Sorry you're going through this. I have no idea on the Butrans patch. Clonidine is very often used to help with withdrawals.
Did you have a pain contract? And did you increase your dosage of the hydrocodone without your doctor's permission? If so, then they do have the right to drop you as a patient. Some doctors won't even help with withdrawal symptoms. Over time some pain patients do need their medications increased. But it's something we have to be very careful about. Even taking one extra pill ever could be cause for dismissal.
If your doctor will still treat your pain, you're fortunate as many won't even continue to do that.
It is likely you will have some withdrawal symptoms. Hopefully the Butrans patch and Clonidine will eliminate most of them. Try not to read too much about withdrawals as it can often make things worse, worrying about them. But do be prepared. There is a Substance Abuse Forum here on MedHelp and you can find a lot of helpful information there. There is something called the Thomas Recipe and it gives suggestions on things to get/do for narcotic withdrawal. One of the most important things is to stay well-hydrated. It is very easy to get dehydrated and it will make everything feel worse.
Imodium is often suggested for diarrhea and it also seems to help people with other withdrawal symptoms as well. Some people experience restless legs and bananas, tonic water (with quinine) or Hylands Restful Legs (found at most pharmacies) all help with that. Hot soaks in the tub help with all the withdrawal symptoms. Some people experience nausea and vomiting, and if you do, try to eat simple foods that appeal to you. (And in that case, it's essential to keep pushing fluids ... water, clear juices, Gatorade.) Sleep can also be a problem, and there are different OTC all-natural sleep aids you can try. Melatonin works for some. I find Alteril to work best for me.
Most people say withdrawals are like a bad flu, and the worst of it seems to last 3 to 5 days with improvement every day after that, though sleep and energy tend to be the biggest long-term complaints.
There are many ways to treat pain, as you know with the epidural injections. If this doctor is going to continue to be your pain management doctor, it is unlikely he will prescribe narcotics for you again. If your pain isn't being controlled, you can try having a frank discussion with him, and throw yourself on his mercy and say you'll never make that mistake again.
You can also try to find a new doctor to manage your pain, but that may be difficult due to what happened with this physician.
Good luck with everything. You're certainly not alone in having this happen to you. I would suggest picking up any items you may need for withdrawal before you begin to feel bad. That way you won't have to venture out to the store if you're not feeling up to it.
With the butrans patch I can't imagine that you'll have any withdrawal symptoms at all. Buprenorphine is a vey potent partial agonist narcotic and is the active ingredient in Subutex and Suboxone. The Butrans patch has been used for pain management in Europe for several years and was FDA approved in the US this year.
I assume your doctor told you how to take the clonidine appropriately if you experience withdrawal. It's an old alpha blocker hypertension medication that helps symptoms by lowering the blood pressure that skyrockets in serious withdrawal. You don't want to take it unless you're actually in withdrawal.
The patch should help your pain but you won't get the "energy buzz" that you were looking for with the hydrocodone. Bupe has a very long half-life which is why it's used for addicts who are trying to get off street drugs. You won't experience the highs and lows of a short-acting medication like hydrocodone which really is the goal of effective pain management.
Learn something new everyday!!! I didn't realize the Butrans patch was buprenorphine.
Thank you so very much for the information. I should have made it clear to the doc that I take care of mother in law and 138 lbs of liftng into car and out of bed and onto water closet is very hard on an already bad back. Still have pain with the patch though even after epidural. I am going to have to stop taking care of mother in law. It is time for asst. living I guess.
I am waiting for the other shoe to drop, I really do not feel to bad. I had some cramping last night, took imudium ( spelling (: and I have been ok so far.
I have not had to take the clonodine patch as of yet. Last hydrocodone was Tuesday and so far ok. Should I feel withdraw at this point? Sleep ok but have taken ativan I had for that.
I do not have energy though. Will I ever feel as good as I did ? Anyone have any good energy secrets. I take vit. d, c, b-complex and those energy pouches you mix with water. Still dont have the energy! Thank you again for your resoponses. It was very thoughful of all. PS I do have a follow up in a week I guess I will see if I am dismissed!
I just wish you would have called your doctor or made an appointment to request a change in dosage or a different medication BEFORE taking 60 pills of 10 mg hydrocodone in a week as it sounds like your pain was not very well controlled.
Hydrocodone is one of the more weaker narcotics (i.e., opioids) that is just slightly stronger than codeine. But, it has dire consequences if taken in excess due to the acetaminophen (i.e., tylenol) that is combined within it. If you were prescribed Lortabs, your acetaminophen intake was under the daily limit. But if you were prescribed Vicodin, your acetaminophen intake was slightly above the daily limit (i.e., 4,000 mg a day). I am sure your physician was also concerned about damage to your liver from taking so many pills in one week.
As others as posted, it is great that your doctor agrees to still treat you despite noncompliance and is helping you with the withdrawal. Clonidine, I have heard, is great for opioid withdrawal. And, I have taken Ativan myself for Tramadol withdrawal when I was shifting to Vicodin awhile back. It does help with sleep a lot. Just don't overdo the Ativan as it is a benzodiazepine that if abruptly stopped can cause seizures, which can be life threatening. Ativan when taken for long periods of time needs to be tapered. I think taking it to get through withdrawal is appropriate. VERY IMPORTANT, DO NOT take Alteril or any other natural sleeping aid that has Valerian root in it while taking Ativan as it will cause severe side effects as they both do the same thing but very differently.
I haven't tried the Butrans patch. I am on Morphine and Percocet but I have heard good things about it as the patch lasts 7 days versus hours.
The best of luck to you. I hope you feel better soon. I am sorry to hear about the lack of energy you have now being without the hydrocodone. But you must understand that this side effect of opioids is short lived unless the dose is continually escalated in short periods of time. Even if you would have stayed on hydrocodone, the energy effect would have began to diminsh. And, I believe you noticed this as to why you were up to 60 tablets in one week after being on hydrocodone for 3 years. I am certain you didn't start off taking 60 tablets in a week??? The ultimate goal (as was stated above in one of the other posts), is pain relief. The medicines will continue to work longer for pain relief than for energy or euphoria.
I really hope the epidurals help for your pain. I have had 6 lumbar epidurals so far and the pain relief seems to lasts longer after each repeat epidural. I don't know what your specific back conditions are but they work great for some and not at all for others. Did you get any relief from the first epidural?
I think it is time to have a caregiver come to your mother's home to help her as that is a lot of weight on your back to have to maneuver her around and it could be causing more damage. If you haven't had an MRI recently, I would suggest that you have one done so that you know and your doctor knows what the current state of your injury is.
Thank you for pointing out the issues with Alteril and Valerian Root and other sleep aids. I wasn't aware that they could cause side effects. I have switched off a prescription sleep aid because it wasn't working as well and I wanted to limit what I was taking prescription-wise. I have had some really strange side effects but didn't link it to the all-natural things I was taking. I had asked my pain management doctor about the Valerian Root in particular but they didn't have any real knowledge on it. I'm waiting for the pharmacist to get back to me as she didn't know much either but was going to do some research on it for me. I think I'll put it aside until I get more information.
The patch is working but some pain it is tolerable. First epidural seemed to work better then second but, I had the hydrocodone. I really do not use the ativan that much. I would rather switch to more natural product. Yes had MRI that is why epidurals. I think if they would up the doseage of patch from 10 to 20 I would have no pain. Each day I seem to feel better. Is the patch habit forming?
Does anyone know if you can take that nuycenta ( spelling ) that is supposed to work on the brain like opioids?
I would recomend the patch now, we well see toward the end of the week.
If I have not had any withdrawl at this point am I safe? And yes, I was only taking 40-60 hydrocodone a month, then I moved, ( across state and I and my son had to load rental moving trucks - then do painting in old house and prep for sale) had to take care of mom in law and 90 lb shepard in and out of my explorer. So I had to increase dose did not realize I had to call them. I just looked at my paperwork and do not see anything about that. I guess I had been taking them so long just figured I knew what I was doing.
Also, I was not really concerned about the opiate (liver) I was very concerned about the tylenol and asked for something with less than 325 mg of act.
Oh well I am here now and for now all good:) Thank you all for your feedback I do appreciate.
To Mary: I read about the serious side effects when Valerian Root and and a benzodiazepine (like Ativan, Valium, Xanax) are combined in a Anxiety Disorder book I had when I was having severe anxiety while back. My psychiatrist prescribed Valium for sleep and Xanax for panic attacks and anxiety during the day. She told me to never take them together even though they were in same class of drugs. One day at work I had a horrible anxiety attack so I took 1/2 of a Xanax and then 4 hours later when I arrived home, I took a Valium for sleep. The four hour difference was still too close together. I had a paradoxal experience. My heart started racing and I began to have a full blown panic attack. Benzos are a weird class of drugs such that they don't mix well with others within their class. Opiates are much different and most of them can be mixed with each other. I don't know if you experienced this with the Ativan and Valerian Root. I have never tried Valerian Root but I read that if you get the right kind that has the right mixture of ingredients, it will work just as well as a benzo. I myself have been on Benzos long term. Going on 6 years to be exact. I take Valium everyday and I am terrified about my switch to a different insurance at the end of the year. I hope I will find a doctor before withdrawal sets in. My meds are almost optimal for all my ailments and I am very afraid of what lies ahead. If I would have known the baggage that came along with Valium when I first was prescribed it, I would have probably decided not to use it for pain but if I miss a dose or two, 2 to 3 days later, severe panic sets in and once I felt like I was going to die. On the flipside, Valium works great for pain as it is a potent muscle relaxer. So I just want folks to know what they are signing up for when they are prescribed a benzo. Benzos are not bad drugs it just ***** that the withdrawal from them is lifethreatening.
To Deano: I think with time your actions will be a distant memory to your physician and he may open you up to other possibilities as far as medication goes. One treatment usually isn't enough to significantly reduce pain and multiple modalities are needed. So I do believe that the hydrocodone was assisting the injectioion for the result of more pain relief.
You are doing way too much heavy lifting! You need to have someone help ou with all of those things. I'll write more tomorrow if I feel like I didn't provide a full thorough answer. I am so tired right now, I am falling asleep while typing. I apologize for any typos.
My pharmacist is actually doing some research for me on Valerian Root and possible interactions with any of the other medications I take. I was on Ativan for many, many years, but I never took it regularly so I had no problem coming off it. I have found Valerian Root is just as good as the Ativan for anxiety. I don't know if it would help pain if you get relief from Valium for that. I have had some really strange side effects with the Valerian Root and I think it's when I take it with Neurontin. It's always the same and it's fleeting but intense as it's happening. The vision in my right eye goes dark and at the same time my left foot and arm feel really tingling and numb-ish. It only last for 30-60 seconds but it's sort of scary. I've taken the VR with narcotics before and never experienced this so my guess is it's the Neurontin. And it could be it's just my own wiring that causes this.
There are so many great medications for us to try for chronic pain. I'm a big believer in knowing what you're getting into. I think it often happens that doctors don't know how hard it is to come off certain meds. I hope you can find a doctor to help you with this. If you need to come off the Valium, you know it needs to be a very slow taper. I guess if you switch to a different benzo that would be a different scenario.
Hi I'm back and fully rested and awake now! :)
To Mary: Thank for your post that provided more info as to what you are experiencing with the Valerian Root. That is VERY scary. I am sure your pharmacist will find out some good info for you in terms of the possible interactions. In the meantime, you could go to http://drugs.com as they have a interactions checker. You could see if you find anything there.
I am glad that you brought up the neurontin and its interaction with other meds as I myself have had trouble with it too. There were some occassions when I forget to take the neurontin in the evening 1 1/2 to 2 hours before bedtime so I would just take it with my valium, morphine, and remeron (anti-depressant) right before bed and when I did that my heart would start racing and pounding like it wanted to jump out of my chest!! It lasted for an hour and I was up tossing and turning because I couldn't sleep! So after a couple of episodes of that I now just skip the evening dose of neurontin all together if I forget to take it early enough before bedtime. I take a daily dose of neuronin as well along with a daily dose of valium and morphine and I didn't get any of those scary effects so it must be an interaction with the antidepressant. I plan to check out the interactions between the two today myself. Craziness!!
As for the Valium, I tapered from 5 mg per day to 3-4 mg per day to make room for a stronger painkiller for my pain, the morphine. 95% of the time I take 3 mg per day. The extra 1 mg is for an anxiety or panic attack which happen rarely these days. When I started the Morphine, I stopped taking the Valium completely as I was afraid of the added Central Nervous System depression when combining Morphine with the Valium. Since Valium has a half life of 50 - 72 hours, I didn't feel the withdrawal until 3 days later when I was driving home from work. I had a massive panic attack and it felt like I was going to die. I have never felt anything that extreme in my life!!! When I took 1 mg of Valium, it went away. Now I am back to taking 3 mg per day because the Morphine was giving me severe muscle stiffness when I woke up in the AM such that it caused pain. So I take 2 mg of valium in the daytime for muscular pain and 1 mg at night and it has helped eliminate the muscle stiffness in the AM.
My employer has decided to oust one of our choices for healthcare providers such that there is only one and it is NOT the one that I chose! Sooo, I have to find another doctor. My PCP has been handling all of my medications and has been my doctor for 5 years and I am not sure I will strike this same balance next year with a new doctor. I am making an exit appointment for next month to discuss with him my concerns. I have a lot of hope that I will find a physician or physicians if I have to go see a pain management physician for my pain medicines. I have been 100% compliant. I have been told by my company that the physician will typically write a few prescriptions post dated so that I will have more time to find a physician. On my end, I am stock piling the valium and whatever else I can in defense. I go through a valium prescription in 45 days vs. 30 days so I am refilling at the 30 day mark so that I have extra to perform a taper next year if needed.
I really have no complaints over the valium. The same dose still works and I have been on this same range of dosages for 6 years so it is not that it doesn't work and I am chained to it without a purpose. It still has it's purpose but I am on 8 different prescription meds so we will see what a new physician will be willing to continue with.
I am very concerned as I have issues with blood pressure so I take two bp meds of very low dosaging plus I get the benefits from the opioids and valium that I take such that my blood pressure is in the normal range consistently. I am worried that a withdrawal from the opioids will cause a spike in bp such that I will have a heart attack or stroke!!! That is my biggest concern, that I won't make it out alive from the withdrawal. Hopefully, it won't get to this point.
To Deano: Sorry I fell asleep while posting last night! I didn't answer all of your questions. I am so glad that the Butrans patch is keeping your pain at a manageable level. If you haven't experienced any withdrawal symptoms by now, it is very likely that the Butrans patch is preventing those from happening.
The Butrans patch comes with its own drawbacks. Since it is an antagonist opiate, it has its own withdrawal symptoms and the medicine has to be tapered if one wants to stop taking it and not have withdrawal or have the withdrawal minimized. The difference with the Butrans patch versus hydrocodone is it has a ceiling effect after a certain dosage amount and it will cause withdrawal symptoms if it is mixed with a pure opioid like hydrocodone. As long as it is taken alone without the combination of pure opioids, it will continue to work and provide pain relief.
If the Butrans patch still leaves a lot of pain behind and you feel you need a lower pain level to make it through your daily activities. Tell your physician about this to see if he/she could make some changes to the dosage. I am not familiar with the different dosages that are available so I don't know if there is a 20 mg, something inbetween, or something above that amount. But, it seems like your physician is still wanting to help you with managing your pain. Does your physician know about everything that you do in a given day that you told us here? If not, you NEED to tell him so that he understands more about what your pain levels really are. Let him know also which of these things causes pain that you cannot stop doing, and therefore, needs pain management. This will help him/her understand more of why you are taking more hydrocodone than prescribed. And again, I will say this again that the hydrocodone is weak in strength, and even much more so after being on it for 3 years that you most likely need something a little stronger such that you can take the prescribed amount and still do the things you need to do. The undertreatment of pain in America is huge due to DEA scare tactics and physician paranoia that they are making their patients drug addicts. So know that you are not alone in this.
I am not sure about the Nucynta mixed with the Butrans patch. Nucynta (Tapentadol) is very often compared to as being Tramadol's big brother. If you know about or have taken Tramadol, Nucynta is stronger and probably also stronger than the hydrocodone. I have not tried it but I have read many posts about Nucynta and there have been mixed feelings. Some say it works well and others say it doesn't work all that well. Many that have said it works well were on the something else super strong like the Fentanyl patch and were using Nucynta for breakthrough pain. Nucynta binds to the opioid recepters and increases serotonin in the brain just like tramadol but stronger. It is a schedule II drug which requires a written prescription every 30 days and it cannot come with refills. Not sure if the scheduling is because it is really that much stronger or if it is because Tramadol (which in most states, has no scheduling) has made many become addicted to it when it was marketed as nonaddicting.
would it be ok to take a over the counter sleep aid while wearing the butrans patch it is a 10