Methadone taper FOR CP PATIENT

[orangejuice]

Hello all, i have a very important question about a matter of methadone taper. I know it has been discussed over and over many times around this site just to let everyone kno before hand i UTFSE already and thouroughly read. My question has a certain specificality (real word?), and this doesnt concern me. It concerns my mother, who i live with and take care of. She is a Neuropathic (Spinal cord injury) pain//chronic pain patient due to a vehicle accident breaking her neck in 2 places. Diagnosis: incomplete quaduaplegic. Well anyways i took her to a new doctor in my state today. (She has been prescribed 40 mg 3x daily for the past year, and before that since the accident in 2000, 40mg 2x daily, tried various breakthrough meds also currently taking 30mg roxy's 3x daily/prn.) Well in mississppi a high percentage if not all doctors will not prescribe methadone (the legit docs) the reason we went to this doctor is because we have been having to drive almost 4 hours one way to a doctor at 350 a visit since hurricane Katrina, and it was becoming a hassle being that she cannot drive by herself and we dont have much money. But anyways this doc is more practical and takes medicade. Well this doctor isnt gonna write her methadone but we done argure as long as she gives something just as efficient. Obviously she said she was gonna have my mother taper the dosage as follows:
First week: 30 mg every 8hrs
Second week:20 mg every 8hrs
Third week: 10 mg every 8hrs
Fourth week: 10 mg every 12 hrs
Fifth Week: Discontinue dosing

At first this seems reasonable but as me and my mother have been talking she has been getting more concerned as she has never had to stop taking methadone the 6 years she has been prescribed it.

My main question is does this sound like something any of you would do? Ive read others but they are pertaining to Recreational usage, and i think of this as different as she doesnt abuse any of her pain meds at all. This is very important to me because i KNOW how bad methadone w/d's are, i go through them frequently. I tried telling her that no matter what kind of taper she will have some minor symtoms of w/d, so i already kno that... i guess im just trying to make sure of this; reassuring ourselves. Is there anyone that could pitch in on this subject (note that she doesnt abuse it; not an addict) You CP patients out there, is there anything you would change with this tapering method?...Any advice is appreciated i just hope this message finds many of your good minds and i trust yall. Thanks a million in advance. Pa~PEACE!

[dorje]

You already know Methadone withdrawals are baaaaaad. The can last a month. Solid. Everything from every other kick but more intense and no real progress from one day to the next, It seems fast to me but doctors never know since they aren;t hooked on Methadone. Get some Benzodiazepams(Valium,Xanax) for sleep. Some people don't sleep for months. eat heathly
. Get kratom. Any small narcotic to take the edge off then hold on tight here comes the wave. I wish your mom luck. I have seen women just put it down (pregnant) with no fuss but it kicked my ass right around the block and back the other way, After 5 days/nights without sleep I got smart and took some valium. I was on 80mg for 5 years of done after a month of heavy physical sypmtoms is this totally blank space with nothing-no drive, no feeling, no fear, nothing. A big grey box for company. Friends and relatives help a lot at this point. Once again, we will send the best energy your way. It ends-finally.

[vaxn8]

First a question for you. Is the doc going to replace the methadone with another opiate? If she is going to replace it and if that new drug is going to be started during the time the methadone is decreasing, your mom wouldn't have any problems. If a new drug is started, the taper with the methadone isn't even necessary as long as long as the correct dose of the new drug is given.

If she is supposed to totally get off the methadone before starting something new, she may have some problems. First, obviously her pain is going to increase with every decrease in the dose. Secondly, that taper is a bit quick for someone who has been on the drug so long. Before attempting this, I would talk to the doc a little more to find out what the doc will do if the drops in dosage are too fast or too much. Also, I would talk to the doc about what she is going to do for pain during that period. If all that is answered to your satisfaction, I would attempt the reduction as written. When your mom runs into problems, she can then call the doc and increase the dose or time interval if necessary.

A week at each progressively lower dose may or may not be long enough for your mom. She won't know until she tries it. Decreasing in increments of 10 mg also may or may not work for her. She really won't know anything until she tries it and sees how her pain and level of comfort is. As long as there is some kind of plan of what can and will be done if she is sick or in pain, I would go ahead with it. I would NOT agree to do it if all that weren't discussed/planned ahead of time!

[Tar_Baby]

Dude that taper plan is fucked..she dont need to drop any faster than 1 % of total dose per month..120 mgs day = 1.2 mgs round down to 1 mg a month , in order to escape wd's. Plus any other opiate pain pill is gonna be really weak after the 120 mg done a day. I fucking cant believe some dr's, what are they thinking?! 120 mg to nothing in 5 weeks is gonna be a hellride

[vaxn8]

she dont need to drop any faster than 1 % of total dose per month


That is insane! At that rate it would take years to get off of it. Ten percent every 2 weeks is about the slowest you will ever see prescribed, many people to 20 - 25 % easily.

[orangejuice]

well its almost been a week since the taper began and for anyone interested she isnt feelling well. she said its not so much the w/d's because its only the first step, but her neuropathic pain has increased, yeah its fucking obsurd about the doctor and all but if you were from around here (mississppi) you would be use to shit like that. Especially pearl river county where im at, is considered the pill head capital of the south, (per capita) but its fucking bullshit for cp patients like her and many others that go to the doctor and they are either afraid to write something cuz all these illegal docs writing illegal scrips and getting busted. im not sure, but does everyone else have problems like that in your area, are there doctors getting busted all the time for writing scripts for illegitement reasons. like basically in a lot of places around here (lousianna) a 20 min drive for me, you can go to a doctor with a 300 dollars that you hand to a receptionist behind a tinted window, you see the doctor put the money on his clipboard, and he writes w/e you want basically. and when he gets busted, they usually leave a paper trail resulting in a lot of busted pill heads ... i was just wondering does that happen in other areas too??

[dorje]

Yep..they bust legit doctors and croakers. The DeA speaks with forked tongue... They tell doctors We want you to treat pain and then pop them for writing too many scrpts, etc. Lot's of doctors won;t take CP patients. They don't want to jeapordize the license. Some Doctors specialize in Pain Management. CP patients do better with those specialists. Good Luck it sounds like a squeeze out there.

[orangejuice]

yeah i failed to mention the main doctors getting popped are the pain manangment clinic/doctors, and its caused a lot of trouble for legit people like my mom and other cp people

[Curio]

sounds to me like the new doctor simply isn't going to write for your mom's pain any longer...and that taper is messed up too!!

Your mom must be seeing my old doctor (the one that went off the deep end and broke my confidentiality, then accused me of being an addict as she "tapered" me from 80mg OC three times a day down to 20mg twice a day in four weeks!).

Sad to say but the only people who can get drugs anymore are the people who DO NOT need them it seems...the way they treat people any more, however, everyone ACTS like drug "addicts" because they are all UNDERMEDICATED most of the time!

[Curio]

I'd suggest you do some searching right here on this forum, Jacky and others have done a fair amount of research into DXM and other ways of potentiating pain med and/or helping prevent tolerance to pain meds from building too rapidly.

Also make sure your mom is on a good anti=inflammatory....they took all the good ones off the market, but you can still get Celebrex I think....or do overseas/online orders and get Bextra or another good Cox-2 inhibitor....

[orangejuice]

Yeah thats what both of us have been doing, she actually is a member here now, but anyways you suggest the anti inflamatory, something like that would help for a neuropathic pain??

[Curio]

yeah, with my nerve-related pain nothing would touch it, including opiates UNLESS I had a couple shots of Toradol over a period of time or when I was taking Bextra 20 mg regularly...
even opiated I could always feel the pain ready to burst into flames underneath the cushion of painkillers....(and I had to PAD it regularly to keep it there!)

[robojunkie]

OJ-As far as I am concerned that is way to harsh for someone with CP issues or anyone else for that matter. I just finished tapering off of the clinic I've been on for 8 years today (0 mgs!) from 20 mg (originally way higher but tapered over more than a year) in 3 and a half weeks. Maybe I've become a big wds pussy but I was (still am) hurtin. Can't imagine it with actual neurogenic/neuropathic pain. She's pretty much coming down 30 mgs a week without any other meds? No clinic would ever expect someone to come down that fast (unless you don't pay da man, then they don't give a shit). I have been taking clonidines from 20 mg down so I can function at my work/school and I feel fucking insane. It just lasts too long. Way, way, way too fast IMO. Maybe she could go on a clinic with the medicaid then she would have some control over the dose with increases and shit.