Advice on lowering my dose

Mental health
1

Hi,

I was originally prescribed dihydracodiene many years ago to help with pain I suffer due to a chronic condition. I also suffer clinical depression and an anxiety disorder. I found that the dihydrocodiene relieved much of my anxiety and lifted my depression a little. 

It didn't take long for me to start abusing these painkillers because of the tremendous relief they brought to my anxiety.

The honeymoon quickly wore off and I found myself having to deal with my severe depression and anxiety, the symptoms of my chronic condition that had required opiate analgesia in the first place and now an addiction problem too!

After some years of addiction I had become highly tolerant to dihydrocodiene and the pain was once again becoming intolerable. I saw my GP who was being very decent and trying to help me wean myself off the codiene. He was quite sympathetic and once he understood that pain was once again a genuine issue, he referred me to a pain specialist. The pain specialist convinced me that methadone would manage the pain and help me with my addiction to codiene. So I began taking methadone, and eventually settled on 85mgs. I've been on 85mgs for years now. But I've reached a point where I believe it is doing me more harm than good and I want to stop taking it. I've been reading some posts by people saying they've reduced their dose successfully. However I am terrified by the prospect of reducing my dose. I have experienced outright withdrawal before and I think because I suffer from clinical depression and anxiety I had a horrible psychotic episode. The whole thing was an ordeal. I had decided to just stop taking the methadone. In hospital I was started back on methadone again and got my dose back up to 85mgs.

My point is I'm now terrified by the prospect of reducing my dose. I really admire people who have successfully done it. I'd like to hear from people who have reduced their dose or even completely come off methadone gradually and been successful.

I am  very fearful and have been putting it off for way too long. Any advice would be very much appreciated.

2

Hi Jack

 I have an addiction to alcohol and there is no point sugar coating it.. It was the hardest thing I have ever done coming off it..But if I weigh up my life now to when I did drink it was the best thing I have ever done for myself stopping..

It is frightening coming off drugs of any kind.  I also became dependent on diazepam that I was prescribed and this time I asked to go back to the hospistal for help..Why? Because I knew that would it be a downward spiral with my mental health and that would lead me to a very dark place like the alcohol did..

Yes there was side effects with both and I had panic attacks,anxiety and depression..  I was  terrified because I didn't know what to expect.. But I had loads of support from the hospital I was in,  AA support and from the friends I made.. I am now 10 years clean and I seen a great improvement in my mental health.. I know you are in chronic pain and I can only imagine how difficult it has been for you as I have now Fybromaligia and in pain a lot..

Its small steps when weaning off, make sure you have others at the end of the phone that are going through the same or have eg NA support group.

You can be admitted to a hospital that deals with addiction and that would be great support for you.. Have you talked to the doctor about other pain management??? 

I can only imagine a pyshcotic episode is terrifying.. But I am going to assume that came from withdrawal and it being done to quick if you have never had one before?

I know its hard but its a choice between staying on something that is affecting your mental health and possibly not helping the pain as well as it should be..Or knowing once you come out the other end you never have to go back there..

You can do this you have come off dihydrocodiene..You should never have been put on methadone knowing you can become addicted..

You need support when doing this from proffessionals as it needs to be monitored and you need to know you can get through this..

 

3

By the way in all the people I have met or worked with I have never met one that wasn't terrified coming off a drug.. So your are not on your own..

4

Thank you so much for your reply Laura,

it it is very encouraging to hear from someone who has successfully overcome a physical addiction. The psychotic episode I experienced was induced by a sudden, complete withdrawal from 85mgs of methadone. I chose to do that, because I thought the withdrawal would be the same as the withdrawal from dihydrocodiene. It was so much worse. I haven't had a psychotic episode since and never had one before.

I do have support in place and I've discussed slowly reducing my dose with my GP and the pain specialist. Both of them are just waiting for me to tell them when I'm ready to start doing it. I keep procrastinating and coming up with good reasons for not getting started. Intellectually I understand that it won't be anything like the horrible experience I had before, but I'm still very frightened by the prospect.

I have to undergo surgery in the next couple of months and my doctor has told me I should wait until after I've had the surgery and recovered from it before I start lowering the dose. I'm seeing the anaesthetist and surgeon for a routine discussion next week and I have a feeling the anaesthetist may tell me he wants me to lower the dose before he's prepared to put me under. If that's the case it may turn out to be just what I've needed, an important and immediate reason to start reducing my dose.

Thank you once again for your encouragement and very good advice, it means a lot coming from someone who has successfully beaten two physical addictions. I know you understand the fear and anxiety I feel at the moment.

5

I completely understand your terror about coming off methadone. Have you discussed lowering the dose gradually with your GP? Are you seeing a Pain Clinic Specialist - because it sounds to me as though you ought to be, as your initial reason for taking the dihydrocodeine was chronic, severe pain. This is not 'just' a simple addiction withdrawal, is it? You need some pain relief as well. I was wondering what made you think 85mg methadone was too much - I mean if your GP has prescribed it and you haven't been abusing it............... and I am not at all surprised that you had awful withdrawal symptoms when you didn't take it. Never go cold turkey on a strong opiate, a high dose of tranquillisers or alcohol addiction - it is very dangerous. Your GP sounds helpful - can't you go back to him/her and share this worry and seek help? All the best and let us know how you're doing.

6

Ok.. then I would wait to see what the anaesthetist and surgeon suggests.  As you said if they want to you to lower the dose it is a positive to get you started..You sound so like me needing that extra push and when you do make the decision you stick to it..If they don't feel you needto reduce then I would defintely go to your doctor and get support and advise for weaning off.   We make too many excuses and then get stuck. We catastrophize things by thinking the worse case scenario and its never that bad.. It will give you something to focus on and take your mind off the up and coming surgery..But please don't ever pull off any medication you have been on a high does or long term use without a doctors advise and your are being monitored..

I think you have given yourself a big scare going cold turkey.. But you won't do it again thats for sure lol..

If you are aware that painkillers are a problem for you in the low term then you doctor needs to beaware of this everytime you speak to one so they can give you alternatives..

My sister went through morphine patch addiction through no fault of her own and it was devastating to see how it affected her mentally and physically.. Luckily I had the background knowledge through studying drug awareness and recognising  the signs through my own addictions to get her help..

 

7

Thank you,

i domhave a good GP. No one is telling me I have to stop taking methadone. I've never had the urge to abuse it, like I ended up doing with the dihydrocodiene. It works reasonably well as a means of managing my pain too. 

I just feel that some of the side effects are getting worse as I get older and I'd like to at least reduce the dose.

Thank you for taking the time to reply, I value your advice. I've definitely learned that a sudden withdrawal from methadone is never a good idea.

8

You are so right when you say we catastrophise things. That describes me perfectly!

youve really given me some great advice and put things into perspective for me. You really have been a great help to me today, and I'm very grateful.

thank you

9

You are very welcome Jack and I wish you all the best..

10

GPs and medical doctors in the UK are opioid-phobic. Many have become so scared that they will be accused of addicting their patients that they would rather we suffered pain or withdrawals.  Most opioids are harmless to the body, and unless you overdose by taking far too much, there is no real risk of harm or death. Also, most opioids have been found to have a 'plateau of tolerance'. That is, when your tolerance rises, and you need higher doses to achieve the same pain-killing effect, this does not go on indefinitely - eventually your tolerance will plateau, and you won't need to take higher doses. Trouble is, most doctors won't let you reach this dose level, because they are too worried about protecting their own arses, and would rather you experienced pain or withdrawals than they should face criticism or a threat  to their salaries/careers. The ineffective Recovery movement in the drug addiction field has made this whole problem worse by insisting that just about everyone goes on a reduction regime until they are 'drug free'. This attitude has spread across the board, and now people are finding themselves thrown into withdrawals, suffering pain, and in some cases, death through suicide. The current situation is an outrage, and eventually research will expose this 'get everyone off the opioids' strategy for the nonsense it is.

11

I absolutely agree with all of that. Well said.

12

Hello JackDm,

I also suffer from chronic pain and am on a pretty high dose of two narcotic

pain meds, i however am not addicted but i keep that from being a problem

by having a loved one lay out my dose and then putting them in a lock away

(some people use lock boxes mine leave the house) but i am told this is what

you get today take them how you want and there will be no more. actually we were

doing that for my ex who got addicted and was stealing mine so now that we are

apart I continue to let my mom take my meds away. but you need to get someone

who will not be ab enabler and break down and give them to you. Use Tylenol with

the meds though eatch how much apap you are consuming a day THis is an idea

that has kept me from ever getting a problem and i know my ex has cleaned up after

realizong what they threw away for a pill high that lasted 4-6 hrs. Even resorted to stealing

from me someone with real serious issues who went mad with pain on the]

days they stole so many I went w/o which is when my mom stepped in and saved the day as

i was in fact an enabler if i heard my ex whine and beg i gave in and gave

them one of thier pills extra until they were out two weeks early then stole

from me, You don't want to loose everything and you will if no help is sought

after. But best of luck my friend it may be a struggle but I bet you

are strong and have a lot to fight for,