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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Festus on October 11, 2005, at 23:40:12
Howdy Folks, I just noticed the Thread Title I put down,it's kinda goofy.I suppose goofy is right on track with my brain responses these days.I'll try'n condense this"Substance History":
1969-1989>Beers,joints,tablets,powder,yyeechh!!
1989-1996>Quit ALL Alcohol(1989-Present),Powder,tabs,ONLY Klonopin and a few Darvocet,oh yes,and Weed.Got"Back to Nature"
1996-2000>HERE WE GO:Cumulative accidents cause major pain issues,get on Tylox,Vicodin,more Klonopin and the Weed is stopped.
2000-2003>ENTER:OXYCONTIN.Starting at 10mgx2,the dose climbs by surgeries,tolerance,gets up to 80mgX8-10 a day(720-880mg)
2003-Present)Went in first week of 2003,from avg.800mg Oxy to 60-100mg Methadone,overnight because Company CANCELLED Px Cards.(Oxy would have cost $1,650.00 a mo.)After about 3-4 weeks of titration,we go with 20mgx4 on the Methadone.It was at this time they(Dr.s)confirmed that I had ADD.The Methadone"Droopies"were so bad,my Doc Px,ed Adderrall to keep my head off the steering wheel.After starting the Stims,I told the docs about it and they did them tests,so there I was.
The Methadone is a potent pain med,but it takes everything out of me.I've gone down to 50mg a day(Got back to the Weed to assist)on the Methadone,but I,m still stuck on this agenda:
Methadone-50mg
Dexedrine-60mg
Prozac-20mg
Xanax-0.5x3
These are daily.I also get 100mg of Testosterone through IM injection weekly.I still use the Weed for nausea and insomnia,I'd rather do that than take more pills.If I were going to try and stop this regimen of drugs,what would be the BEST way to do it???THAT IS MY QUESTION.
DOES ANYONE KNOW OF RESOURCES TO CHECK,HAVE PERSONAL EXPERIENCE,ETC.,on how this could be done? Thanks,Festus
Posted by Declan on October 12, 2005, at 10:25:22
In reply to WARNING ! (Questions on tapers for Experienced), posted by Festus on October 11, 2005, at 23:40:12
Methadone will either make you stoned or depressed. Not badly, and not nearly as bad as hanging out, but a low grade chronic depression. Having said that it might be difficult to reduce methadone when you are taking Dexedrine. If your head was anywhere near the steering wheel it sounds as if you were stoned then. But you adjusted to your dose and stims were added.
Imagine you are an alcoholic and an opiate addict. You want to give up both. Which do you do first? Obviously the alcohol, because drinking during an opiate withdrawal is much worse than taking opiates during an alcohol withdrawal.
So, you want my thoughts?.....lower the Dexedrine a fair bit but so that you can still cope. And then lower your methadone dose to maybe 20 or 30 at the rate of 2.5 mg per week or so. At those doses I didn't feel so unhealthy. If you lower the opiate first the dex may leave you feeling unhinged.
Keep taking the Xanax (of course).
Dunno anything about the Prozac.
(This is assuming you want to take less stuff).Declan
Posted by Festus on October 12, 2005, at 23:50:50
In reply to Re: WARNING ! (Questions on tapers for Experienced) » Festus, posted by Declan on October 12, 2005, at 10:25:22
Thanks for the info,Declan.I should start doing,like:50mg Methadone a day that week,47.5 mg a day for the next week,45mg a day week after that,etc.,till I can get to 30,maybe 20mg daily?
The Depression you described,is what it gives me.It seems as though my drive,ambition,fun-side,all those have gone.I started HRT 21 mos.ago from low-Testosterone levels(Doc said the Methadone did it).The Stims sort of restore some of my drive,but they can burn you out,can't they?Right now,I ain't gonna worry too much about the Prozac/Xanax till I can do the first two.I guess.Thanks, Festus
Posted by Declan on October 13, 2005, at 3:12:35
In reply to Re: WARNING ! (Questions on tapers for Experienced), posted by Festus on October 12, 2005, at 23:50:50
Hi Festus
Perhaps it is best to think in terms of a percentage reduction of the total dose. So at 50 you will find a 5mg reduction just makes you feel off colour for a couple of days. But at say 10, a 2.5mg reduction is really difficult. So at the beginning you should take it more quickly than you would at a lower dose.
The reason I mention 20mg/d as something to aim for is that I felt halfway normal on that dose. And it still works. As you would know 20mg methadone to an opiate naive person would knock them out for a day or two.
I've never known anyone on methadone who hasn't mentioned the depression. Hell, it was too toxic for the Wermacht.
Anything I can do to help, I know what it's like,
Declan
Posted by Festus on October 19, 2005, at 22:55:39
In reply to Re: WARNING ! (Questions on tapers for Experienced), posted by Declan on October 13, 2005, at 3:12:35
I get it, now,Declan.That's something I've seen often on these Med Forums, when folks are asking about Methadone tapers and such, that the lower you get, the tougher it gets. Is that about right? Did you do a taper(answer only if you want)from some type of Pain Med or something?I guess I'm really starting to feel the "Hard Part"coming on.I'm at 40mg a day,as of 10-15, and I can say that it was "noticable",but I'm goin the 2.5 route from here on out.Thanks,Festus
Posted by Declan on October 20, 2005, at 0:46:39
In reply to Re: WARNING ! (Questions on tapers for Experienced), posted by Festus on October 19, 2005, at 22:55:39
Festus, I started on codeine and moved up to heroin. I guess I've used some opiate almost every day since 1975 or so. Currently my dose is 0.5mg/d methadone, at the end of a decade long taper. I can notice the difference that a quarter of a milligram makes. It's not a huge difference, but it's there.
The tapering doesn't get really difficult until you get to 15 or so, especially below 10. You'd be better off at that point, or anywhere below 25 to switch to buprenorphine. There is less depression with it, but the switch from methadone (in particular) can be difficult. Easier to get off too.
Don't even consider LAAM. I've never taken it, but I imagine it would be even harder to get off because of the long half-life. I know nothing about it of course, but I wouldn't trust what I was told anyway. They say methadone is no harder to get off than other opiates, some of them do anyway.
Declan
Posted by Festus on October 22, 2005, at 1:43:22
In reply to Re: WARNING ! (Questions on tapers for Experienced), posted by Declan on October 20, 2005, at 0:46:39
Man,that don't sound too encouraging,the part about "the decade-long taper".That's amazing you can tell the tiny change in the dosage.I must confess that I have resorted to Weed(after a 10 year absence)too aid with WD's and the nausea.It does help me to relax better and sleep better.I almost always wait till nighttime to partake.I don't know what will happen but I'll soon find out.Thanks,Festus
Posted by Declan on October 22, 2005, at 13:31:31
In reply to Re: WARNING ! (Questions on tapers for Experienced), posted by Festus on October 22, 2005, at 1:43:22
Festus, don't worry about my decade long taper thing. I have other problems that have simply made it too difficult. For me it's not the withdrawal, it's just the way I feel, as I'm sure you can imagine.
Declan
Posted by mitchshrader on October 24, 2005, at 7:32:50
In reply to Re: WARNING ! (Questions on tapers for Experienced) » Festus, posted by Declan on October 22, 2005, at 13:31:31
i'm currently prescribed 3x15 oxycodone for chronic pain, and modofinil ?sp for fatigue.
the combo is effective but debilitating long term. I have to rotate off and on the modofinil
and when i'm off, the oxycodone seems to cause depression.
i've found that high grade marijuana (very) in small quantities has less side effects than either or both of the above.
chronic pain seems less after a few days use of marijuana and with less oxycodone, i need less modofinil..
overall, it can replace 1/3-1/2 the oxycodone, and that lets me half the modofinil and some days skip it.
it's very difficult to obtain (where I am) medical grade marijuana. considering my condition isn't curable nor likely to improve, i'm satisfied the marijuana use is 'safe and effective' (acts as expected) ..
i can't say your condition would benefit from same treatment, but, as you are currently using marijuana (and seem to be habituated to painkillers) increasing the strength of the marijuana "MIGHT" (your call, you know and I don't) be a way to lessen dependence on the methadone.
i found the usual 'street' quality was barely adequate, in ANY quantity, and certainly not as effective at relieving pain.
there's considerable range in quality and apparently in effect. your mileage may vary
Posted by Festus on October 25, 2005, at 23:10:53
In reply to Re: WARNING ! (Questions on tapers for Experienced), posted by mitchshrader on October 24, 2005, at 7:32:50
You hit the nail,Mitch.That's exactly what I'm doing.In my case,it helps cut the edge off the extra pain and WD's.I won't use too much detail,but not knowing where you live makes it tough to understand what may be considered either"good" or "bad" Weed.Maybe if I just say that it resembles a cluster of small,piney-sweet and skunky smelling buds of bright green,reddish-brown and greenly-tinted white fuzzy nuggets and sprigs,all tossed into a small,plastic bag.
This is as "Graphic" as I dare get on Dr. Bob's (The True Medically-Oriented Web site Legend) site.It(Methadone) is the toughest thing I've EVER tried to quit.I know I will get old,wondering what it would have been like not taking Pain Meds.I want to keep going,but I feel that I have a better chance if I slow it down a bit.Sometimes it would be real easy to take 20-30 mg more,but I just keep my focus on the goal of tapering off to 0.It helps keep from letting the WD and pain get the upper hand.Take Care,Festus
Posted by greenhornet on October 26, 2005, at 11:54:16
In reply to Re: WARNING ! (Questions on tapers for Experienced) » Festus, posted by Declan on October 12, 2005, at 10:25:22
> Methadone will either make you stoned or depressed. Not badly, and not nearly as bad as hanging out, but a low grade chronic depression. Having said that it might be difficult to reduce methadone when you are taking Dexedrine. If your head was anywhere near the steering wheel it sounds as if you were stoned then. But you adjusted to your dose and stims were added.
>
> Imagine you are an alcoholic and an opiate addict. You want to give up both. Which do you do first? Obviously the alcohol, because drinking during an opiate withdrawal is much worse than taking opiates during an alcohol withdrawal.
>
> So, you want my thoughts?.....lower the Dexedrine a fair bit but so that you can still cope. And then lower your methadone dose to maybe 20 or 30 at the rate of 2.5 mg per week or so. At those doses I didn't feel so unhealthy. If you lower the opiate first the dex may leave you feeling unhinged.
>
> Keep taking the Xanax (of course).
>
> Dunno anything about the Prozac.
> (This is assuming you want to take less stuff).
> > DeclanBecause Prozac has such a short half-life it can be quit pretty fast Like 20mgm for two days, 10mgm three days, then every other day for about six days Then "drop" one day, five days drop another etc. If you have a real problem get the liquid and "dose down" more slowly.
Posted by Festus on October 27, 2005, at 23:31:18
In reply to Re: WARNING ! (Questions on tapers for Experienced), posted by greenhornet on October 26, 2005, at 11:54:16
Well, dunno why my first response to this did'nt appear,but I was gonna say I take the generic 20mg capsules(Insurance got cancelled)so I don't know if they can be used for a taper or not.In fact, I'm only guessing at the order I should go with,as far as weaning down off all the Meds I been taking.Green Hornet,I've read several responses you penned,and would be of the opinion that you may know a good deal about Pharmacological facts and fiction.If so,look at:
1) Methadone 20-30mgBID
2) Dexedrine IR tabs,30mgBID
3) Prozac 20mg,one cap daily
4) Xanax 0.5mg,TID
5) Testosterone Cypionate IM inj.,100mg, a week
The T levels were probably a mix of age(51)and 20 years of Opiate Therapy,with Methadone for the past 3.This question would help me if it were answered in the appropriate manner(Facts,not BS)Thanks,Festus
Posted by greenhornet on October 28, 2005, at 11:35:43
In reply to Re: WARNING ! (Questions on tapers for Experienced), posted by Festus on October 27, 2005, at 23:31:18
> Well, dunno why my first response to this did'nt appear,but I was gonna say I take the generic 20mg capsules(Insurance got cancelled)so I don't know if they can be used for a taper or not.In fact, I'm only guessing at the order I should go with,as far as weaning down off all the Meds I been taking.Green Hornet,I've read several responses you penned,and would be of the opinion that you may know a good deal about Pharmacological facts and fiction.If so,look at:
> 1) Methadone 20-30mgBID
> 2) Dexedrine IR tabs,30mgBID
> 3) Prozac 20mg,one cap daily
> 4) Xanax 0.5mg,TID
> 5) Testosterone Cypionate IM inj.,100mg, a week
> The T levels were probably a mix of age(51)and 20 years of Opiate Therapy,with Methadone for the past 3.This question would help me if it were answered in the appropriate manner(Facts,not BS)Thanks,FestusFestus --
I am doing a bit of research for you so hang in there. I agree with what Declan wrote on 10-12 --".....lower the Dexedrine a fair bit but so that you can still cope. And then lower your methadone dose to maybe 20 or 30 at the rate of 2.5 mg per week or so. At those doses I didn't feel so unhealthy.
If you lower the opiate first the dex may leave you feeling unhinged.
Keep taking the Xanax (of course).
Dunno anything about the Prozac.
(This is assuming you want to take less stuff)."You are looking at a long taper, but if that is what you really want it will be worth it. I'll get back to you as quickly as possible -- meantime "for sures" --
1) do it umder the supervision of a competent physician.
2)WAIT UNTIL ONE TAPER IS COMPLETE BEFORE STARTING ANOTHER.
3) Take a vitamin supplement and extra B1 and B6
I'll be back...GH
Posted by greenhornet on October 28, 2005, at 14:13:30
In reply to Re: WARNING ! (Questions on tapers for Experienced), posted by greenhornet on October 28, 2005, at 11:35:43
Festus,
A little info for you on withdrawing from the meds you mentioned, you may already know some of this.
keep in mind
1) I am not your physician, you need to discuss all of this and any other suggestions given here with him/her.
2) While I am familiar with the medications and or proceedures presented here (and have first hand experience in some cases), I am not an expert, these are merely suggestions and references.First , done properly your are looking at a long process.
Stimulant first? Probably, but I am not 100% confident on this Maybe just backing off 5mgm.
Then stay on the lowered Dex dose while you cut the Opiate. I believe thatBromocriptine is sometimes used for stimulant withdrawal Talk with your doctor about the possible risks of using this drugHave you ever tried Buprenorphine., Naltrexone (Trexan) or Clonadine (Catapress), for opiate withdrawal? The beauty with these is that none of them are addicting.
http://www.aafp.org/afp/20000501/2763.html
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3977557&dopt=Citation
For the Prozac AFTER the first two are finished and probably at least a two week wait then taper 20mgm 1week, 10mgm about another week ask the doc for particulars
Lastly the Xanax, here I can give you first hand experience In all honesty Benzos were the worst to kick in my case. A taper over eight to 12 weeks or longer may be indicated in patients who have been taking benzodiazepines for several years. It took me three months and I still didnt feel right for six more months at least. Sometimes a lowered dose of one of the other shorter acting benzos is used,
I hope something here is of help Keep in touch with us too..GH
This is the end of the thread.
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