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Opioids NEW- NEED URGENT FENTANYL TITRATION HELP

FindingSanctuary

Greenlighter
Joined
Nov 19, 2020
Messages
6
FindingSanctuary - Hello, I’m new here- I apologize for posting [the following topic] here, but I feel I’m in medical danger, I require urgent, experienced feedback re: reverse titration of Transdermal Fentanyl patch (which Ive personally titrated-down (alone,- after 25+yrs of Rx for 300iu!) reverse titration beginning 12/2016 to present but I am now stuck at 1/3rd of a 25iu (malinckrot) patch—this part has been done semi-secretly & with zero help from prescribing Dr as he is a politically-connected evil bastard I no longer trust. I have used everything including Thomas recipe since 2016, I went relatively slow taking necessary breaks in between & as my body tolerated etc. -no one in hospitals have a clue- this has thrown my body into hell In an attempt to rid myself of 27 YEARS worth of prescribed 300iu-Fentanyl which destroyed my organs. I have severe medical issues-(exacerbating by this patch) so research, patience, & medical knowledge were key for me— but now I’m stuck it seems at 1/3 of 25IU Q.48. , I cannot go in Hosp. for multi reasons, & I need your help to get off the remainder of 1/3 of a 25iu patch slow & with minimal effects,- ie: intolerable chronic cough/drip, dehydration, uncontrollable heart & body temperature issues etc. I will not use HOSPITALS/& Detox-Dr’s as I now trust no one- theyre uneducated & nearly killed me twice. PLEASE P/M me to assist- as Im beyond desperate & REFUSE to be a statistic.
btw: if you research (diligently using proper browsers) you’ll realize this drug was originally developed by DoD for crowd control in aresol form & 1st used in the Russian Opera House- takeover in 90’s killing hundreds.
I have serious medical conditions now- Im willing to talk to a respected moderator or an experienced “success-story” in depth- BUT PLEASE HELP ME— MY LIFE DEPENDS upon “YOUR” successful help. I’ve used Thomas recipe but it’s occasionally contra indicated due to my conditions. I’m begging for help. Don’t let me die—& plz don’t suggest bufrenex etc.- I have certain Rx’s avail. to assist. My goal is zero Fentanyl & zero benzodiazepines POST fent. complete w/d. Please help me- & forgive me for posting here. I’m desperate & It’s been a long 4 yrs. if moderator re-post’s this to another appropriate heading please inform me. Thank you all & God Bless...
 

FindingSanctuary

Greenlighter
Joined
Nov 19, 2020
Messages
6
@dalpat077 is someone who has some knowledge re: Fentanyl dosages and he might be able to help you.
I’m going to look and see if there are any user(s) that have discussed this issue specifically. I’m hoping we can find someone who might be able to help or steer you in the right direction.
I appreciate your help- I’m at the end of my rope, I literally have only 1/3 of a 25iu patch left to titrate- (which sound minor, but after 25+ yrs, every centimeter counts) & the symptoms are almost impossible to control even with the Thomas recipe & keep me coughing /dripping all night & w/horrific body cramps- I lost 75 Lbs in 60 days when this began- I can’t lose more & I can’t eat due to sudden other weird medical allergies & issues. Idk HOW to gtfo this shit without wanting to jump off a bridge. TY- I await your help.
 

MsDiz

Banríon na Fothrach
Joined
Mar 31, 2020
Messages
3,222
Location
Ireland
I’m gonna be honest and say fentanyl is nothing to be messed around with. Yes @dalpat077 has limited knowledge as will anyone here in regards to titration of fent patches.

You have many medical issues and you’re on pharmaceutical fentanyl patches. The only responsible and harm reduction advice I think is for you to seek out a dr or detox to help you. You can not do this alone, it would be incredibly dangerous. If you trust us, a bunch of random people on a drug forum then you can place your trust in a medical professional.
 

BellaJewel

Bluelighter
Joined
Mar 24, 2020
Messages
1,359
Location
Land of the Big Surf
@FindingSanctuary
I found quite a few threads (questions) that discussed this very topic. If you go to Forums, then select Other Drugs, then select Opioids you will see a magnifying glass on the top right. Type Fentanyl in the subject and indicate “”this forum only” in the area to the right of where you’ve typed Fentanyl. Also check the search titles only box.
I should add that although you’ve indicated you’re not interested in seeing a doctor, if you’re in a life threatening situation, you shouldn’t rely on information from non medical professionals. We don’t have any test results to interpret and guide you toward the soundest advice for your particular situation. Were I in your situation, I would seek medical treatment.
I’ve included a screenshot below.
I think you’ll find a lot of relevant threads re: the issues you’re dealing with.
 

Deru

Moderator: CEPS
Staff member
Joined
May 18, 2020
Messages
2,443
FindingSanctuary - Hello, I’m new here- I apologize for posting [the following topic] here, but I feel I’m in medical danger, I require urgent, experienced feedback re: reverse titration of Transdermal Fentanyl patch (which Ive personally titrated-down (alone,- after 25+yrs of Rx for 300iu!) reverse titration beginning 12/2016 to present but I am now stuck at 1/3rd of a 25iu (malinckrot) patch—this part has been done semi-secretly & with zero help from prescribing Dr as he is a politically-connected evil bastard I no longer trust. I have used everything including Thomas recipe since 2016, I went relatively slow taking necessary breaks in between & as my body tolerated etc. -no one in hospitals have a clue- this has thrown my body into hell In an attempt to rid myself of 27 YEARS worth of prescribed 300iu-Fentanyl which destroyed my organs. I have severe medical issues-(exacerbating by this patch) so research, patience, & medical knowledge were key for me— but now I’m stuck it seems at 1/3 of 25IU Q.48. , I cannot go in Hosp. for multi reasons, & I need your help to get off the remainder of 1/3 of a 25iu patch slow & with minimal effects,- ie: intolerable chronic cough/drip, dehydration, uncontrollable heart & body temperature issues etc. I will not use HOSPITALS/& Detox-Dr’s as I now trust no one- theyre uneducated & nearly killed me twice. PLEASE P/M me to assist- as Im beyond desperate & REFUSE to be a statistic.
btw: if you research (diligently using proper browsers) you’ll realize this drug was originally developed by DoD for crowd control in aresol form & 1st used in the Russian Opera House- takeover in 90’s killing hundreds.
I have serious medical conditions now- Im willing to talk to a respected moderator or an experienced “success-story” in depth- BUT PLEASE HELP ME— MY LIFE DEPENDS upon “YOUR” successful help. I’ve used Thomas recipe but it’s occasionally contra indicated due to my conditions. I’m begging for help. Don’t let me die—& plz don’t suggest bufrenex etc.- I have certain Rx’s avail. to assist. My goal is zero Fentanyl & zero benzodiazepines POST fent. complete w/d. Please help me- & forgive me for posting here. I’m desperate & It’s been a long 4 yrs. if moderator re-post’s this to another appropriate heading please inform me. Thank you all & God Bless...

I’m fairly certain you mean you’ve tapered down to 1/3 of a 25 mcg/hour fentanyl patch. A 25 mcg/hour patch is roughly 60 MME, and assuming the fentanyl is distributed evenly (I’m not confident it is), that would give you 8.25mcg/hour or 20 MME with the 1/3 of a patch you’re using. You ideally want to reach 5 MME or less per day before you stop, so if you could accurately dose it (in your case, I’m not sure you can), you would drop 5 MME per week until you were at 5 MME and then either stop or reduce in even smaller increments. In my experience, a reduction of 5 MME per week once you reach below 50 MME results in a bit of flu like symptoms, fatigue, but nothing unmanageable especially if you stay active and eat healthy.

With all that said, without knowing your specific medical conditions, this may be a conversation best left between you and your prescribing doctor.
 

FindingSanctuary

Greenlighter
Joined
Nov 19, 2020
Messages
6
I’m gonna be honest and say fentanyl is nothing to be messed around with. Yes @dalpat077 has limited knowledge as will anyone here in regards to titration of fent patches.

You have many medical issues and you’re on pharmaceutical fentanyl patches. The only responsible and harm reduction advice I think is for you to seek out a dr or detox to help you. You can not do this alone, it would be incredibly dangerous. If you trust us, a bunch of random people on a drug forum then you can place your trust in a medical professional.
I appreciate your reply, but Sadly three Dr’s nearly killed me upon my seeking help & one attempted to flip me (permanently) to MOROHINE XR (which he knew full well does not have an effect on me, & I didn’t want to do it— certain bodies do not respond to certain drugs- I do not respond to morphine AT ALL.) I’m beyond aware of the lethal dangers of detox, I once had a “casac” degree (pre fentanyl) but I “made it” on my own from 300iu q.48 to 25iu q.48 in 24 months basically ALONE with ZERO MEDS TO ASSIST per Dr’s plan - when I reached 25iu q48 I then kept the partial acetate on the back of the 25iu patch until all that was exposed to my skin was 1/3 of that patch. that’s where I’m stuck. (I’m sure I’m also impatient) it’s seems to be the final 1/3rd of this patch causing the most pain & issues—but if I can get passed this final step in a reasonable amount of time-(idc if it takes 2-3mos.) I’ll be home free. My situation is a matter of physical dependence vs. “traditional addiction” (ie: like insulin would be, I despise this narcotic) & always have. But that is entirely another topic, so I feel I have that in my favor. I have a cardiologist I trust monitoring my heart as needed, my prime Dr assisting as he can w/Xanax for myclonic jerks, & the rest I do myself. I use L-tyrosine B12 etc (& Thomas Recipe) to combat dopamine/Seratonin drops etc., but idk why the final 1/3 is giving me so much difficulty- Fentanyl is like nuclear waste, it has a long half life...I take my blood pressure daily & O2 readings daily. I just don’t know how to get the final 1/3 off without complications- ps: “Detox Dr’s” advised just ripping it off - so u see why I can’t trust them,- I’ve been on this crap for 25+ years, that’s not exactly gentle for a lupus pt. So many Dr’s truly are ignorant- they are unaware of the potential cardio/pulmonary edema, stroke risks, rapid spikes in BP, & body temps.,believe me I’ve seen plenty. That’s why I go a millimeter down a week (or longer) if necessary- I was just hoping someone else walked in my shoes & had more info & success. . Thank you for replying, & I hope people will continue to please send all further suggestions. I appreciate them all. I know everyone means well.., — Much love❤️
 

MsDiz

Banríon na Fothrach
Joined
Mar 31, 2020
Messages
3,222
Location
Ireland
I appreciate your reply, but Sadly three Dr’s nearly killed me upon my seeking help & one attempted to flip me (permanently) to MOROHINE XR (which he knew full well does not have an effect on me, & I didn’t want to do it— certain bodies do not respond to certain drugs- I do not respond to morphine AT ALL.) I’m beyond aware of the lethal dangers of detox, I once had a “casac” degree (pre fentanyl) but I “made it” on my own from 300iu q.48 to 25iu q.48 in 24 months basically ALONE with ZERO MEDS TO ASSIST per Dr’s plan - when I reached 25iu q48 I then kept the partial acetate on the back of the 25iu patch until all that was exposed to my skin was 1/3 of that patch. that’s where I’m stuck. (I’m sure I’m also impatient) it’s seems to be the final 1/3rd of this patch causing the most pain & issues—but if I can get passed this final step in a reasonable amount of time-(idc if it takes 2-3mos.) I’ll be home free. My situation is a matter of physical dependence vs. “traditional addiction” (ie: like insulin would be, I despise this narcotic) & always have. But that is entirely another topic, so I feel I have that in my favor. I have a cardiologist I trust monitoring my heart as needed, my prime Dr assisting as he can w/Xanax for myclonic jerks, & the rest I do myself. I use L-tyrosine B12 etc (& Thomas Recipe) to combat dopamine/Seratonin drops etc., but idk why the final 1/3 is giving me so much difficulty- Fentanyl is like nuclear waste, it has a long half life...I take my blood pressure daily & O2 readings daily. I just don’t know how to get the final 1/3 off without complications- ps: “Detox Dr’s” advised just ripping it off - so u see why I can’t trust them,- I’ve been on this crap for 25+ years, that’s not exactly gentle for a lupus pt. So many Dr’s truly are ignorant- they are unaware of the potential cardio/pulmonary edema, stroke risks, rapid spikes in BP, & body temps.,believe me I’ve seen plenty. That’s why I go a millimeter down a week (or longer) if necessary- I was just hoping someone else walked in my shoes & had more info & success. . Thank you for replying, & I hope people will continue to please send all further suggestions. I appreciate them all. I know everyone means well.., — Much love❤️
Fentanyl has a relatively short half life actually.

I’m sorry I’m not telling you what you want to hear.

You say you don’t trust drs yet you trust your cardiologist and your dr who is giving you Xanax. How can they assist you properly or know how their patient is if you are withholding incredibly important information from them. Information that is critical in that patients care.

Again I say, I highly doubt anyone here has your medical history or more importantly your medical complications especially in regards to lupus, stroke risk and cardio risk. This is a harm reduction site and it would be totally against it for anyone to advise you how to taper your fent with your conditions and your medical drs unaware.

I really am sorry for your situation.

Please put the trust in your drs that you are putting into this forum.
 

Deru

Moderator: CEPS
Staff member
Joined
May 18, 2020
Messages
2,443
I’m wary to assume the fentanyl is distributed evenly, so for instance if you split it into four separate pieces, what guarantee is there that you will have 6.25 mcg/hour in each piece? Another issue I can think of is if cutting the patch somehow affects it’s distribution. @dalpat077 might know the answer to both of those, actually. The reason this matters is because if you have pieces with varying amounts the whole taper becomes useless and you can easily go backwards.

Like I said, once you get below 50 MME per day things become complicated. You absolutely need to do something to get your endogenous opioids flowing or it’s easy to get stuck and a healthy diet is so essential during this time. And slow and steady wins the race here, 20 MME for two weeks if you need to, 15 MME for two weeks, 10 MME for two weeks, etc. It’s not a sprint, there is no reward for finishing it first.

Another huge thing that comes to mind, when I tapered and reached below 50 MME, I always tried to go as long as I possibly could at night without anything. So, 8 hours of the day (sleeping) with no exogenous opioids would be the first portion I’d start with.

For the sake of clarity, MME is morphine milligram equivalents. If you take your dose and multiply by 2.4 you arrive at the daily MME.

For instance,

25 mcg (not IU)/hour * 0.001 = 0.025 milligrams/hour. 0.025 milligrams/hour * 24 hours = 0.6 mg/day (600 mcg/day). 0.6 * 100 = 60 MME.

So,

60 MME / 25 mcg/hour = 2.4
 

FindingSanctuary

Greenlighter
Joined
Nov 19, 2020
Messages
6
I’m fairly certain you mean you’ve tapered down to 1/3 of a 25 mcg/hour fentanyl patch. A 25 mcg/hour patch is roughly 60 MME, and assuming the fentanyl is distributed evenly (I’m not confident it is), that would give you 8.25mcg/hour or 20 MME with the 1/3 of a patch you’re using. You ideally want to reach 5 MME or less per day before you stop, so if you could accurately dose it (in your case, I’m not sure you can), you would drop 5 MME per week until you were at 5 MME and then either stop or reduce in even smaller increments. In my experience, a reduction of 5 MME per week once you reach below 50 MME results in a bit of flu like symptoms, fatigue, but nothing unmanageable especially if you stay active and eat healthy.

With all that said, without knowing your specific medical conditions, this may be a conversation best left between you and your prescribing doctor.
Yes! (re: absorption rates)- and according to brand or generic that will change per hour according to a chart I found on a medical site comparing all brands & when I was forced to switch from brand Duragessic to Mallonkrot . That’s when I found a chart on line somewhere documenting: Duragessic was about 6mme per hr while the “same” size patch only dispensed half as much per hous!? — which became immediately clear asa I was forced to use mallinkrot & went into unexpected, instant horrific withdrawl! So you’re correct there! And yes, that’s been my plan,— small reductions slowly & as tolerated. However, I started experiencing things I hadn’t experienced even as high up as tapering off 300iu duragessic patch (brand name)- now at 25iu (mallinkrot I experience severe unstoppable sneezing, constant post nasal drip & cough, blood pressure highs & lows, etc. so yes I’ve been tapering small & slow as possible but it feels like it’s taking forever...the other prob has been eating right as severe lupus caused additional complications there but I’m trying. I just want off so bad. I hate what these Dr’s did to me- I was 22yo when they put me on this weapon, I’m more than double that age now. I sincerely Thank you for your understanding & suggestions. I guess I’m going to need more patience. Ty for all your suggestions & concern- I’m grateful. (Scared but grateful😔
 

MsDiz

Banríon na Fothrach
Joined
Mar 31, 2020
Messages
3,222
Location
Ireland
Fentanyl has a very short plasma half-life but the elimination half-life, especially with chronic use, is very long.
You’re correct. I wasn’t thinking of the patch and the initiation build up of it in the system. It’s like 12/16 hours or something then isn’t it?
 

FindingSanctuary

Greenlighter
Joined
Nov 19, 2020
Messages
6
Fentanyl has a relatively short half life actually.

I’m sorry I’m not telling you what you want to hear.

You say you don’t trust drs yet you trust your cardiologist and your dr who is giving you Xanax. How can they assist you properly or know how their patient is if you are withholding incredibly important information from them. Information that is critical in that patients care.

Again I say, I highly doubt anyone here has your medical history or more importantly your medical complications especially in regards to lupus, stroke risk and cardio risk. This is a harm reduction site and it would be totally against it for anyone to advise you how to taper your fent with your conditions and your medical drs unaware.

I really am sorry for your situation.

Please put the trust in your drs that you are putting into this forum.
I’m sorry if I wasn’t clear, but the Dr’s (the Cardio, the Prime, a Neurologist, a GI,are all aware of my intentions & monitor me as necessary) & I also have an Rn daughter & an EMT at home) all are aware I’m tapering.
They are also very aware & wary of the very (public) & valid reasons to fear this prescribing Dr.—(btw: the Xanax was used to combat early myoclonic jerks & anxiety due to rapid withdrawl due to no pharmaceutical assistance prescribed by the original prescribing physician.)
The Dr who prescribed this poison to me when I was 22yo has since become a crooked,unethical & powerful politician who continues to practice, (sadly, no other Pain Dr would accept me when I tried, although I tried multiple times to leave his practice) so I cannot afford to “cross” this wicked man, - & I cannot trust him- any Dr. who just decides to taper a pt. Off from 300mcg fentanyl AND other controlled substances contaminently & abruptly with ZERO assisting meds imho is barbaric, & dare I say it’s mal-practice, yet he’s done both- (he had also since been investigated by the DEA & FBI for various charges —including double-dipping &voter fraud) he also doesn’t take phone calls if you require “help” & goes on vacation whenever he feels like it w/no warning or covering physician. He wasn’t always this way in 1997-(imho after his divorce in early 2000’s) he got greedy, he was investigated for double dipping & hacked electoral computers in his district etc..(& I’ll leave the rest where Jesus flang it)
My other Drs assist me as much as possible symptomatically (ie high BP, migraines, nausea, vomiting, dehydration, etc.) within their specialities but now covid has made hospitalization potentially deadly for me w/lupus, kidney disease & other. Also I have read Peak absorption of transdermal fentanyl is reached between 17-24 hrs when applied (for relatively short term use) & elimination was still detected up to 72 hrs upon cessation in urine tests, 48 hrs for blood, & 3 months for hair samples —HOWEVER a fentanyl-metabolite called “norfentanyl” is detectable up to 96 hrs post single use cessation (4 days) according to American addiction centers.org & it halves. In personal experience this increases if youve been on 300mcg transdermally for 20+ years. It is written on the duragessic patien insert that fentanyl has a “half-life” elimination process.(???) To be fair, even Medrol has a total washout period of 6 weeks. So I’m sure the ROI, dose, & length of time makes a difference in elimination, Ive experienced w/d well past 4 days in my time. I Typically experience 14 days before stabilizing- but that could just be “my system personally”. Idk. My point is, it’s never been 3 days for me. Hence my struggle. But I appreciate your concern & suggestions. I do my best. I once saved my daughters life when a D.O. in a hospital claiming to be a board cert. Pain management specialist applied a 50mcg patch upon her body post her kidney transplant!— DESPITE her being NON OPIOID TOLERANT- She became incoherent, spiked a dangerously high fever, & if I hadn’t had experience & ripped that patch off of her within 30 min. (as I did AMA) she’d have died of CNS depression & rejected her kidney. I’ve learned not to solely trust everyone in a “white coat”. I read JAMA & medical journals voraciously & try to be as vigilant & accurate as possible.. I value the physical experiences others have actually endured. I am NOT a Dr nor portend to be, these are my own personal experiences. I merely seek ppl who may have experienced my situation & had a successful way to deal with it. I am partial to the advice I thus far read of going as small & as slowly as I can until I can eliminate it safely & completely. This seems to be the safest way although frustrating & lengthy. Awa also minding my BP, O2 rates, & being hyper aware of potential cardio & pulmonary edema. (Which apparently was responsible for several deaths in an early published case-study I read (whose name escapes me atm) in the early days of rapid-fentanyl detox, & unsupervised detox. So imho it’s best to gather as much knowledge as possible in this situation to help yourself, others, & at times inform a “Dr.”— many who’ve thanked me for my candor. I am grateful for everyone’s input, I hope to read more on personal experiences here as well. Tyvm again for your reply & help. It’s greatly appreciated. I look forward to more reading experiences God bless.
 

dalpat077

Bluelighter
Joined
Oct 14, 2019
Messages
543
Yes @dalpat077 has limited knowledge as will anyone here in regards to titration of fent patches.
Jesus. And good morning to you too. There's a vote of confidence. My life's work and passion taken out at the knees in one sentence! Only joking. 😇

That said: nice to see I'll be remembered, by some anyway, for my Fentanyl research and contribution to medical science and pharmacology insofar as Fentanyl is concerned. 😇

For the record: I'm the local extraction, and subsequent titration, (research only) specialist. And have a fairly good knowledge (a bit of an understatement even if I have to say so myself) re: Fentanyl patch types, design, construction, and delivery mechanisms. :cool: None of which, unfortunately, qualifies me to give advice or input re: the cessation of use of Fentanyl patches, Fentanyl withdrawal, or Fentanyl tapering. And that under perfect conditions i.e. there seems to be a bunch of other underlying problems and issues here so I have to agree with everyone that has said that you need to see somebody way more qualified than anyone on these forums given what appears to be a severe problem.

I did, in fact, see this thread start late last night but didn't respond (mainly because it was so late but also because I wasn't quite sure what to make of the initial details provided). But this morning I see there's more information that's been provided and it appears to me the OP has done a fair bit of their own research on the topic and understands more than most here (myself included when it comes to use and withdrawal) (I don't use). I think it important to lay bare my credentials to the OP before proceeding further!

All of the above being said let me throw out a few random things here that come to mind (which may or may not have any value in this situation).

I assume we're talking about MICROgrams per hour as in µg/hour. I don't know what the other abbreviations being used are in reference to. I know that @Deru has already picked up on this. Just making sure is all.

I assume we're NOT talking about gel patches but rather drug in adhesive/matrix type patches. It may be a redundant question because they're don't make gel patches anymore. But you never know. And of course: the OP is referencing Durogesic DTrans™ (which by definition are drug in adhesive/matrix type patches). But like I said: you never know and given the subject matter I reckon it's worth being sure. Point is that with gel patches: it's just not possible to a) cut the patch up without exposing the gel and b) assume that each piece will contain the same amount of Fentanyl.

While every effort is made by the manufacturer(s) to ensure an even distribution of Fentanyl in drug in adhesive/matrix type patches (don't I just sound like an ideal candidate for a medical rep. for Janssen) it's important to note that cutting the patches is not licensed and I've never seen any manufacturer NOT warn against cutting the patches. I have seen it mentioned in one or two medical (nursing or palliative care) publications that it's alright to do so BUT that the unused portion MUST be immediately discarded and NOT used and I can see the logic behind this i.e. the Fentanyl may begin to degrade (and the rate of such degradation will vary depending on environmental and storage conditions) albeit that the Fentanyl is only being exposed along the cut (assuming of course the backing layer has not been further damaged or removed). Given all of this: I'm not entirely sure that cutting a 100µg/h patch (for example) into four exactly equal size quarters would result in having the equivalent of four 25µg/h patches. And even if this be the case and given that a patch is supposed to be removed after a period of 72 hours then it stands to reason that the other three quarters of the patch could degrade (the last quarter would have been exposed for a period of 9 days before being applied). Whether or not it would degrade by a material amount is an unknown to me. But given that we're talking about Fentanyl here: every little bit, and every little error, could be material.

It is true that the amount of Fentanyl contained in a patch varies from manufacturer to manufacturer (in one or two cases vastly). The total amount of Fentanyl contained in a patch MUST be clearly stated on the wrapper though so if these are legit patches then it's easy enough to see. However: the release rate per hour is supposed to be constant across the board with drug in adhesive/matrix type patches In other words: per cm² the amount released per hour should be identical across the board and regardless of manufacturer. This is why patch size varies from manufacturer to manufacturer depending on the total amount of Fentanyl contained in a patch. This is as per my extensive research. But let me say I've seen conflicting information in this regard. The only patches I can and would vouch for are Durogesic DTrans™ made by Janssen. And I personally, given your situation, would not jump from manufacturer to manufacturer but go back to, and stay on, the Janssen product. There have been studies and tests done and not all patches are created equal (as the saying goes).

With regard to the per hour delivery vs. the total amount of Fentanyl contained in a patch: the total amount of Fentanyl contained in a patch far exceeds the figure that you would arrive at by simply multiplying the strength of the patch e.g. 100µg/h multiplied by 72 hours (the maximum time a patch is supposed to be worn and this as recommended by all manufacturers) equates to 7.2mg (MILLIgrams) yet a 100µg/h Durogesic DTrans™ patch contains a total amount of 16.8mg (MILLIgrams) of Fentanyl. For reasons which I don't think are worth detailing here (unless you're REALLY interested and want to get technical): it's for this reason that there is always a fair amount of residual Fentanyl left over in a used patch. It's also the reason why there's a big danger when cutting patches up into small pieces for recreational purposes because this little known fact results in way more Fentanyl being accessible than one may think for a given cut to size.

I assume you're aware that there are 12µg/h Durogesic DTrans™ patches available? Unless I missed it (sorry but your posts are a tad difficult to read) I see only talk of 25µg/h patches being cut?

That's it I'm afraid. And I don't know if any of it helps at all. It is information, though, that you will not find in any leaflet (and I'd be willing to wager a large amount of cash that it's more information than even your GP has at his fingertips).

There's no point in my getting into half lives and plasma concentrations etc. as I'd simply be retyping the information detailed on the link below (one of the really good ones I happened to find some time ago). If you've not seen it before: go through it i.e. there's loads of detail and everything you need to know I think (the above, as noted, being over and above my in depth and laborious research).

In closing (albeit stepping over my boundaries here I think): I honestly don't see your freeing yourself of these things on your own. I know you don't want to hear that. But let's assume that my warnings and take on the issue of cutting patches up is valid: best case scenario is that you're going to end up going through a pile of 12µg/h patches and I know these things don't come cheap (and that's just to begin with). And given the amount of time that you've been on these things: it's going to take a good while trying to taper off of them using bits and pieces of patches and hoping for the best. As I noted when I started this post: under perfect conditions i.e. were these patches the ONLY issue well then I'd be inclined to say that it'd be possible doing it this way. But there seem to be various other medical conditions present (as my FRIEND @PrincessDiz has already pointed out) and advice or input given here is not something I'd take a gamble on under these circumstances. Fact of the matter too is that there are many variables at play when it comes to these patches. In other words: it's impossible to accurately say that with every taper and on a daily basis you're getting the exact same amount of Fentanyl in your system. It's not like you're able to measure and taper in exact strengths with each step of the taper (some of the variables I've detailed above and there's others e.g. temperature, metabolism, the list goes on). I'd go so far as to say that you're probably looking at having to substitute Fentanyl in another form once you've stabilized on 12µg/h patches and which can then be tapered accurately on a per ml basis until you're over this. Whether this is possible or practical for you: I know not.

On a personal note: I get the impression that you're panicking a fair bit too (and not to mention dealing with anger at medical professionals to boot). First step: stop panicking (assuming I'm right). There is no drug addiction in the world (including Fentanyl) that cannot be beat. So sit back, accept it for what it is (your situation), and then start taking a measured and calm approach toward getting off of these things. And let me also say (not sure if this is a factor but I'll mention it anyway): there is absolutely no shame in having ended up where you have and in asking for help from others (whether it be here or anywhere else). I can attest to an unintended and unwitting benzodiazepine dependence some many years ago and which was purely the result of over prescription (no abuse on my part i.e. used only as directed but each and every time they stopped working the solution was simply to increase the daily dosage as prescribed). In fairness: I don't believe at the time that my doc. even realized or knew about the possible ramifications. I believe that TODAY, and given the fascination that I developed for them since that time, I know more TODAY about them than my doctor knew back then. And given the amount of time you've been on these patches: I'm inclined to make the same assumption about your doctor or medical professional when this all started. That too is probably not something you want to hear. But it's my personal opinion nevertheless.

By the way (and in defense of Fentanyl): it was never prepared and developed for the purposes of crowd control or to be weaponized. It was developed in 1959 by Janssen (Dr. Paul Janssen to be exact) as a potent analgesic and became adopted as a pain reliever and anesthetic thereafter and with major benefits over the use of morphine. The Russians supposedly (and this has still not really ever been confirmed nor denied by the Russians) used a Fentanyl analog known as Carfentanil in the hostage crisis. And this assumption based purely on the fact that traces of Carfentanil were found. What they actually used could have been a combination of Carfentanil and who knows what else (possibly). And we've come a long way since then too i.e. look up the grand daddy of Fentanyl analogs called Ohmefentanyl. It's around 6 300 times more potent than morphine and has it's own analogs which range between 18 000 and 30 000 times more potent than morphine.

If nothing else: I've done my homework due to a morbid fascination with this stuff let's face it! 😇 I don't, however, expect that to make you feel any better.

Any questions? Anyone?

Here's the link to which I was referring to above:

 
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TheInvisibleStoner

Bluelighter
Joined
Sep 2, 2020
Messages
1,565
Location
USA
You are correct not to trust doctors. Some are good. Most are not. Doctors in western medicine are completely twisted. At least my mom had some sense to block any doctors from giving me stuff when I was a kid. I always thank her for that.

The doctor that scripted you xanax should lose his license. Its probably too late, but adding a benzo dependence to all this is not good. Be careful with these. Especially when mixed with opiates. They both multiply each other. Someone here said it best...what comes up, must come down. And with benzos, you will wish you were dead. Keep your intake as low as possible.

Not much to add. Taper slow. Doctors suck indeed. There is always methadone for pain and dependency if needed. But learn some deep breathing techniques. From basic breathing to chi gong. It will suppress your CNS and calm you once you know how to do it. If I didn't know that shit, would of been admitted to the hospital last thursday. Told them give me some sugar and 20 minutes. Was squirming on the floor in alcohol withdrawal, and opiate withdrawal after getting hit with 8mg of IV narcan (yes, would of needed close to 10 OD kits to have been revived in the street). Pulled my bp and heartrate down to normal levels. 30 minutes later walked out.

I could never claim to know what the withdrawals are like from 27 years of fent patches. So would be curious to know what your blood pressure and BPM are like. And that is exactly what I go off of when in withdrawal. As long as I know my BP, blood pressure, and temperature are good, then I am good.

In any case, if you ever do feel your life is in danger due to bad BP / BPM / temp, do not hesitate to call 911.

And if you ever have to come off those benzos cold. Many other things to look out for, but outside the scope of this.

Best of luck.
 
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Deru

Moderator: CEPS
Staff member
Joined
May 18, 2020
Messages
2,443
I have to agree that going to a pain management doctor to be weaned off opioids can be problematic. There seems to be an increasing shift to not allow tapering with the prescribed opioid and switching to maintenance medication like buprenorphine or methadone, which, in my opinion, can create even larger challenges to the patient.

Ultimately, at one point or another, the only logical and rational way out is tapering off one opioid or another. It’s the inevitable price of admission. I’d chose a short half-life opioid every single time over a long half-life opioid, and fentanyl is probably the easiest opioid I’ve ever tapered off because there is little to no reinforcing positive rewards like euphoria that make it extremely difficult psychologically.
 

FindingSanctuary

Greenlighter
Joined
Nov 19, 2020
Messages
6
Dear @dalpat077:
“Jesus” & Goodmorning indeed!☺️—many of your points I believe concur with my experience & do indeed apply (to me). I’d like to thank you for your valued input & I’d also like to provide some additional info I think will help clarify my situation & a few confusing matters.. I live in the USA, (don’t throw tomato’s at me😬), and 22+ yrs ago I was a “baby/novice” & I did initially begin on the brand name Duragessic “gel-reservoir patches” which were finally OUTLAWED for “home use”,- after that, (aprox. 2002?) I remained on 3- 100iu Jansen Duragessic matrix patches q48 (as I was a rapid metabolizer & would experience withdrawl after approx 50hrs or so🙄) So for 22+yrs I was outrageously prescribed 3 100iu q.48 Duragessic brand matrix patches.!? Fast-forward to 12/2016 & my pain mgtm. Dr. was “investigated” & I was forced to taper fairly rapidly (losing 75 lbs. in 60 days) & routinely hospitalized by my PRIMARY Dr. until being forced to cease taper at 25iu matrix duragessic after 2yrs of tapering from 300iu matrix (duragessic) to 25iu (duragessic) with zero pharmaceutical assistance until medical complications arose at home-(myclonic jerks etc.). I remained at 25iu q.48 matrix duragessic patch since to stabilize.
BUT In April 2020,—4 years after beginning the initial taper w/no medical/pharmaceutical assistance (aside from 2qid -1mg Xanax as needed for “myclonic jerks”) I felt vulnerable & wanted OFF. Then in MAY, 2020 the USA announced Janssen Pharm.(Duragessic brand) & Mylar (it’s Generic & nearly identical in every way) of North America ceased producing or distributing Fentanyl (& its chemical cousins ie: carafentanal etc.) in North America (idk if true worldwide) for home Rx use. (Except <25iu or use in hospital) SO suddenly as of 5/2020 the ONLY brands I were able to obtain thereafter (per my “Dr.’s info”, internet info, laws &my reliable pharmacist) in my state or the USA,- was 1 of 2 brands left- which only some pharmacies carried for sale: 1 was made slightly similarly to the clear Duragessic or Mylar matrix patch but this Co. (Mallinkrot) matrix’s was completely different & has a much slower absorption rate, OR—I could try a brand matrix made by a Co.(which I can’t recall its name at the moment) but it’s far worse [for me] & mimics the material made for-use as a fabric-type of “Bandaid” (which in my past experience is the WORST variety available for MYSELF) & as you already know, the absorption rates varied greatly amongst them all, some by as much as less than half the absorption rate of Duragessic in most cases & this one was the absolute lowest. So I chose Mallinkrot because I already knew from unfortunate experience the other matrix patch definitely would NOT work for me. WOW!- the Mallinkrot matrix was an INSTANTANEOUS mega-drop in dose absorption rate compared to Duragessic despite no change in dose:( 25iu q.48) & it was like a sledgehammer to the base of my skull & I appeared as if I had a stroke.
SO YES- you are absolutely correct in stating all matrix patches are NOT created equal & dose at different rates! (Idk if Jansen continues to make transdermal patches & its chemical cousins outside of North America) but it’s illegal in the US for pts. -aside from Hospital use, & Veterinary use notwithstanding.
So I suddenly find myself stuck w/Mallinkrot (aka:Mallin-crap) transdermal 25iu matrix patches q.48—and YES I DID attempt the 12.5 version but it was so tiny it was nearly un-absorbable & a huge drop from 25iu, my body instantly again went into violent withdrawl, I looked & seemed like a stroke victim🙄😢. I absolutely could not tolerate it at the time & was forced to go back up to 25iu😢- especially since my sadistic wanker of a Dr. refused to offer ANYTHING to ease the taper (likely due to his being raided/investigated by DEA & FBI for Medicare fraud & political fraud—he’s a politician as well, —nice.)
SO, I didn’t know what to do if I wanted to be free from this nightmare & this corrupt Dr./Powerful Politian...I fear for my life. I don’t want a stroke or worse. I decided to try using the 25iu matrix patch but NOT CUT IT- I simply left the acetate plastic backing partially on it & slowly worked my way to have 1/3rd exposed to my skin currently— but I’m concerned, I know you’re not a chemist, dr., or pharmacist, etc. -however in your experienced opinion will I still not exceed using this “covering” method? (I have noticed the Fentanyl seems to be concentrated in the center of matrix patch & appears to avoid the outter most side edges upon opening foil packet, but does the drug shift? (I am currently using only the bottom (or top) 1/3, uncovered against my skin & keep the backing on the rest)— in your opinion will the fentanyl “slide downward” anyway? I considered cutting the matrix patch & sealing the cut portion with scotch-brand tape? Again, I realize you’re not a dr. chemist, pharmacist etc. however does [that] in your opinion seem like a more plausible alternative to merely keeping the plastic/acetate on the back of the unused portion potentially more sufficient? I’m truly in a bind here, (especially with covid rampant in my state)-sadly I HAVE to achieve this on my own🙏🏼😢.I obtain it monthly for mow but fear the future. Anyway, I greatly appreciate your info & reply, but I’d be anxious to hear your opinion on covering vs. cutting. God Bless & thank you immensely!!
 

dalpat077

Bluelighter
Joined
Oct 14, 2019
Messages
543
Good morning.

Apologies for my belated response (there's, I'm guessing, currently, at least a seven hour time difference between us) (I'm in South Africa by the way).

Very surprised to hear about the 100µg/h Janssen patches no longer being available to out patients and private individuals in North America. I did not know that. Pisses me off to be honest (and I will lose my own shit if they try get clever here and I don't even use these things). I'm guessing but probably a knee jerk reaction to the opioid crisis that everybody bangs on about. And of course who gets shafted: the people that genuinely need them. Also like closing the stable after the horse has bolted type of thing. Very interesting and worth fact checking myself and getting to the bottom of the reasons (and also seeing if this is in the cards globally).

I need to say this again: I don't use any drugs (well other than very low doses of Alprozalam and Zopiclone and that merely for sleep) and I've never used a patch. So I'm really not qualified to help you. I'm not even an expert on opioids having never used them. So you need to know this. But I'm hearing you and would love to try and help even although I don't think it's a good idea.

Anyway and let's see. Maybe we come up with something that's workable and not life threatening. I'm only to happy to try help if I can (and as noted: I've a morbid fascination with Fentanyl so I don't mind trying to go down some more rabbit holes at all).

On the subject of cutting them: it's mere speculation, on my part but based on what the manufacturers say to NOT cut them, that the Fentanyl will degrade. And for all I know: those nursing and palliative care sites mentioned could simply be advocating that if they are cut then the remainder should be thrown away but for safety reasons and has nothing to do with degradation of the drug. I have indeed seen it said that Fentanyl in and of itself is a pretty stable drug. So maybe it's just for safety and sanitary reasons. This being said and thinking out of the box here: you will notice on many harm reduction websites (not this site but sites that belong to harm reduction centers) that the general consensus is that IF somebody is going to abuse them via the IV route they are told to cut them up into smaller pieces and boil and inject that way. That tells me another story logically speaking. And although not an exact science: gives credence to the idea that the drug in adhesive/matrix type patches have an even distribution of the drug. Otherwise they'd not be sanctioning this as a safe method of abuse. Just a bit of lateral thinking is all this morning.

The above all being said and taken into account: if you're going to cut them then would it not be better to cut them and put the pieces back into the pouch, maybe fold over, and place under a light book or something? That would all but ensure that what is being stored is at least protected from sunlight and air. Just a thought (again: not sure if there's any validity to my thinking that they would degrade by a material amount if or when cut). Not sure I like the idea of using tape as the tape has its own glue. No idea if there's enough contact on the cut edge of the patch with the tape glue for it to be a possible issue. Maybe they react together? No idea. In just thinking about it though: we're not talking about storing pieces of patches for weeks or months here. So maybe I'm way off the mark here and detailing a problem that is in fact non-existent.

Clever idea you have there i.e. peeling back only a portion of the backing (or covering) layer in steps. Although let me say this: bear in mind that the initially exposed part of the patch will continue to deliver Fentanyl for up to ten days. So by doing this: you're actually INCREASING the amount being delivered with every further cut of the backing (or covering) layer because you are now getting delivery from each previously exposed section PLUS the newly exposed section. Again: just logic being applied here and food for thought.

With drug in adhesive/matrix type patches (Durogesc DTrans™ anyway) I'm 99.999% sure that the drug is even distributed throughout the entire patch right up to the edge. Matter of fact and in just thinking about it: there's no way the FDA would approve anything less I don't think (that would be the equivalent of having 'hot spots" in a patch). Don't be fooled by the labelling on the patch either e.g. Durogesic DTrans™ have a lovely little border and their name imprinted on the BACK of the patch and it's easy to assume that the drug is within that border and does not go to the edges. That's definitely not the case i.e. the drug (and the adhesive) covers the entire patch (this I know from my experiments anyway). That printing is on the BACK of the patch and is indicative of nothing i.e. purely for aesthetic purposes (and of course identification).

But after all the above nonsense let's get to the nitty gritty here (SLOWLY and in point form if possible):

What ALL are you on right now? What ALL drugs are you on right now? And what are the doses? And how often? Where are you at RIGHT NOW with patch strengths, manufacturer, cutting, etc. And how often are you changing these patches and cutting them up etc.? And let's see if we can come up with something.

I know you have probably detailed the above already but I am indeed having a bit of a hard time reading your posts and making sense of them. What I'm saying is let's keep it simple and get where we are RIGHT now as a starting point (just to be sure).

Once again let me make it clear though: I've never used these things, am not an expert on opiates (matter of fact I'd go so far as to say that my so-called studies and research is limited to Fentanyl only and nothing else i.e. anything else I post about opiates is merely anecdotal), and am not qualified to be helping you here. But I'm only too willing to give it a bash in trying to find a possible solution and one that may make sense but then ultimately it will be your decision of course. And of course the major factor here is the length of time that you've been on them. To be frank: I didn't even realize they'd been around that long (well: it wasn't on my radar anyway).
 

MsDiz

Banríon na Fothrach
Joined
Mar 31, 2020
Messages
3,222
Location
Ireland
Good morning.

Apologies for my belated response (there's, I'm guessing, currently, at least a seven hour time difference between us) (I'm in South Africa by the way).

Very surprised to hear about the 100µg/h Janssen patches no longer being available to out patients and private individuals in North America. I did not know that. Pisses me off to be honest (and I will lose my own shit if they try get clever here and I don't even use these things). I'm guessing but probably a knee jerk reaction to the opioid crisis that everybody bangs on about. And of course who gets shafted: the people that genuinely need them. Also like closing the stable after the horse has bolted type of thing. Very interesting and worth fact checking myself and getting to the bottom of the reasons (and also seeing if this is in the cards globally).

I need to say this again: I don't use any drugs (well other than very low doses of Alprozalam and Zopiclone and that merely for sleep) and I've never used a patch. So I'm really not qualified to help you. I'm not even an expert on opioids having never used them. So you need to know this. But I'm hearing you and would love to try and help even although I don't think it's a good idea.

Anyway and let's see. Maybe we come up with something that's workable and not life threatening. I'm only to happy to try help if I can (and as noted: I've a morbid fascination with Fentanyl so I don't mind trying to go down some more rabbit holes at all).

On the subject of cutting them: it's mere speculation, on my part but based on what the manufacturers say to NOT cut them, that the Fentanyl will degrade. And for all I know: those nursing and palliative care sites mentioned could simply be advocating that if they are cut then the remainder should be thrown away but for safety reasons and has nothing to do with degradation of the drug. I have indeed seen it said that Fentanyl in and of itself is a pretty stable drug. So maybe it's just for safety and sanitary reasons. This being said and thinking out of the box here: you will notice on many harm reduction websites (not this site but sites that belong to harm reduction centers) that the general consensus is that IF somebody is going to abuse them via the IV route they are told to cut them up into smaller pieces and boil and inject that way. That tells me another story logically speaking. And although not an exact science: gives credence to the idea that the drug in adhesive/matrix type patches have an even distribution of the drug. Otherwise they'd not be sanctioning this as a safe method of abuse. Just a bit of lateral thinking is all this morning.

The above all being said and taken into account: if you're going to cut them then would it not be better to cut them and put the pieces back into the pouch, maybe fold over, and place under a light book or something? That would all but ensure that what is being stored is at least protected from sunlight and air. Just a thought (again: not sure if there's any validity to my thinking that they would degrade by a material amount if or when cut). Not sure I like the idea of using tape as the tape has its own glue. No idea if there's enough contact on the cut edge of the patch with the tape glue for it to be a possible issue. Maybe they react together? No idea. In just thinking about it though: we're not talking about storing pieces of patches for weeks or months here. So maybe I'm way off the mark here and detailing a problem that is in fact non-existent.

Clever idea you have there i.e. peeling back only a portion of the backing (or covering) layer in steps. Although let me say this: bear in mind that the initially exposed part of the patch will continue to deliver Fentanyl for up to ten days. So by doing this: you're actually INCREASING the amount being delivered with every further cut of the backing (or covering) layer because you are now getting delivery from each previously exposed section PLUS the newly exposed section. Again: just logic being applied here and food for thought.

With drug in adhesive/matrix type patches (Durogesc DTrans™ anyway) I'm 99.999% sure that the drug is even distributed throughout the entire patch right up to the edge. Matter of fact and in just thinking about it: there's no way the FDA would approve anything less I don't think (that would be the equivalent of having 'hot spots" in a patch). Don't be fooled by the labelling on the patch either e.g. Durogesic DTrans™ have a lovely little border and their name imprinted on the BACK of the patch and it's easy to assume that the drug is within that border and does not go to the edges. That's definitely not the case i.e. the drug (and the adhesive) covers the entire patch (this I know from my experiments anyway). That printing is on the BACK of the patch and is indicative of nothing i.e. purely for aesthetic purposes (and of course identification).

But after all the above nonsense let's get to the nitty gritty here (SLOWLY and in point form if possible):

What ALL are you on right now? What ALL drugs are you on right now? And what are the doses? And how often? Where are you at RIGHT NOW with patch strengths, manufacturer, cutting, etc. And how often are you changing these patches and cutting them up etc.? And let's see if we can come up with something.

I know you have probably detailed the above already but I am indeed having a bit of a hard time reading your posts and making sense of them. What I'm saying is let's keep it simple and get where we are RIGHT now as a starting point (just to be sure).

Once again let me make it clear though: I've never used these things, am not an expert on opiates (matter of fact I'd go so far as to say that my so-called studies and research is limited to Fentanyl only and nothing else i.e. anything else I post about opiates is merely anecdotal), and am not qualified to be helping you here. But I'm only too willing to give it a bash in trying to find a possible solution and one that may make sense but then ultimately it will be your decision of course. And of course the major factor here is the length of time that you've been on them. To be frank: I didn't even realize they'd been around that long (well: it wasn't on my radar anyway).
The only solution for this person is to speak to a dr about a proper taper. There are to many health issues that make tapering alone plain dangerous.
 
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