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Duragesic patches---any medicine comparable to it so I can switch without withdrawls?

Hi,  I've been on the Duragesic (Fentanyl) patches for approx.  3 yrs now, I am on 200mcg every 2 days.  I want OFF the patches---but do I still need the help of opiate therapy.  I am facing another surgery and cannot go without-not do I want to go thru withdrawls.  Does anyone know of another opiate medication that I can take by mouth (well, as long as its not a PATCH!) that will be a substitute for the patches---so I won't go thru withdrawls?  I was wondering about MS Contin?  Is Duragesic really morphine or a form of it?   Eventually, once surgery is done and I can taper off whatever I will be on.....I want to be done with pain meds.  I've been so depressed for years now, I am not sure if its due to the pain or the patches?  Anyone ever used Duragesic for a long time and got really depressed?  
Thank you to anyone who can give me info on my questions.  I really do appreciate it.  I just hope I can figure out HOW to use this site again to read the responses!  I am new this this site.  
Tinamat
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Avatar universal
i am re  ading allabout the patches i am on two of the patches a 100 and a 25 also on pills and oramorph all for pain i feel like i am addicted to it all pain theripist is trying other stuff to help with pain but feels like i just get given more and more pills which do not deem to help the pain i dread having to come off all the pills i even had ketimin for a while i had my teenage kids atg home then i tend to lock everything up in a safe i dread coming off it all i have been on it all for ten years i often thnk about comming off my medication but am scared but they do not seem to work anymore so is it worth still being on them
Helpful - 0
Avatar universal
I'll first start out by saying Good Luck with your surgery and detoxing. Now I must tell you something very important. Under NO circumstances, do either of the following: cutting your "Duragesic" or "Santos" brand patches and trying to re-seal them; or poking a pinhole in the patch and trying to release some of the Fentanyl. Either of these two methods could prove to be FATAL!!! First, with either of these methods, you could get an overdosing amount of Fentanyl on your skin...especially when dealing with 100mcg patches. Duragesic has been sued by several dozen people a couple of years ago, due to a faulty batch of patches. These particular batch of patches were not sealed properly during manufacturing and their edges were leaking Fentanyl...directly on the skin. Many people died from this. Even if you get through the process of cutting and re-sealing and/or the "pinhole" method unscathed, the next part has just as high of a potential for overdose. Any type of hole in a gel patch works as a carburetor. In other words, it creates a vacuum and can send the Fentanyl into your system a 2x the normal flow/absorption rate. I'm not a Doctor, and I actually only know all of this for a friend of mine is a Pharmacist. I had a situation once where I was in need of my prescription refilled and my Doctor was on vacation. No one at his office was able to write a Schedule II prescription (or so they said), and I was going to be without patches for 3 days. So, my friend, the Pharmacist, told me that if I poked a hole in my patch on the last day...it would release the remaining amount of Fentanyl (for there is actually more Fentanyl in the Patch than what is used). He also informed me a few more things that people were actually doing and were dying from...but we will not discuss them here. I just wanted to warm you about trying either of these methods, for they could result in serious injury....or even be Fatal!!
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Avatar universal
Thanks so much for your advice.  I haven't been online for a while now---sorry for the delay in responding.  Question, I do NOT have health insurance nor do I have a lot of money (pretty much, I am broker than broke!).  Long story their!  Just health problems and working at a job that doesn;t offfer health ins, but pays my bills---that's it.  I'm sure you don't want to hear my sobbing in regards to money!! Sorry.
So, is the suboxone expensive?  I seriously could not afford anything that would run me more than approx $50-$100.00 a month.   I've been getting the Duragesic for free for the past 2 1/2 (?) years from Janssen Pharm--I qualify for their "poor people" program, thank God!   I go see the pain mgmt Dr in Indy on mon 8/20/07, and I am scared to see what he will do with me.  I talked to a pharmacist locally and he mentioned Methadone as a possibility for me.  Price is cheap he said. He also said Dilaudid works on the same receptors as Fentanyl.  That drug is a little more expensive though.  I just don't want withdrawls----I want to be able to switch to something and not be sick so I can continue to work etc.......I never in a million years knew that Duragesic was so damn strong.  I do remember the first patch---it made me feel so "in the clouds"---high i guess.  And that was just by wearing a 50 mcg!  I am now  on 200mcg---and NEVER feel a thing anymore (just helps with pain).  That's scary, that must mean i am so used to opiates that something that strong that I might as well be swallowing M&M's----and another person would be very messed up on it!  I am so scared.
I hate that I agreed with my Dr long ago to go on such dose.  
Well, again thanks.  I will keep you posted.  Any suggestions---I would appreciate them!

Helpful - 0
228936 tn?1249094248
these folks who posted seem to be knowlegable but defer to the anestioligist or pain specialist. all the best
Helpful - 0
82861 tn?1333453911
With another upcoming surgery, I would not go the suboxone route right now.  Save that as a possible option after the surgery - and hopefully when you're pain is lessened.  The reason for that is suboxone contains a partial opiate antagonist along with a very strong synthetic opiate.  The partial antagonist will basically counteract any other opiates you put in your body.  Not a good idea for post-op pain.

No, fentanyl is not morphine.  They are 2 different chemicals.  Morphine is derived from the opium poppy and fentayl is a synthetic compound.

The Mylan patch is a generic version of the fentanyl patch made by a pharmaceutical company called Mylan.  Instead of gel, the medicine is embedded some way into the adhesive, and the patch just looks like a piece of clear tape.  Since it doesn't have the gel in it, the Mylan patch can be cut little by little to reduce the dose.  It's working well for me so far.  I have heard of people cutting the gel patches and re-sealing them with a lighter, but I don't know how well that works personally.  Maybe just poke a pinhole in it and squeeze out a tiny amount to begin with?

I think you'll also be in big trouble if you cut your dose in half right off the bat - meaning putting on one patch instead of both of them.  That's a 1/2 decrease and I suspect you'll experience some pretty bad withdrawals going that route.

Hopefully your new doc will be able to help you decrease your dose.  Just make sure you tell him all of your concerns.  Write it all down if that will help you to remember everything.
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Avatar universal
By the way...I was on a 75 mic Fentanyl patch every 2 days and the wd's were quite bad.  You have to prepare yourself for this.  I would recommend taking a week  off work if possible.  I dont want to scare you but the first 4-5 days will be the worst.  Sweats, diareaha, vomiting, not sleeping, rls..those are only some of the things you can expect.  

Day 6 I started to notice some physical improvement.  Day 14 all physical symptoms seemed to disappear but the mental problems persisted.  It took approx. 2 mths for my mental state to return to almost norman...if any of us are normal.  My point is if I can do it anyone can but prepare yourself.

If you need someone to talk to I come to this board every night around 7pm central time...I'll gladly help in any way I can.

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Avatar universal
Suboxone is the latest/greatest thing to come along for opiate withdrawals.  Suboxone is an opiate but it acts differently.  It is prescribed only as a way for people to get off of narcotics and most people take it approx. 30 days...all are different.

Suboxone does not give you the "high" that we all like.  The problem is for this stuff to work you hvae to be in a moderate state of withdrawals and those are a b itch.  Google Suboxone for more info...I have heard it works great.  Good luck.
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Avatar universal
Thank you soooooooo much for replying.  No body has.  I am so happy that someone out there knows what I am going thru--and about to got thru. The patches have been free to me thru the Janssen Pharm. company due to low income,  I priced them and they are like in the hundreds of $$$ for a months worth., I have no money.  I has NO idea that these were much harder to detox off of than pills.  I went thru Vicodin/perc detox yrs ago, and I said I would rather die than go thru that again.  I just pray that I can wean myself off.  Ya know, the smart side of me is saying to only apply 100 mcg instead of 2 every 2 days and try to cut down myself--as you mentioned, but the scared "of the unknown" part of me, won't do it.  I should.  Is Fentanyl morphine?  Or a whole different drug altogether?  You say it's STRONGER that morphine?   WOW!   I am in for the ****!  I am scared to death, i can hardly type i am shaking.  
I had no idea their was such a Dr as a "pain psychologist".  Thanks for that tip.  I will seek one AS
AP.  
Hey, this Mylan patch....is that a medication patch or what?  I have these 100mcm patches here---ans would like to cut it in half and begin coming off of them slowly, but we know the gel will oooze out---I have these dressings that I apply over the patches to help keep them on, I wonder if I cut the patch in half and used that dressing to seal it closed if that would work?  Did i make sense?
Please let me know what u think about that.  I only have 2 weeks left to make this work, than I go see a new pain Dr and possibly face surgery..   I am so scared.....
Tina
Helpful - 0
82861 tn?1333453911
Hello and welcome!  I've been on the fentanyl patch for over 2 years, and my maximum dose was 75 mcg - not even close to where you're at.  Fentanyl is one of the most difficult opiates to detox from and it has to be done very slowly.  I am currently detoxing myself and went through horrible withdrawals a few days into decreasing the dose by only 25 mcg to 50.  Puked my guts out, diarrhea, RLS all over my body that just would not stop, and blood pressure through the roof.  My pain doc was of no help whatsoever in this area.  I certainly understand your desire to get off these things.  While they worked great for my pain, they really limited me in activities I like - most of which involve being outside and in the heat or in my pool.  As you probably already know, sweat and the patch don't go together well.

First, fentanyl is the strongest opiate on the market - one of the reasons it is measured in micrograms instead of milligrams like morphine or oxycodone. Unlike morphine, It is a synthetic compound.  Comparing morphine to fentanyl is like the difference between a grenade and an atom bomb.

Second, since the patch is a long-acting medication, if you want to change to a pill form of medication you're looking at MS Contin, oxycontin, or methadone.  I'm sure there's others, but that's what I can think of at the moment.  Detox brain phart I guess!

Since you are on such a high dose of fentanyl, you may not have a problem tapering by 25 mcg on each taper early on.  Withdrawal symptoms may not become evident until you reach the lower doses.  Since my pain doc was of no help and actually tried to talk me out of detoxing, I had to figure it out myself.  I ended up getting the Mylan patch (non-gel) and started cutting slivers off it with a razor blade each time I changed it.  This method has worked well for me and I have experienced no withdrawal symptoms.  Obviously, the gel patches can't be cut since all the gel will ooze out.

Are you trying to taper before surgery?  If not, you might consider doing so as your pain will be easier to treat post-op if your tolerance is lower.

As for depression, oh yeah, I've had some real bouts of depression, but it's been more situational - due to my underlying condition.  I honestly couldn't tell you if the fentanyl made it worse - probably it did is my guess.  But what do you do?  Since all opiates are depressants, it probably wouldn't make much difference mentally if I were taking something other than fentanyl.

Are you also seeing a pain psychologist?  If not, give it some serious consideration.  Mine has been invaluable to me over the past couple of years - particularly through my detox adventures.  Withdrawal has two components - physical AND mental.  The same as chronic pain.  You'll do much better if both your body and your mind are treated.  Don't settle for just any phsychologist either.  A pain psychologist is trained to understand opiate medication issues whereas others aren't.  For instance, a non-pain shrink will hear that you're experiencing withdrawals and label you as an addict.  Addiction is a mental problem, whereas a compliant pain patient is physically dependent.  A pain shrink will understand the difference.

Hope that helps with some of your questions, and best of luck with your next surgery.  :-)
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