tapering fentanyl

[melodyl]

Hi Everyone. I am now 3 months post op from a 3 level cervical ADR and 15 months post op from a major lumbar revision surgery with fusion, removal and addition of hardware. After years of serious narcotics, I am tapering. I've had help (thanks!) with tapering schedules for oxycodone and norco, but I can't seem to find a conversion table or chart that goes FROM fentanyl to oxycodone or vicodin. My highest level of Fentanyl was 175 mcg patch every 48 hours plus oxycodone as needed for breakthrough. I have managed to get down to the smallest patch (12 mcg) every 72 hours, but am still taking 30 to 60 mg. of oxycodone a day. The taper from 25 to 12 was hard! It took 4 times (and ruined that many weekends feeling yucky from WD's). I don't think my pain requires that much oxy, but after being on such high doses for such several years, I am trying to taper slow enough that I don't have to take any time off of work. If anyone has suggestions on how to finish the fentanyl taper, I would love to hear from you. It would be nice to know how many 5 mg oxycodone a day equal a 12 mcg fentanyl patch spread out over 3 days? I look forward to hearing from anyone who can help. Thanks to everyone and good thoughts to all for a happy and pain free day! Melody

[Katie]

Hi Melodyl,

When I asked my pain management doctor, who is an anesthesiologist, if I would have much trouble getting off the narcotics when I eventually have surgery, she said no.

Apparently there is a drug that has been out in the States for awhile, but is new in Canada this past fall, which allows you to taper off very quickly. She said I could be off morphine in less than a week. Unfortunately, since I don't need it yet, I didn't keep track of the name, but I remember talking to Terry Blackburn here on the board about it.

He has a great knowledge of medications, and may be able to remember what I was talking about. If not, he may have other ideas. I think he may be in the industry, but not sure.

Good luck with it. I was always worried about it until I got reassurances to the contrary. I was always also told that the body doesn't really get addicted to the pain meds if it is truly needed for pain. I hope that is true, but you seem to be arguing that point with your symptoms.

[Justin]

Originally Posted by melodyl

If anyone has suggestions on how to finish the fentanyl taper, I would love to hear from you. It would be nice to know how many 5 mg oxycodone a day equal a 12 mcg fentanyl patch spread out over 3 days? I look forward to hearing from anyone who can help. Thanks to everyone and good thoughts to all for a happy and pain free day! Melody

Melody, sorry for your spine history; it sounds like you've been through hell. About the fentanyl taper, are you under physician guidance during your taper? The 12mcg is the equivalent of ~20-30mg of oral oxycodone. Would you be able to spread 30mg over 72hrs?

Have you thought about tapering with the help of Suboxone for help with withdrawal? You were on an incredible amount of fentanyl-- 175 mcg--that's over 300mg of oral oxycodone. I'm so sorry for you...my gosh!

Good luck and, as always, consult with a professional about changes in medication(s).

Originally Posted by Katie

Good luck with it. I was always worried about it until I got reassurances to the contrary. I was always also told that the body doesn't really get addicted to the pain meds if it is truly needed for pain. I hope that is true, but you seem to be arguing that point with your symptoms.

Hey Katie, you're body doesn't get "addicted" per se, but it becomes "dependent" (needs them) on opioids . Over time, your body becomes accustomed to a given dosage in which there comes a point where you have to increase the dosage to get the same effect (this is called tolerance). I hope this makes sense. BTW, Terry is the man! The guy is brilliant.

[Terry Allen Blackburn]

There is a huge difference between addiction and dependence. The brain contains many receptor sites that accept neurotransmitters that fit in to the receptor site like a key in to a lock. The mu opiate receptor site is where the opiate locks in to, thereby, blocking the pain messages to the brain. When a person is in pain, the opiate works to block the pain signals to the brain. Unfortunately, when a person is on the short acting opiates, tolerance is achieved quickly and, it requires more of the opiate to achieve the desired result. In chronic pain patients, it is very useful to utilize long-acting opiates, as tolerance is not increased so quickly and, the amount of time between dosages is longer than, the one or two pills every 4-6 hours as needed for pain orders. These medications are taken, on average, every 12 hours, with some immediate release medications utilized for break through pain. When a person is on the opiates for a period of time physical dependence occurs. This means the person will experience withdrawals when taken off of the medication too rapidly. It is then better for the patient to withdrawal gradually though, every person is different, depending on the amount they are taking and, the length of time they have been on the medication. It is always necessary to have your physician come up with a gradual withdrawal protocol, which will taper you off in the safest and least uncomfortable manner possible.

Addiction occurs, when the patient is no longer utilizing the medication for pain management but, to feel euphoria. Once the person is not experiencing pain, the effects of the opiates cause a pleasurable, euphoric condition. The person then experiences cravings to continue the use of the medication and, to find ways of obtaining it, no matter the cost or consequences. It is still unethical for a physician to cut the person off even if addiction sets in. The physician owes it to the patient to refer the patient to a detoxification program so they can be withdrawn in a humane, safe manner.

It is up to your physician to provide you with a taper protocol to gradually bring you off of the opiates in a safe, sane manner. Once you get down to an acceptable level, Buprenorphine may be used to make the withdrawal safer with less withdrawal symptoms. There is also a possibility of utilizing a Tramadol protocol which also gradually removes you from the primary opiates in a safe manner.

Please discuss this with your physician to have them help you in this important step. No one is more qualified than your personal physician to taper you off of the medications. If you want any further assistance you may PM me and I can make an appropriate referral for you.

Do not feel ashamed of this process as, this is a naturally occurring phenomenon, that can take place with the protracted use of long-term pain medications.

Terry Newton

[melodyl]

Thanks for the prompt replies. This site has been incredibly helpful through my spine surgeries and recoveries. I want to reassure Dr. J and Terrry that I am under a doctor's help with the narcotic taper. However....he is not a pain management specialist and there are not any in the area I live. He has been my primary physician for 25 years and we have a good relationship. I have made it this far with him and don't want to start over with someone else. Like lots of you, I have a job, family (including 2 wonderful grandkids), home and all the other pleasures and demands of life that take so much time to accomplish. I see my primary dr. every 4 weeks for pain meds, my orthopedic surgeon (90 miles away) every 2 months and a massage therapist every 2 weeks.

Dr J- thanks for the conversion of fentanyl to oxy. It should be easy to take a little extra oxy for the first few days that I remove the final patch and then taper off of the oxy by taking one less each day as soon as my body adjusts.

Terry-you mentioned Tramadol......which is something my dr. and I discussed at my last visit. Dr. thinks I should be able to start converting from oxy to Tram. when I get off of the patches and under 30 mgs a day of oxy. I have mixed feelings about that....stemming from conflicting information I've heard. Some say Tramadol is NOT addicting and others say it is? I would hate to have gone through all of this only to be dependent on another prescription.


Terry brought up a great point regarding shame. I truly appreciated his remarks. It is/was easy for me to request time of off work for my surgeries and recovery. However......I haven't said a word to anyone about not feeling well during the taper process. It is an embarassing subject. hmmmm....might be worth starting a new thread.

Last (at least for now).....the withdrawal symptom I am finding the most annoying is excessive sweating. I had to get out of bed and change pj's twic last night. I brought a blow dryer to work and have had to use it to dry my hair and body in between appointments/clients. Lucky for me, I am at a normal menopausal age. I prefer letting clients and co-workers think I am having serious hot flashes. If anyone has any suggestions for helping with that symptom, I'd love to hear it!

Katie....keep us updated on your surgery and recovery.

THANKS!!! The support from this group is just what I needed to get through another day of tapering! You are all fantastic, caring individuals.

Melody

[Terry Allen Blackburn]

As usual the drug reps do not always tell the truth about drugs they are putting out in the general public. A great example is the debacle over Oxycontin.
Oxycontin Manufacturer Lied About Dangers of Drug
The fines this company experienced pale in comparison to the great profits they achieved versus the amount of lives that have been absolutely destroyed by this drug. There are more deaths that occurred through overdoses of this drug than anyone can imagine. It became a nationwide problem that we are still reeling from the effects of.
Abuse of prescription drugs surges across globe - Addictions- msnbc.com
In my business I get several copies of the yearly Physician Desk Reference which lists the most commonly prescribed current medications utilized today. Unfortunately, many physicians do not have time to read the warnings and rely on what drug representatives tell them. Since Ultram (Tramadol) came on the market in the United States it has been erroneously stated by many physicians that it is not addictive. There could be nothing further from the truth. It may not be a potent as some of the other long-acting pain killers but there have been reports of increasing addiction associated with the use of the drug.
What is the addiction risk associated with tramadol? | Journal of Family Practice | Find Articles at BNET
However, just because a drug carries a risk of having the patient become addicted to them does not mean that the benefit is offset by potential harm. As with any medication you have to assess whether the benefit outweighs the side effects or potential for harm. As with any painkiller medication the patient should be tapered off of the medication rather than an abrupt cessation.

As far as the sweats associated with the withdrawal effect of an opiate taper there is very little that can be done to alleviate this. It is only uncomfortable and somewhat embarrassing when it looks like you have just come out of the shower from perspiration. At least you are on the path to a gradual, comfortable as possible, taper program. The medications can be switched to Tramadol as your doctor states. It is better to realize the importance of adequate pain relief and how this enables the body to sleep and heal from surgical or injurious pain. Pain can definitely affect mood, healing, sleep, and your overall psyche which makes it important to take care of.

No matter what you do, we will support you in the process as most of us have been where you are at.

Hang in there.

Terry Newton

[Katie]

Terry and Dr J, thanks so much for all your help and knowledge. It is indeed invaluable. I don't know what we would do without your help in so many areas.

Bless you both,
Katie