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Need Advice for Fentanyl Taper
  1. #1
    zman2299 is offline New Member
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    Question Need Advice for Fentanyl Taper

    Hello All. I underwent surgery in early July. I have been on Oxycodone IR30mg as needed for chronic pain for about a year. Because of this I was put on Fentanyl 25mcg/hr. I had to bump up to 50mcg/hr, and then my pain felt controlled. I do feel I need to say that I have Always taken my pain meds AS PRESCRIBED. Now that I have healed from the surgery it is time to come off of he fentanyl. I was told to drop down to 25mcg + 12 mcg. When I did this I felt fine for the first few days and then...BAM. I was so tired that I couldn't get off of the couch. I could sleep for 20 hrs, wake up to eat, and then go back to sleep. I contacted my Dr about this and he said that he believed that since the surgery had healed that I was actually being overmedicated, explaining my fatigue. I am now down to 25 mcg patches, which I have been advised to be on for 2 weeks, and then switch to 12 mcg for two week, and thenn stop completely. I am still extremely tired all of the time. I literally sleep for 20+ hours, with very vivid dreams. Is this a withdrawal symptom, or is my body just catching up on sleep. I occasionally feel anxious, which is normal for me, and it completely goes away after taking .5mg of xanax (I am prescribed 2 mg per day). I guess I just want to know if this is withdrawal?. Is it goin to be worse when dropping to 12 mcg, and ultimately nothing?. I have 10 and 30mg OxyIR for BT, which I havent had to take for a while. Would taking one of these help with the symptoms? Can I switch to just these and taper from there? All I know is that I want off of Fentanyl ASAP. Thanks for any help/advice anyone can provide. I just fell lost, like something is just not right inside, and pretty depressed.
    Thanks again.

  2. #2
    Robert_325 is offline Retired
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    These are the two options I would suggest. Detoxing from a time released medication like fentanyl is just asking for misery. First I am posting the Thomas Recipe which should be sufficient if you can stand a little discomfort for a short period of time. The next link will be to my Subutex therapy protocol that I used years ago and lots of people here have been successful following it as well. God bless.

    Thomas Recipe
    "PLEASE NOTE: I am not a doctor, simply a long-time Rx opiate junkie who has had many opportunities to develop a way to detox. This is a recipe for at-home self-detox from opiates based on my experience as well as that of many other addicts. It is not intended as professional medical advice. It is always wise to make sure none of the recipe ingredients or procedures conflict with medications you may be taking. Likewise, if you have any medical condition, disease, allergy or any other health issue, consult your doctor before using the recipe. Thanks, Thomas

    THOMAS RECIPE

    If you can't take time off to detox, I recommend you follow a taper regimen using your drug of choice or suitable alternate -- the slower the taper, the better.

    For the Recipe, You'll need:

    1. Valium (or another benzodiazepine such as Klonopin, Librium, Ativan or Xanax). Of these, Valium and Klonopin are best suited for tapering since they come in tablet form. Librium is also an excellent detox benzo, but comes in capsules, making it hard to taper the dose. Ativan or Xanax should only be used if you can't get one of the others.

    2. Imodium (over the counter, any drug or grocery store).

    3. L-Tyrosine (500 mg caps) from the health food store.

    4. Strong wide-spectrum mineral supplement with at least 100% RDA of Zinc, Phosphorus, Copper, Magnesium and Potassium (you may not find the potassium in the same supplement).

    5. Vitamin B6 caps.

    6. Access to hot baths or a Jacuzzi (or hot showers if that's all that's available).

    How to use the recipe:

    Start the vitamin/mineral supplement right away (or the first day you can keep it down), preferably with food. Potassium early in the detox is important to help relieve RLS (Restless Leg Syndrome). Bananas are a good source of potassium if you can't find a supplement for it.

    Begin your detox with regular doses of Valium (or alternate benzo). Start with a dose high enough to produce sleep. Before you use any benzo, make sure you're aware of how often it can be safely taken. Different benzos have different dosing schedules. Taper your Valium dosage down after each day. The goal is to get through day 4, after which the worst WD symptoms will subside. You shouldn't need the Valium after day 4 or 5.

    During detox, hit the hot bath or Jacuzzi as often as you need to for muscle aches. Don't underestimate the effectiveness of hot soaks. Spend the entire time, if necessary, in a hot bath. This simple method will alleviate what is for many the worst opiate WD symptom.

    Use the Imodium aggressively to stop the runs. Take as much as you need, as often as you need it. Don't take it, however, if you don't need it.

    At the end of the fourth day, you should be waking up from the Valium and experiencing the beginnings of the opiate WD malaise. Upon rising (empty stomach), take the L-Tyrosine. Try 2000 mgs, and scale up or down, depending on how you feel. You can take up to 4,000 mgs. Take the L-Tyrosine with B6 to help absorption. Wait about one hour before eating breakfast. The L-Tyrosine will give you a surge of physical and mental energy that will help counteract the malaise. You may continue to take it each morning for as long as it helps. If you find it gives you the "coffee jitters," consider lowering the dosage or discontinuing it altogether. Occasionally, L-Tyrosine can cause the runs. Unlike the runs from opiate WD, however, this effect of L-Tyrosine is mild and normally does not return after the first hour. Lowering the dosage may help.

    Continue to take the vitamin/mineral supplement with breakfast.

    As soon as you can force yourself to, get some mild exercise such as walking, cycling, swimming, etc. This will be hard at first, but will make you feel considerably better.

    Thomas"[/QUOTE]


    My Suboxone/Subutex Therapy
    http://www.drugs.com/forum/featured-...apy-50887.html

    I guarantee this work with little discomfort if you listen to me to the letter from day one.
    Last edited by Robert_325; 09-01-2012 at 12:22 PM.
    I am not a dr. My statements are based on years of experience and related education. Consult with the professional of your choice regarding matters of concern.

  3. #3
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    Well....
    this is a bit difficult.....
    i'm with robert....two options.
    he has more experience w/the subs....well i have NO experience.
    I jumped off 200mcgs of fent patches.....
    if i saw someone coming off a larger amt.. i would immediately warn them to do subs....
    you're at a pretty low dose...
    if i were you i would just use the thomas recipe and treat the symptoms....
    but i am MORE THAN WILLING to bow to Robt's expert advise here...
    Marian

  4. #4
    Robert_325 is offline Retired
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    Quote Originally Posted by shadowwally View Post
    Well....
    this is a bit difficult.....
    i'm with robert....two options.
    he has more experience w/the subs....well i have NO experience.
    I jumped off 200mcgs of fent patches.....
    if i saw someone coming off a larger amt.. i would immediately warn them to do subs....
    you're at a pretty low dose...
    if i were you i would just use the thomas recipe and treat the symptoms....
    but i am MORE THAN WILLING to bow to Robt's expert advise here...
    Marian

    Marian and Zman..... I actually agree with you on this, Marian. Using subs takes a good two months and it's hard to find the drs that will dispense the medication to the patient rather than controlling them to pad their wallets. So many of the sub drs are just trying to build up an ongoing income by telling patients they need to be on doses that will do nothing but make the patient addicted to subs to create a cash cow for themselves. Some of them will tell you that you may need the subs for life which is a total lie! We've both seen it happen on this forum for years. Most people semi-trust their drs at least and most of the sub drs are doing nothing but trying to accumulate 100 patients as the law allows them to do. Many of those drs charge hundreds of dollars for each appointment ... as much as $300 or more. Do the math! 100 patients being seen a couple times a month is $600 for each patient. That's $1200 in office calls alone per month times 100 patients. Works out to a LOT of money (as in $120,000) some of these bandit drs are pocketing as addicts don't have anyone lobbying for what is best for them. Usually no one really cares enough about addicts as they are a pain to everyone around them. Usually the only people who give a damn about addicts are other addicts that have accumulated some clean time. And you know the drug company reps will kick back to the dr who has a list of clients like that. You go in to the office for a ten minute appointment, get your script and cough up whatever that dr charges because you're desperate and that dr could care less. I am not talking about ALL sub drs. I actually have a few that call ME for help. Those are the ones an addict needs to find, a dr with integrity. And think about the fact that most of the really good drs don't even have time for new patients. These sub drs take an 8 hour class and that certifies them to do whatever they think is best with their sub patients. I could pass that test blindfolded. So lots of drs take that 8 hour exam and use the subs as a way to get off and running to becoming rich, and it's at the addict's expense.

    I am able to induct a sub patient usually at less than 3mg, or 4mg at the very most where the sub drs almost always start patients out at between 16mg to 24mg which is total greed so they can make money. For those that are able to obtain a "real" dr with scruples, who doesn't rip the patient off I have no problem with subs. I usually have to do the induction myself however to get the person stable on the "lowest effective dose" and have them completely clean in 60 days or thereabouts. I know of very few drs that will induct anyone like I do it. That is why you see SO MANY sub threads on this forum. You've watched me time and again, Marian, and I am always successful when the patient gets a script for as many subs as they can get, then I can work with them and quite often they never even have to go back and see that dr again.

    If a patient can't find a dr that will be reasonable with office call charges, that being the same as they would charge any other patient for an illness, it will cost the patient a fortune by the time the dr finishes with them and they end up here trying to get clean off the subs.

    If a person follows that Thomas Recipe they will experience some w/d symptoms for the normal week or maybe a little longer and the vitamins and supplements in the Thomas Recipe will work for most people. But it isn't a two month process of spending a bunch of cash. For those who have relapsed numerous times, have a great dr that will work towards the benefit of the patient, and don't try to take advantage of the patients subs have their place.

    I always suggest the route that doesn't include taking another drug first, and subs are a schedule III narcotic just like hydrocodone, so they can become addicted to subs too. It's a tricky process that a person using subs needs to be sure they are working with someone who knows what they are doing. Most drs aren't or have never been addicts like all of us have. So I say it's fine to check out some sub drs by phone and get the specifics of what they intend to do, how much they prescribe, they need to get all the info on costs, and then if it's a scenario as I described where the drs want a fortune, at that point I would go with the Thomas Recipe, bite the bullet for a couple weeks, but then you are done with it and you don't have to add another narcotic to what they are already wanting to rid themselves of to start with. Hope that makes sense. God bless.
    I am not a dr. My statements are based on years of experience and related education. Consult with the professional of your choice regarding matters of concern.

  5. #5
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    z-man...
    well that makes me feel better.. i would go with the thomas recipe then.
    if you can handle tapering...go for it....
    i personally couldn't stand the constant withdrawal symptoms and jumped.
    post on here and we will support you in every way we can!
    Marian
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  6. #6
    Char123 is offline Junior Member
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    I have a different DOC but I used the Thomas Recipe for w/ds and it really helped. I also drank chamomile, passion flower, and valerian root tea almost non-stop for anxiety and sleep. I also took a GABA relaxer. I used Hyland's leg cramps (ate them like candy) to help ease the leg cramps. That was my worst w/d symptom. I spent lots of time in the bath with epsoms salts and that really helped the most. MIT eased some of the anxiety and really helped wi the leg cramps (although they would come right back when I got out). I drank alkaline water to stay hydrated which helped somewhat but made the nausea worse so I had to use some Zofran I had. Everyone says getting exercise helps but My legs cramped so bad I did not feel like getting up. I forced myself in the evenings just to go on a very short walk (5 mins or less). It was excruciatingly painful but it did help me feel better overall and I felt proud of myself for doing it. After about 72 hours the withdrawal symptoms started to ease. Aside from the weird nagging hungry feeling that abused me to continuously crave my DOC for a while longer, most of the physical w/ds subsided after about a week. I am now 30 days clean and fighting the mental battle everyday but the physical symptoms are gone. Each experience is different since every person is unique but these are the things that really helped me get through it.
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  7. #7
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    Char...
    how many of the hylands can you take?
    i have a bottle and have never used 'em.
    i have rls all the frickin' time!
    Marian

  8. #8
    mottam is offline Advanced Member
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    Z-man:

    Welcome to the forum.
    I came to this site seeking help, and got some life-saving expereinces shared with me.

    I had looked up Suboxone, read some of the threads here, and felt it was not a good choice, for me.

    C/T was the way for me to go, and the Thomas Recipe was HUGE in my home detox. You have received some very good experience-based advice. C/T is scarey at first. I remember on day three, I thought I was losing it. People on this forum "talked me down". By day 5, I was eating like normal, sleeping, and enjoying life again. That was after a long run of oxy abuse at what was a high level, again, for me.

    If the Thomas Recipe does not meet your detox needs - there are other options. This forum is FILLED with success stories of various types. Don't give up, and join the "no matter what" club. Simply do not use - no matter what!

    You can do this my fellow addict. It is from my expereince that its next to impossible to alone.

    D.C forum is a fanastic, diverse family to work with. However, for "real-time" help when those urges come (and they will come) you will need to be prepared. Please think of what you will need to do once you have beaten the physical stuff.

    D.C along w/ my doctor got me clean. D.C and N/A have kept me clean.
    Like with all who post here - I sincerely want to see you succeed in beating your demon. Whatever approach you choose to detox - as long as you detox. Recovery is the really hard work. The forum is here for you. I hope you consider some "outside" support also.

    In my prayers - best of luck.
    mottam
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    Persistency is consistency

  9. #9
    Char123 is offline Junior Member
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    I have the PM formula and it says you can take 3 for the first dose and then 1-2 every 4 hours. On their website it says you can take 2-3 every 4 hours. I usually took 3 at night and then 2 every 4 hours throughout the rest of the night and day until the next night when I would take 3 again right before attempting to go to bed. They gave me some relief but it didn't take the cramps away completely.
    Last edited by Char123; 09-01-2012 at 06:09 PM.

  10. #10
    Robert_325 is offline Retired
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    Quote Originally Posted by mottam View Post
    Z-man:

    Welcome to the forum.
    I came to this site seeking help, and got some life-saving expereinces shared with me.

    I had looked up Suboxone, read some of the threads here, and felt it was not a good choice, for me.

    C/T was the way for me to go, and the Thomas Recipe was HUGE in my home detox. You have received some very good experience-based advice. C/T is scarey at first. I remember on day three, I thought I was losing it. People on this forum "talked me down". By day 5, I was eating like normal, sleeping, and enjoying life again. That was after a long run of oxy abuse at what was a high level, again, for me.

    If the Thomas Recipe does not meet your detox needs - there are other options. This forum is FILLED with success stories of various types. Don't give up, and join the "no matter what" club. Simply do not use - no matter what!

    You can do this my fellow addict. It is from my expereince that its next to impossible to alone.

    D.C forum is a fanastic, diverse family to work with. However, for "real-time" help when those urges come (and they will come) you will need to be prepared. Please think of what you will need to do once you have beaten the physical stuff.

    D.C along w/ my doctor got me clean. D.C and N/A have kept me clean.
    Like with all who post here - I sincerely want to see you succeed in beating your demon. Whatever approach you choose to detox - as long as you detox. Recovery is the really hard work. The forum is here for you. I hope you consider some "outside" support also.

    In my prayers - best of luck.
    mottam



    Hey my man Tom. Good to see you posting old buddy! God bless.
    I am not a dr. My statements are based on years of experience and related education. Consult with the professional of your choice regarding matters of concern.

  11. #11
    Robert_325 is offline Retired
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    Quote Originally Posted by Char123 View Post
    I have the PM formula and it says you can take 3 for the first dose and then 1-2 every 4 hours. On their website it says you can take 2-3 every 4 hours. I usually took 3 at night and then 2 every 4 hours throughout the rest of the night and day until the next night when I would take 3 again right before attempting to go to bed. They gave me some relief but it didn't take the cramps away completely.

    Zman ..... Hylands is good stuff for the legs. I thought that we had talked about that Marian. Sorry if I failed to mention Hylands. Couple more things I would add is to drink pedialyte for dehydration if you get diahhrea. It's loaded with electrolytes and it will help you. Also try to drink some really good protein shakes, you can get them with loads of protein, good for you as well. Remember this didn't happen in a day and it will take some days to get better. Sleep will be the last thing to come back. I would plan on just staying up the first night if you start tossing and turning. Makes a long night going through that. God bless.
    I am not a dr. My statements are based on years of experience and related education. Consult with the professional of your choice regarding matters of concern.

  12. #12
    Char123 is offline Junior Member
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    Protein definitely helps. I drank a strawberry shake with almond milk and whey protein powder each day and it seemed to help. I still drink it now.
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  13. #13
    zman2299 is offline New Member
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    Wow! Thanks so much for the outpouring of support and advice. It's definately a lot to digest. I am planning on tappering down to 12mcg or even 6, and then doing the thomas recipe. It is a little vague about the first 4 days. Do I just sleep through them using the benzos, or do any of you know what to expect, and how to survive without relapsing?

  14. #14
    Robert_325 is offline Retired
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    Quote Originally Posted by zman2299 View Post
    Wow! Thanks so much for the outpouring of support and advice. It's definately a lot to digest. I am planning on tappering down to 12mcg or even 6, and then doing the thomas recipe. It is a little vague about the first 4 days. Do I just sleep through them using the benzos, or do any of you know what to expect, and how to survive without relapsing?

    Take it easy on the benzos as much as possible. I would suggest taking care of the opiate detox first, then tackle the benzos. Start doing both at once and you won't be able to tell what your symptoms are even coming from. The Thomas Recipe calls for some benzos for a few days but you really need to eliminate the benzos as well once you get off the fentanyl. Just take it one step at a time. This didn't happen over night and it will take a little time to get totally clean. But in the end it will be worth it. God bless.
    mottam likes this.
    I am not a dr. My statements are based on years of experience and related education. Consult with the professional of your choice regarding matters of concern.

  15. #15
    mottam is offline Advanced Member
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    Z-mann:
    Just want to support Robert's advice with my personal experience. Opiates were my DOC, but I also addicted to benzos. In reality - my drug of choice was/is "all".

    Anyway, it took a lot of effort to get off of and stay off of the oxies. Benzos are a whole other world in addiction. Robert and members on this forum pointed me in the direction of the published work by Dr. Heather Ashton (you can Google her).
    Anyway, depending on how much and how long - benzo taper is tough.

    From my own personal experience I could not agree with Robert more: Get off the opiates, get a solid recovery foundation (NA, CR, etc.), then tackle the benzos.
    Some people may not agree with this approach. Some have had positive outcomes doing it all in one shot. NONE I know of can do it w/o being hospitalized.

    Benzo w/d, like alcohol w/d can lead to seizures, stroke, heart attack, and death. Not trying to scare you - just want to share real world expereince - my experience. Everyone is unique and different.
    Benzos are really bad-boys in the drug-world/withdrawal. Be very careful, follow the good advice you are getting, and always talk w/ a qualified medical pro when taking on something like benzo w/d.

    Best of luck.

    Kindest Regards.
    mottam
    Robert_325 likes this.
    Persistency is consistency

  16. #16
    zman2299 is offline New Member
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    I'm sorry, shouldve clarified: I currently take 2 mg of xanax per day for anxiety. I am comfortable with this relatively low dose, and am not trying to detox from them at the moment. I noticed that the thomas method included taking benzos for the first few days, but the actual first few days us fairly vague from the post earlier on this thread. I was wondering if anyone had a more detailed process (maybe from personal experience) for the method. I plan on tapering my dose from 25mcg to 12mcg, after speaking wih my doctor. I will make tis jump on tuesday, and am a little nervous on what to expect. after this, My doctor has suggested to switch to half of that dose (the patches are able to be cut). When comfortable here, hopefully two weeks from now, I'm going to try the Thomas method if I can find a little more detailed version of it.

    Thanks for all of the replies! They have really given me the confidence that I can do this. Can anyone give me any advice on the taper, or any suggestions to maybe try the thomas method and just go c/t from my current dose?

    Thanks!

  17. #17
    zman2299 is offline New Member
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    I'm sorry if my last post might hve offended some in anyway. I would be very gracious if someone ho has experience with this could help with some of my concerns. Please provide feedback.

    Thank you and God Bless

  18. #18
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    hey zman.....
    been gone for a bit.
    don't worry about the benzo's while coming off the patches.
    if i understand correctly it's not the benzo's you want off of anyway.
    okay.....
    you have a aplan with your dr. for tapering....
    good for you.
    go with the flow, treat the symptoms as they come up....
    since your doctor is helping you, he may even give you some advice if you show him the thomas recipe.
    also..........you can use the thomas recipe to help you as you are tapering.
    if that's not clear enough....just let me know.
    Marian
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  19. #19
    zman2299 is offline New Member
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    Thanks for the reply. When tapering I just get VERY VERY tired for 3 or 4 days. ike I sleep for 17 hours and then 2 hrs ater, I'm tired again. Is this normal. Also, I recently noticed that I have lost 30 lbs or so in the last 3 months w/o doing much. I'm hoping its just due to the decreased appetite from the patches. I have been on the 12 patch for the last 4 days. WHen comfortable with this dose, where do I go from there. I have a great Dr who has helped through all of this, but we are stumped about dropping doses any further. Can the Mylan patches be cut in half, or half covered up?

    Thanks for your support, please let me know what you think about the weightloss and decreasing doses from here.

    -Chris

  20. #20
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    Chris....
    I had a similar weight loss coming off the patches.
    when i could eat again, my body craved good food and i ate tons and maintained a healthy weight.
    After the 12mg i would make the jump.......
    use the thomas recipe and treat the symptoms.
    the patches take awhile to get out of your system so it will be awhile before you are in full withdrawals.
    just take a day at a time.
    when i came off it took a long time to feel better physically and emotionally but i had jumped from a very
    high dose.
    hang tight. post here as often as you need.
    it will be soooo worth it to be free of those patches!!!
    sounds like you have a good doc....nice!
    Marian

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