Three years ago after a spinal fusion, because of chronic pain, my doctor put me on the fentanyl patch. It didn't last three days as advertised and I kept going into withdrawal so my doctor kept upping the dose.--25 to 50 to 75 mcg, which only made me swing wildly from feeling good to being in withdrawal every other day. I told her, but she had no idea why I was feeling that way. I finally realized I needed to take a lower dose more often--every 48 hours instead of every 72. I came down from 75 mcg to 50 mcg. Two years ago and began putting on a new patch every other day. This made it possible for rme to work for the first time. Two weeks ago, I reduced from 50 mcg to 25 mcg and this weekend I'm going to go to zero, I hope. But since I came down, I feel exhausted a lot and keep having chills and cramps. How long is this going to go on? A month? Longer? (I still have pain, but I want to try functioning without the fentanyl, which I think is more trouble than it's worth.)

I am also on a low dose of methadone, also for pain, 2.5 mg per day, but if I miss the dose, I feel awful. I would really like to get off both drugs, but am wondering how long the withdrawal is going to last. I have work I need to get done and it's really hard to work when I feel so tired. I have never behaved like an addict in the sense of getting high or looking forward to the drugs--in fact, I forget to take them sometimes. But I've been on so long, I am wondering how dependent my body is. I haven't found anything on the internet about how long withdrawal lasts, except from people who have abused the drug, which I didn't, to my knowledge. Most people seem to have used them only for a few months, not three years! Will that make a difference? Also I am 53...
Thanks,
asking

Well, I'm off. Day 4 and I feel tired and hot--like having a sunburn in my bones. Reading elsewhere on the internet, looks like a month is the total time until you feel half normal. Unless you are on a much higher dose--like someone on 150 mcg patch took about 6 weeks and it was very hard for her. The worst is the anxiety and shaking. If my doctors had warned me about this when offering it, it would have been nice. Also, for anyone who stumbles on this, if you are having bouts of pain and comfort on the fentanyl patch, DON'T let your doctor increase the dose. If you go to a higher dose, you will just have more exaggerated ups and downs. Instead, ask him or her to prescribe the patch every 48 hours instead of every 72. The doctor CAN do that. They just have to fill out some paper work. Make them do it.

And if you are thinking of going on a fentanyl patch, think twice. It is effective for pain control, but has many problems and is hard to get off--though not impossible by any means. Much easier that quitting smoking!

To get off the fentanyl patch -- a dose of 50 mcg every 48 hours -- I went off in stages. First I went cold turkey for about 36 hours and then went to a 25 mcg patch. The worst was over in 5 days, still crummy for 10, felt decent in about 3 weeks. I did the same thing again except I went to no patch. I was still on 2.5 mcg/day of methadone throughout this and after 3 weeks without the patch I still felt awful (I also had a bad sinus infection), so the doctor upped me to 5 mcg methadone. I felt better after that and stabilized about a month out.

I still have chronic pain but it is not significantly worse without the fentanyl patch, although it's been worse lately, but then I often seem to say that. Not sure why. I may have some undiagnosed condition like MS that comes and goes.

I am still on 5 mcg of methadone. I take that in two doses of 2.5 mcg 12 hours apart. It turned out that once I was off the fentanyl patch, it became really obvious that I was going into withdrawal from the methadone after only 12 hours. I thought the methadone was smoothing out the cycles from the fentanyl, but it may have been the other way around.

Anyway, getting off the methadone is my next project. I read it's difficult because of the long half life, but I'm on a super low dose and some people just laugh at the amount. I must be really sensitive, since I go into withdrawal really quickly if I forget to take it, which I do a lot.

Since no one is answering here, I'll just treat this like my own drug withdrawal blog. :)

When the pain is so bad I can't sleep or function, I take vicodin, about once every ten days. I think I would continue that without the methadone. I'm not a masochist. (I can't take acetomenophin or ibuprofen.)

I've never been addicted to fentanyl or methadone, but had a real bad addiction problem with lortab/vicodin/percocet which from what I understand are the same when it comes to withdrawl feelings. It is the worst! I can tell you from my experience that the cramping last for a couple of weeks off and on and your digestive system doesn't return to normal for a couple of months. As far as sleep is concerned, you will sleep but in very small increments. Just be thankful when you do. Normal sleep patterns won't return for about three to six months. Please feel free to ask me any questions because I can sympathize with you 100%. Just because you don't take them to get high, doesn't mean your body won't become addicted, it will.

Thanks, julbox! I appreciate your answering. I agree that it is about the same. I have read around on boards for people with addictions and I feel a lot more sympathy for that situation now. As far as I can tell, illegal drugs and the prescription drug industry aren't that different.

It does seem like it took me a lot longer to feel normal than the doctors said. My regular doctor told me I'd be off the fentanyl in a week or 10 days, which wasn't true. I was still having cramps off and on for weeks. (I was on the fentanyl for 3+ years.)

I guess my main question now is about whether to try to taper or just plan a week's "vacation" to go cold turkey. When I try to cut back even a tiny bit I feel awful and don't get anything done. But maybe that's just me or me and the methadone...

Thanks again for answering.

Asking,

I wish I could answer your question, but this time I am truly baffled.

Thanks j-9. I'll figure it out. But nice of you to comment.

You might be predisposed for additive behavior. As an example, if alcoholism runs in the family, it might be very easy for you to get addicted.

Tapering is always the way to go, but eventually you can't go any lower in dosage. What you don't know is if going cold turkey will bring about symptoms that are a medical emergency.

I know the addiction cycle (rebound headache) and yes, it's tough. Once is enough. Been taking the same med for 25+ years. No sign of addiction.

Fenatyl brings some unique problems and you did manage to "substitute", so the "dose" could be reduced even further.

If you can't reduce, try to increase the time between doses even if it's 2 hours at a time.

KISS, Thanks for you thoughts. I know you mean to help, but I feel slightly annoyed to have you tell me I am showing "addictive behavior." I am not predisposed to addictions and I've become sensitive about this. Unless you count coffee (I drink one cup a day) or posting here, I have never had any other physical dependencies. There is no alcoholism in my family. This is a physical dependency caused by the drugs that were prescribed to control pain, not "addictive behavior." It's relevant that I do not get high off these drugs, never take more than the minimum and frequently forget to take them. I do think there are parallels between the legal drug industry and the illegal drug industry, but that doesn't turn me into someone who is out of control. If anything, my problem is that I am too high functioning, in that I can't just vanish for a few weeks to be in withdrawal.

In order to get off the fentanyl, I basically had to quit working for 6 weeks. It's not easy to schedule something like that, which is why it took me so long to do it. As a direct result of kicking the fentanyl, I lost a client for my business. I have a lot of sympathy for people with drug dependencies, however they started, whether through addictive behavior or a doctor's prescription, because once you are on an opiate, it's hard to stop without bringing your whole life to a stop. If you have responsibilities like kids and no network--partner, family--to take up the slack, then you are pretty much stuck. That's what happened to me.

I don't think that going cold turkey from 5 mg of methadone would bring on a medical emergency. Other people take 100 to 300 mg a day. I just want to be able to keep functioning at a reasonably high level.

[/QUOTE]If you can't reduce, try to increase the time between doses even if it's 2 hours at a time[/QUOTE].

This seems like a good idea. But if I delay 3 hours a day and get back around the clock (in 8 days), then what?

Very hard to reduce in small increments, since the pills are tiny and hard to break into regular size pieces. Pharmacist did not have any bigger pills or smaller doses. I asked.

I am stumped too, and I guess I'm just going to have to tough it out. Maybe I just need to whine!

I don't blame you for being "slightly annoyed". I used the word "might". What I guess I was trying to say is that you could be too sensitive at this point. My rule is I only take the meds early in the pain phase and only when the trigger is present. My cocktail that I have to choose from is very unusual.

What I was saying is if you are taking a dose 2x/day that's every 12 hrs. Make it every 14 hours, then every 16 hours, then every 18 hrs. A PITA.

Just checked my mini PDR. It says that "Dispersable tablets may be dissolved in 4 oz of water or fruit juice." That's a way you can reduce the dosage. Dissolve into 4 oz. then dump half of that liquid (2 oz) and fill with 2 oz. of water. You just halved the dose. This would be more reliable than cutting.

It's also available in a concentrated liguid form that must be diluted with water.

Onset in 30-60 min and peak in 1.5 to 2 hours.

I don't know how far you are willing to go in order to make this transition a smooth one, but I can tell you from personal experience, there are facilities that can bring you down slowly. They don't push you to go to meetings or admit you are an addict. They are just there for the medical detox part. If you want to know more about let me know and I'll send you my email address. I just doubt if I am allowed to post the name of the facility in this public forum. I'm praying for you because I know how truly crappy you are feeling right now.

Kiss and Julbox, I really appreciate your advice. I think I will try dissolving the pills as KISS suggests. That is a great idea. Thank you so much! It sounds so obvious now that you say it, but I was totally stuck on this problem.

Julbox, if I can't manage that, I hope to ask you for the place you were thinking of.

You are certainly right that I am too sensitive about this.

Kiss, you mentioned an unusual cocktail and I am curious about that if you want to describe it. I take it you have episodes of pain?

I sympathize with you as I am going through the same. Were you ever able to get off fentanyl completely and how hard was it? Do you fell like you are back to normal or are there problems from reducing or getting off the fentanyl. Any information would be appreciated. Thanks, Star

Hi Star,
I did get off the fentanyl! I have been "clean" since June. I wish I had done it a lot sooner, as my pain is the same as before and I feel much better than I did on the fentanyl.

I went cold turkey from 50 micrograms/48 hours to nothing for a long weekend, then put on a 25 mc patch and weathered the continuing withdrawal. That was the most frustrating part, how long that lasted. I felt off for 2-3 weeks. I was just starting to feel better when I repeated this from 25 mcg to no fentanyl.

I went as deep into withdrawal as I could stand for the 4 day weekend, because I hoped that would shorten the total time of feeling crummy. That part wasn't that bad since I wasn't trying to get anything done at all. I just watched movies and did nothing. Both times I hit a really low spot where I got all twitchy and couldn't sleep, lots of anxiety. Nasty feeling. But only for about an hour each time, because the first time I put on the 25 mc patch and took a valium. The second time I took a Norco and took a valium. Valium is really useful to take, but only occasionally, NOT three days in a row or you'll hooked instantly.

The whole thing took longer than I could have wished, but not as horrible as I'd been lead to expect. Like I say, I just wish I'd done it 2 years ago...

Do you have pain? What's your dose?

Hi Asking, I don't know if you ever came back here to check your "personal blog" ;) but I hope that you have had success in getting off the methadone. I'm sorry that in your last post you had to explain to someone what it's like to be on methadone and to get off it. I wish the world knew that no matter how much of an addict/or non addict a person it, if they take any mg of methadone regularly they will be physically dependent on it... (addicted). It's sad that people try to categorized people this way though. Humans are made up of hormones/chemicals and after taking methadone for years, even Mother Theresa would be in pain coming off... this doesn't mean that she needs a 12 step program. Anyway, to answer your question... methadone simply takes a very long time to come off, no matter what the dose you were on. You biggest problem will be long term fatigue and feeling like an elephant is sitting on top of you. You need to just push threw it and eat healthy and take many vitamins. Make yourself exercise. I wish you the best of luck and hope that you are already off it. Congratulations on getting off Fentanyl... that stuff is just plain nasty. I'm just seeing that there are more pages to this... maybe I'll find out your off. Good luck!

My Brother died from Fentanyl patch. It released all at once and caused respiratory failure... STOP TAKING IT NOW!

Daniel, I'm so sorry about your brother. It's good that you are posting about it, to help others.

Fentanyl patches release all at once very easily, especially the older ones. Supposedly, they've made them better. But I had them leak, which is bad and one one time in particular, I had respiratory depression and slept for two days. I woke at some point, could tell my heart was beating really slowly, ripped off the patch and went back to sleep. When I finally woke up again many hours later, I was okay. If I hadn't woken up that time and realized I was in danger, I probably wouldn't be here. When I told my doctor, she just shrugged.

Anyway, I've been fentanyl free since June 2008 and methadone free since December 2008. I still have chronic pain and have been diagnosed with rheumatoid arthritis. But I don't take an opiates except for a vicodin maybe every other month when things are bad.

I think I posted about the methadone withdrawal elsewhere. It was much worse than the fentanyl and took me three to four months to get off the lowest dose available.

Daniel. So sorry about your brother.

My elderly mother started to take the patch and she cut the envelope and I'd say almost died too. Arthritus made it tough for her to tear the patches open. I know we were able to take care of the resulting problems without major intervention.

Yep. Just plain nasty.

Hi Asking. I am currently on 100 mcg Fentanyl patch. I like you had no idea the depth of addiction this patch could create. I was in a very bad accident on July 23rd. I was hit by a drunk driver while riding my bicycle. I had a crushed spine and broken pelvis. Those were the worst injuries, all others were just minor. From the second day I was in the ICU I was put on this patch. I didn't even know it was there. They just changed it every 3 days. I ended up having a spinal fusion of the T11-L3 and a pin placement in my pelvis and sacrum. The patch has been the only thing that has managed the pain. I have been on it for 5 months now. I want to get off. As of right now it is the only narcotic I am on. I have Oxycontin and Valium for breakthrough pain, but don't really take it. My doctor had me changing the patch every 48 hours and for the past 2 patches I have been wearing them for 72. I went into a pretty bad withdrawl episode and it really scared me. I discussed this with my doctor, and we have come up with a plan to wean me off the patch. I am very scared of the withdrawals however. I am to go on a 75 mcg and 12.5 mcg, and wean the 12.5 each month. I will go to 75,then 50 & 12.5, then 50, then 25 & 12.5, then 25, then 12.5. He says that the w/d should not be bad. He stated that he could prescribe me Clonidine to help if I need it. I guess I am just wanting some re-assurance that I can do this, and not breakdown. Especially in front of my kids. I am a Stay at home Mom. My family has been through so much with this accident, and I can't bear to put them through anything more. I am sort of sad that I will have to "detox" from drugs as well. All of this on top of recovering from my injuries. So I hope that you are still reading this, and that you can give me a ray of hope. Thank you.