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- čas přidán 16. 08. 2024
- Who are good candidates for opioid tapering? What is opioid induced hyperalgesia? What is withdrawal mediated pain?
In this video Dr Furlan explains how to select patients for opioid tapering, and how to conduct a trial of tapering that can help the patient to achieve their goals of better quality of life.
Opioids are a type of painkiller prescribed by physicians.
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#drAndreaFurlan #DrFurlan #DoctorFurlan
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ALERT: This video is not intended to replace medical
advice. If you think you have a condition that is
causing you pain, please consult with your doctor
to get a diagnosis and a treatment plan for you.
The intent of this video is only for educational
purposes.
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What a GREAT physician and human being. Thank you for the compassion that led to this video. Good luck to anyone out there who will take the steps to step off the opioid train.
Very nice of you
Please, please, keep on doing this type of videos. So hard to find a comprehensive but multidisciplinary approach to chronic pain from a PhD. Thank you so much.
Thank you for watching the video and writing this comment. Please share this video with your friends. I have lots of videos about chronic pain on my channel czcams.com/users/DrAndreaFurlan And don't forget to turn on the notifications 🔔
Dr. Andrea, your approach, knowledge and compassion for the “opioid dependent”are refreshing. You explain tapering step-by -step and you make the viewer feel it is possible to jump off opioids. I am feeling helpless because the withdrawals kick in after 4 hours and I’m in agony. I know I can do this! I subscribed and I will share with others.
Hi, I already recorded a video about how to taper opioids. It will be released soon.
Thank you for this information. The more knowledge a patient has the better they can advocate for themselves.
Knowledge is important. I agree.
Dr Dr Furlan,
I suffer since 5 years from chronic whidespread pain and I have been on maximum dosis Tramadol, Diclofenac and benzo’s for many years. Thanks to your videos I discovered how hyperalgesia works. The side effects of pain killers and benzodiazepines are extreme and cause in many cases more harm than it benefits. That’s why I decided to stop these medications. I tapered and stopped benzodiazemines in 2 weeks time and afterwards Tramadol from 400mg to 0 in one month. The diclofenac I just stopped as it doesn’t need any tapering.
Getting off these medications was going through hell but it was defenitely worth it. Is the pain gone? No. But it is not worse and the side effects of the medications are gone. Now I try to treat the pain problem with body mind techniques and non-medical treatments. Thank you very much for your video’s. It helped me a lot to make the right desicions.
Thank you very much.
You are providing a needed service. Please ignore the negative comments.
You are helping many people that have no where else to turn.
Hi, thank you for posting this comment. I'm receiving so many comments lately that I don't have time to answer all of them. I hope you are doing well.
I was just kicked off my pain management today, effective immediately, after being on pain medications for 3 years. I had 1 false pill count today. I've never missed an appointment, never had a positive drug screen. I was not given any guidance on how to taper off with my remaining medication. I am likely going to end up in the hospital. I need help and nobody is helping me. Not to mention the excruciating pain coming back as well.
Oh no! I am so sorry to hear that. Beth Darnall from Stanford University has been advocating on behalf of people in the same situation. profiles.stanford.edu/beth-darnall
Try kratom for a week or two
Dear B, I don't agree with your suggestion to try kratom.
I found this information from RxFiles in Canada - Kratom is a herbal product, opioid agonist properties; mostly obtained as a powder and consumed as a beverage; doses >15g may produce opioid like toxicity; severe adverse events, including death, have been reported; naloxone may be given (if drowsy/respiratory depression). www.rxfiles.ca/rxfiles/uploads/documents/CHT-Substance-Abuse.pdf
The U.S. Food and Drug Administration is warning consumers not to use Mitragyna speciosa, commonly known as kratom, a plant which grows naturally in Thailand, Malaysia, Indonesia, and Papua New Guinea. FDA is concerned that kratom, which affects the same opioid brain receptors as morphine, appears to have properties that expose users to the risks of addiction, abuse, and dependence. www.fda.gov/news-events/public-health-focus/fda-and-kratom
I am going to do more research on this topic.
This is a little late, but Robitussin can help a lot. It helped me when I was tapering. I don't remember how much to take, but you can google it. I keep some on hand because sometimes the doctor acts like he wants to take me off.
Surgery and poisoning chemotherapy changed my body and qol. My pain was controlled with 2200 mme for 10 yrs. I have a very healthy sex life on ot. Since forced tapering has been pressed upon me , has effected my ability to workout and stay healthy. I was the healthiest on my OT. My lymphedema was controlled, my mind was clear and I was able to sleep well. Dr. Have the obligation to be honest with patients. I have been taking lt opiate therapy, bc my body metabolizes the meds faster. I should feel heard not gaslighting. I was very active and still trying the best I can with no breast. I have a complex history with so many misdiagnosed illnesses that could have been fatal if I did not advocate for myself. Don’t punish pain. If people are against taper and family also, this should be considered strongly.
I'm sorry to hear that.
SAME..The state shut down my amazing pain management doctor and 7 other's in 1 week I was on 60mg a day nothing crazy compared to others with the same medical condition i need to work im the soul provider for my family had to go to the ER they did get me a new doctor in 2 days we'll while I was at Roswell park loosing my Father she went out to have her baby the doctor who came in just started cutting my does FAST down to 15mg a day its like Tylenol for a broken leg my intire life was effected Work,Cleaning the house,Taking care of my daughter ive bin in sooo much pain for 2 year's 3 weeks ago my spine gave up on me now im about to have a major surgery I can't work i don't know what I'm going to do the recovery time is 6 months alone i understand every bit of this epidemic But I'm sure a doctor can tell the difference between do the pill counts,Monatore the patient people are that never abused or even used a drug in their lives are suffering because of the Fentanl problem and yes they definitely over prescribed in the beginning but that was BIG PHARMA yet we suffer, I have a 24 and 20 year old i educated them hard on these drugs I kept my medication in a safe lockbox because i had teenagers but it didn't matter they listened to me about the harm not everyone should be punished and have to live a life low functioning because of other problems bigger than them...Pray i dont loose everything while im out of work I'm petrified of surgery the last one i had I hemriged coded twice multiple blood transformations and while my new born baby should have bin in my arms i was in ICU i walked out that hospital with severe panic disorder so yes i feel i had to right to be petrified of surgery..Now my spine is giving me no choice i pray your not fighting to stay out of pain.....
After pancreas surgery and later internal bleeding on top of chronic pain the doctors refused to prescribe more hydrocodone. I was in pain and insomnia follows. A friend gave me some medical pot and so I finally decided to try it after more than six months. At night around 9 pm I take a pinch of pot in some sleepy tea or a few puffs and I sleep pain free until, like this morning, I wake around 5-6 am. Pain and insomnia suck and I will use medication if I have it, one way or another.
Hi Mark, I suggest you to watch my video about medical cannabis. I am not a big fan of smoked cannabis for all the problems it causes to the lungs. czcams.com/video/q_0tXsVnr_E/video.html
There have been a couple of times that I've smoked weed or are an edible gummy, and it amplified my pain. I know, it sounds weird.
I am 76, a concussion left me challenged on mobility, then developed severe & ongoing pain. Have been on opioids but need to quit and trying to taper but only assume it will help. Thoughts?
I am sooooo glad I found this video 📹
So wonderful to hear some common sense with this!
Thank you.
@@DrAndreaFurlan I’ve been VERY lucky with my doctors. I just hear so many nightmares. I also hyper react to pretty much all medications so I am very limited on meds. But this was such an honest and intelligent opinion. I appreciate you going against the norm right now of running away and realizing medications used properly and monitored can really help certain people! Keep up the great work and perspective
When you say no one dies I have to disagree w you, the withdrawals that cause depression it causes constant feeling of ending ones life..if you haven’t experienced getting off these meds you have no idea how horrific this truly is doing it all alone.
I am sorry to hear about your experience.
Yes but you won’t die from the withdrawals. Stop whining
When Pain Mngt. Dismissed me after 10yrs and No positive drug test, I took KRATOM for 2weeks for the WDs and sleep, 15days later, I'm leveling out. Good luck and God Bless, TG I'm off 60mg day.
Sorry to hear that
This was very helpful, thank you Dr. Furlan.
You're very welcome!
@@DrAndreaFurlan ❤
Thank you god bless you I’ve been on perks for about 16 years and Iam in desperate need of help I have heart problems and I have Arnold chairi disease and bad back problems . I take 30 to 40 ml a day and if not for taking them I couldn’t get up and do everything like taking care of the house my husband and play with the grankids when they visit . I have to take care of my husband who is stage 4 pancreatic and liver cancers . I feel my life is over in some ways but I love my life with my family and my home . I’ve been trying Kratum tea leaves . It helps me some a great deal but still need the perks sad to say .
Sorry to hear that Ricki.
@@DrAndreaFurlan thank you hope you have a blessed day 🙏
many people are dying of opioid tapers. pain can cause death and many people are on these drugs for severe pain. the quick tapers, doctors cutting off patients, and abandoning patients. the depression it causes. suicides are up in the pain community Very unethical things are going on. if a patient has been on opioids for decades their brains are changed. especially chronic pain patients who have been on for decades and are expected to get off in months. doctors are taught to prescribe all kinds of dangerous drugs yet are not shown how to de-prescribe. it's a very sad time for the elderly, disabled, or anyone in pain.
Everything you said is right! ..even the drugs to take when you do come off opioids ..the only thing that’s missing to me is how you would take pregabs for the withdrawals ..as I think that they only pre long the withdrawals.
Many thanks.
Hi Lee, thank you for sharing your experience. Please talk to your doctor about the pregabs.
Hello. I was at 50-70mg oral methadone hydrochloride for 13 years. I’m presently at 6 mg and I was wondering if you know the time period involved with a full recovery? I know it’s so hard to quantify so I don’t expect anything succinct but I’d appreciate the insight. Thanks.
Thank you for the CME! This was very helpful.
Glad it was helpful!
Hi Dr.I'm on 80 mg of methadone,7-8mg of lorazepam,1800-2100 mg of gabapentin,and i smoke like 3-4 joints of cannabis...I feel good but i'm thinking to start tapering all of the drugs.I need a kind of protocol on wich and how to start first,for how long,if i need something else during the taper etc!Any advice would help.Thanks,have a nice day...
Dear Gys, it is fantastic that you want to start reducing the drugs that you are taking. Are you in Canada? I know a lot of physicians in Canada who would be able to help you.
Thanks for this life saving info!
Happy to help!
How is it that one day your taking these meds for excruciating back pain for many years then these meds are causing change w my mental health? I no longer was myself, I had to change meds but they all affected me terribly. I now want to get off Norco which I have done all on my own.My doctor/healthcare provider will not assist me. I’m down from 10 per day I now take 3 a day. I’m almost done but I can’t manage the horrible side effects while tapering,it’s agonizing! Depression,isolation,no appetite,irritable,crying all the time,I’m miserable. I hope w this great info I can finally be done w this nightmare! 🙏 Thank you
I am sorry to hear that.
A prescribed clonidine patch may help a little. Keep going, once you stop completely, it takes about 2 weeks and things will start to turn around for the better.
@@lisahalston3154 more like 2 months
What about using suboxone or the other one I believe is Subutex, which I think the only difference is one has a opiate blocker and the other does not. Are these not good alternatives to get off of opiate's? I've read that if you stay on those long you can have an addiction to them. But if you use them for a short time, 1-2 months that's the way to do it. Can I ask your opinion on this approach? Thank you
Hi J Garcia. I am not an expert in opioid use disorders (addictions to opiopids). I would suggest you to ask that question to someone who is an expert in that area.
My son is taking subs for with draw from perks . Iam so worried he’s very dependent on them
Suboxone has the naloxone, yes. Why? The world will never know. They said it is to discourage IV use and "blocks" other opiates. Let me tell ya, I myself shot up suboxone so many times I can't even count & never, ever, had a negative effect due to the naloxone. Unless you are heavily medicated on traditional opiates/opiods (aside from the subs) then the naloxone is not going to affect anything. Naloxone will however induce precipitated withdrawls if you are heavily medicated on other substances like I said. Now secondly, the true "blocker" in suboxone is the bupenorphine itself. Suboxone/cebutex/bupenorphine has an extremely high binding affinity which does not allow other opiates to bind for the most part. I really wish more people (including doctors) knew more about the maintenance drugs they prescribe. Don't ever get it twisted... addicts are some of the smartest & strongest people in the world 💪🏼 and to anybody going the suboxone route... do not stay on subs more than 1-2 weeks if you can help it, and if you just can't cope, absolutely by no means do not stay on it longer than 6 months to 1 year. Trust me. The withdrawls are absolute hell and worse than heroin/norcos/etc. I'm on day 21 clean from 4 years suboxone now. Was on street drugs 6 years before that. I hope this helps somebody!
@@allyc4t39 no, the naloxomr is the blocker, that's why precip withdraw happens (that's the worst feeling ever) the naloxomr will knock opiates (heroin, pills) off the receptors causing instant withdraw.. the bup is a opiate but it's a partial agonists which helps with cravings because it partially attaches to the receptors so it partial gives the feelings off full agonists (heroin, pills) so the bup gives u light opiate effects so cravings go away and the naloxomr blocks u from getting high. I been on suboxone for 5 years with small breaks in between doing heroin. it all sucks, I hate it all, I miss the feeling of not having to take anything
@@allyc4t39 can I get offsubutex I been on it 2 weeks do I need to come down
Hi , I was on 6 co codomol 30-500 mg a day for 6 years I’m now on 5 a day I’ve been I’ve been on a five a day for around a month .. I’ve had the extra tablet but nothing major..
When I dropped 1 tablet a day I did have a headache and sweats and anxiety for a couple of days with a few heart palpitations..
That’s now stopped .. do think I should carry on with 5 a day or drop to 4 a day ? Maybe 1 in the morning one at lunch and two in the evening? So I feel comfortable?
Many thanks
I'm Emma. Thank you for taking the time to write this comment. I don't have the ability to give medical advice here. Please talk to your doctor. Consider subscribing to this channel.
Thank you so much doc
Most welcome!
It is not true that nobody dies from opioid withdrawal. I have run into several cases in my searches where it has happened to people in cold turkey situations.
Hi Alannah May, thank you for your comment. It gives me the chance to explain it.
The video is just a small portion of what we teach in our courses for physicians. The courses that I give about opioid tapering have many hours of duration. So, the video does not contain everything that physicians need to know about opioid tapering. The video is intended for patients. If this video was intendende for doctors it would be too long, and my channel is not intended for doctors. I have another website that I teach doctors.
Here are the situations that we teach physicians to be careful about opioid tapering:
- pregnant women, tapering can precipitate uterine contractions and lead to miscarriage or premature labour
- unstable cardiac condition such as angina, as withdrawal may precipitate vasoconstriction
- unstable psychiatric condition such as suicide ideation
Quick tapers are rarely indicated, and should only be done if it is safe for the patient and the patient agrees with this plan. Sometimes we have to admit the patient to a hospital to do the quick taper safely.
Thank you for watching the video.
@@DrAndreaFurlan I have a heart condition and had to talk with my doctor about possible tapering. He promised that if he did it, that it would be slow. Thank you for this information.
I tried going cold turkey & needed to get on suboxone because I felt like I was slowly dying. I had no appetite, wasn’t eating, no energy. Wasn’t getting any nutrition... I’m back on suboxone on my 10th day sober & I can finally put something in my stomach. Not eating can cause issues. & if I didn’t get back on suboxone I don’t think I would have made it. 🥺💔
I’m only on .5 mgs . 2mg of suboxone was too much for me.. they had to lower my dose. Which I’m thinking, I shouldn’t be on it that long.
@@DrAndreaFurlan I was under threat of being tapered off when I failed a drug test. I reminded the doctor that I had heart failure and a serious anxiety disorder. He promised that if he had to taper me off (there were those above him calling shots at his medical center), that he would do it slowly. Then I passed the confirmatory test and my pain and anxiety meds were safe. Then I told my doctor that I had been suicidal at the prospect of being left in severe pain and anxiety. I thought that he should know. I had actually had a suicide plan waiting.
Surprised to see that the comments aren't disabled because hearing the truth hurts on other videos you can't comment
Thank you for watching.
It’s Harm. Not harms.
Thanks
I want to try this. The Kratom solution scares me.
Thank you for taking the time to write this comment. I don't have the ability to give medical advice here because I am not able to get all the details that I need and most importantly, to examine you. I don't give individual medical advice via social media or by email. This channel is for educational purposes only. Please talk to your doctor.
Please get me a video of SEROTONIN thanks
Hi, serotonin is a neurotransmitter in the brain. What exactly do you want to know about serotonin?
Very rare! Oih not studied on humans. I hv not been able to work. My family depends on me and I was working while on opiate therapy.
Thank you for sharing your experience.
Hi Dr.
Hi Jainamma.
Unfortunately this day and age 9 out of 10 chronic pain patients do not qualify for opiods and I would argue 10/10 do not qualify for long term mu receptor agonists like norco, morphine, hydrocodone etc. there are better medications like buprenorphine that are much more effective and does not cause all the problems with the other opiods.
Thank you for mentioning buprenorphine.
There is not a "one size fits all" for people who suffer from terrible chronic pain. Buprenorphine works great for some, but not for others.
Hello I have a question I have been on 10 325 norcos for about 6 years or so I take between 4 and 5 a day I want to taper down and eventually get off of them I took them for my knee pain after 7 surgery for acl replacements what regimes do you recommend I take 1 in the morning at 6am 1 and a quarter around 10am and another 1 and a quarter around 4 pm then a quarter around 8 before bed I thinking about cutting off the quarters every dose for a week or two then taper off that down to ³/4 a pill and so on an so on every week or 2 till I'm down to almost nothing then just quit
Is that a safe plan ?
Just take enough to feel ok when you're really sick then repeat. Hard fast taper
You said either taper or stop the opioid in one of your comments. Your one of them doctors that just cut people off. And people can die off opiate withdrawl. Look at the lawsuit's going on now of patients dying left to withdraw in prison.
Dear Martin, I am sorry to hear of patients dying left to withdraw in prison. That is really heart breaking.
@@DrAndreaFurlan yes it is heart breaking but its caused by misinformation. Opioid withdrawl has and will continue to kill if this misinformation continues.
Misinformation kills people.
Denise, I appreciate your comments, especially when we can have a polite conversation. We both can learn wth each other.
Here is what I learned about kraton. There are major concerns:
- contamination of kratom products with high rates of salmonella
- high levels of heavy metals in kratom products
- there are many deceptive medical claims that are not backed by science or any reliable scientific evidence
- certain substances in kratom have opioid properties that expose users to the risks of addiction, abuse and dependence
- kraton contains some psychoactive compounds, mitragynine and 7-hydroxymitragynine
- Using products with unsubstantiated claims may prevent those addicted to opioids from seeking treatments that have been demonstrated to be safe and effective.
- Reliance on products with unsubstantiated claims may delay people's path to recovery and put them at greater risk of addiction, overdose and death.
I dont know what to do I have infected pilonidal sinus disease which has damaged my spinal nerves, I fell down the stairs and jammed my tailbone coccyx into my rectum at my anal area where I have two anal fistula and fissure , I lose my balance my legs are stiff and burn when I walk, I have nuropathic itching inside my buttocks and legs inside the muscles and tendons that can only be relieved by squeezing so hard I break chairs pressing and grinding my butt apart, I have a l5 prolapsed disc , double groin hernia, I take zapain which my doctor has not given me now I've ran out , buprenorphine patches and naproxen baclofen and pregabalin , surgery has failed and my fistulas are getting worse, the bed sheets are all blood stained through scratching in my sleep , I have reassurance seeking OCD and cognitive therapy has failed to work, I'm on sertraline 150mg . I've tried cutting down but I've been on my meds for years , i managed to quit cannabis and tobacco I was using for pain 9 years ago but i vape nicotine eliquid.
I’m sorry to hear about that
@@DrAndreaFurlan do you think I should slowly try to cut down on zapain pregabalin and baclofen , I dont know how I can taper off my 25mccg hour patch of buprenorphine , I'm fed up putting in for my repeat prescription for zapain 30 / 500 every 12 days sometimes I have to put in again a few days later as they dont give me it .
I just posted a video about coccyx pain czcams.com/video/yGu5cMh1YnU/video.html
My doctor doesn’t know how to taper me.
I am sorry to hear that.
If you know of a doctor that can taper Seroquel that hold be great. I’m in NY.
Tyty
I had to taper back from 6 to 3 pills with Tramadol.
Thank you for sharing that.
What is e mail
My email is dr.andreafurlan@gmail.com
Dr. Andrea Furlan just sent and e mail to you
HELLO BUPERNORPHINE
I've prescribed buprenorphine and it is a good opioid for pain.
They should have a higher dose