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Avatar universal

How do I make morphine withdrawal more tolerable?

I am a 67 year old long term chronic pain patient that was put on methadone 14 years ago when I underwent cancer surgery and was not expected to live. When I moved to Mexico three years ago methadone was available, but it has recently (six months ago) been replaced by morphine, so I have been taking morphine since then. While morphine does seem to reduce my pain, it is not effective in affordable quantities. I go through about 400 30mg tabs a month. Curiously, methadone, one of the worlds least expensively manufactured drugs is twice the price of morphine here in Mexico.  I reduced my intake down to 90mg, or three tabs a day and tried to quit but perhaps because of my age, I was not able to tolerate it. I will continue to taper off, reducing 15mg. (1/2 a tablet) every five days until I try again, but I suspect it will still be extremely difficult.

I am hoping someone can suggest something that will make quitting more tolerable. I am also suffering from a rather severe depression probably brought on by the loss of a long term goal due to my progressive disability--I was a sailor on my own ketch hoping to sail the world but was stopped about 1/4 of the way around. That hurt me! Now I can't leave the house or do much of anything else. No drive to do anything, and being like this is all new to me. I have always been very active. Someone suggested this lack of desire is due to the morphine. Could it be true?
    
Thanks, any help on these two questions will do a lot for my plight. Having no energy, no desires, and withdrawing is apparently too much. Still, I hope to quit...
11 Responses
177003 tn?1266273955
Hola,

I agree that it's much harder to change as we get older. You can do a slow taper off the morphine/methadone. Which ever you wish to get off of now. The part I'm not sure of is that you will need something for your pain always. No one could expect you to go with no pain meds.

Do you have a doctor you could talk to about this?? Once you decide what you want to do you will get lots of support here. The people are wonderful.

Please keep posting so we know how you're doing. Welcome to the site and the forum here. I am second generation in American. I'm sure you have come across plenty of Navarro's. I am in a northern state now and freezing.

Take Care.....LS    paz
Avatar universal
Thanks for your kind comments, they are welcomed and appreciated.

I should say that I haven't used methadone for about seven months now. I can't help but wonder if I might be able to use light amounts of methadone to assist in my attempt to get off the morphine more easily. Medical web sites have stated this as effective providing the magic 21 day number is not reached. If it is, then maintenance procedures are suggested. I do not understand the makeup of receptor sites well enough to know how this applies to someone who has a long-term history of methadone use. Are the sites completely cleared after disuse of one drug in favor of another and will usage begin as if it had never been or do the sites retain a "memory" of sorts for a particular chemical.

I went from methadone to morphine with no difficulty so I suppose the morphine and methadone are occupying the same receptors. If such is the case, I suspect taking methadone, even though it might be a short time and effectively ease withdrawal, it may quickly put me back into the previous methadone dependency possibly causing me an even more difficult withdrawal.  Methadone has a lengthy half life in the human body making withdrawal more difficult just from the the aspect of the time required if not necessarily the intensity.

I do suspect my pain problems will be sufficiently diminished to make removal of the narcotic analgesic a possibility, but not one I am capable of easily accomplishing. I suspect this withdrawal will be a worthwhile endeavor or I would not attempt it.

Yes, I do have a doctor, but I suspect I am far more methadone knowledgeable than he. In Mexico one studies little about pain management, and even less about opiate pharmacologies. This is still a very backward, very corrupt country. He is a good friend and helpful, but not particularly knowledgeable. Strangely, I found much the same with physicians in the states.

Sorry, long post. Difficult to do science in short however. Additionally, I'm a technical writer and we understand the difficulty of effective communication.  Makes for more words, never less. In future posts I will make attempts to be more concise.
177003 tn?1266273955
I didn't think your post was too long. Sometimes typing things out here helps a person. If I understand you correctly, you are concerened you will trade one addiction for another. I also understand about the Drs. I am very lucky in that respect. My Dr. has been the most encouraging person throughout this whole thing for me.

I am on fentanyl transdermal pain patches. It's hard to taper from fentanyl because you can't cut the patches in half or quarters. I have made three tapers so far. Now I have the choice of seeing if I can go lower or go on methadone for two to three weeks and take the patches off now. I'm afraid of that, also. I don't want to become addicted to the methadone. I have an addictive personality so my fear is founded.

I'm glad you won't have to be on pain meds when you're off all drugs. That's a plus. I won't be on any, either. I do hope you come up with a plan that will work for you. Posting here is helpful because you will hopefully come across a person who is going through the exact same thing as you.

Again..keep posting

Take Care....LS
Avatar universal
My mom lived in Playa for almost 10 years.  She noticed quite a few americans go down and get playa syndrome.  it's laid back there, not a lot goin on yadda yadda.  That could have something to do with not wanting to much.  Are you living in Mexico.
Avatar universal
Yes, I do live in Mexico--in Baja Sur. It's desert of course and hotter than a stove with a broken thermostat. Even in the winter it's hot.

I think the reason I don't want to do much has nothing to do with Mexico, but is primarily a product of the morphine. I hear that is a product of morphine use. I read about one guy who did nothing but lay on the couch for two years. Never left the house.

I'm a pilot and I own an airplane that I love to fly, but I don't do that because I feel completely wiped out.

Must be the morphine.
177003 tn?1266273955
I'm mixed up and confused about what's going on with the board suddenly. I suspect there is some drama, but it's things that are really bothering addicts and they should be able to talk about it here. I think I might get lost in the shuffle. please use this to write me. ***@****
Hugsss, LS
176889 tn?1234356182
Welcome to the forum... a lot of really good people here are able to help in unique ways with a lot of experience and honest enthusiastic support... and you were quite lucky that one of the nicest ones here was first to respond...  I had some experience being hooked on a low dose of methadone - as you point out, the 1/2 life is very long, and despite being brought on as a "cure" for heroin addiction, in itself is one of the worst w/d's going... opiate addiction definitely cuts into one's drive, inevitably makes you sleepier (even if there's an initial burst of energy), and eventually depresses your mood... as you taper you might talk to a doc about a good antidepress med - it might really help... Good Luck to ye!  You sound like a good honest clear-headed person who definitely has what it takes to win your life back... people here who you'd think are maybe sick dropouts ("addicts"!) turn out to have amazing inner reserves of heroic strength and spirituality, as well as being wonderfully giving and caring people even amidst all their own pain and struggle...       All the best!            Nefesh
Avatar universal
What a great and uplifting post. Thank you for the kindness and the support.

I don't feel taken over by addiction as I don't have any "high" that I have ever noticed. I just have this nagging depression problem. Unfortunately most seritonin reuptake medications used for depression are contraindicated with opiate use. I researched methadone in concert with other pharmacologies and find over 100 difficulties. I have even had doctors make huge mistakes. The big surprise was in having pharmacists pass those errors along to me. They shoulod be more kinowledgeable tham physicians in this area but they get so busy and there are so many variables that it is difficult to know with any precision which pills will damage you. Consider that each med accompanied by another produces one one but multiple possibilities for unexpected results.

This may be a surprise but there are over 100,000 people each year killed by mixing inappropriate meds. Now, and especially in Mexico, I do my own research through some specialty sites. Even there I will not accept the findings of one site unless I can find similar results from others and I will look at none that do not have medical science backing them.

I'm frankly very positive about this board. I usually do not find many accepting folks as I tend to be so bloody scientific about things. Thanks to everyone who responded so kindly. It is sincerely appreciated.
176889 tn?1234356182
you one interesting feller - except one small correction my friend... you mentioned that you don't have an addictive personality - with the exception of your science addiction, that is!  could I ask you a few questions? I respect your quest for real info and you seem to have struck on quite a lot of it (although I think you also need that far less quantifiable necessity that is so strong in this forum - the power of common bond, shared experience, prayer, reaching out to help/be helped, honest caring...)  I'm taking lots of darvocet, fair amount of codeine, smallish amts. of percocet (in a rush, I can give more precise info next time) and ALSO 30mg daily of serotonine reuptake inhibitor (Cipralex) which seems sometimes to help... I was also on methadone (small dose) but stopped after three years... this other stuff's been going on for many years... I guess I'd like to know about the combo interactions if any, the cipralex, and there's a newer category of anti-depressants that stimulate the pleasure centers of the brain - would this be an option for you, or me?  also: you sure you don't mebbe get a leetle enjoyment/good feeling when you take a dose?  really just purely to reduce the pain except now you're addicted?  by the by, it's probably a blessing that you don't feel like flying!  doing it on morphine might not be the most wonderfullest idea!!            L,   Nefesh
Avatar universal
Again, thank you for the pleasant and uplifting words.

Yes, I realize the lengthy withdrawal from methadone. I have been there several times as new doctors have cut me off. This makes for a rather frantic search for someone knowledgeable enough or someone willing to accept reality. Unfortunately, doctors are not the brightest group of people and often it's a fight to bring their thinking into the present. The DEA is no more looking for them than Santa Clause or the Easter bunny. Writing scripts for methadone is both legal and acceptable. I have spoken with the DEA and a very close friend of mine is with the FBI. No one cares if physicians prescribe methadone. What they do care about is continuous and rampant prescribing.(read: amounts completely over the top)

When I was using methadone for pain relief and the pain was much less manageable than now, I went into one doctor for a spinal block. He was a pain specialist and within 20 minutes, gave me 12 injections of the same chemical as in your fentanyl transdermal patches to numb my back. It didn't work. In fact, the effect was  never noticed. The methadone completely blocked the fentanyl. It was so dramatically blocked that the doctor was extremely upset.  After the spinal attempt, I told him I was going across the street for lunch and he said I would just throw it up, that I had enough fentanyl in me to kill a smaller person (I'm 6' 4 & 250 lbs). I felt the same as I did before the injections. Lunch didn't come up. When he was finished, I told him I would ride my motorcycle home (Honda 90) and he forced me to sign lengthy release forms and was extremely angered. He felt I was being unsafe for all the chemical he injected. Still, I felt nothing and stood on one foot, eyes closed, looking at the ceiling (not possible when impaired) this still failed to convince him I was fine and I was again chewed out. A rational person would see cause and effect--he refused to look instead relying on his emotional uptake and a staunch belief in his chemicals even though his training has told him people react very differently.

This tells me something about the way the methadone saturates the mu-receptors (the sites where methadone is known to replace endorphins) as well as the possible inability of fentanyl in metabolic pathways ((cytochrome p450 enzyme)) Sorry, this is science and a favorite tool for me but often boring to others. I probably shouldn't use it. It drives many potential friends away--they don't seem to care for intelligent people. I don't understand this completely either, but am attempting to find how morphine and methadone are treated in common association within the body but more specifically if the mu-opiate receptors (neural receptors) can "learn" to appreciate one chemical over another, binding with methadone too rapidly and easily. Thus in a long term methadone user will the methadone bring on the past addiction more quickly than from an original, or unknown state where methadone had not been introduced? I just don't know.

Basically what this means is that if my research is successful, I should be able to tell you if methadone will help you in your quest to get off fentanyl without archiving a methadone addiction. Obviously this is my concern as well, but the answer should be beneficial to both of us. So far however, my search over the internet has not been successful. If there is a scientific paper produced on the mu-opiate receptor sites (regarding this "learning") I can't find it. If you do, please tell me. I generally can speak and understand most of the scientific and medical language and may be able to understand enough to know what will occur if I use methadone temporarily.

So far, I can say with some authority that my experience tells me that methadone may be more receptive than fentanyl, and this is not necessarily good unless you can taper the methadone within about 15 days. That should not produce methadone addiction and it should kick out the fentanyl. Obviously this is little more than an educated guess.

The problem is that I am not a particularly good test bed as I am far too objective while most people are rather subjective. The psychology of drug use may be more important to some than the actual science of it. Additionally I am not at all an addictive personality.

So, as I research, I will attempt to post you my findings. Perhaps the short term use of methadone will be OK. I think, if I remember correctly, that you have not used methadone. If so, you might be successful in using it to taper providing the usage is kept short.

Methadone is such a long acting opiate with a slow response time so that it is not always seen as capable of producing the typical opiate high. No sharp up's and downs. I have never been high with it in the 15 years I relied on it. It was successful in reducing pain, but other than that, I didn't notice it. As an addictive type, you would have to be particularly careful not to use high doses and force yourself to remain true to your planned reduction schedule. Be advised that some people can't use it as it can produce some pretty horrible itching. If your doctor is very knowledgeable he may be able to correctly advise you.

I was unfortunate in my dealings with physicians, finding few I thought capable of objective and rational thought. Additionally there was no common thread of findings doctor to doctor, and there should be. Methadone is one of the most studied drugs in history. You would think that that body of knowledge would find it's way into the practice of pain medicine but that is not the case.

Thanks again for the positive input. That is always appreciated.
Avatar universal
Lots of questions concerns to respond to. A bit difficult for me tonight as I just dropped another 15mg yesterday and am feeling somewhat empty. Although I can tolerate this somewhat easily, it does effect me.

First I must recall all your questions as my browser kicks me out if I go back.

OK, Solved it by pasting your post to notepad.

First, science is not an addiction, but a tool. Just as language is a communication tool, science is a problem solving tool. I use it in that way. Were I to give it up it would be akin to forgetting English a bit at a time, say in 50 word groups--would you do that? Nor will I quit my search for truth.

Jeez, typing is difficult tonight. My kitty scratched my finger quite deeply and the bandage is causing numerous multi-key errors.

"The power of common bond" I have difficulties finding common bonds with most folks. I do enjoy helping others however. I always have. Few wish to help me however. I have always been "the boss" and after 40 years at the top it's hard to loose that natural social positioning. I'm not attempting to be the top dog, it just seems to naturally work that way. I always seem to wind up in that position. Frankly, my psychological testing profile even indicates that. I doubt I could change it at my age.

darvocet, codeine, percocet, Cipralex. Hmmm, I could dig out my PDR and give it a go, but you would be better off asking a well educated pharmacist. A very bright one, not someone who appears lazy, tired, disinterested, or gives short uncaring answers. Find one who is younger, bright eyed, active, with a pleasant smile and if my studies are correct, good looking as well. These sort of folks tend to be more intelligent and careful.

I would expect the re uptake inhibitor to be a bit of a suspected drug however.

If I recall correctly, and chemistry is not my forte, acetaminophen and propoxyphene make darvocet. Acetaminophen is  manufactured aspirin, not the willow bark derivative that is the basic compound in true aspirins or acetylsalicylic acid. Codeine is an opiate that would block the mu-opiate receptors [Greek letter that looks like a "U" is mu] kicking out natural endorphins because the receptors have a natural affinity for opiates.

Percocet is just about the same thing as codeine or oxycodone. So, you are taking three narcotic analgesics and a re uptake seritonin inhibitor. I can't recall exactly, but I believe that is contraindicated. I will look it up. Be careful with the amount of acetaminophen you take. That can do some liver damage in excess, and it's used with two of the three opiates you are taking, although I don't know the quantities. Again I'm using an old memory but isn't the upper limit somewhere around 4000 (mg?) Plus, it's not a bad idea to stop for a while and flush things with loads of water.

I haven't studied this since I was in college, so I may be incorrect. I was premed for a while on my way to an MD and psychiatry but gave up the MD and graduated in psychology instead. I can't take nasty smelly body fluids getting all over me...yukkk.

So I mastered in business and went on to law school. What a change huh? Never did a thing in psychology or law--not a horrible waste of time however, but almost as the only accurate psychology I studied turned out to be the behavioral sciences like with Skinner and his over packed rats, Pavlov and the slobbering dogs.  

I will look up the re uptake inhibitor and get back to you. Wait a min, I'll do it now.

Didn't find any problems but don't take methadone while you are using the other opiates. Here is what I found with that:

Alfentanil, hydrocodone, fentanyl, meperidine, morphine, oxycodone,and propoxyphene have common CYP450 pathways with methadone. However interaction probably occurs due to possible additive opioid effects. Long-acting excitatory metabolites of
meperidine and propoxyphene can reach toxic levels!
(Harrington et al. 1999).

Be careful mixing drugs. I caught my mother taking 19 different drugs. Spoke with her physician and he had no idea what all the possibilities might be. She died several months later. Was it drug mixing? I thought the possibilities existed because the potentials were so high. So did a good friend of mine who is a PhD chemist with the FDA. He is head of the department and was concerned with a combination that could dramatically alter her blood chemistry.

Finally... No, I never have felt a high. I use opiates only because the doctor started me on them and they reduced my pain, gave me a life back, then abruptly pulled it a year later. I am physically addicted as everyone who takes opiates generally becomes, but not psychologically, and I do know the difference. No, I am not kidding myself. As I said, I am extremely objective.

Again, another huge post. Good bloody gawd! I can't help it I guess. Between the writing history and my enjoyment of seeking the truth it just goes on and on and on and on and on and on ad nauseam...  Sorry! And I mean it. I do beleive the involvement is helpful for me. I just noticed that the hour I have been doing this (and having an ice cream) that I almost didn't notice my feel-bad (well, feel less good anyway) from the recent reduction. I don't feel my best, but it's nothing I can't do.

This depressed thing is brand new to me and must be the morphine. I have been so damn "up" all my life. Never depressed, never a problem, always high on living and doing something new. Even with the methadone I was doing reasonably well. I think having to give up my 40 foot sailboat and the goal of sailing around the world coupled with the morphine has me seriously depressed. I still have the plane but don't feel like flying right now. Now that's strange! I love flying my little airplane over the Sea of Cortez and the desert Baja mountains looking for animals. I land on the beach and can fly 50 feet off the deck anywhere I want here. It's so fine! But I can't seem to drag myself out of the house. No interest, no desire. I guess my pain levels are bothering me a bit too,. but nothing I can't tolerate.

I do thank you for appreciating my assistance and saying good things. You are a certainly wonderful person!
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