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  • Farmboy, Re: Methadone withdrawal

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    Old 05-20-2004, 11:45 AM   #1
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    Farmboy, Re: Methadone withdrawal

    Hey Farmboy, I just read you experience with meth and how your tapering off it. If you don't mind I can explain why your having such a hard time and perhaps give you food for thought to make a few changes.

    Whether they replace 20 mgs of methadone with 60 mgs of oxyC or 160 mgs of OxyC, you would still experience withdrawal once your serum level dropped, like you experienced on the 3rd day,it really gets bad. It actually gets worse for about 10 days and then slowly improves over the next if your simply converting to another opiate.

    This happens because the only other opiate even close to the same properties of meth is levor phanol. Meth has properties morphine, Oxy and Fentanyl don't have. So what you experience is differential withdrawal. I've switched away from meth 3 times while taking 120mgs aday, and the dose of new opiates had nothing to do with my withdrawal experience.

    Increase after increase didn't make a difference, so I learned to ride out the first 20 days and then make the final adjustments in dose. If I had increased and increased to try to prevent something an increase couldn't control anyway, I would be taking 10 times the dose I do now. A higher dose of OxyC will not stop the withdrawal, But dragging it out over months will certainly make the experience worse.

    It takes about 20 days to make the switch and for the differential withdrawal to subside.They can use meds like Clonidine , Librium and phenergan to ease the transition, but because no other opiate is like Meth, no amount of new opiate will stop the withdrawal. You just end up needlessly increasing after increase when you could ride it out for 20 days and be done with it.

    Personally I would rather put up with a rough 20 days then a rough 20 weeks. The longer you stretch out the transition, regardless of dose increases, the longer you will experience withdrawal. I take 150 mgs of meth a day, and having gone through this 3 times I know what to expect and how bad it will get. The only part you really aren't prepared for and people don't generally talk about is the profound depression, You can compound that depression as you see your dose of new meds steadily increase and not make a difference.

    All the equienalgesic charts you see will tell you meth is roughly equal to morphine in strength, However that only takes into account single dose comparison. All the latest info on meth for pain management suggest it's between 5 and 10 times stronger than morphine once you factor in the buildup from the long half life.

    So taking 6 times the dose of Oxy probably isn't wrong but you don't want to keep increasing it thinking it will make the transition easier. It's just going to jack your tolerance through the roof if you continue to increase with every decrease of meth thinking it will help. Has it helped so far? Or are you still stuck on meth as your Oxy dose rises.

    The taper off meth your doc has you on is a taper designed for complete detox with the end result of no opiates. That's why it's ridiculously slow. If the withdrawal became severe, an addicts first response would be to return to their opiate of choice and try to ease their pain. So they take baby steps.

    You mentioned doing some research on meth, I've done plenty, been on it for 4 years, switched 3 times off and my dose has was steady at 120mgs a day up until I broke the screws in my sacrum. They bumped it up another 30 mgs and it seems to help some but The side effects, like sweating, lost libido etc are too bothersome , so after 3 years of investigation and 2 pump trials, It looks like that's the way I'm going to go.

    I see the surgeon next week. If I were to taper off meth as they increased the IT morphine at the same rate your going it would take a year and a half. That's rediculous. I refuse to feel crappy from withdrawal for a year and a half. I've already DC meth 3 times and I know the differential withdrawal only last about 20 days, regardless of the dose they put you on of the new med.

    After about 20 days as the differential withdrawal subsides you can finish the titration and remain stable for quite some time. But if you have to increase Oxy at every single decrease of meth, your dose will end up so much higher than it would if you just accepted the present conversion and discontinued the meth completely.You will be fine in 20 days, It's not like you have gone from meth to nothing. Then you finsih making the adjustments and you really will be fine.

    When you say cold turkey I assume you mean a cold switch right from meth to oxy not from meth to nothing. Meth to nothing would be very different and much more severe. When you research about meth withdrawal, you need to distinguish between the MM patient and the CP patient. The meth maint patient is going from meth to nothing so their withdrawal is extremely different and so their taper is extremely different.

    But when switching from meth to another drug, if you can get passed the first 20 days, have a decent initial conversion and BT meds, You can do 20 days without going nuts. The thought of feeling like crap for 20 weeks would be much less appealing to me, But People tend to need to learn for themselves. But if you continue to do it this way, Every decrease will be a set back and increase your tolerance to the new med.

    When you get technical, The info you read from doctors, they think meth withdrawal is easier because the long half life, slow termination which eases you off as your serum level decreases. The medical community thinks meth withdrawal is less severe than short acting drugs because as soon as the short acting wears off, you have nothing in your system.

    If your going by other peoples experience, you need to determine why they took meth, and what the goal of discontinuing meth is before placing yourself in the same group as meth maint patients trying to discontinue methadone and get clean. Meth maint patients don't switch to another opiate.

    If you do a google search on methadone withdrawal, You will have to dig passed 20 pages to find someone withdrawing from meth and switching to another opiate because they are a CP patient. Information about methadone used for chronic pain is hard enough to find, If you through in meth withdrawal into a search engine, you will get 99% addicts experience or what the medical community and addictionologist think about meth withdrawal.

    There isn't a vast amount of info from people like me, or other CP patients that use meth for PM that have switched to and from meth several times in a short period of time that understand there is a huge difference between Differential withdrawal and withdrawal simply caused by abstinence syndrome of any opiate. Many PM docs don't even know enough about meth to even prescribe it and some GP's don't even know it's used to treat chronic pain and don't know they can prescribe it themselves.

    If you are going to research as to why you having such a hard time, and what I'm saying doesn't make sense based on your experience do a proper search. Look for methadone withdrawal in Hospice, and the info you will find will be very different although not nearly as abundant as Meth maint information for addiction. If you researched meth before strting it you know this is true. You didn't apply meth maint info for addiction to yourself did you. You looked for information on meth used to treat CP.

    If you do a search for methadone withdrawal, you will get every addicts horror story ever posted on the internet, and there are hundreds of thousands of stories about how bad it is. But if you ask an addict how was coming off OxyContin,.I bet you get the same type of info, that it was harder than coming off Heroin. Discontinuing meth to change opiates is not the same as going cold turkey. A cold switch from one opiate to another isn't the same as cold turkey either.
    Continued on next page....

    Last edited by Administrator; 05-21-2004 at 05:11 PM.

     
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    Old 05-20-2004, 11:51 AM   #2
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    Re: Farmboy, Re: Methadone withdrawal

    I can personally Guarantee that my experience, taking 7 times your dose for 31/2 years longer has been easier that what you went through, Why? because I didn't stretch the misery out over months. I'm not saying I'm tougher and can withstand meth withdrawal better, In fact I'm very sensativbe to med changes. I've just used the same method 3 times and know how long it lasts. If you didn't get passed 3 days without returning to meth, You can't know it starts to get better after 10 or 12 days.

    You can be done in 3 weeks or you can stretch out the misery to see how much weight you can loose and see how miserable you can make yourself and everyone around. If you were my best friend, I would say, stop the meth cold today and in a few weeks you will be fine and stable on a lower dose of Oxy than you will be in 6-8 weeks after a long slow transition where an increase in oxy is given for every decrease in meth.

    I could likely have the pump implanted within a couple weeks and I will not waste my entire summer going through withdrawal going through the transition from meth to IT morphine even though IT meds are 300 times stronger than oral meds. Even though I know IT meds are 300 times stronger, Differential withdrawal has so little to do with the strength of the new med it's not a concern. It's just adjusting to a few of the properties you no longer receive from meth that makes the first few weeks miserable. But having been miserable for 11 years, 20 days doesn't sound too bad if the pump or a new med works better or has less negative side effects.

    Trust me, I know how miserable it can be, But it doesn't have to last months. I've DC 120 mgs in cold switches to morphine, to Duragesic and back to morphine and still went back to the previous dose of meth so each transition didn't jack my tolerance through the roof trying to fight differential withdrawal with an opiate that doesn't have the ability to stop what your experiencing. Each time it only took 3 weeks ,to get passed the withdrawal part and make a few adjustments in dose. That's not the experience of meth maint patients, It's the experince of a CP patient that has taken healthy doses of meth for several years.

    Just think about it, You are receiving more opiate than ever and still feel like crap. That tells you that the amount of opiate isn't going to make a difference until you get passed the differential part and can then assess how much pain relief you need. Right now is the oxy for pain relief or simply to try to control the withdrawal. So now your on 2 meds simply because of withdrawal which seemed to bother you to have to take meth simply to avoid withdrawal.

    If you have lived with pain for any amount of time, 20 days is nothing in the grand scheme of things , and you don't want to needlessly crank up you tolerance when it doesn't help anyway. Meds like Clonidine for BP, Klonopin for anxiety, sleep and restless leg synrome and Phenergan for nausea will get you through 20 days and do more for the withdrawl symptoms than increasing your dose of OxyC.
    Good luck with whatever you decide, Dave

    PS, Did I read this wrong that your replacing every 1.25 mgs of meth with 20mgs of Oxy? Where in gods name did he get a 1:20 conversion from meth to oxy. Even the most recent articles estimate that meth is 5-10 times stronger than morphine and Oxy is stronger than morph. See what I mean about skyrocketing tolerance. To go from a baby dose of meth to a whopping dose of OxyC and still experience withdrawal?
    When I switch from meth to morphine I have always used the same conversion and 600mgs of morph works better than 120-150 of meth. So your doc would convert me to 3000 mgs of Oxy?

    Last edited by Shoreline; 05-20-2004 at 01:06 PM.

     
    Old 05-20-2004, 02:57 PM   #3
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    Re: Farmboy, Re: Methadone withdrawal

    Whew! Are your fingers sore now? Seriously though, thanks for all the info. In answer to the ps. question, either I typed it wrong or you did read it wrong. I have been reducing 1.125 mg of methadone and adding about 10 mg of oxycodone (from 20 to 30 total) temporarily. Then I try to get back to 20mg oxy per day before I do the next reduction so theoretically I would still be at 20 mg when I finally finish the meth. This is mostly for the increased pain. I'm not sure if the doc prescribed additional oxy (I was already taking it for BT) for the withdrawal from meth or for controlling the pain. I can agree it has not been much help with the withdrawals. I have been wishing I could just drop the meth and get it over with but it was really bad when I stopped it completely and I'm not sure what would happen. If I had just been able to stick with it the first time I would be all done with it now but I had no idea what was going on because the doc did not even warn me that withdrawals could happen. In the past when I was taking codeine or hydrocodone if my back pain was low I could lower my dose drastically or skip a few days with no side effects other than a speeded up digestive system. This was at lowere doses than now though. Even recently when I was taking meth. and oxy for BT I could go from 4 oxys per day to 0 or 1 per day for a few days with no problem if my back was OK. I guess that is why I may get a little overly dramatic about meth withdrawals because it is by far the worst for me but I realize everyone is different. I did find a lot of info (some on these boards) on meth withdrawal for pain patients, not only addicts.
    Meth withdrawal gets worse for 10 days?!?!? I only made it 3 (4?) so I surely would fail w/o some kind of help. They offered Subutex, but I figured that would just be something else to quit. Tried Phenergan for the nausea but it did not work and they still don't know where the nausea is coming from. I think it's from the constant throbbing in my entire midsection (T-9 is my problem)
    Now see you got me writing a book too! and I still don't know what I'm going to do except I know I don't want to do this for 7 more weeks.

    farmboy

     
    Old 05-21-2004, 05:07 AM   #4
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    Re: Farmboy, Re: Methadone withdrawal

    Hey Farmboy, I'm glad I got that conversion wrong, It would be scary to think it took 300mgs to come off 17 mgs of meth.

    You definitely don't want subutex yet. It's a combination opiate agonist/ antagonist and it would purge you fast, like immediately, and the ride would be even worse.

    It may not even take you as long to convert as I do because my dose is so much higher. Meth is stored in fat cells and stays with you for a good while, I consider 20 days a good while. I do know how bad it is, But if you ask anyone that's going through withdrawal and what there withdrawing from is usually the worst thing they have ever experienced.

    I don't mean to be sarcastic, but if you don't have experience withdrawing from anything else, The person withdrawing from OxyContin will think it;s the worst experience ever, folks withdrawing from morphine will think morphine is the worst or Valium and Klonopin can be terribly because of long half lives.

    The drugs that really fry your brain when you go cold turkey are meds like Paxil. That is probably onme of the hardest meds to DCand your brain feels like it's been zapped with about 10k vols.The UK's version of the FDA has banned prescribing any SSRI to anyone under 18. In the US we have 7 year olds on combinations of Prozac and Ritalin.

    Even the meth withdrawal I go through when switching, aside from the restless leg, class 5 rapid bowels and the feeling my brain has been zapped, My vision was blurred, I couldn't type because the screen was jumping. It's a rough couple weeks, and my first instinct was to increase the new med to stop the withdrawal. When I hit 400mgs of Kadian the first time I was extremely depressed that it took that much morphine and I was still miserable. That's what made me decide to ride it out the first time.

    After things calmed down, about 3 weeks, My doc made the final adjustment and I was able to stay at the same dose the entire time I took morphine, a little over a year.

    MY PM clinic now uses a withdrawal cocktail of phenergan, Klonopin and Clonidine either in patch form or pill. It's a BP med but pretty sedating and calming and keeps you from loosing it when it's bad. I really think you could do it but you also have to look at you overall health, can your heart take the BP increase, are you at a point where depression is under control,kids aren't out of school, things like that. There are better times than others to DC opiates once you become physically dependent.

    That's the word for the day. Not the same as addiction.LOL Addiction is basically destructive where dependence is just a consequence of round the clock opiates, It should improve the quality of life unlike addiction that destroys every aspect.

    I doubt the folks on the addiction forum would see the difference between addiction and dependence part of the reason is that physical dependence on opiates is the only factor when allowing a patient into a meth maint program. Unfortunately because more and more CP patients can't find a doc they are turning to meth clinics for whatever relief they can find. The way the regulation for admittance into a MM program If you are physically dependent on opiates you qualify., why you took them isn't a consideration, just the fact you need them to prevent severe withdrawal makes anyone physically dependent eligible for meth maint or meth detox. The regs on meth detox allow a 221 day withdrawal program that can't be repeated again until 30 days has [assess since the last attempt. If your unable to withdrawal then you move into the maint stage which I have seen folks on MM for 10-15 years.

    When you have been on opiates that long, there are actually 3 phases of withdrawal when done after a 21 day detox or cold turkey. It's day 1-21, then 4weeks to 3 months is a different period where you brain starts making endorphins, "natural pain killers" and then the final stage can last from 4 months to 6 months before normal sleep patterns return and hands stop shaking and your bowels calm down. So there really is a huge difference between going from meth to nothing and going from meth to another opiate, You cut out those months of nothing when you feel like he## and can't seep and shake. But that's addiction and there are cravings and a large psyche component gong on that if treatment for the underlying problem is found the rate of return to addiction is quite high without the support needed all the way through the process.

    If you can't handle the dependence factor than you would need to get totally clean and then use a med like Buprenex or subutex, combination opiate agonist /antagonist used PRN the way you used too. This would prevent physical dependence, but there is a ceiling on how much relief you can get from the combination opiates. Unfortunately PM docs tend to go the long acting route thinking CP patients don't have the ability to use PRN meds responsibly and there is some logic to keeping the pain in check and not allowing it to spiral totally out of control. You can keep it in check easier than you can bring a very high level of pain down.But physical dependence is a hefty price to pay.

    That's the justification of long acting meds, although I haven't seen a single study that conclusively proves long acting meds are more effective than proper dosing of short acting meds. Purdue's big speal was that with long acting meds you don't have the highs that cause euphoria and the lows that cause people to feel the need to redose every 4 hours just to do something to manage their pain.

    I have no doubt there are folks on long acting meds that could very effectively manage their pain with SA meds.Not to mention the ridiculous price of a 30 year old release system "the Contin" was patented in 72, and MSContion came out in 84. Morphine been around for 300 years so there is no convincing me the pricing of any of the long acting meds is justified. I don't have script insurance so right now meth is my only choice.

    I do have Medicare and they will cover the pump and refills and when I did the last trial the relief was amazing, I wanted one more shot in the spine before I went home.LOL I'm fused from L1-S1 and that was the most relief I had in 5 years.

    You might want to talk speeding things up with your doc and ask about meds to make it go a little smoother.Clonidine, Klonopin or Librium, and Phenergan. I'm sure you would be glad to be done with it and I'm not sure it would take you as long as it takes me to stabilize. That may have been your worst day on day 3. You won't know unless you try. .

    Good luck and you may need a little more than 20 mgs of Oxy when your done with the meth but certainly not into the numbers I thought you were heading. Good luck, Dave
    PS, That was a book wasn't it, You can only enter 10,000 characters per post and I exceeeded it.LOL

     
    Old 05-21-2004, 03:49 PM   #5
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    Re: Farmboy, Re: Methadone withdrawal

    Hey Shore,
    I read this and your post to my guardian angel kelliegh with interest. Even though I am only 1/2 way thru my taper off meth I am experiencing a lot of what she is still feeling. Especially the "just not right" part. I am also going to have to print the part about the lost libido for my wife. Can they do testosterone therapy to fix us up? Hope you feel ok talking about this here, if not, no worries.

    Antidepressants. I was given Elavil and Effexor in the past year to see if it would work on the pain. I am really scared of this stuff and after about 1 week on each w/o results gave them up. Last night I was desperate for a good nights sleep and being depressed anyway took half an elavil at bedtime. I slept pretty good but was still tired even at noon today (lately I'm tired all the time so it's hard to tell if it's different) Anyway the reason they scare me is because of my mother taking them for about 30 years for depression and attempting suicide at least 5 times, most recently 2 days ago. So now I have the somnolence thing too because it was no big deal. I guess I have enough of my own problems, nothing I can do I'm 6,000 miles away and she is safe now, it wasn't totally unexpected, told her I definitely could not fly for any funerals but she did it anyway.

    Still trying to find a way to speed this up without ending up on the floor again. What if I skipped the meth for a few days until I couldn't stand it and then carefully added back 1/2 pill at a time until I was at 1/2 the dose I was on? Right now I take 1/4 at breakfast and then 1/2 at lunch, dinner and bedtime. I spread it out to try to keep an even amount in my blood without the ups and downs. Does this sound right to you? I always feel lethargic and in pain in the am but then feel a little better until late in the day when my back pain really starts kicking in.

    Well, I hope I made a little sense here, just kinda talking out loud.

    farmboy

     
    Old 05-21-2004, 06:11 PM   #6
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    Re: Farmboy, Re: Methadone withdrawal

    Hey farmboy, I did make an error in my previous post. When talking about the two types of meth programs, one is detox and lasts 21 days , not 221, the other is meth maint.

    As far as testosterone, supplementing absolutely does work. There is a process to go through, get your blood tested, see an endocrinologist, have an MRI of your brain and rule out a pituitary tumor, which is another cause of lost labido and low testosterone and once you have ruled the Pituitary tumor it's safe to go ahead with Androgel or another testosterone product. The gel maintains a more even level where the shots give you a big boost on friday and it wears off quickly. It's expensive if you don't have insurance. 30 5gram packs is about 180 bucks, but if you have decent insurance it's not bad.

    I'm 38 now and they tested me about 3 years ago after I had been on meth about 6 months,Normal for a 35 year old man was 220-440 and I tested at 104. 1 gel pack boosted me up to 310 a day and they added a second pack, but I switched to morphine before I started using the second pack and the next test came back at 880, I dropped to one pack and I was still in the 600's, So I have no doubt it's the meth. Unfortunately I just don't have 180 bucks every month for testosterone.

    IT was like someone just turned off that switch in my brain as soon as I started meth. I did the MRI,waited to see if I had a brain tumor, which I didn't. Then they started me on Androgel it was a miracle cure, everythng returned to normal and maybe even a little boost from such high levels when I switched to morphine and didn't need the extra. It's an alcohol based topical gel that evaporates fast and you notice results within days, It also wears off in days if you stop using it.

    I would definitely talk to your PM doc and if he doesn't see the link, go to your GP and he will likely refer you to an endocrinologist. This is something if you have the insurance you really don't have to put up with. The effects of boosting testosterone are noticed in more than one way. Muscle mass seemed to be returning, more energy plus the libido. So if you have the benefits check it out. You wife will apreciate it.

    As far as Elevil, It's apretty benign drug, It's a better sleep aid than an anti depressant although some docs use it as a tranquilizer because it is so sedating and non addicting.

    I hate to tell you to go against your docs orders but I don't see the harm in increasing your weakly decrease to 2.5 a week and see how you feel. When you get down to your last couple decrease try to stay below 25% decreases and you shouldn't have to hard of a time. When you get down to 5 mgs a day, from there you may even be able to stop cold and just take a half tab when you feel it get bad.There has to be a way to speed it up gently. There is no reason to stretch the last 5 mgs out over a month. I do still think you could be done in a few weeks but your right, You could melt down, that's why you want your doc onboard helping out with at least clonidine to keep your BP in check. You have Klonopin right?

    There are so many factors, you need the support and help at home when your feeling rotten and going through this. You don't need to be made out to feel like a junky just because your experiencing withdrawal. Any other drug besides opiates and they call it abstinence syndrome. But folks seem to like to attach the dirty word withdrawal with those horriable narcotics. LOL

    I do think the sooner your off meth the sooner you will feel better. But if the 1.25 decreases are pretty much undedectable, it may be worth continung at that pace. I just wanted it to be over and didn't want my wife and daughter seeing me look the way I did.

    Keep us posted how it's going, Are the idecreases virtually undedectable or do you feel rotten once your serum level drops by the 3rd day? If what your doing is working, It's certainly a slow and smooth taper which many people would prefer to a fast and furious one. Docs tend to go a biyt fast so your doc is being very cool about he slow decreases although it does take a long time at a mg a week.
    Take care and I would bet your testosterone will rebound once your off meth but of your not feeling normal, have it checked.

    Feel free to ask anythng, there isn't much that I won't talk about. I think the medical comunity did a great job at removing any bashfullness with a tube and hose up every whole in my body at some point or another. I've had Kidney stone "cystoscopic surgery" a half a dozen time in addition to the 3 back surgeries. That's when they go up the only entrance and remove the blocked stone from the Uretor. The tube that connects the kidneys to the bladder. They always put a double J stint in the uretor to keep it from collapsing which means they have to go back in to remove the stint a week later. More fun and humiliation. Not as bad as a naked piramid, but it still wasn't any fun. LOL

    Good luck , Dave

    Last edited by Shoreline; 05-21-2004 at 06:21 PM.

     
    Old 05-22-2004, 01:52 PM   #7
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    Re: Farmboy, Re: Methadone withdrawal

    Hey Shore,
    No, I do not have Klonopin or a clue to what it is.

    I also do not have a schedule for the taper from my doc, he is letting me go at my own pace. It has been roughly a week for each reduction though. I feel crappy for about 5 days, then a little less crappy so I start all over again.

    I got over some of my bashfullness when the doc was trying to figure out my nausea. He asked if I ever had my prostrate checked and I had to say no. He starts putting the gloves on and I protest in vain, "But Doc, we hardly know each other! Don't you have to take me out to dinner first?" "Drop 'em and hold on to that counter!"

    farmboy

     
    Old 05-22-2004, 03:23 PM   #8
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    Re: Farmboy, Re: Methadone withdrawal

    LoL Been there too.

     
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