Comparing dosage of opiates and how to avoid withdrawal post surgery reduction of opi

[Bev J.]

I shattered my wrist May 31, 2015 and the ER doc recommended oxycodone since she thought my daily dose (for longtime chronic illness of 2 Codeine at 60 mg. a day or 1 hydrocodone 10 mg. -- which I was trying since I'd built up tolerance to the codeine) would not be enough. She was right. I went through 6 weeks of the worst pain I'd ever been in and had bad casting, bad surgery and another surgery. I kept asking for 10 mg oxycodone and got it until after my last surgery, so it helped tremendously. I was taking 4 a day as well as 2 codeine 60mg. The pain was so bad I found out I couldn't cut back, and then as it got better, I got to 1 oxycodone a day and 3 codeine, and now, October 16, that's what I'm still taking. I can't cut back more without feeling horribly sick. My last surgeon warned that the second surgery could make my Myalgic Encephalomyelitis (feels like constant flu with joint and ligament pain, migraines, etc.) much worse, and it did. Plus I'm in withdrawal after a few hours.

Unlike friends in similar situations, I held onto the oxycodone as much as I could and look forward to it at night to relax, to not feel depressed at my hand being permanently damaged from the bad medical treatment, having my social life more limited, being poor, etc.

My regular RA doc is very kind but can't prescribe more than codeine or hydrocodone. I have an appt. months away for a doctor who has more ability to prescribe, but since the authorities are cutting down on access to opiates (a wonderful local doctor who was helping dying people was arrested), I'm worried if I won't get more.

I'm not sure what to do, so was wondering if anyone had ideas. I don't take any other pharmaceuticals and do not want the acetaminophen that's in everything I've been prescribed (though a friend gets pure oxycodone from her VA doctor). I've been trying to extract the acetaminophen out of the codeine.

I saw on another thread that 10 mg of oxycodone is equivalent to 100 mg of codeine, but to me the oxy is wonderfully strong and gives me a peaceful, relieved few hours while the 2 tablets of 60 mg codeine has very little affect. I'm feeling in painful withdrawal almost all the time and do not know how to cut back without suffering more pain. Not sure what to ask for if the new doctor is sympathetic, but also worry they will prescribe nothing and tell me to just deal with it.

I'm almost 65. People can buy all the alcohol and tobacco and now where I live, cannabis that they want (I absolutely hate cannabis and react with PTSD symptoms), yet I can't get what I know has helped and will help, which are opiates.

I'd like ideally to cut back to where I'm not in almost constant withdrawal, but I also would like to just get enough daily oxycodone to continue how I've been. (Before starting the codeine a few years ago, I was much more limited and it gave me the freedom to be able to hike, dance, and have a life.

Thanks!

 

[Kittycat5]

I am a little confused as to exactly what you are asking. Let me start by saying we cannot tell you what to say to your doctor to procure medication. It is against BL rules and is too speculative to make a difference in most cases.

I dont believe that was your intent, however. It seems to me you are neither getting adequate pain relief nor high/frequent enough doses to keep you out of withdrawal. Do you have fears of the side effects from oxycodone or other opioids? There is no max dose (for most of them) and should be given in the lowest dose that provides analgesia without adverse events. This does not mean you should be on the lowest strength available, rather your therapy needs to be optimized balancing the positives and negatives. As you are 65 years old, advice given, by your doctor or here, should consider the fact that older individuals have differences in how they process drugs and are more prone to side effects.

But you still need to be treated properly to relieve pain and improve functionality and QOL. It is often trial and error, being cautious when changing drugs or increasing dosages, but it needs to be addressed. It seems the oxyodone is helpful. Have you considered talking with your doctor about a long acting form of a narcotic pain reliever, in this case Oxycontin? Taken twice daily, it will provide more around the clock coverage to keep the pain in check without high spikes in blood levels the short actings forms can, thus potentially leading to less side effects. You still will need some immediate release tablets for breakthrough pain. A good rule of thumb, is about 10 to 20% of your total daily dose should be IR forms for acute attacks of pain and the rest the long acting. This will surely keep the withdrawal away better as well.

Regarding the codeine, most equivalency charts would equate 10mgs of oxycodone to around 120mg of codeine. But this only relates to pain relief, not other subjective effects like relaxation, lessened anxiety, and euphoria. Many feel oxycodone is superior to codeine at equal doses in such things and this certainly can make you feel better even if the amount of pain taken away is the same. It is difficult to divorce the pleasurable effects of any opioid from just the analgesia when patients are deciding what works best.

Dont rule out non-drug approaches to treating your pain. Things like ice/heat treatments, stretching exercises, physical therapy, etc. Your condition is similar to chronic fatigue I believe. Besides the pain, make sure you are addressing any other symptoms (depression, poor sleep, GI issues) as it is often that untreated symptoms unrelated to chronic pain can actually intensify the pain itself.

Let me finish with a few questions. You said you do not take any other drugs, even would prefer to not have the Tylenol. Is there a reason for this or do you just dont have enough issues other than pain to warrant their use? Why is your one doctor unable to prescribe anything "stronger" than hydrocodone? Is this just personal policy?

I hope I helped a bit. Good luck in finding the answers you seek. Feel free to ask me anything else and I will answer to the best of my abilities.

 

[Bev J.]

Thank you so much. I'm sorry I didn't reply sooner. I kept thinking I would get a notice for a reply and didn't.

I'm not sure why my doctor can prescribe codeine and norco but not oxycodone, but that's what he says. It's seeming like more doctors are being restricted or losing licenses or being afraid to prescribe opiates. I'm afraid to talk about how I feel in withdrawal most of the time in case I'm cut off completely.

I don't want to take other drugs because of being worried about liver and kidney damage or other problems. Doctors' drugs killed my mother after destroying her kidneys.

I AM chronically ill, with Fibromyalgia/Myalgic Encephalomyelitis or possibly Lyme and the co-infections. When I first started codeine, it helped tremendously with my chronic pain and difficulty sleeping. But then I've built up tolerance over the last few years and so I wake after about 4 hours. Since the surgery, where I started taking oxycodone 10 mgs 4 times a day, plus twice a day codeine 60 mgs, it's been hard to not feel in withdrawal after a few hours, though I now take only one oxycodone a day, and 2 to three codeine.

I think part of my problem is not having a doctor to talk to about any of this. I see the one who prescribes the codeine for about 5 minutes every three months. I'm afraid to ask more questions. I keep wondering if it would make sense to just take enough to stop withdrawal, but then worry I'd keep building tolerance. I'm also very tired and exhausted from the codeine, so wonder if the oxycodone would be better for that. It's seemed to be.

The real problem is not being guaranteed of ongoing prescriptions or getting adequate information. What you're saying about something that would keep the dose steady makes a lot of sense. I have no idea what other people are doing or getting. A friend who did well on time released tramadol for chronic Lyme is being refused that now. Another friend uses alcohol to deal with gaps in her norco use, but that wouldn't work for me, and again worry about liver damage.

Thank you!

 

[Bev J.]

I have never been addicted to anything, so it's scary to feel sick when not taking opiates every few hours. Still, they have helped me physically, mentally, and emotionally. I have friends who have committed suicide who I think would still be alive if they had tried opiates for their pain. Morphine did wonders for my mother after the other drugs doctors prescribed destroyed her kidneys (and ultimately killed her.) For the first time ever, she was less bitter and angry, it was possible to really talk and be close, and she was in less pain. I believe opiates should be as available as the more dangerous drugs, tobacco and alcohol, are. But they aren't, so what to do? I wonder if it's possible to stop taking opiates to be less addicted, but I don't want to go through the pain. I feel like the bad treatment and bad surgery I got for my broken wrist has led me to being so addicted, and theoretically there should be help from doctors. But the atmosphere is so punitive that while people seem able to take cannabis unrestricted, we are less able to get opiates. And is there a way to cut back or stop with less suffering? And should we if it's helping us anyway? Thank you.

 

[Kittycat5]

You're not addicted, you're dependent on opioids. Big difference, which I can briefly go into if interested, but just keep that in mind. Unfortunately, only abstinence or lowering your doses will truly lessen your tolerance but will come at the expense of more pain.

I am sorry to hear about your Mom and understand how that may make you hesitant to try new or increased dosages of drugs. Can I ask what she was on so maybe I can relate it to your condition and assuage your fears about certain drugs. As I mentioned, and you seemed to agree, a long acting drug such as Oxycontin, may be of great benefit. Well, Oxycontin's active ingredient is simply oxycodone which you are already familiar with. As long as you keep dosages reasonable, oxycodone by itself isnt really damaging to the liver, kidneys, or heart.

Im assuming it is either an insurance reason or there are few pain or CFS specialists near you that is making you wait to see a new physician, but I will ask anyway if there are no other options to get you into a doctor sooner. Hell, even an infectious disease specialist would be worth it if you can get in quicker.

And I agree your one doctor is just being cautious, probably overly so. If he can prescribe hydrocodone, he can prescribe oxycodone if he wishes as they are bot C-II drugs. It is a sad state of affairs what the so called prescription drug abuse epidemic has done to those truly in need. Hope you get this figured out. Be honest with the new doc when you see him, tell him your pain level is still too high and chronic and your current regimen wears off too quickly and hope for the best. I also think you should consider Lyrica or gabapentin for the fibro, but that is something you need to decide.