Hydrocodone Withdrawl while on Tylenol 4 Codeine

[sunnyginjersey]

My brother had back surgery in '95.  Since then, he's been on Hydrocodone (low dose to begin, gradually increasing until the latest 7.5/750 dose, prescribed at 4x's day) and Tylenol with codeine (starting with a lower dose, now he's up to the Tylenol 4 with codeine 4x's day).  Of the latest Hydrocodone 7.5/750 dose (aka Vicodin ES), he was taking 3 in the AM, 3 in the PM.  On the days between his script renewal, he would take 4 Tylenol 4 w/codeine (2 AM, 2 PM) to get him through to his next script (which normally took about 5 to 6 days - it was a 15 day script that he finished in 9 to 10 days).  

After approaching him, he said he would quit, cold turkey.  About the 6th day, he began to have severe pain in his neck & shoulder (I even had to rush him to the ER).  He was still on the Tylenol 4 when I rushed him to the ER (he had taken 3 that morning, 2 in the evening on the day we went to the ER & the day that followed).  The Dr. in the ER said it was a muscle spasm, gave him a shot of liquid Advil & sent him home.  Could he be having severe withdrawls after 6 days?  Could the Tylenol 4 prolong his symptoms of withdrawal?  How long would the withdrawals last?  When do they "peak"?

A few days later (Sunday morning), we put him on a Fentanyl patch (25 mg) because he was in so much pain again, sweating, clammy, cold...  He said he was clammy & cold because of the pain, not because of the withdrawl.  (The last time I saw him in so much pain was when his back went out and he was rushed into surgery the next AM!)  His Dr. had prescribed the patch to give him some relief while getting him off of the Hydrocodone.

Are we throwing him from the pan and into the fire by placing him on the 25 mg fentanyl patch (aka Duragesic)?  I know we have to find out the underlying problem is...  We're waiting to get an appt with a good Orthopedist / Pain specialist.  I don't even think that my brother knows exactly the extent of his pain anymore.  He says his shoulder is killing him but his back was fine (then why was he taking the Vicodin ES for so many years - it's a rhetorical question).

All of July has been very trying on me and my family.  Having confronted him twice, being lied to, playing detective to "catch him" in the lies and monitoring his med usage(he sure as hell wouldn't admit that he was taking the pills again, but he was & he was hiding them from our family).  Now that he's on the Fentanyl patch, he's a happy camper again (with some pain in his shoulder - he's still taking 2 Tylenol 4 w/codeine a day - 1 pill, twice daily).

[quartermiler66]

Codeine withdrawal sucks, between the aches, chills, sweating, runny nose and generally feeling like ****, keep in mind that it WILL get better......If you can taper off, that would be the way to go, if not, grab a blanket, turn up the heat and drink lots of water......

[perctd]

on day 4 with c/t from 70 mg percocet. the frist few days were pure hell. i am now walking in a daze and trying to function as a mother of two teenagers, wife and medical office manager. how long is this physical thing going to last? i am going to see someone about the mental stuff. i would take the pill's just to get through the evening. and it got to be more after Katrinia hit our home. is there anything i can do? i am under a dr's care he told me to throw all pills away... i did this 4 days ago. i did not taper dowm. he put me on tow antidepressants and xanax to get through....

[Wounded Soldier]

I am sorry to hear about your brother. But the Fent. Patch is a severly addictive drug. After I was med evaced from Iraq, I was put on those patches 50mg. Because I couldnt take pain pills. They made me very sick. So the army doctors kept me on those nasty patches for 6 months. Then just took me off them when I was getting medicaly discharged due to my injury. I have never been addicted to anything before in my life. But I honestly thought I was going to die. The first day off the patch was so unreal. I was rushed to the ER on base, because I couldnt keep anything in my stomach. It was horable. The ER doc informed me that I was going threw detox due to the patch. The Doc even made a joke at my expense. Saying now I can relate to a heroin addict. Well I could have gone my entire life not knowing that. And it took me several weeks to get over the withdraws. And now that I am seeing a civ. doctor, I am on pain killers(hydrocodone 7.5). And have been for several months. And I am reading alot about the addiction. And it sounds to me like I am going to have a problem with the pills as well. But if it were up to me I would ban tose patches.

[sunnyginjersey]

Caregiver222,
Thanks for the comment.  An Orthopedist just put my brother on the steroids for 5 days (I think - it tapers)...  We'll see how he does.  He's due for an MRI to check for a possible herniated disc.  As he has a Dr. who knows his past (with the dependency / addiction) and is looking to get him off the narcotics, I think we're headed in the right direction.
- Sunny g in jersey

[caregiver222]

Read the book by Dr. Tom Szasz on "The Therapeutic State". Get him a TENS device, which is a little complicated to use, and is best used when you get trained by a pain specialist. It works because the brain can only recieve one pain signal at a time. The small electrical pulses over-ride the incoming messages from the pinched spinal nerves. Accupuncture works the same way. The thing to remember about oxycontin (I posted this in an other message, but its worth saying again) is that you may be popping them like candy, and then get off them for a month or two, and if you start with the same dose you end up in respiratory arrest. Most of the deaths are because some kid is popping them like candy and introduces someone new and that dose will paralyze the lung muscles, especially when combined with booze. Percocet is especially dangerous, because when the number you take goes up you introduce toxic levels of aspirin into the blood. Many addicts end up with scratches that bleed because their blood won't clot from the aspirin.

[sunnyginjersey]

You are correct, MD-RG.  I do suspect that he is addicted to the meds and it is beyond the dependency stage.  

We have an appt with an orthopaedist on Aug 7th and hope to be able to take it from there.  Yesterday with the immense heat (on the east coast), his body temp rose and he started feeling nauseated from the fentanyl patch - so he took it off (he works in unfinished homes - therefore, no air conditioning...  it gets HOT!).  He took 2 Tylenol4 w/codeine this am and is starting to have the onset of pain again.  

We'll have to see about other forms of help (for his addiction) to work with the ortho.  I can't say I trust his regular MD as he prescribed the meds for years without obtaining any blood work from him (since 1998!!).  I guess we can start with his Ortho?

Thanks again.

[Roger Gould, M.D.]

I see the problem but I am not sure what the question is, so let me guess, and respond.  I think you suspect, and are probably quite correct, that your brother is severely addicted,and all of the behavior you described is consistent with that.  He needs to be in the hands of someone who can understand and treat his addiction, and someone who can work hand in hand with a good orthopedist.  It's impossible to determine if I am right from this vantage point, but that is where I would start if I were to advise your family. It may have started as pain, but now it is much more complicated.

[caregiver222]

Generally, anti-inflammatories are more helpful than pain killers. Prednisone is a killer drug, but two or three days of prednisone, followed up by ibuprufin (Motrin), is a much better pain strategy than taking tylenol. You have to kill than inflammation.  Oxycontinin is good, but you quickly develop a tolerance. The pain is also mediated by osmolality, which in turn is influenced by blood sugar levels. A low sugar diet and small meals will reduce that pressure.