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Suggest Treatment To Wean Off Norco?
Question: I am trying to get off taking Norco, I'm opiate tolerant and need something different. I signed up for my medical marijuana card to see if it will help the pain and slowly help me to stop taking the Norco. My pain management Dr prescribed butran 15mg patches. Can I use the butran and medical marijuana? Or will it cause a bad mixture? I'm definitely going to try the medical marijuana, as soon as my card gets here. Any info please?!
Brief Answer:
no, they do not interact
Detailed Answer:
But the butrans can be a potentially tricky drug. It is a partially acting narcotic that not only can be weaker than the narcotics you are on, but will block the action of other narcotics added to it (THEORETICALLY, in practice, this does NOT generally happen).
But, narcotics work by a separate reaction with their own separate mechanism from marijuana. And the two systems do not directly interact.
Hope I am clear.
no, they do not interact
Detailed Answer:
But the butrans can be a potentially tricky drug. It is a partially acting narcotic that not only can be weaker than the narcotics you are on, but will block the action of other narcotics added to it (THEORETICALLY, in practice, this does NOT generally happen).
But, narcotics work by a separate reaction with their own separate mechanism from marijuana. And the two systems do not directly interact.
Hope I am clear.
Above answer was peer-reviewed by :
Dr. Prasad
so basically my PM Dr wants me to take the butran patch and the Norco, but the butran patch is weaker and will block the Norco from working as a breakthrough pain management?! correct?! I sought out medical marijuana through a different Dr and he told me that eventually the medical marijuana should help so I eventually take less Norco (which is what I'm looking to do). Do you believe this may be true?! I just don't want to be addicted to pain pills anymore, I've been on them since March 2011 and my tolerance is really built up. And I'm having to have blood work done on a regular basis to make sure my liver is good, which thankfully it is. And since the butrans are a weak narcotic, they may not help with the pain? Not to mention that I'll have to be weened off them also, correct?! Thank You so much for your time!
Brief Answer:
I do this for a living.
Detailed Answer:
Ok, this is a back end arrangement for the Most Standard Treatment for people who've gone from your situation into slightly more problems (addiction).
Suboxone therapy is the standard practice for people who've gone from your situation into a bit more trouble. Butrans is a reasonable middle ground.
Suboxone has the same main drug in butrans that works on pain, given by a LOUSY method (buccal; the patch is much easier/better method of drug delivery)
and SUBOXONE but NOT BUTRANS has a SECOND DRUG to enforce people to not abuse drugs (which you are not doing. By abuse I mean buying off the street, shooting up, etc.) the SECOND DRUG BLOCKS narcotics and causes withdrawal.. but butrans does NOT.
http://www.addictiontreatmentmagazine.com/addiction-treatment/replacement-therapy/why-is-suboxone-a-promising-therapy-for-opioid-addiction/
http://www.suboxone.com/Treatment/Suboxone-film?gclid=Cj0KEQjw8aeiBRCknPXk-u_V_4gBEiQAD2-mga1Yi5E1rDms8pJjKcfYqD4LUZJSzzOX1Ogz6TmGgu0aAtgL8P8HAQ
BUTRANS only goes up to the 30-50mg equivalent dose of oxycodone/hydrocodone.
Ok.... Hydrocodone (and oxycodone, dilaudid, morphine, meperidine, and heroin) are all straight up narcotics. More does more and will be fatal at some very high dose. You can acheive much higher effects with these than you can with butrans. BUT, as you well know there is tolerance (likely less with butrans). The maximal effect of butrans is about 30 mg per day of hydrocodone (not huge).
AND, it is a narcotic. Lowering narcotic dose causes withdrawal. If you go directly from much more than 30 mg/day to ONLY butrans you will have withdrawal. If you go off of maximal butrans dose (30 mg equivalent to zero mg equivalent of narco) you will have some withdrawal also. BUT, BUTRANS does NOT BLOCK the narco, and you can take them together. HOWEVER, it also does NOT PREVENT FATAL OVERDOSE. GET A NALOXONE PEN WHEN INCREASING/CHANGING YOUR NARCOTICS!!! Taking butrans and narco together is a higher dose of narcotics.
I suspect this approach you doctor is doing is quite a good one, but it isn't proven. Butrans might lower tolerance to narcotics because it isn't fully active. Naloxone, blocking narcotics would likely do this better AND not have any pain effect and induce withdrawal... so.... you can't really go with naloxone. Suboxone might be better than butrans for the tolerance (MIGHT.. NOT PROVEN) but it will be lower narcotic and pain effect and likely will give withdrawal. So...kind of boxed into the approach your physician is setting up.
Butrans can be tapered, but it is easier with suboxone simply because more doses are available of suboxone. but again, you get less narcotic with suboxone than butrans with narco. The dose of narco should be immediately decreased if you are taking another narcotic with it (butrans), just so you won't be on MORE narcotic and WON"T be into a dangerous overdose range.
Marijuana's pain effect is totally different from narcotics. It is helpful in many/most people with pain. It won't help withdrawal very much, but generally taking another effective non-narcotic pain treatment allows people to use less narcotics. Should work. Other non-narcotic drugs work well if the pain is due to an injured nerve (nerve dampers like anti-epileptics gabapentin, lyrica, amitryptiline) or if it is a spasmed muscle (muscle relaxants) or spinal based (carisoprodol probably works to damp down spinal nerves). Marijuana works a bit on everything.
Then, XXXXXXX Chiari is a very specific problem. Shunts are often helpful. ACETOZOLAMIDE (DIAMOX) very very temporarily lowers pressure in the head and might be an interesting diagnostic aid to whether lowering pressures matters. For that matter, one might google PSEUDOTUMOR CEREBRI and see if that sounds like you. If it is, then weight loss of all things is curative of the pain ?!? In most/all pain syndromes gradually increasing exercise up to the strenuous level is very helpful on pain control.
(follow up question... much much more information!)
I do this for a living.
Detailed Answer:
Ok, this is a back end arrangement for the Most Standard Treatment for people who've gone from your situation into slightly more problems (addiction).
Suboxone therapy is the standard practice for people who've gone from your situation into a bit more trouble. Butrans is a reasonable middle ground.
Suboxone has the same main drug in butrans that works on pain, given by a LOUSY method (buccal; the patch is much easier/better method of drug delivery)
and SUBOXONE but NOT BUTRANS has a SECOND DRUG to enforce people to not abuse drugs (which you are not doing. By abuse I mean buying off the street, shooting up, etc.) the SECOND DRUG BLOCKS narcotics and causes withdrawal.. but butrans does NOT.
http://www.addictiontreatmentmagazine.com/addiction-treatment/replacement-therapy/why-is-suboxone-a-promising-therapy-for-opioid-addiction/
http://www.suboxone.com/Treatment/Suboxone-film?gclid=Cj0KEQjw8aeiBRCknPXk-u_V_4gBEiQAD2-mga1Yi5E1rDms8pJjKcfYqD4LUZJSzzOX1Ogz6TmGgu0aAtgL8P8HAQ
BUTRANS only goes up to the 30-50mg equivalent dose of oxycodone/hydrocodone.
Ok.... Hydrocodone (and oxycodone, dilaudid, morphine, meperidine, and heroin) are all straight up narcotics. More does more and will be fatal at some very high dose. You can acheive much higher effects with these than you can with butrans. BUT, as you well know there is tolerance (likely less with butrans). The maximal effect of butrans is about 30 mg per day of hydrocodone (not huge).
AND, it is a narcotic. Lowering narcotic dose causes withdrawal. If you go directly from much more than 30 mg/day to ONLY butrans you will have withdrawal. If you go off of maximal butrans dose (30 mg equivalent to zero mg equivalent of narco) you will have some withdrawal also. BUT, BUTRANS does NOT BLOCK the narco, and you can take them together. HOWEVER, it also does NOT PREVENT FATAL OVERDOSE. GET A NALOXONE PEN WHEN INCREASING/CHANGING YOUR NARCOTICS!!! Taking butrans and narco together is a higher dose of narcotics.
I suspect this approach you doctor is doing is quite a good one, but it isn't proven. Butrans might lower tolerance to narcotics because it isn't fully active. Naloxone, blocking narcotics would likely do this better AND not have any pain effect and induce withdrawal... so.... you can't really go with naloxone. Suboxone might be better than butrans for the tolerance (MIGHT.. NOT PROVEN) but it will be lower narcotic and pain effect and likely will give withdrawal. So...kind of boxed into the approach your physician is setting up.
Butrans can be tapered, but it is easier with suboxone simply because more doses are available of suboxone. but again, you get less narcotic with suboxone than butrans with narco. The dose of narco should be immediately decreased if you are taking another narcotic with it (butrans), just so you won't be on MORE narcotic and WON"T be into a dangerous overdose range.
Marijuana's pain effect is totally different from narcotics. It is helpful in many/most people with pain. It won't help withdrawal very much, but generally taking another effective non-narcotic pain treatment allows people to use less narcotics. Should work. Other non-narcotic drugs work well if the pain is due to an injured nerve (nerve dampers like anti-epileptics gabapentin, lyrica, amitryptiline) or if it is a spasmed muscle (muscle relaxants) or spinal based (carisoprodol probably works to damp down spinal nerves). Marijuana works a bit on everything.
Then, XXXXXXX Chiari is a very specific problem. Shunts are often helpful. ACETOZOLAMIDE (DIAMOX) very very temporarily lowers pressure in the head and might be an interesting diagnostic aid to whether lowering pressures matters. For that matter, one might google PSEUDOTUMOR CEREBRI and see if that sounds like you. If it is, then weight loss of all things is curative of the pain ?!? In most/all pain syndromes gradually increasing exercise up to the strenuous level is very helpful on pain control.
(follow up question... much much more information!)
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Shanthi.E
Answered by
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