“The Choice”

SO you made the decision to finally wean off opioids and seize the day. You may have read the news about the dangers of long term opioids and the misinformation that led to so many people becoming dependent on these medicine. But now that you’ve made this important choice, you’re unsure how you’re going to do it and who will help you? From the outside looking in, it seems like a giant mountain. Maybe you’ve even attempted to quit before and had multiple set backs where you were unable to achieve the goal and had to start the process all over – like Sisyphus having to push the same stone up the hill time and again. How you do it is important, along with planning for realistic goals of how long it will take along while managing any symptoms that can happen along the way. The first step is sitting down with your provider to discuss your decision so that you can come up with a realistic timeline.

            If you’ve been on chronic opioids, you probably shouldn’t quit overnight as there can be side effects associated with their discontinuation. The normal goal should be to decrease your dose of medication by 10-20% every 1 to 2 weeks. Though people believe withdrawals only happen to those withdrawing from illicit medications, they can also occur with opioids you get from physicians. The receptors are the same and so sometimes even though the dosages tend to be lower there can still be symptoms when coming down on the strength of your medication.  This usually will occur in those who are opioid tolerant. The FDA definition of opioid tolerant is anyone who is on 60 mg equivalent daily dose (MEDD). Some of these symptoms can be muscle aches or excessive yawning initially which progresses to diarrhea, runny nose, or panic attacks. Usually by day 5 or 6 most of the physical symptoms will resolve but some of the psychological symptoms can be longer lasting. In addition, there are certain medications that can help with withdrawal symptoms and during this time avoid other opioids or benzodiazepines.

            With all this being said you should have the confidence in your physician to discuss your decision to discontinue these medications. Your provider will understand that reliance or dependence on opioid medications is different than addiction. Addiction is, of course, markedly different than dependence or chronic use, as addiction is defined by uncontrolled and compulsive drug use despite harmful side effects, aberrant behavior, and psychological fixation. When dealing with dependence, you should be open and honest with yourself and also with your healthcare team so they can come up with a personalized treatment plan. This may take intensive therapy in an outpatient drug treatment facility who can manage your care and coordinate all the steps required to keep you drug free long term. The end goal of all this of course is returning back to your life and seizing all the memorable moments with your family on amazing adventures!

-Mike Martinez II #DOFW