Difficult transition from Fentanyl to Buprenorphrine

[Jax32]

Hi to all,

I have never posted before and am not familiar with how much history I should provide. I can give as much history as needed if asked but will just present the crux of my current issue: The main thing I need advice about is transitioning from Fentanyl to Suboxone. I tried this once before and was prepared to rate myself on the scale of withdrawals to make sure that I would not put myself into precipitated withdrawals by using the Buprenorphine. However, what happened is that I did not have the graduated steps towards increasing withdrawals - I started vomiting violently and repeatedly before I even had that many symptoms such as nausea or sweating or chills, etc. I took the patches off and the next day I started vomiting - so bad that by the third or fourth time, it was only bile, and by the 7th or 8th time even bile wouldn't come up and I was violently contracting and unable to breathe while heaving. I thought I might die of not breathing during some of the vomiting. I vomited about twice an hour for 11 hours before I started taking Suboxone, and it took me several tries of melting it under my tongue without vomiting.

My concern is that I want to transition off Fentanyl to Buprenorphine again, with greater ease, this weekend. I only have the weekend and Monday until 3 before I have to be at work again. I am scared to go off the patches this time and confused about when to take buprenorphine - since last time I was waiting for signs of withdrawals when I started vomiting uncontrollably.

Any ideas or suggestions on making this transition other than tapering the fentanyl? When can I use the bupe so that this doesn't happen again? I almost feel as though using bupe early and risking precipitated withdrawals couldn't be worse than what I went through. I honestly thought that with dehydration or gasping for air I might die.

Any help would be greatly appreciated. And I plan to pay it forward to read other posts and help with advice if I can give any - I have lots of experience with opiates.

[Robert_325]

Jax ...... I hate fentanyl. I think they should ONLY use it for terminal patients it sucks SOOO badly trying to get off it. I can help you but I'm not sure I can do it in a timeframe dictated by a clock. I can't help what your work schedule is. I do know how to take you from any opiate and get you stable on subs however. But it has to be done properly.

How much are you taking and for how long? That will give me an idea of what we're up against. I don't know if you've read my sub therapy link. Here it is. Pay close attention to the INDUCTION section and the COWS worksheet..

http://www.drugs.com/forum/featured-...apy-50887.html

I've done this for years here successfully. But we have to do it according to the process explained in the link. You can't just say that you have from Friday to Monday at 3:00. If you read the link you see how touchy the induction is. We have to have your reactions to the Fentanyl w/d under control to an extent and still get you ready for induction. And after I know more about your fentanyl history I'll have a better idea what we are up against. It won't be fun getting to the induction I promise. But once we do the induction right here as I give you instructions while you're doing it you'll end up feeling great.

Get subutex for this rather than suboxone. It's much easier to work with and you may have been reacting adversely to the naloxone in the suboxone. About 15% of ALL people don't tolerate the naloxone. Your dr will likely say I'm crazy but I've probably inducted more people than he has. Trust me the subutex will go better. I'll wait to hear back from you. God bless.

[Jax32]

God Bless you for answering me. I have seen you on forums re: suboxone for years and prayed you would respond to my post. I didn't want to bother you but luckily you replied. I know this is lengthy and if I can do anything to help you - send you homemade treats, a gift card, anything, let me know.

Ok - the good news - I am familiar with Suboxone. I have been a regular Bupe patient (no suboxone) several times over - I take generic Buprenorphrine. Cheaper than Subutex. The only reason I stopped talking it on a regularly tapering schedule (i.e., with the goal to get off it within 6 months or less) was that I got hit by a car and suffered many injuries. Because of my history with addiction to pain meds (for a spinal issue), my doctor will only prescribe me Fentanyl while I wait to have surgery for my arm. She (aptly) sees less abuse potential and wants me to be on something longer acting. I also don't like it and have pleaded for other longer-acting meds, but she is firm. She has been my doctor for 15 years so I don't want to lose her. I also see another doctor to help re-train my parasympathetic nervous system to better deal with chronic pain through mental exercises and visualization. In short, I am committed to dealing with pain without the strong opiates but recently I have had significant shortcomings in my choices.

I started taking Fentanyl when I had bad pain in my shoulder (torn biceps tendon and Labrum). I described to you the last time I got off it - this was less than a month ago and I really thought I could die. I swore it was not worth taking the fentanyl instead of buprenorphrine and I would not do it again. I suppose the addict in me kept working on me since after I reinjured my shoulder at Thanksgiving holding the babies, I started the Fentanyl again. Now I am promising again I won't do this since I was so sick last time!

I am prescribed 50 mg Fentanyl patches but the problem is that in order not to go through withdrawals from Suboxone (my current does was 8 mg daily, down from 24 daily after the accident in April), I put more and more Fentanyl on. Basically for a little more than a week I have had between 100mg and 250mg of patches on me - NOT THAT MUCH ADMINISTERED ALL AT ONCE - only rotated and adding a new 50 mg one when I start to feel nausea from withdrawals or bad shoulder pain. I never put on more than one 50mg patch a day.

Currently I have 4 50 mg patches on me - although only two are recent (today and yesterday). I am worried I don't have time to taper them. I tried this week but felt too nauseas to stand up and threw up once. I know it is foolish to rip them all off and try to time the bupe right before I get sick - but I have to at least try to go to work on Monday. I am a social worker and I am responsible for managing groups of kids and every time I don't go to work several parents are forced to find urgent same-day child care for their children. I feel awful if I miss work, and I already missed a lot when I was hit by the car.

I understand buprenorphine induction well, under "normal circumstances." But here because of time I may be forcing a rapid withdrawal. I am definitely abusing Fentanyl by taking more than prescribed and I am committed to stopping this after realizing the behavioral loop my addict brain has forced me into.

My main question is - if I am sick enough to vomit because I don't have enough Fentanyl in me - am I sick enough to take Buprenorphine? I have a fast metabolism and last time I was in severe Fentanyl withdrawl very fast. I think I made a mistake to let myself vomit more than 10 hours before I took the Buprenorphine but I did not want to make myself even sicker (now I think that was not possible). My plan was to rip these off tonight and hope that I could begin Bupe sooner than last time - sooner than rapid and repeated vomiting with almost no warning signs.

What is your best advice given the time constraint? Due to my work ethic and concern for those I would displace by not coming to work, I would rather get sick like last time or even try precipitated withdrawals hoping they would be less severe than take a longer transition schedule and risk missing work (I tried tapering and would have had to miss work several days this week if I did not slap another patch on to feel functional). So shocked by how soon this can take my system over - my last Fentanyl trial was only two weeks long - and I was in worse withdrawals than my 15 year history of abusing most opiates normally prescribed by physicians and pain specialists.

Again - anything I can do to return the favor and kindness you give to a stranger - don't be shy if I can give back some time to you - of course when I am in the clear from feeling so sick!!

Thanks again, Robert_325. I am also new to this - do I keep checking this thread - or do I start a new one, or are we now communicating with just each other? How does this work? I read the FAQs but ended up a bit more confused than when I started regarding threads and contacting individual members.

Your advice is invaluable - in fact I wanted to contact you when I get back to 2 mg of generic Subutex - I was hoping you could help taper me down from 2 mg to 0 - from my readings over the year(s) you have been so skilled in your advice.

Thank you most kindly!

[melinda7.5]

just stay on this thread he will be here in a minute
talk to you soon, Melinda

[Jax32]

Hi real quick -

I meant to explain that I don't have enough Fentanyl to continue tapering as I use more than I am allowed when I use it. Due to my physician's concern I cannot get access to any other shorter acting narcotics as I explained in my reply.

I don't mean to be disrespectful to the process of induction, in the past I have done this when I have enough medication, but in this case I do not, and as I wrote in my last detailed reply to you - I can't really even do this without missing work, I tried to get a sense of my Fentanyl withdrawals by taking less this week approaching today, but I was too nauseas to go to work and vomited once. I was trying to taper but that made me too sick to make it to work so I opted for the harder fall over the weekend. I have a very fast metabolism - pain meds usually affect me for 3-3.5 hours instead of 6-8 as they should - wondering if the Fentanyl leaves my body sooner as well, making me much different than others I have read waiting 50 hours after fent and still winding up in precipitated withdrawals after that!

I do have an anti-nausea medicine - ondansetrone (only 4 left and dr. wants me to stop these) and xanax (many 1 mg) that I can take to assist in this process. I also wondered about trying to knock myself out with a sleep medication such as Ambien, possibly sleeping some of the time after I take off the patches so I could try not to vomit before I am truly ready to take the Buprenorhine.

Thanks again for your time and efforts upon my behalf. Who are you - why do you help so many people? It is so generous of your time and life-changing for those who you help!

[Jax32]

that is encouraging,

I will wait to take the patches off until I hear from Robert_325. This is going to be a very rough weekend for me - I am so scared to take these off and go through what I went through - but less scared than missing work.

Thanks Melinda7.5!!!!

[Robert_325]

Jax ........ Thank you for the kind words. You're a very nice person. You've got lots going on. I'm glad you're familiar with buprenorphine. That saves us lots of time as I agree that is the best route. I just have to think about this one. You're on four patches right now and I need to figure a way to successfully pull this off. Plus you have pending surgery planned.

Let me think about this and I will post back here in the morning. Fentanyl is tough to deal with especially 200mg. You're going to be in for an unpleasant experience regardless of what we do and I want to make this as easy for you as I can.

I also have sleep disorders and may be up during the middle of the night. If that happens I'll post again then. Let's keep all of our communications right here on this thread so we know where to find each other. I will talk with you again by tomorrow. Hang in there, we'll get this done. I'll stick this out with you until you're clean if you're willing to pay the price. God bless.

[Jax32]

I hope I am not overwhelming you by innundating you with more posts - but one very important question to ask - if I do decide to start taking the buprenorphrine and i precipitate more/other withdrawals then fentanyl ones, should I take MORE bupe or LESS at this time? Last time it seemed that I would not stop puking until after taking 2 or 3 whole 8 mg pills (between several rounds of vomiting). I have tried to read and research as much as possible so I don't bother you since you are so busy - but there are so many conflicting opinions about this....whether if you precipitate withdrawals if you should back off or keep adding more - and also whether you should take a tiny amount of buprenorphine to start the transition from Fentanyl or a large amount for the first dose.......

Thanks again, most heartfelt.

[Robert_325]

I hope I am not overwhelming you by innundating you with more posts - but one very important question to ask - if I do decide to start taking the buprenorphrine and i precipitate more/other withdrawals then fentanyl ones, should I take MORE bupe or LESS at this time? Last time it seemed that I would not stop puking until after taking 2 or 3 whole 8 mg pills (between several rounds of vomiting). I have tried to read and research as much as possible so I don't bother you since you are so busy - but there are so many conflicting opinions about this....whether if you precipitate withdrawals if you should back off or keep adding more - and also whether you should take a tiny amount of buprenorphine to start the transition from Fentanyl or a large amount for the first dose.......

Thanks again, most heartfelt.

Don't be concerned with precipitated w/d if you do as I ask you to do. I have NEVER put anyone into precip w/d. Don't even be concerned about that. We will talk tomorrow and everything will be fine. Try to RELAX!!!. God bless.

[Jax32]

ok - I'll hang on - but since I am in the window that i allotted myself to be "allowed" to be sick, maybe I should take off one or two patches tonight - then i'll be closer to a state of withdrawal by tomorrow, similar to when i tried to do with less patches this past week. now i have the ability to just lay down if i am nauseated and taking some off earlier during the weekend seems better than all at once....maybe i'll take the older ones on and keep 100 mg of newer ones on - just to have less in me. thanks for your thoughfulness and willingness to help me with a ridiculous time frame.

[Robert_325]

Take off one of the patches tonight and let's see what happens. That's a good idea. Will give us a little more insight to how you wll react. Talk with you tomorrow and you can let me know how this goes. God bless.

[Jax32]

Hi again,

I'm on the west coast - going to bed. I took one patch off and was tempted due to the short timeline to take them all off but I decided to follow your advice and wait to hear from you. I am scheduled to work tomorrow and it would be great if with three on I could work with moderate withdrawals, if that is all I had. But while work tomorrow can be missed, work Monday cannot - I do not want to jeopardize the time frame whereby I need to be successfully induced to Buprenorphine by 3 on Monday - am worried that if I don't take all patches off early tomorrow I may not go into withdrawal early enough. But perhaps I could keep 2 or 3 on, go to work, and take them all off at night - making more of a transition?

I look forward to your thoughts and guidance - but respectfully at your convenience, not to be a burden. Thanks for keeping up with me during the weekend.

Sincerely,

Jack

[Robert_325]

Hi again,

I'm on the west coast - going to bed. I took one patch off and was tempted due to the short timeline to take them all off but I decided to follow your advice and wait to hear from you. I am scheduled to work tomorrow and it would be great if with three on I could work with moderate withdrawals, if that is all I had. But while work tomorrow can be missed, work Monday cannot - I do not want to jeopardize the time frame whereby I need to be successfully induced to Buprenorphine by 3 on Monday - am worried that if I don't take all patches off early tomorrow I may not go into withdrawal early enough. But perhaps I could keep 2 or 3 on, go to work, and take them all off at night - making more of a transition?

I look forward to your thoughts and guidance - but respectfully at your convenience, not to be a burden. Thanks for keeping up with me during the weekend.

Sincerely,

Jack

Jack .... with the long half life of fentanyl you will have to get rid of the patches by tomorrow afternoon to have a chance for Monday. You'll be sick as a dog this weekend but if you wait any longer than tomorrow to remove them you won't have a chance by Monday. And they will need to come off early tomorrow as possible. And I still can't promise Monday will be sufficient, but we can try. We'll do the best we can. God bless.

[Robert_325]

See I told you that I have sleep disorders and would probably be awake in the middle of the night. It's pushing 4:00 AM here. I am still wide awake and haven't slept a minute.

[Jax32]

Ok - just got up and feel fine after taking one off - a little nauseated but ok....you are right - I am going to take them all off now...and tell work I cannot come today.

I am so sorry about your sleep problems......I am sure you have tried different approaches for this.....melatonin helped me when I had problems in college. Do you take any natural supplements or pharmaceutical medications?

Well, I am going to hang out at home today. My only concern - how to get the Buprenorphine in me before I am in too far advanced withdrawals from Fent - should I just check in and keep observing myself as far as withdrawal signs go?

Thanks again for your help.....did you end up getting any sleep?

J.

[Robert_325]

Ok - just got up and feel fine after taking one off - a little nauseated but ok....you are right - I am going to take them all off now...and tell work I cannot come today.

I am so sorry about your sleep problems......I am sure you have tried different approaches for this.....melatonin helped me when I had problems in college. Do you take any natural supplements or pharmaceutical medications?

Well, I am going to hang out at home today. My only concern - how to get the Buprenorphine in me before I am in too far advanced withdrawals from Fent - should I just check in and keep observing myself as far as withdrawal signs go?

Thanks again for your help.....did you end up getting any sleep?

J.

Jack ....... I never got any sleep at all last night but am going to lay down in a little bit for a couple hours so maybe I'll still be able to sleep tonight before church tomorrow. Sundays are very important days for me, they're my favorite day of all as I'm very involved in my church. Just going to church makes me feel so much better so I'll be okay. God looks out for me, He's never let me down yet!

With my four autoimmune diseases I have to take a couple pharm medications. I don't take any opiate medications for pain though. I did for decades, but I only take Ibuprofen for pain now. I just have to watch myself closely as I've had three blood clots and I have to be careful not to get all stressed out like one gets with days on end of no sleep. Plus I have permanent CNS damage from all the garbage I took for decades thinking I was being cute when I was younger. So I have to watch myself closely, but when I developed a real relationship with Christ that totally saved my life. :

Taking off all the patches right now you're going to be over the 26 score on the COWS worksheet obviously as soon as they start wearing off so this is a tricky induction. You need to allow as much time as possible to get it out of your system before a re-induction. And obviously don't take any subutex or sleep meds. You will need to be in very severe w/d when we start the induction. I can do it in a matter of a few hours but you have to be at the right point in w/d for the induction to work properly. Whatever dose we induct you at it will be less than where you are if for no other reason than the process I use. It's just imperative that you take NOTHING, not even an advil, to make you feel better. I want to see you feeling like hell litlerally! The induction will be more effective when we do it if you're really in bad w/d. And we definitely won't do it before Monday. You'll have to trust me on this, I don't know what else to say. I would really like to have you get another couple days off work if you can call in sick. It would REALLY be to your benefit to give it that extra time. Let me know if that is possible. If you were really sick the company would go on. This is very important for you!

I'll speak with you later today or tomorrow after church. Just plan on getting sick and dealing with it. I know how bad the fentanyl w/d are. That's why I am saying those couple extra days would really help us. Talk later. God bless.

[Jax32]

Thanks so much,

I hope you got some sleep. I am very sorry about your CNS problems. I am trying to stop "getting cute" myself - I have really been thinking differently the last couple of years, and have been acting differently this year. But I have a long way to go!

I don't even know you and I am so proud of you taking only Advil for pain. Your determination is wonderful. I am so happy that you have found God and it does sound like your life is truly blessed. Well, I feel blessed that you are helping me.

I took off the rest of the patches earlier today. Actually I took one off before a friend came over, and then the other two in the last hour since I was already feeling nauseas and sweating a ton when the friend came over.

I do not think that taking Monday or Tuesday off is an option. If I worked for a company I would call in sick but it is different - I work for myself and for individual families in a program that I run and I will only miss work if I am too sick to go - which may happen.

I am confused about induction - do I have to wait until I am vomiting to take Suboxone? Or is it too late then? Since last time I couldn't STOP vomiting.....

I will look forward to hearing from you and will be just fine for a while. I can stand anything except repeated vomiting. And no - I won't take anything else, not even Advil. Thank you so much for your help.

Jack

[Robert_325]

Jaclk ...... you are going to have ALL KINDS of symptoms. Puking could be the least of them.

I would get yourself some fluids to drink NOW before you get sick with lots of electrolytes in them. You'll need them for dehydration and you won't feel like going to the store when you start getting sick as hell.. You'll likely puke and have diarrhea both along with other stuff.

Just keep me posted as we go along. We will have to play this by ear as we go forward.. I'm right here with you. Have faith in me. But you need to get ready to get sick as it's going to happen for sure!. God bless!

[Jax32]

Ok - I guess I was hoping to slip the Buprenorphine in before I was vomiting this time! Here is what I have going on now.

symptoms I notice:

Sweats
Chills - (feeling freezing even though temp to 75 and wearing a sleeping bag)
Nausea - hard to be standing up for a while
Tiredness

Nausea is the worst so far. If I fall asleep early tonight (sorry to say that to you) I will report back in the morning.

Good idea about fluids. I started drinking coconut water and stocked up at the store on other things.

Thanks and I will write back tomorrow morning or if symptoms elevate,

God bless you!

[Jax32]

Good morning,

I had a horrible night last night - restless quivers, muscles aching,chills to the bones, sweating. Mostly in nerve and muscle pain unable to sleep.

Shockingly nausea seems better today but I'm sure that will change.

I know you have a big day at church today so I hope you have a wonderful day.

Thanks for your help.

[Jax32]

Hello again,

I hope your day went well yesterday and that you were able to sleep enough Saturday to feel good for your Sunday.

Throughout the day, (Sunday) my symptoms got worse and worse - all that you can imagine. About 4 in the morning yesterday I was vomiting bile and I decided to try just a teeny piece of Subutex (since I was already vomiting I was hoping a teeny amount woudn't make it much worse). And almost instantly, I felt better! I slept for a few hours and woke up this morning feeling totally (well almost) normal again. Just to make sure I was on the right track I melted a whole tablet of Subutex in my mouth and kept it there. And I still feel alright. Weak a bit and tired from the horrible weekend, but I am much, much, better and think I crossed the threshold of the Fentanyl being gone enough not to compete with the Subutex.

I am sorry that I did this without you - I was waiting for you but it was such an odd hour and I was really suffering and took a teeny risk that seems to have worked. I hope you don't feel like I don't value your guidance, because I do - very much so - in fact I hope that you can eventually assist me in tapering the Subutex. I have gotten to as low as a quarter pill (2 mg) in the past and then had troubles trying to go lower, Perhaps when I get to that point again, you could help? I do not plan to take more than one 8 mg pill right now each day unless I start getting bad symptoms residually from the fentanyl.

You have been so helpful - thank you so much. All night when I was thrashing around like a caught fish and moaning the only thing that anchored me was knowing that somewhere, someone knows about what I am going through and cares to help me. That meant a lot to me.

Thanks and if you would be interested in helping me get off Subutex gradually let me know - you seem busy but I trust you very much.

J.