default_collection|Newsletterated?

I'm not recommending anything, I'm not qualified.

 

[Backfromthebrink]

Excuse me for busting into this conversation, in the name of harm reduction I felt compelled to add to this, a question maybe a suggestion - to at least consider.

Isn't a switch to methadone the "gold standard" for opioid dependent pregnancy?

At birth the new born is treated with opium tincture or morphine, and tapered in hospital?

Why - withdrawal can be problematic for pregnancies.

Am I passing off old standards? This is how things were when I was on methadone.

Didn't matter why the woman was dependent, illicit or licit, methadone was the way to go.

Is this outdated?

Edit: I should have checked there first, but I believe this standard of care is recommended by SAMHSA. I'll check and link or return and correct myself.

No not really...it depends.

If the mother is dependent on a large amount of opiates and is a long term heroin user or something then conversion to methadone is usually appropriate...but for someone only on 24mg of oral morphine a day it would be overkill to convert her to methadone and either keep her on and wean the baby (as I mentioned) or reduce the methadone..(not usually done due to distressing the baby).

For such a small dependency as this it's usually to just taper her down over a few weeks and get off.

Convereting this lady to methadone and leaving her on it for 9 months, then trying to get her off would be insane in this instance

There is no one size fits all "gold standard" any doctor with a modicum if common sense would weigh up the situation individually and acct appropriately...not just bliindly put someone on a drug like methadone..

A quick taper off 25mg of oral morphine at this stage in the pregnancy will put minimal stress on the baby and the withdrawls the mother and baby experience should also be minimal.

 

[speedballs_over]

Agreed.

 

[Scrofula]

"Tincture of opium" does sound like something from The Knick, speedball.

I don't know nothin bout birthin no babies or opiate tapers, and don't disagree with anyone, but OP needs to do exactly what her doctors tell her, even if it sounds wrong to us. And OP is of course seeing actual doctors with MDs and licenses, right? And wouldn't try an opiate taper on her own without telling them.

I'm not directing this at you OP, it just made me wonder: surely assistance programs (in the US) have some way to include mothers with dependencies that don't threaten or scare them off with legal strings? I'd hate an addict to find she's pregnant, but be too afraid of courts or losing other aid to let a doctor know. Or mandatory enrollment in some kind of class full of parolees that conflicts with work, you know, the American way of helping those in need.

My ignorance just speaks to my testicled privilege.

 

[Backfromthebrink]

"Tincture of opium" does sound like something from The Knick, speedball.

I don't know nothin bout birthin no babies or opiate tapers, and don't disagree with anyone, but OP needs to do exactly what her doctors tell her, even if it sounds wrong to us. And OP is of course seeing actual doctors with MDs and licenses, right? And wouldn't try an opiate taper on her own without telling them.

I'm not directing this at you OP, it just made me wonder: surely assistance programs (in the US) have some way to include mothers with dependencies that don't threaten or scare them off with legal strings? I'd hate an addict to find she's pregnant, but be too afraid of courts or losing other aid to let a doctor know. Or mandatory enrollment in some kind of class full of parolees that conflicts with work, you know, the American way of helping those in need.

My ignorance just speaks to my testicled privilege.

I'm not from the US but I imagine they would be no threat of legal action anymore than if a non pregnant person sought help.

I'm this case though the oramorph seems to be prescribed so no worries there....

I agree that she should follow her doctors advice re. the taper and not change anything .If the reductions become too severe, speak to the doctor about it but don't change anything without asking him first.

Being on prescribed opiates at low doses and then needing to taper off in the early stages of pregnancy is a very common occurrence..

If OP follows the doctors plan all will he OK. I've cone across cases like this numerous times in my job...

I hope the OP checks in every now and then and let's us know how she's doing.

 

[Scrofula]

Yes, there has to be quite a few people on prescribed opiates for legitimate reasons who get the happy news and need to slowly come off.

I'm sure its an easy routine treatment, and didn't mean to distract.



I just thought of how as harm reduction specialists here, we should know about assistance and then the Not America mention made me realize we never cease to shock with our cruelty sometimes
[rant]
Certain areas of the US think public assistance (to others) is deserving of shame, and that becomes worse for pregnant women, and then unwed young ones, until the barrel bottom of scorn probably goes to young unwed mothers with drug dependencies (don't even ask if they aren't white).

So barriers are put in to constantly remind the recipients of their status as sub-human. There are places all too happy to have women in labor give birth while literally shackled, so I would not be surprised to hear of scare tactics and hurdles for prenatal care.

And with it the attitude to never even mention drugs for fear of triggering the Machine of legal moralism.[/rant]

Hey, that was serious restraint; I didn't even get into why it's a perceived shame and how that works here.

 

[Nightraver]

You should ask your doctor if it?s safe to take gabapentin while pregnant
They are a godsend to me when coming if of OxyContin
But I?m not sure if they are safe during pregnancy so make sure to ask the doc