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Need guidelines for long term, long-acting morphine withdrawal plan
I have been on MS Contin 15 mg twice daily for six years for fractured discs and arthritis. I am told by my PCP (a nurse practitioner) that there is a federal mandate that I must get off opoids. I am a retired nurse so I know something about medications. Her proposed withdrawal schedule was: Short acting morphine 15 mg twice daily x 1 week; then once daily x 1 week, then every other day x 1 week then stop. I told her I completely disagreed with her schedule - that 15 mg short acting was way too much and that it would shoot me way up then crash me in the middle of the day and the middle of the night. I reminded her that I had been on this medication for six YEARS and a far longer and more gradual taper was warranted. She told me to try it. About the 4th day it started to hit me. "Fortunately" I was seeing my rheumatologist that day in the late afternoon so I was at my max.- I was nauseated, sweating, shaking, and my BP was up. My PCP is out of town for this week and I am scheduled for a phone appointment on the 5th. In the meantime, I have cut the 15 mg tablets in half and am taking 7.5 mg every 8 hours combined with 8 hour Tylenol. In addition, my rheumatologist upped my prednisone from my usual 5 mg daily to 10 mg daily x 1 week then 7.5 mg daily x 1 week then back to my usual 5 mg daily. I am comfortable on this regime and I could see where a GRADUAL withdrawal in this manner might make me successful at getting of morphine. I do not feel my PCP is qualified to manage this withdrawal but my managed care insurance doesn't have any pain specialists in our community. Does anybody have any suggestions as to what I should/could do? Could you point me to guidelines for withdrawing opoids?
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Hello @beausonge Nice to e-meet you here. I am Scott and while I am no type of medical professional, I would say this may not be the proper forum for the type of highly specific medical advice you are seeking and that you need.
My wife was on opioids for more than 30 years so I can only say it could well be quite dangerous to self-adjust your medications without the direction or knowledge of your physician.
I wish you all the best.
Hi Scott,
I agree I should not be doing this on my own but I seem to be left in a lurch as my provider is gone until next week. I am doing a "best guess" until I can talk to my provider next week. I do seem to be doing MUCH better than what she had me scheduled. I was not seeking specific advice but looking for links to written guidelines - like 10% per week per whatever.
Was your wife able to get off opioids (thank you for the spelling!). I just recently had a breast reduction and it eliminated pain from my waist up and so I am hopeful about this. I would be very happy if I could get off of them! I just want to do it safely.
@beausonge Can you tell me where these federal rules for ending opioids comes from and direct me to a site to read more about it? I am not knowledgeable about coming off opioids except that it should be done carefully and under proper supervision. You might check with a local subtance abuse center or look on line under that heading to see if there is some information there. When working with aditics they help them come off safely so they may know more on the best and safest way to do this. As a chronic pain suffer I am interested in hearing more about being forced to stop opioids and what federal mandate is requiring this. Please respond to 19lin. Thank you and good luck. 19lin.
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1 ReactionHi @beausonge, welcome to Connect. I really like your username "beautiful dreams".
I agree with you and @IndianaScott and @19lin that discontinuation of opioids should be done under professional supervision.
In the meantime, I did some searching of guidelines for you. The Center for Disease Control and Prevention might be a good place to start. Here is the main page for CDC Guideline for Prescribing Opioids for Chronic Pain http://www.cdc.gov/drugoverdose/prescribing/guideline.html. It includes:
- Opioids: Guideline Information for Patients http://www.cdc.gov/drugoverdose/prescribing/patients.html which doesn't include info on discontinuation
- CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016 http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm This information is written for health professionals and includes some information on discontinuation, but individual circumstances vary the methods to be tailored to the person.
I also recommend watching the Opioid Chat we did with Mayo Clinic's Dr. Hooten where we took questions from Connect members discussing a wide variety of topics and pain and opioids. Included on this same page are several Mayo Clinic Minute videos covering the following topics:
https://connect.mayoclinic.org/discussion/opioid-epidemic-chat-with-dr-hooten/
- Prescription drugs - the changing face of addiction
- Facts on fentanyl
- Avoid opioids for chronic pain
- 2 reasons not to share pain pills
- When are opioids OK to take?
- What opioids do to your gut
- How to stop popping painkillers
https://www.youtube.com/watch?v=YcENrBVXPsY
Beausonge - Do you have an appointment with your provider next week? Can you stay on your current dose until then, and then begin tapering under supervision?
Hi all,
We took the question about discontinuation guidelines to a pharmacist at Mayo Clinic. Here's what she had to add to the conversation:
"There are no specific guidelines for tapering long-term opioid therapy in patients with chronic noncancer pain. The Department of Veterans Affairs and Department of Defense have suggested tapering the total daily dose by 20% to 50% per week. Some medical facilities will decrease by 10% of the original dose every 5 to 7 days. The taper your physician suggested does not seem unreasonable, but there may be room for adjustment if you’d like to talk with her about that. I’m glad that you are feeling better now. It will be very important to have her available so that you can contact her or a colleague if you are noticing withdrawal symptoms as you continue to step down in your dose.
As you understand, it is important to be in touch with your provider during this taper. It may be a good idea to stay at your current dose until she is available to guide you the rest of the way." ~pharmacist, Mayo Clinic
@beausonge, how are you doing today?
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1 ReactionThank you for all the information! I do have an appointment on the 5th and I do have more than enough to last me until I speak with her. I did let her know by email about what I did and that I would continue that dose until we spoke. I am happy to say that it seems to be going very well at this point.
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1 ReactionThanks so much for your concern and helping me sort this out. I am going to stay on this dose until I speak to my provider on the 5th. So far it seems to be going very well. I am very hopeful I can kick these opioids to the curb!
You're welcome. I'm glad you asked and now this information is also shared with all the members of Connect who are active in the Chronic Pain group. So your questions have potentially helped many. Please keep us posted on your progress and results of your consultation on the 5th.
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1 ReactionThanks and I will let everybody know how it goes. Maybe by sharing my experience - especially if I am successful might encourage others to try.
Every medication has side effects and especially in higher dosages. Instead of narcotics, again the push is anti-seizure medications that have many serious side effects in higher dosages also.
Some chronic pain people do need opioids and it is a shame that we are all being "grouped" into the category of "drug addicts" and WE ARE NOT! The stats they report are not about us. Most chronic pain users that are managed by responsible pain doctors, use their medications the way they are prescribed, get tested to make sure the medication is in their system, also via computer for no polypharmacy. Due to the increase in substance abuse problem, many doctors are closing shop because regulations are strangulating them. Patients are being left out in the cold unable to find a treating physician and in my journals...many chronic, responsible pain patients have needed to turn to the streets for narcotic medications! It has been a scare to many of us. I do understand wanting to be off narcotics but as I stated for some, it makes a big difference. As with any medication, if it is not needed or the dosage lowered, than you should do that. Other modalities also need to be utilized...TENS, meditation-tapping-guided imagery i.e., exercises, chiropractic, anti-seizure medication etc.
Pharmacists are excellent resources and are often more knowledgeable than doctors about medications and interactions between drugs that you are taking and side effects. No long acting medication should ever be cut in half. Ever. MS Contin is a long acting opioid. I do not smoke or use marijuana in any form and I have read conflicting stories on pain relief.
Best of luck for you. Cutting down your dosage is good but not cutting a long acting pill. Pharmacists like I stated are a very good resource.
I am also a RN and former Clinical Instructor but can no longer work. I pray you get the help you desperately need.