Rapid detox from Fentanyl?

[Scrub2313]

I have been on 50mcg Fentanyl patches (1 every other day/15 per month) along with 120 7.5 percocet per month for about 8 years.  I generally take 2 percocet on the day I put on a new patch and 6 on the 2nd day as it wears off.  I have never increased my doses over the years and have only had it prescribed by the same Dr.  Over the last few months I have started to have bad side effects and my Dr. said I am likely developing hyperalgesia from long-term pain medication.  At this point, I have no idea if I am still suffering my original chronic nerve pain or if my pain is from messing up my bodies pain management system so that everything hurts more.  I have decided it is time to try life without any pain medication but after reading up on fentanyl withdrawals I am not sure I can handle it.  I am employed full time in a very significant position and do not have the ability to be away from work for several weeks.  Plus if it were discovered that I was going through withdrawals, it would likely ruin my career even though I have never abused any medications.  My primary care dr. had me see a Pain Management specialist and they suggested I either go through a long taper or consider rapid detox.  With how much I am currently struggling with increased pain (I am convinced this pain is from the medication's impact on my body rather than any true physical issue), I cannot imagine going through a slow taper over months if not longer.  This brings me to rapid detox.  I have a 2 week break from work coming up and am considering doing the detox at the beginning of the break giving myself 2 weeks to recover and be back to work.  I have read a lot of really positive and really negative comments about Rapid Detox.  I recognize there is risk and cost.  Fortunately, the financial cost is not an issue and I am in overall good health so I do not feel overly concerned with the physical risks.  But I do not want to do this if I am just going to be in terrible WDs for several weeks and miss work.  My question then is has anyone actually gone through Rapid Detox off Fentanyl or a similar dosage strength/length of use?  If so, what was your experience like following the procedure?  Thanks for your help!!!

[philnoir]

Every one of us has this feeling, and at one time or another gives it a shot.

I hope your pain doc will be there for you. Perhaps it would be a good time to talk to him about your fears.

Docs are on call 24/7 -- they accept this responsibility and that's why they have answering services. I imagine that if you were in trouble, he'd be there for you, even on a Sunday night.

But your best bet is to hold out a little bit of medication and keep in in your safe. Save it for a rainy day -- this way if you need help on one of those inaccessible days or nights, it's no further than your medication safe.

The trick to weaning from opioids is to first rotate from long acting to short acting medication, and then to wean slowly and steadily. When you step down to your first day without meds, have adjunct medications nearby that can help with the side effects of opioid withdrawal -- nausea, diarrhea, anxiety, insomnia, and myoclonus (nervous muscle twitching).

For many, the hyperalgesia is the worse side effect. Some people discover rapidly that they do need the medication for pain, and discover they need to stop withdrawal in order to function.

Knowing that stash is there to rescue you from misery and pain will help get through the difficult days and nights until you can see your doctor.

I would never try to talk anyone out of giving a life without pain medication a try, but as one who has been there, I know this is not always possible.

Best wishes.

[Woodworth1963]

Good Luck Scrub with your decision! I have been on opiates since 2007 and can't really tell you anything about rapid detox, sorry. I just know that I want to try to get off these things myself. But I'm not so sure I trust my PM Dr. to do this with me. I to have heard the stories of withdraw and have cut my own meds down on my own. When I ask him about coming off the meds or express my fear of what's on the other side of this journey he just says "Its no big deal" All you have to do is call me if you are having issues! Ummmm he is only available 2 days a week, otherwise you leave a message with his staff. He has also told me that the stories I have heard from other patients were exaggerated and it's no were near as bad as they say.... sigh...

[cin333]

I am wishing you good luck with your decision about rapid detox. What hospital or pain management group are you going to? I just hopeyou checked out the hospital or pain management with the success rates. Wishing you the best Scrubs.  Smiles/Hugs  Cindi

[philnoir]

They are correct about the gel evening out serum testosterone levels, but most do fine on a monthly cypionate injection over time, too. Often the choice between the two is a matter of cost -- the injection is much less expensive.

It may take you longer to reach steady state or you may be on to low a dose. Ask your PCP to draw another serum testosterone level at your next appointment.

[Scrub2313]

Hi Cindy,

Thanks for your comments and support.  Your story is exactly why I am seriously considering rapid detox.  There is no way I can keep up with my job while trying to taper down off the F-patch.  I have read too many horror stories and have felt the initial WD pains that set in so fast when the patch is wearing off.  I am still researching but I am tentatively going to do the rapid detox next Thursday or Friday as I have 2 weeks off work for the xmas holiday and I hope that is enough time to be somewhat back to normal... at least good enough to handle work.  I am so nervous that I cannot sleep at all!  I feel completely trapped in that my current med levels are no longer enough but I will not increase (commitment I made to myself at the beginning of this journey). I just hope this works....

[Scrub2313]

Been using the testosterone gel for 5 days and not sure I can tell a difference yet.  Still sweating sometimes but haven't had a full breakout sweat yet so that could be good news.  They said it can take longer for the gel to reach normal levels but that it is better than the shots as it provides a more steady experience rather than having swings in the levels...

[cin333]

Hi again..Just wanted to know how you are feeling today? Smiles/Hugs Cindi

[cin333]

Hi there..Sorry to here about your agony..Last year I to decided to "get off" the Monster med Fentanyl.  Last November I went to a pain management doc. d/t I wanted to come off the Fentanyl patch..I had asked my family doc and he suggested to "JUST' titrate from 100mcg to 75 mcg and drop my dosage by 25 mcg. I tried this and I went thru Hell. I finally went to a pain management specialist and I had told him what my family doc. had stated.  I must say he helped me so much..I have a lot of faith in this pain management doc. I was on Fentanyl 100mcg(for 4 years d/t DDD, multiple muscles issues,fibro nd spinal stenosis. He decreased my dosage by 12mcg every month. This was not a party, but it could have been worse..It took me 6 months to be completely off of Fentanyl. Now I am taking Methadone 5 mg. twice a day and dilaudid 4 mg a day for breakthrough pain. I wish I would have never even started Fentanyl..your body build up a tolerance to it. I find that the Methadone helpsmy pain level and I became more productive and a better quality of life,although I am still disabled. I wish you luck on your journey. the med-help community is very helpful.Wishing you great days ahead and a good Christmas Holiday. Smiles/Hugs and Good Bless.  Cindi

[philnoir]

Good for you. We all need to learn to ask for care when needed.

I've always insisted that a chronic pain patient needs to learn everything he can about his condition, treatment options, and outcomes, because the best informed patient gets the best pain treatment.

It will take a few days for you to reach steady state serum testosterone levels, but you'll start feeling better vis-a-vis the sweats tomorrow.

Best wishes.

[Scrub2313]

Met with my Primary Care Dr. and he prescribed me a testosterone gel instead of shots.  He did say that it was likely my levels would rise once i finish detox but who knows... i just gotta get past these side effects!  Starting the gel treatment tomorrow morning.  Hope it takes effect quickly.

[philnoir]

No, the sweating (what women call hot flashes) is from your low testosterone -- I've lived with it for many years, and starting getting monthly injections about 15 years ago. Now that I'm in my 60s, I can go many months between shots, but I know that discomfort. I suggest you ask your doc about testosterone cypionate injections.

[Scrub2313]

Thanks again for the feedback.  I really think it is just that my body has finally gotten used to the level of meds I have been taking for 9 years now.  Not sure why it decided to get used to them all of a sudden after being stable for so long but it is what it is.  I also found that my testosterone count has gone way down which the pain dr. said is from chronic opioid use so perhaps that alone can account for my increased symptoms and pain.  One symptom that is so horrible is I will start sweating profusely with no warning.  I have had to get up from meetings at work multiple times because i start sweating so bad that i have to go to the bathroom, take my shirt off and wait till it passes and i dry off... it is humiliating!!  The dr. said that is from the low testosterone rather than the pain meds but perhaps it is both... i don't ever remember sweating like that before the last few months though so who knows.  I just want to have a life with no medications so badly or to at least try to see if I can.  I am tentatively planning on doing rapid detox the week before xmas as I have 2 weeks off work to recover.  I have a lot more research to do though before my final decision.  Thanks again for the advice!  I sure wish I could find someone that has done UROD from a similar Fentanyl patch...  Incidentally, I heard someone refer to it as the "F" patch and that sounds about right to me!

[philnoir]

The theory of opioid induced hyperalgesia (OIH) is a fad that has grown, not out of science, but out of the increased mortality rates that parallel the increase in Rx for opioid medications over the past 12 years.

Many doctors love it -- it gives them the excuse to take their patients off the dreaded poppy. Unfortunately, it is very much in vogue here in the US. Its deleterious effects on those of us who require higher doses due to opioid tolerance cause much misery.

I believe the proof is in the weaning. Wean by 25 % -- if the pain doesn't reduce, then OIH is disproved. Yes, I know it will be a great inconvenience, but is the only way to convince a stubborn practitioner who's self deception regarding "peer reviewed science" and prejudice against long-term opioid use has been blinded to the suffering of her or her patients.

You are not alone in this quandary -- it is a phenomenon that is occuring all over the US. It seems that I see a new report supporting this view from every medical direction but one.

Do you have a pain psychologist? In this field I find more rational and compassionate thinking regarding opioid tolerance, high-dose opioids, and the only effective force opposed to the dogmatic support of OIH.

[CarolinaFreddie]

"...how I am supposed to carry on a normal life while slowly reducing my pain medicine"

Well, as I said, if it were me, and if I were to choose the "taper" route, I would taper so slowly (remember the "window pane of glass analogy!) that my mind/body would not know I was tapering.

And, I wouldn't have to "miss work."

But, if I were not going to do the "taper route," then I would either risk my life never waking up from one of those "Rapid Detox" places (I'd pick the best one in the world, with most favorable "statistics" e.g. least complications, least deaths if any), or, if I were feeling brave I would CONSIDER, not necessarily DO, but CONSIDER the possibility of the ayahuasca (http://www.youtube.com/watch?v=X5M1zppjJT4) detox.

And, as far as work, if you are in THAT important of a position, then you are important enough to figure out how to take some leave.

But, again and again, that's JUST ME, you do whatever you and your medical professionals decide.

But, here's my thought on your situation: I don't think you really want to quit opiates, you just want something done about the side effects.... so why not ask your doc if he feels it might be better to switch you to a different med? Some docs say all that fentanyl, oxy, etc., is all a bunch of Bese-Esss, and they go straight morphine, the mother of all opiates.

When switching from one opiate to another, some docs call that "rotating" the opiates, and some find that dosages can be lowered.

So if you were to say, "hey doc, if you 'rotate' me to morphine, maybe you can get me on a lower dose of morphine if you feel it is safe for me, doc," and that may make him all happy...

[fntn]

On a related topic, my PM doctor has me do holidays every several weeks or so, if I'm able to tolerate it. I usually do 2 to 3 days and it's of the "rapid detox" form since I simply stop taking meds for that duration. He's interested in keeping my dosages within the newly required equiv limits of course and has also discussed doing a rotation (if needed).

It's miserable of course since I'm really not looking to get off of the meds, just doing it to make them more effective in the long run. Given that my normal dosages are in the 200 mg equiv range, I am surprised that the detox effects aren't apparent. My pain levels increase of course and makes me pretty much house bound with extremely limited activities but I tolerate it knowing that relief is just around the corner and just tough it out as before I started PM. It also gives me a basis in knowing whether I need to continue treatment or I can consider stopping or reducing.

I haven't gone beyond the 3 days since I'm absolutely disabled by then. I'm wondering if the full detox issues would present themselves if I pushed the holiday longer? All in all, I'd say this approach has allowed the treatment to reduce the pain levels by half and at no time in the past has the pain gone away fully.

Tricky business this PM stuff, and I have know idea if what I'm doing is standard or not, so certainly not an endorsement either.

[Scrub2313]

philnoir, what you say makes sense with regards to my body finally crossing some "tolerance" line to where my current medication levels are inadequate rather than my having developed hyperalgesia.  It's hard to know for sure I think as the type of pain I was experiencing before starting medications was very similar to moderate to severe withdrawal pain from an overall body-ache perspective.  What makes no sense to me is how I could be totally stable on the current dosage for over 7 years and all of a sudden it isn't enough...??  I have never increased my usage at all... always used exactly the same way.  Hard to know how/why your body does anything it does I guess but ultimately I have no intention of upping my doses which brings me to my delimma...  

[Scrub2313]

Thanks for the feedback.  One thing I cannot understand is how I am supposed to carry on a normal life while slowly reducing my pain medicine if I am already struggling at the current dosages?  My concern is that I will be in for months of significant pain to the point that I will not be able to function in my job.  I assume that tapering = increased discomfort although nowhere near what would occur should I just quit taking the medication altogether.  

[CarolinaFreddie]

It is my understanding, through a LOT of reading, that an *ABSOLUTELY SLOW* taper would be what I would do in your situation.

How slow? Here is an analogy. When you look at a window, it is made of a pane of glass. The glass looks solid, right? Wrong! Glass is *actually* a liquid! If you look at ancient (hundreds of years) windows, they are thicker at the bottom than at the top! (Because the glass, being a liquid, 'runs' down).

Back to your Fentanyl. Read the 3 important disclaimers below before continuing to read.

If I were to do a taper, I would make sure it was done *precisely* with NO deviation. For example, if I had gone from 11mg percocet down to 10mg, I would not "throw in an extra pill" if I had more pain one particular day. I would tell myself that I am on a TAPER, and I would do what everybody else does that isn't on opiates (e.g. ice, over-the-counter crap, etc.). And do do such a precise taper, I would do it completely under a doctor's supervision, using special tools to split the pills, because it's all about PRECISION. Further, when it comes to Fentanyl, a lot of time and effort and *communication* between the doctor, myself, pharmacist AND manufacturer would have to take place to make SURE the kind of Fentanyl I am chopping up/trimming/cutting is the kind that is acceptable to do so, because cutting or modifying the wrong kind of fentanyl WILL KILL ME! And, possibly others around me, getting that gel over doorknobs, etc., people may die. So I would make 100% SURE that the exact brand and style of Fentanyl I am using can be cut, and I would only do it under the direction of at least 3 people: my doctor, my pharmacist, and the manufacturer of the fentanyl.

Disclaimers: 3 of them:

1.) IMPORTANT: only CERTAIN kinds of Fentanyl patches may be cut (for example, to trim off the edge to make your 50mcg become 49mcg) -- otherwise, ANY kind of cutting, altering, trimming of Fentanyl Patches is DEADLY -- can and WILL kill you! Again, Fentanyl can be tapered, but ONLY under the direct scrutiny and supervision of your physician (and, I'll even throw in Pharmacist, too, because they know what brand or brands may be cut up into pieces).

2.) AGAIN, cutting/altering/modifying the incorrect type of Fentanyl patch is DEADLY. However, certain types of fentanyl patches can be cut under professional supervision.

3.) In theory, a company that produces one "brand" of Fentanyl MAY CHANGE the "patch style," so before assuming a certain brand can be cut, double check with all the professionals, your doctor, pharmacist, and the manufacturer before doing such a thing.

So, if it were me, I would do a really slow taper under a doctors supervision.

[philnoir]

It always amazes me how many docs suggest that hyperalgesia is the "cause" an opioid treated pain patient experiences increased pain after being on a steady dose for years. It's as if everyone has forgotten about opioid tolerance when you get near that arbitrary 200 mg daily morphine equivalency. This is a very different philosophy from 10 years ago, when my pain was better under control with high dose methadone.

Regardless of my particular problems, all chronic pain patients come to the point where you are -- we want to see if all this trouble in acquiring our monthly supply of medication is worth it. So, we wish to 'get off the drugs'.

I wish you luck. The rapid detox clinics put you under for so many days, treating you with opioid antagonists, supposedly rebalancing the nervous system and avoiding withdrawal symptoms. I've no experience with these.

As a pain patient with over 30 years of opiate therapy, I'd like to believe that this would work for me, but I also know the condition of my spine and my nervous system.

The last time I tried to wean and quit -- about 18 months ago -- I had a very difficult month. The side effects were minute-by-minute misery and a the end of 28 days, I was exhausted from an insomnia condition that is finally getting better 18 months later. The pain w/o medication was crippling. I learned that I do need pain medications because I have a severely diseased spine and nervous system.

I wish you luck and hope that this treatment works for you.