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  1. #1
    notRight's Avatar
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    Default Detox from Fentanyl-how to use my Ultram &Percocet

    In what started as a misguided effort to avoid back surgery, I got myself dependent on Percocet and Fentanyl. I'd appreciate someone to explain how to mix and match the drugs I have on hand so that I can finish detoxing and get my life back.

    A month ago I was on a 50mcg Fentanyl patch and taking 140mg/day of Percocet. Now I'm down to 15mg/day of Percocet and am currently wearing my last 50mcg patch. My remaining inventory is one 25mcg patch, 75 Percocet 10/325's, and 30 Ultram(tramadol) ER 200's. I have to be clean and happy when those are gone because my Dr. won't give me any more prescriptions, not that I blame her.

    I haven't taken any tramadol for months and don't know how useful it is during withdrawal. I think that the pain-killing equivalency of tramadol to oxycodone is roughly 170 / 30 but is it a narcotic replacement at the same ratio? Fentanyl 50 is reported to be roughly equivalent to 100mg/day of oxycodone but, again, does the body treat them the same? I've read so much about the nightmares of coming off Fentanyl that I'm worried that it is much harder to wean off than is Percocet.

    Can anybody tell me how best to manage all this stuff to be totally detoxed in 17-18 days with a minimum amount of pain? It's not the math I need help with but someone who understands how these drugs relate to one another and knows how much Percocet equals how much Fentanyl and how Ultram ER can be used in the mix, etc. The Fentanyl 50 patch will come off at midnight on Sep 2 to be replaced by the 25mcg patch which will come off 60 hours later. Then it's nothing but pills.
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  2. #2
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    Default

    I wish I could help but I do not know anything about that, unfortunately. I just wanted to wish you luck and strength for these next couple of weeks. I'm pretty new here but I understand people post more slowly on the weekends. But I'm sure someone more knowledgeable and helpful than myself will come along soon.

  3. #3
    conch girl is offline Junior Member
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    Not Right-
    I just went off Fentenal (Duresic) myself, finishing just this past August. Let me make one thing very clear-

    YOU CANNOT GO OFF WITH JUST ONE 25 PATCH! You must stablize first on the 25, which could be as long as 3 weeks before you taper down from the 25. Your body is going to fight you like hell and it is the HARDEST that last 25 drop.

    You doctor will agree with me on this.

    When I was ready (I was on 100's every 48 hours)to start taper off the 25's, I cut the plastic the duragesic patch (name brand) came in, the size of a dime and wore it for 4 days.

    Then I would get a new 25 patch, and cut the plastic the size of a nickel and wear that for 4 days...and so on and so on.

    This way you don't wind up in the hospital freeking out.



    conch girl
    3 neck surgeries, DDD in neck and lumbar

  4. #4
    MoonlightMile is offline Senior Member
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    quote:Originally posted by notRight

    I have to be clean and happy when those are gone because my Dr. won't give me any more prescriptions, not that I blame her.
    Just a thought- have you considered talking to your doctor about this predicament? After all, she has been prescribing these narcotics to you, with full knowledge of their strength.

    Standing on the edge of the frontier...

  5. #5
    conch girl is offline Junior Member
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    Two more things....

    only use the percosets & ultra's when the withdrawals are severe and try cuting them in half. You must try and get by with as little as possible.


    Your Pain doc doesn't know much about the pain patch if she is expecting you to go off with one 25. You can do a GOOGLE search to find documentation that proves this. You need at least 3-4 25's, and preferably the name brand so you can alter the surface contact with the drug. You can't do this with the generic.

    BTW, I was on generics and almost OD'd on one patch (a 50 )since it released too much drug in a couple of hours. Never again would I use a generic patch.


    conch girl
    3 neck surgeries, DDD in neck and lumbar

  6. #6
    notRight's Avatar
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    But can't I make up the difference between the 25 and the 50 patch with Percocet and Ultram? If not, I'm in big trouble! I'm wearing my last 50 now and it will deplete around midnight. Then it's the only 25 I have for 2.5 days and then it's just the Percs and the Ultram, if it has any value.

  7. #7
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    Hi NotRight,

    Hmm...where to start here. OK, first, unless you have the mylan fentanyl patch, you shouldn't cut them (any of the name brand ones with the gel in them). Now, conch girl is correct and in an ideal world, it would be best to gradually taper the fentanyl...but it looks like you're gonna have to work with what you have there.

    Now, the issue of equivalencies is kinda problematic here as first, this implies maintaining an equivalent level of comfort...not good for a taper...and physiologic responses to different opiates are often individual. Some claim hydro works better than oxy when in fact, hydro is technically weaker than oxy. For me, ultram is like using skittles for pain, for others, it works great.

    Unless one has a great deal of time and a huge quantity of meds to taper with very gradually, the basic principle is that one can either go cold turkey and suffer a shorter period of intense withdrawal or one can gradually taper and suffer a longer but milder period of withdrawal. Most pain pills involve 5-7 days of withdrawal but fentanyl usually has one week of acute withdrawal and then a second week of intense leg pain and persistent symptoms. For this reason, I think I would hold the percocet for when you are finished with the 25 mcg. patch. You will experience some withdrawal from this, as this will knock out the 15 mg. of percocet you supplement with. But then the percocet can carry you thru the 2 weeks of fentanyl withdrawal. Only take as much as needed to be relieved of really unbearable suffering, and you will be making progress. Pay at the front or pay at the back end...that's how it works. Trust me, I've detoxed off every opiate out there in my day.

    By the end of the second week, you taper down the percocet. If the ultram works for you (which it does for many) use that at the end of the taper and taper that down as well. Go from strongest to weakest, tapering the whole time. Just remember, if you keep taking enough to feel good, you'll pay for it at the end.

    dee

    Dee--off MMT 9-12-06

  8. #8
    notRight's Avatar
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    Thanks for all the responses but I'm still confused. I'm a beginner at this addiction thing, this being only my second time. And the first was with Vicodin which sure didn't seem this hard!

    Here's the schedule I had made several days ago to taper off using my remaining patches and Percs:
    [u]Aug </u>
    23 60
    24 60 Fent50 8p
    25 50
    26 50 Fent50 8p
    27 40
    28 40
    29 30 Fent50 10a
    30 30
    31 25 Fent50 6p
    [u]Sep </u>
    1 15
    2 10
    3 55 Fent25 12a
    4 50
    5 40
    6 80
    7 75
    8 70
    9 65
    10 55
    11 50
    12 40
    13 35
    14 25
    15 20
    16 10
    17 5

    Is this not a reasonable schedule? What am I missing? Trust me, I am not taking enough to feel good! No energy, sleeping 12 hours a day, sweating except when I'm very cold, skin one size too small for my body, this is by far the stupidest thing I've ever done despite a page full of nominees.

  9. #9
    sudokudee's Avatar
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    OK, hold on, I'm studying this schedule. So far, it looks perfectly reasonable to me and looks like about as good a schedule as one could possibly come up with working with what you have.

    Let me ask just a few questions here. This end date of 9/17...is this strictly due to being the date you'll run out or do you have to report back to work or something like that at that date? What other obligations, like work, school, children, etc. do you have to deal with while going thru this?

    If you're able to stay home and take it easy for the entire time, the schedule looks perfectly reasonable to me if you can stick to it. It might be a bit challenging but sticking to this will get you there. And you can use the ultram sparingly after you jump off the percocet.

    You see, the actual mechanics of a taper are fairly simple to map out. The problem is that many of us couldn't stick to the tapers. But if you can stick to this, you can do this.

    There's a gal here, defiantgroundhog (Nikki) who did almost the exact same thing as you only using hydro instead of oxy (percocet). I'll PM her and see if I can get her over here to help you too.

    dee

    Dee--off MMT 9-12-06

  10. #10
    notRight's Avatar
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    Thanks Dee, I'm scared out of what wits I have left. The 17th is the date that I ended up with when I calculated the most even taper with the drugs I have left. Work is my only obligation but it's a big one, one of the owners of a small company. It gives me a lot of freedom but I can't just disappear for a couple of weeks.

    And you're quite right, making the schedule is easy. But then the BeeGees start and that Rx bottle looks right at you and says, "You don't have to hurt, now."

  11. #11
    sudokudee's Avatar
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    Oh, you are so right about that...why tapers are so hard. The only really successful tapers I've done were purely accidental. I would be totally out of drugs and crawl, suffering for about 2 days. Then I would come across 2 or 3 measly pills and take them...mild relief. Then crawl for a few more days and come across maybe one pill...mild relief. And then make it out the other side. Had those pills been right in front of me, they wouldn't have lasted more than a few hours. I repeatedly tried to do this myself and failed.

    Of course, back in the early years of my addiction, I could do my own taper successfully...why I think you can do this. Over the years, you develop such a knee-jerk abhorance and fear of withdrawal, that the anxiety becomes overwhelming with the appearance of the first mild symptom...the dread is just impossible to deal with sanely.

    Theoretically, one could do a true taper if one went slowly enough and decreased in such minimal amounts that the drops were barely noticeable. This is possible with a long-acting opiate like methadone, with the liquid form and computer-driven dosing machines. It takes months and tons of patience. But this is difficult with short-acting opiates, as the symptoms kick in after about 4 hours if you have any significant habit/physical dependency.

    You know, even after 3 days, there is still some fentanyl left in the patches. You could leave the patch on for a fourth day and use a heating pad to increase absorption of the small amount left. This is dangerous to do with full patches due to risk of OD but with a non opiate naive person and with a 3 day old used patch, it could be done safely if done carefully. Just use the heating pad for short periods during the day. This will give you a little extra to work with.

    Can you take a few days off when you jump off at the end?

    I did PM Nikki and am waiting to hear from her. She successfully used hydro (vicodin) to do the same thing you're planning here. And she is a really nice person. I think you'll really like her.

    dee

    Dee--off MMT 9-12-06

  12. #12
    notRight's Avatar
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    Well, I feel like a battle-weary soldier waiting for another inevitable invasion. I pulled off the Fentanyl 50 patch at midnight last night and replaced it with my last 25. No problems during the night. I took two Ultram 200's this morning and haven't taken a Percocet yet today because I haven't needed it. I know this is a false peace, maybe because the F50 hasn't been fully depleted out of its reservoir yet. Sure wish it was a lasting peace but I know the war will resume soon.

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