Aa
Mislead
I hope in the days to come my inquiry will be considered by an MD. The nature of my question is multifold. Firstly i will outline my background in a nutshell; 21 yrs, male, canada. 3 years ago I was taking Dilaudid 8mg/4mg tablets for moderate pain in my lower back (lumbar) and both ankles from a sports injury. My pain has not to this day, ceased. my ankles hurt every step of the way, and my back hurts day in, day out, and i cant sleep from it. my dr. whom prescribed my the dilaudid suddenly cut me off...no taper...nothing...i suffered severe withdrawals, and contacted local ER. there i met with a dr. who in a nutshell...put me on dolophine to manage for the time being. he failed to explicate his obligations to me in terms of his practice...and failed to explicate that dolophine is far more difficult to kick than dilaudid is for a number of reasons: halflife, affinity, metabolites, etc...(and ive tried and failed to taper from methadone)so this leads to my conclusive question.
Is there somewhere somehow... a Dr. whom would be confortable to involve in his practice, an unusual treatment as per follows: Take me off the dolophine, put me BACK on Dilaudid, and taper me off the Dilaudid for the reasons being: the halflife differs exponentially...the withdrawal symptoms are much more manageable...and the stigma of being on methadone is no longer existing(ive defamed myself because of methadone=my family, girlfriend, friends...everyone)
IS THERE A DR. OUT THERE THAT CAN SAVE MY LIFE AND SUPERVISE A DILAUDID TAPER???(i know it sounds bizarre to ask for more narcotics but my tactic, thru research, appears to have a 99% probability of success.)
ALSO, THERE IS A VERY BOLD LINE THAT DIFFERENTIATES ADDICTION...FROM CHEMICAL DEPENDANCE. I SUFFER THE LATTER. I AM NOT ADDICTED. I AM CHEMICALLY BOUND TO METHADONE AND I WANT OFF! SWITCHING TO DILAUDID MAKES SENSE. ITS CHEMICALLY EASIER TO METABOLIZE AND SO ON...PLEASE HELP.
Is there somewhere somehow... a Dr. whom would be confortable to involve in his practice, an unusual treatment as per follows: Take me off the dolophine, put me BACK on Dilaudid, and taper me off the Dilaudid for the reasons being: the halflife differs exponentially...the withdrawal symptoms are much more manageable...and the stigma of being on methadone is no longer existing(ive defamed myself because of methadone=my family, girlfriend, friends...everyone)
IS THERE A DR. OUT THERE THAT CAN SAVE MY LIFE AND SUPERVISE A DILAUDID TAPER???(i know it sounds bizarre to ask for more narcotics but my tactic, thru research, appears to have a 99% probability of success.)
ALSO, THERE IS A VERY BOLD LINE THAT DIFFERENTIATES ADDICTION...FROM CHEMICAL DEPENDANCE. I SUFFER THE LATTER. I AM NOT ADDICTED. I AM CHEMICALLY BOUND TO METHADONE AND I WANT OFF! SWITCHING TO DILAUDID MAKES SENSE. ITS CHEMICALLY EASIER TO METABOLIZE AND SO ON...PLEASE HELP.
MEDICAL PROFESSIONAL
I agree with Eagle-- there is no way that your odds approach even 50%, and the fact that you anticipate a 99% success rate tells me that you are deeply in denial-- one bit of evidence that you are not dealing merely with 'physical dependence', but rather you are dealing with addiction. I can agree that the withdrawal after methadone is more difficult than the withdrawal from dilaudid in SOME respects. It is thought that the 'total withdrawal' is the same, if doses are comparable; methadone had longer, milder withdrawal, and dilaudid has shorter, more intense withdrawal. But the total pain is the same.
A second thing, though, that pushes me to see you not having only 'physical dependence'... those people do not have near the trouble tapering the drug as do addicts. I have seen people merely physically dependent many times back when I was a pain clinic doctor; the people got sick and got angry, but they didn't have trouble stopping. They wouldn't do anything unethical or illegal to get more drug, like borrowing more from a friend or buying on the street-- because the use of drug had not yet affected their mind and insight on a deep level, as it is affected during addiction. Let me put it to you another way... say a person has viral gastroenteritis and is vomiting and uncomfortable. He could call a pharmacy and illegally order himself an anti-nausea medication... but of course you never hear of such a thing. Likewise a physically dependent patient coming off pain pills (taken for real pain) is not going to run around looking for a place to get more-- he will simply feel crappy for awhile, and maybe cuss out the doctor who didn't warn him about the withdrawal.
The addict, on the other hand, cannot do that. He can't because it is not just a matter of saying 'I will be sick for a week, but in the grand scheme it makes little sense to keep on the opiate, as the sickness will then ultimately be worse'. The decision is clear-- the time to stop is now, as soon as possible, as all future attempts will only be worse. Only during addiction does it become impossible to make that simple judgment, and stop taking the medication.
You are likely addicted much more than you realize. As for research, it is not easier to taper off dilaudid than methadone; such things have been tried, and in general long-duration meds are easier to taper with, as they can be taken less often, therefore extinguishing the conditioned pattern of dysphoria--use--euphoria several times per day.
But... it doesn't matter, because in the US you are asking for something illegal. It is illegal (the Harrison Act) to use an opiate to treat withdrawal or addiction, EXCEPT in two, highly regulated circumstances-- the first being methadone, since the early 1970's, and the second being buprenorphine since 2000. A physician is allowed to dispense, not prescribe, opiates each day for a maximum of three days to treat withdrawal. But it is illegal to prescribe a taper of a schedule II narcotic. The way many docs do things is to be sure to document that they are treating a pain condition and doing a trial of lower doses... but doing things like writing out taper plans for schedule II drugs can easily end up costing a doctor his ability to prescribe narcotics.
I wish you luck, mislead; you might find the answer you are looking for from someone else out there-- that is always the case. But as I have said many times, tapering is a fool's errand. All serious efforts to truly stop opiates start with a period of severe misery in a detox center... which is why Suboxone is appealing to some. In both cases, the underlying condition will always threaten to mess things up.
A second thing, though, that pushes me to see you not having only 'physical dependence'... those people do not have near the trouble tapering the drug as do addicts. I have seen people merely physically dependent many times back when I was a pain clinic doctor; the people got sick and got angry, but they didn't have trouble stopping. They wouldn't do anything unethical or illegal to get more drug, like borrowing more from a friend or buying on the street-- because the use of drug had not yet affected their mind and insight on a deep level, as it is affected during addiction. Let me put it to you another way... say a person has viral gastroenteritis and is vomiting and uncomfortable. He could call a pharmacy and illegally order himself an anti-nausea medication... but of course you never hear of such a thing. Likewise a physically dependent patient coming off pain pills (taken for real pain) is not going to run around looking for a place to get more-- he will simply feel crappy for awhile, and maybe cuss out the doctor who didn't warn him about the withdrawal.
The addict, on the other hand, cannot do that. He can't because it is not just a matter of saying 'I will be sick for a week, but in the grand scheme it makes little sense to keep on the opiate, as the sickness will then ultimately be worse'. The decision is clear-- the time to stop is now, as soon as possible, as all future attempts will only be worse. Only during addiction does it become impossible to make that simple judgment, and stop taking the medication.
You are likely addicted much more than you realize. As for research, it is not easier to taper off dilaudid than methadone; such things have been tried, and in general long-duration meds are easier to taper with, as they can be taken less often, therefore extinguishing the conditioned pattern of dysphoria--use--euphoria several times per day.
But... it doesn't matter, because in the US you are asking for something illegal. It is illegal (the Harrison Act) to use an opiate to treat withdrawal or addiction, EXCEPT in two, highly regulated circumstances-- the first being methadone, since the early 1970's, and the second being buprenorphine since 2000. A physician is allowed to dispense, not prescribe, opiates each day for a maximum of three days to treat withdrawal. But it is illegal to prescribe a taper of a schedule II narcotic. The way many docs do things is to be sure to document that they are treating a pain condition and doing a trial of lower doses... but doing things like writing out taper plans for schedule II drugs can easily end up costing a doctor his ability to prescribe narcotics.
I wish you luck, mislead; you might find the answer you are looking for from someone else out there-- that is always the case. But as I have said many times, tapering is a fool's errand. All serious efforts to truly stop opiates start with a period of severe misery in a detox center... which is why Suboxone is appealing to some. In both cases, the underlying condition will always threaten to mess things up.
You stated above...
"A physician is allowed to dispense, not prescribe, opiates each day for a maximum of three days to treat withdrawal. But it is illegal to prescribe a taper of a schedule II narcotic. The way many docs do things is to be sure to document that they are treating a pain condition and doing a trial of lower doses... but doing things like writing out taper plans for schedule II drugs can easily end up costing a doctor his ability to prescribe narcotics.
I ended up the local ER in full blown w/d's losing fluids by the gallon's. I was on the 75mcg patch and oxys for break through. I had lost two patches in my bed due to a heat wave and extremly high humidity. The Dr popped me in the ER with no opiates in my system at all when I also have break throughs.
The ER Doctor started to wean me off the patch as is stated in the pain contract when you break it. He wrote me a scripts for three 50mcg patches and even more oxys(omg) cause I was in W/D's. Then my Dr. wrote me for 3 more 25mcg..then 12.5's etc.. and clonidine. She did a taper. Do you think this goes against the Harrison act what she did?
"A physician is allowed to dispense, not prescribe, opiates each day for a maximum of three days to treat withdrawal. But it is illegal to prescribe a taper of a schedule II narcotic. The way many docs do things is to be sure to document that they are treating a pain condition and doing a trial of lower doses... but doing things like writing out taper plans for schedule II drugs can easily end up costing a doctor his ability to prescribe narcotics.
I ended up the local ER in full blown w/d's losing fluids by the gallon's. I was on the 75mcg patch and oxys for break through. I had lost two patches in my bed due to a heat wave and extremly high humidity. The Dr popped me in the ER with no opiates in my system at all when I also have break throughs.
The ER Doctor started to wean me off the patch as is stated in the pain contract when you break it. He wrote me a scripts for three 50mcg patches and even more oxys(omg) cause I was in W/D's. Then my Dr. wrote me for 3 more 25mcg..then 12.5's etc.. and clonidine. She did a taper. Do you think this goes against the Harrison act what she did?
If anything had a 99% probability of success it would be in widespread use. If anything had a 39% probability of success it would probably be in widespread use.
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