Best way to titrate off of narcotics?
 

Hi,I have complex regional pain syndrome and I am wish to get off of my narcotic -- kadian. One doctor tells me that the best way to do it is to go incredibly slow -- taking possibly a year, and to maybe switch to using liquid methadone so that I can titrate into really small doses. My other doctor tells me that it is better to do it faster -- like over a period of a couple of months. Does anybody have any experience with titrating off of narcotics? I have gone off of a short acting narcotic before, but kadian is a long-acting one. I am on about 120 mg a day, I've been on that dose for the last two or three years and have been on the drug itself for about four years. I would be very grateful for any advice. This is my first posting and I'm glad to be here in the community. My hands are afflicted and in the past few months I Acquired Dragon Naturally Speaking and am just now been able to explore the web a little bit more. Thanks for your help.

Hi Lulabelle ~ Are you SURE you'll be able to function ok without the meds? Are you sure the pain will not be too much for you? Make sure you've thought long and hard before you go off the meds.

A slow, long weaning process is the best. If it were me, and I was on 120 mg., I would start weaning at 5mg per week, i.e. week one I'd take 115mg., week two 110mg., etc. Then when I got down to about 50mg., I'd wean at 10mg per week until I was done.

The reason for such a slow process is so you won't have withdrawals, and also it keeps you from having seizures. Also you're much more comfortable at a slow taper as withdrawals can be very uncomfortable!!!

Best of luck, and I hope you don't regret going off the meds. God bless. Hugs, Lee

You also might want to explore our RSD/CRPS forum for more info & support from others with the same condition.
here- lots of active members there -
http://neurotalk.psychcentral.com/forum21.html

and possibly our medications forum will be of help too-
http://neurotalk.psychcentral.com/forum72.html

the smallest incremental change would be 10 mg....

I've tried it at 10mg. and it's difficult. It''s much easier at 5mg. ;)

how did you do that? the med does not appear to be supplied in a dose that would allow this

thank you for all of your replies, I agree with all of you that going down in the smallest dose would be best. But it is true what Papp wrote, the smallest dose that kadian makes is 10 mg. My other option is to switch to liquid methadone so that I can titrate down as slowly as possible. My normal pain doctor is adverse to this idea. He wants me to, as it were, rip the Band-Aid off, and get it over with. Any thoughts? My thoughts go out to all of you.

What state are you in? I know of a great doctor that specializes in chronic pain.

Getting of Kadian alone!!!
 

Hey Lulabelle,

Believe me!! I UNDERSTAND your desperate need to WANT to get off these highly addictive narcotics. I saw my pain doctor this morning and we discussed the EXACT same thing. Personally, I'm on 360mg of Oxycontin a day. I hate the idea of me being "drug dependent." The simple fact is that I broke my neck (and by the grace of God, I am nort paralyzed) and suffered a TBI. I *need* that amount of Oxycontin to keep me out of horrific pain. I don't like it ... but that's the deal. There is no such drug for us that is not addictive and without side-effects.

But please listen to what Leesa was telling you. IF you successfully titrated off the narcotics, you might very well be left to suffer in a mire of pain and agony!! Kadian is a very strong narcotic. I don't believe your doctor is prescribing that to you unless you absolutely NEED something that is powerful and potent. No doc (unless he plans on going to prison) is going to prescribe Kadian for minor aches and pains. That is a long acting Morphine compound that is CLEARLY for chronic pain patients. No one is EVER given Kadian (from a legit doctor) that is not in brutal and chronic pain.

Lulabelle - I understand your concern with your dependency and I'm guessing that's why you want off of it. You and I are in the same boat!! I am terrified of being "drug dependent" also. The truth is, we are NOT addicts. There's a WORLD OF DIFFERENCE from being "dependent" upon a drug versus being an "addict."

Also, about liquid Methadone ... OH MY LORD, BE CAREFUL. That is one of the most addictive substances known to man. However, if used properly, it can be fast and effective in breaking the dependency cycle (I know, it's a very strange contradiction, but it's true). Please don't mess with Methadone by yourself. Please consult a doctor or a rehab.

I'd love to talk with you. You sound very worried and I KNOW HOW YOU FEEL. E-mail me and we can chat online or use the telephone.

Good luck and God bless!

Joey

Hi, I am currently getting off avinza+morphine. After receiving ketamine treatments for the past 3 months, I have dropped my dose from 280 mgs to 135mg, and hope to have the dose at 100 mgs in 4 to 6 weeks.

After talking to many experts, I have found out that every 4 to 6 weeks, drop your current dose by 20 to 30%. Notice that as time goes on, the amount that you drop your dose will lessen, but the percentage will stay the same.

If you start at 120mgs, a 20% drop will be: 120 x 0.8 =96 mgs
If you start at 120mgs, a 30% drop will be: 120 x o.7 =84 mgs

Since kadian doesn't come in 1 mg doses, try to drop your dose to say 90 mgs per day - which would be a 25% drop.

After 4 to 6 weeks, make a 20 to 30% drop from 90 mgs. That would be equal to taking approx. 65 to 75 mgs per day.

Please clear this with your Doc. I have heard that if you get off too quick, especially if you are still having pain or have the "addictive gene", that you will get cravings. Also, I am unsure why you want to get off kadian. Did your pain get better? If not, I agree with the guy above me - you can be drug dependant, but not a drug addict.

Hope this helps and good luck!
Jessica

To answer how I did it at 5mg. I have a pill cutter, and I just cut them in half. It worked very well. Peace, lee

You cut Kadian, a long acting medication, in half with a pill cutter ?????

That is NOT advised and extrememly dangerous.

When I got off all medications my PM Doctor rx a medication called beuphnorapone/subotex(spelling,sorry if I spelled these names incorrectly). Doctors need a certain certification to rx this type of medication. How he did it with me was to titrate down as I was taken the subotex.. I tried all the tirating down without the subotex and forget it. Once I started the subotex it truly was a miracle drug. When I started it I felf so sick it just was unbelievable and I could not sleep at all, I think I went with 4 weeks of almost no sleep. Ask your doctor if he does not have the certification then ask him to recommend someone who does it truly in my opinion the safest and easiest way.

Good Luck

Gabbycakes

Hi, lulabelle:

I also have CRPS (RSD Type 1). I had been using Duragesic (fentanyl patches) for several years at the dosage of 100 mcg (one patch every 72 hours) when a group of doctors (psychiatrist, neurologist, and anesthesiologist) forced me to wean off of my fentanyl patches if I wanted to receive the lumbar sympathetic nerve blocks I wanted so much.

I was able to wean off of my fentanyl patches in exactly 18 days (6 days at 75 mcg, 6 days at 50 mcg, 6 days at 25 mcg, then I was at 0 mcg). I had no bad withdrawal effects; I just had some diarrhea. The only problem, which was not caused by withdrawal but by my having CRPS, was very severe pain, because I did not have any fentanyl in my blood to control the pain anymore.

After the group of doctors who had promised to give me the lumbar sympathetic nerve blocks if I was able to wean off of my fentanyl patches did not give me the blocks (they just wanted to get me off of the fentanyl patches, no matter how much severe pain I would have), I asked my primary care doctor to prescribe the fentanyl patches for me again. Now, I am at the dosage of 125 mcg (one 100 mcg patch and one 25 mch patch every 72 hours). The severe chronic pain that had come back after I was forced to wean off of my fentanyl patches disappeared.

Depending on how you feel while weaning off of your narcotic, it will take you either a short or a long time to wean off of it. Only time can tell. There are also medications to ease the withdrawal symptoms, should you have any.

Good luck!