Am I going to have a seizure?
October 21, 2011 7:16 PM   Subscribe

Can I safely stop using Fentanyl transdermal and hydromorphone "cold turkey"?

12 mcg/hr for the fentanyl (72 hr. patch) and "take half to one tablet by mouth up to three times daily" for the hydromorphone (2 mg). I have not used any more than prescribed. I switch out my patches every three days and I only took a whole hydromorphone twice in the last month.. My Dr. told me to come back in a month, but I made the appt. too late and can't get in until 11-11. When I inquired about a refill, the nurse at the clinic told me that my Dr. is out until 10-27; she asked another provider and he wouldn't prescribe them and said I need to wait until my Dr. gets back on Thursday. I have one patch left and I will put that on tomorrow.
posted by wafaa to Health & Fitness (17 answers total)
You would do well to consult your pharmacist in the morning to learn more about this. You need accurate information, and they're probably your best resource.
posted by heyho at 7:30 PM on October 21, 2011 [3 favorites]

I have been here, though not with the same drugs. I take a couple drugs to manage the symptoms of a condition I have, and it is SCARY thinking about the possibility of going without them for several days. In reality, I'd probably be OK (as in, I'm not going to die or anything), but I'd certainly be uncomfortable, and the effects of being off the meds for a short time could last for much longer. So when I've been in the "oh crap, prescription ran out" situations, I've scrambled.

Here are things I think you should do:

1) Call your pharmacy and see if they can give you a 3 day supply (or even one day or one dose). They will do this for the variety of drugs I'm on, but may not do it for narcotics.

2) Call the clinic back and ask to have an appointment with ANY doctor, not just yours, as soon as possible. Assuming the office has multiple physicians, making you wait until the 11th to see one of them is ridiculous. You'll have to go in to see them since another doctor won't call in a refill for your doctor's prescription, but they should be able to write you a new one (or, at the very least, a script for a short-term supply to hold you over until the 11th).

3) If your clinic won't play ball, you should start calling other clinics/hospitals to see if you can make an appointment with SOMEONE. You could also try an urgent care center or an emergency room.

4) Explain your situation clearly and calmly, and bring any and all paperwork you have regarding the prescriptions. Going to a new doctor with "drug-seeking behavior" raises a lot of red flags, so anyone you see will probably be on alert. Don't give them any reason to turn you away.

Personally, I would not feel comfortable going without my drugs for such a long amount of time, and since going off of the drugs that you're on could have serious medical consequences, it makes it an even less desirable option. Regardless of what you choose to do about actually getting a refill in the interim, you should definitely call a pharmacist and ask what the side effects of going off your meds are. If you can't get in contact with your doctor to ask the questions of him, asking a pharmacist is your next best resource.

Good luck.
posted by phunniemee at 7:37 PM on October 21, 2011 [2 favorites]

Find out if your doctor has a messaging service or some emergency way to get in touch while he's out. Even if it's just to speak to his colleague and OK his prescription.
posted by bleep at 7:52 PM on October 21, 2011

For what it's worth, withdrawal from narcotics is typically extremely unpleasant but not life-threatening, unlike withdrawal from alcohol or some other prescription meds. I've heard it described as "the worst flu you can imagine" and "you won't die but you'll wish you did."

Can you leave a message with a nurse at your doctor's office explaining the refill situation? They might be able to call in a short-term refill for you, especially since you have an appointment scheduled. You've got to get past the scheduling people, though -- get a nurse or a medical secretary or somebody who can actually let the doctor know WHY you either need to be seen sooner or need a phone refill.
posted by vytae at 8:05 PM on October 21, 2011 [1 favorite]

vytae is correct about narcotic withdrawal. you will not have a seizure.
posted by treehorn+bunny at 8:08 PM on October 21, 2011

True story: grandpa with cancer used to cut his fentanyl patches in half because they interfered with his drinking.

I don't know if tapering off this quickly will help with the withdrawal, but can't hurt to try. If it doesn't work, put the other half back on.
posted by gjc at 8:16 PM on October 21, 2011 [1 favorite]

Cut your meds/patch in half if you can

DO NOT CUT YOUR FENTANYL PATCH AND THEN APPLY IT TO YOUR SKIN. This defeats the time-release mechanism and can result in you receiving much more of the drug at once than you were prescribed. This is a Bad Thing when dealing with powerful synthetic opioids.
posted by Inspector.Gadget at 8:24 PM on October 21, 2011 [13 favorites]

Schedule II narcotics can't be called in to a pharmacy except in "emergency situations," and then only enough to cover the period of the emergency. It might be hard to find a doctor willing to try. You'll likely have to make an appointment to come in. If no doctor is able to accommodate you in time, I'd say urgent care is your best bet.

As Inspector.Gadget just pointed out, all forms of Fentanyl patch that I've looked into have directions not to cut the patch.
posted by WasabiFlux at 8:30 PM on October 21, 2011 [1 favorite]

It won't be pleasant, but the risk of seizure or death is way low for the opiates, synthetic or otherwise.
posted by solipsophistocracy at 8:41 PM on October 21, 2011

Best answer: You need to contact a doctor, clinic, somebody, or you will feel like shit. Even weaker narcotic opioids after a month will cause a minor withdraw symptoms.

They are not fun. Your body is requesting something that has become normalized in your body. A gradual step down is way better at avoiding these types of symptoms than just quiting cold turkey. You wont die, but you will feel disgusting.

Good luck, and jump to it with the quickness.
posted by handbanana at 9:04 PM on October 21, 2011

Sorry you have to experience this.I too have experienced the same things when a doctor went on holidays when I was due to get a renewal = one week off meds( I am on fentanyl and Ms Contin- a lot higher dose than you).

You "should" be able to handle a couple days as you will still have a certain level built up.For me personally it is not horrid until I approach 24 hrs off then it =drastically increasing pain.

Going off cold turkey will not kill you buy you will certainly be in a lot more pain and perhaps be violently ill.Your body no longer makes it own dose of opiate type pain relief so the pain that hits can be almost double duty feeling (of course every person will have different results)

I am not sure where you are but here (Canada) my experience has been that you WILL NOT get another doctor to fill a scrip but perhaps try to see if a specialist you might be seeing will have mercy? or a pain clinic? (usually pain clinics take forever to even get into but your area may be different.

I don't know of any pharmacists in my area that would cover a short term loan of an opiate-doctors and pharmacies both get too much hassle and pressure from various fronts.Sadly (again in my area) it can be hard to find a doctor who will even prescribe pain meds- the quasi hostage a opiate patient can experience is really crappy to say the least.

If you cannot get any medications-maybe try cannabis is some form to try and make things a little more bearable

Good luck
posted by plumberonkarst at 10:50 PM on October 21, 2011 [1 favorite]

BTW DO NOT CUT your patches-some get away with it but depending on patch type-the gel can dose full in short order when cut.Many accounts of overdoses are attributed to this.
posted by plumberonkarst at 10:51 PM on October 21, 2011

Best answer: Also, I wouldn't give up on your doctor's office. Show up in person and ask to speak to a doctor or at least a nurse or supervisor. There's a big difference in talking over the phone and seeing them in person - it's easier for them to verify that you're for real and you know you're getting the correct first hand information. They have all your records, a way to contact your doctor to verify any may even recognize your face - unlike any other place you may go. It's really not right for your doctor to leave you stranded like this and they should make it right, not just leave you to suffer.
posted by bleep at 12:15 AM on October 22, 2011 [3 favorites]

Best answer: It sounds like you may have some hydromorphone left if you have not been taking them very often; they can help tide you over until this is straightened out. You may want to leave your current patch on until you start having symptoms of pain or withdrawal and then switch it out; you might be able to get an extra day or two out of each patch that way; it's not as if the drug suddenly stops all at once. Also, you are on the lowest dose of transdermal fentanyl available (for short periods in the OR we give several times your dose in mcg/kg/hr) so that should work in your favor towards minimizing symptoms should you be unable to get a timely refill.
posted by TedW at 7:11 AM on October 22, 2011

You can cut hydromorphone pills in half. The new (at least in the US and probably Canada) changed the formula to have the time release difficult to bypass and if its an IR it should be fine.

Cannabis can definitely help with some of the symptoms (nausea and killer headaches).
posted by handbanana at 8:55 AM on October 22, 2011

Urgent care type places are unlikely to write you fentanyl. Agree with TedW that you can probably stretch these meds a bit; it is not like some drugs where missing doses is dangerous. The dose you're on won't be like cold turkeying heroin or some such, but your pain will come back. Agree that harassing your MDs office is reasonable; your record there should clearly document the situation. Recommend not trying to mix in self-med with alcohol or cannabis.
posted by a robot made out of meat at 5:52 PM on October 22, 2011

Response by poster: Thanks everyone! I went to Urgent Care yesterday, and explained my situation to Dr. "K". He was very sympathetic but (understandably) couldn't help me. He did pretty much say it was lame for another provider to refuse my request. Although UC has access to my records, the fact that it's not in the same office (family practice) limits him in what he can do. He suggested I go down to my Dr's office on Monday and say 'c'mon, guys, help me out here.' In the mean time, he suggested I wear my current patch for an extra day or two before switching to my last patch.

Yes, I should have not waited to make that next appointment, but this is ridiculous! Hopefully I can make it through the next few days at work. Thanks again for all your advice.
posted by wafaa at 8:13 AM on October 23, 2011

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