Codeine withdrawal - I need a plan

Discussion in 'Opiate & Opioid addiction' started by trixel, Aug 3, 2013.

  1. trixel

    trixel Silver Member

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    I have been taking codeine for almost 10 years, the first three years it was codeine/paracetamol tablets, then just codeine 30mg tablets. I am now taking 360/450mg per day, and have been taking as much for about 2 years. It's not even fun! Of course I can't speak for the entire world but on me codeine is a very dull drug, effect-wise.
    2 months ago I quit cold turkey. Well, I tried. The type of person I am, slow tapering never works because I end up eating everything I have in two days.
    I was quite determined, read a lot about which the over the counter/herbal aids I could get to help. I spoke with my GP who refused categorically to give me any benzo to help with the anxious state and the insomnia. The only thing he gave me was Britlofex (lofexidine).
    I resisted for 5 days, actually, I had some Kava which helped a bit, and pregabalin (for which I have the prescription) but the panic attacks and severe restless legs syndrome completely broke that little spirit I had. So I went back to the codeine.
    What I don't understand is how is it possible that this codeine withdrawal is so severe!
    I have quit heroin hundreds of times, and many other drugs, I have quit benzos another hundreds of times... a few years ago I quit drinking. I quit Tramadol, countless antidepressants, the last one was duloxetine and the withdrawal was brutal and lasted months, but still I managed. All of these I quit cold turkey. And now I can't get rid of this stupid codeine... it's really hard to accept. The lamest drug is really beating me badly this time.
    Given the fact that my GP will not help on this, can I still make up a successful plan? Obviously cold turkey is not an option, given the latest results.
    All I have is about 100 x 30mg codeine [with no paracetamol]; 22 lofexidine tablets (2 is the lowest dose and I need to be careful because it makes my blood pressure precipitate); some promethazine; loads of pregabalin. That's about it. Is there anything else I can add to what I have to increase my chance of success? maybe a different antihistamine instead of the promethazine?
    Also, what is the best way to taper on these 100 tablets? How many days of tapering and how many mg less every day?
    I really need your input because at this point I don't know what to do, any suggestion and help is greatly appreciated!
     
  2. Space Numpty

    Space Numpty Bad Mother-Fucker Palladium Member Donating Member

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    Hi Trixel and welcome to DF :)

    This is a bit perplexing. Codeine metabolises into Morphine from which as im sure you know diacetylmorphine (Heroin) is derived from so i am at a loss to explain how it can be kicking your ass this badly, compared to more potent opiate Withdrawals you have experienced in the past.

    I can only assume it has more to do with your current state of mind/health, because it should be relatively comfortable compared to Heroin and a walk in the park compared to benzo's and certainly some anti-depressants.

    To taper properly i don't think 100 tablets is going to cut it love, to be honest. Not when you are taking 12-15 a day. I would have suggested a 30mg drop every few days.

    You could do that until you run out and then use over-the-counter co-codamol by extracting the codeine which is a simple process. Then take the lofexidine, maybe with some loperamide towards the end. The pregabalin may help with residual anxiety.

    Kava will help. So will kratom, but you might just end trading one addiction for another with kratom.

    As this seems to be causing such problems for you i would also be aware of post acute withdrawal syndrome (PAWS), which you have probably experienced before if you have previously quit heroin many times.

    Keep us updated and stick around. Ton's of support here and better, more accurate advice than anywhere else, Doctors included.
     
  3. trixel

    trixel Silver Member

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    Thank you for the welcome, Space Numpty, and thank you for the advice. It's very true that my overall health is not as good as it used to be, even just compared from last year. I might be weaker.
    I forgot to say in my OP that my codeine prescription comes through every 3 week, so if i can manage starting the tapering now and make those 140 tablets last for 3 weeks, then I can continue tapering to zero after that, using the new prescription. Do I make any sense? They are 140, not 100, I counted them wrong yesterday. Would it be possible? Taking off one pill every other day, how many days these tablets would last? I may start with 11 or 12 maybe?
    My GP would keep me on those forever, it's my decision to quit. He actually prefers me to stay on the codeine than prescribe me 10 days of lorazepam to help me with the withdrawal. I find this stupid and cruel.
    Yes the PAWS scares me. After 30 years of antidepressants I finally kicked the last one last summer and I have no intention to take that stuff again, but after I manage to get rid of the codeine I will talk to the psichiatrist (who is slightly less stupid than the GP) and see if there is something he can do for me. I doubt it but you never know!

    For what I read on the extraction thread at some point you need to put the concoction in the freezer, and I don't have that. Talk about complete disorganisation! So for that one, the only thing I can do is to take 2 x 9/500 cocodamol tablets and, as you can imagine, a placebo medicine would help more than those lol
     
  4. Baritji

    Baritji Newbie

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    Hi trixel,

    I'm on day 5 withdrawing from around 1.5grams of codeine a day. I turned the corner yesterday and things are really starting to improve. I really hope you can manage to do the same. Codeine is a weak opiod yes, but the addiction is still very real.

    You won't need a freezer for CWE. Just use cold water (from the fridge) to dissolve the tablets right from the beginning. Let them dissolve for ten mins or so and then stir every few mins for another 10 minutes or so before pouring the solution through a coffee filter moistened with the cold water.
     
  5. trixel

    trixel Silver Member

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    Hi Baritji, thank you and I hope everything is gonna go well for you!
    How did you do it? tapering or cold turkey?
    Have you got any advice for me? You can surely help me, already reading your post makes me feel less lonely on this ordeal.
    How do you think I should go regarding tapering the codeine tablets?
    Did any other remedy or medication help you?
    Sorry for the loads of questions
     
  6. quickiB

    quickiB Silver Member

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    If you get a new script or whatever every three weeks, just take whatever your current dose is for five days, then take away 30mg, then five days later do the same. I can understand why your dr won't give you any benzos so if possible, ask for some clonidine (if you has restless legs), and buy yourself some loperamide if you start (or beforehand) noticing diarrhea. Try to stick to a plan and let someone (dr?) know what you're doing so you have a sense of accountability.

    I wouldn't use pregablin as it will make you duller and leave you with even less energy than the withdrawal would otherwise cause. Further, I would restrict your use of anti-histamines to night time and sleeping. In case you don't want to use promethazine, other OTC anti-histamines include diphenhydramine (Benadryl), doxylamine.
     
  7. Space Numpty

    Space Numpty Bad Mother-Fucker Palladium Member Donating Member

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    If you do the math on this the OP will run out of tablets by day 13, leaving her 8 days without anything. Not exactly a good option.

    I worked out a pretty steep tapering regime starting at 12 tabs for 3 days then dropping to 10 for three days then dropping by one tablet every 3 days but she will still run out by day 16.

    In conclusion 140 tablets every 3 weeks isn't enough to taper properly. I will give you what i feel is the best you can do with these tablets....

    First 3 days take 10, then reduce by one tab every 3 days. This will keep you in Codeine until day 19. By then you will be down to 4 tabs a day or 120mg which you can easily get through buying co-codamol over the counter and extracting the codeine.

    Now don't panick. I know if you read the CWE thread it looks a bit daunting. It isn't and many of the steps mentioned are not really necessary. Its a simple case of 1/4 glass of cold water (if its nice and cold from the tap thats fine, otherwise keep some water in the fridge). Add crushed co-codamol tabs to water. Stir well a few times over the course of a couple of mins and then pour it through a coffee filter. That will leave the insoluble Paracetamol (APAP) in the filter and you will end up with Codeine Water. 120mg of Codeine means you will need to CWE 15 tablets, so a pack of 32 will last 2 days.

    By then you can get your next script and continue with the reduction.

    Its a wee bit steep a taper, but the best in the circumstances, and you do have the lofexidine if you need it, and loperamide will help also. Regardless of what the poster above feels, if the anxiety is bad Pregabalin WILL help with that.

    Feel free to DM me if you want to talk Trixel.
     
  8. Diabolicaldoll

    Diabolicaldoll Titanium Member

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    Hey Trixel,

    I too have had a long affair with codeine, a 9 year long affair. I too have hit the proverbial wall where codeine isn't fun anymore for me and for the first time throughout these past 9 years I've took quitting seriously.

    My opinion is that codeine isn't a dull drug, unless one was to use the word dull to describe a drug opposite to a stimulating one. While I don't get stimulated by codeine the euphoria and over all good-feel effects it provides for me is what I fell in love with and have continued to use it for those reasons for 9 years. If, like you say, you have experienced a drug like heroin then I can understand why you would think codeine was dull but I do wonder what it is about codeine that kept you taking it for ten years. Or are you just physically addicted?

    You say cold turkey and a slow taper isn't an option so the other options are a quicker taper than the previously tried or a maintenance programme all though I personally wouldn't advise on the latter but other people would and if you feel it is the only way for you then why not!?

    I see that others have advised on an actual tapering plan so I hope you can find a taper that will work for you.
     
  9. Transition

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    Hi, I am new but wanted to reply because so much to what you said was so familiar to me... Someone I know became addicted to codeine shortly after quitting drinking 4 years ago (She is an alcoholic). She started off with bot 6 Nurofen + and quickly progressed to 32 a day (32 x 12.5mg = 400mg, but some days would take more).
    She continued this way for about 3 years, and did one cold turkey successfully (it was absolute hell, they hadn't expected it to be anywhere near as bad as it was). She felt she was dying with the physical symtoms which lasted a week. Her family thought she must have been ill on top of the withdrawal because the effects were so horrific.

    Anyway, about 4 days in, she could finally speak again and went to the doctor. The doctor prescribed a sedating antihistamine (which didn't help much) but was supportive and non-judgemental. She managed to stay off the codeine for a few weeks, but the depression and insomnia lasted those few weeks and showed no sign of dissipating, so she went back on the codeine.

    The next time she decided to quit, she decided to taper. Like you mentioned in your post, tapering was difficult for her because she would take more. On the occasion where she actually quit codeine (for over a year now), she tapered down over a long period of time, going down from 24 tablets, around a tablet a week if she could manage it. Her head was in the right space and she had a lot of support, and saw a drug counsellor once a week during this time.

    She managed to taper down to around 6 tablets. However, she had been taking valium, and eventually relapsed on alcohol to add to the mix. She thinks during the alcohol and valium binges, she completely forgot about the codeine as (like you said), its effects were so minimal in comparison. however, after the alcohol relapse, she became suicidal and made a serious suicide gesture and ended up being assessed for mental health.
    The day after, She decided she could not continue anymore, and came off all three of the drugs (alcohol, valium, codeine) in one swoop. She felt nothing but relief that it was finally over. She can't remember any particularly bad withdrawals during this time, which shocks her now. She can't remember not sleeping. She has a theory that it was only because she had the determination and was frightened that if she carried on she would commit suicide.

    Her advice to you would be to taper for a while because it seriously reduced the withdrawal effects for her. Try to keep that in mind - although you wont get the effects during tapering, you also will be significantly reducing the withdrawal effects. Tapering is definitely the way to go with codeine, as the withdrawal effects are horrific. She has since spoken to former heroin addicts who said that the codeine was worse to come off. Do not be hard on yourself for finding the codeine so difficult to shift - I have a theory that it is because the effects are so minimal, one can still function whilst taking it. Also, the withdrawal is so bad that those two factors combined make it a really difficult drug to come off.

    Please post your progress, this forum is an excellent resource that she uses again and again.
     
    Last edited by a moderator: Sep 10, 2013
  10. rosielee

    rosielee Silver Member

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    yes i can totally relate- i too have come off heroin cold turkey in the past quite successfully but i cant get off of pescription opiates- doesnt matter what they are- and i have switched them all.

    it is due to the length of time you have been relentlessy relying on them. ive tried slow tapers but when i get to a really low dose - fear holds me back and its just mysery quite frankly. ive decided not to live in this mysery but to keep myself stable on low doses- but not to sweat over it too much. its never worth the anxiety, endless sleepless nights the eternal strung out feeling.

    many people however do come off opiates. some of us decide we dont want to make that transition any more- as its very much like falling off a cliff with no parachute. if you really dont want to be an addict any more, and i can relate to this with all of my heart- as i wake up in the morning and the fact that i am an addict makes me so full of dread and upset- then you will have to take a very slow reduction.
    but dont let anyone heap pressure on you and dont heap too much pressure on yourself either. we have been on opiates for a heck of a lot of years- your brain chemistry totally revolves around it. quitting the heroin is easier as there is so much negative stuff around doing heroin. but quitting pharmaceuticals can be hard as your whole being can adjust to being on them.

    i do know people who have got clean and no quest is big enough for anyone to take on- just take it easy. you get people in meetings and people on here that really want you to follow their path and get clean too. sometimes it takes a long, long time to wean your mind off of the opiates- i knew someone in NA and it took her 6 years to get off of the methadone. she would get to extremely low doses- go without a few days then need to go back on.

    none of us are super human and in sure you will have your own personal pain threshold which you dont want to cross over. in my view its good to take it easy and to think of it in the long term- because of the obsessional fixations you get over your symptoms etc. you absolutely need to be in the right positive frame of mind. and i think you really need support and structure to work around- something to get you through the hours.

    but for me it all fell apart when i tried to become opiate free as life became a complete standstill and i got very desperately lonely and bored. maybe for this reason i think some people are better suited to just going through the pain and agony of cold turkey because its painful on the slow reduction too and it expands the length of time you are unable to live your life properly- always hovering on the withdrawal symptom mode.

    but for me it was the mental side of it- the over thinking and ploughing through the minutes and hours. so for now iv halted all thoughts of becoming opiate free. it can be like a dog chasing its tail- you can go round in circles and never get that tail....and in the end you come to realise that you could have devoted your time to studying three degrees in that time.

    however a detox is never wasted and in the time ive been trying to get off of the methadone ive calmed down a heck of a lot. i am no longer the manic, out of control, over enthusiastic- not able to be in society person i once was. so its always worth trying to face your issues and to deal with them. just take it easy though.
     
    Last edited by a moderator: Sep 10, 2013
  11. Chemical_Fantasy

    Chemical_Fantasy Newbie

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    I have not experience anything anywhere near as hard core as what u described. However I I've been on codeine on and off for about 5 years, I get a repeat prescription for chronic lower back arthritis pain. I can't take nsaids cos I have crohns disease. I'm on the equivalent of 300 mgs a day of codeine at the moment which is my maximum. I usually quit periodically for a month or 2 for tolereance reasons then I'm back on for a few months.
    When I'm quoting I taper down over a few weeks but suppliment with ethylphenidate in low to moderate doses until I'm off the codeine. It may sound bizarre but opiates increase dopamine and the same goes for ethylphenidate and it definately helps with cravings!
     
  12. flup

    flup Newbie

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    I would like to thank you all for contributing to this post, you have helped me realise what my mum might be going through (wether she realises it or not). since I was very young she has been in one type of pain or another and as long as I was old enough to understand she has been on some sort of codine based pain releif (cocodamol or solpadol etc.) and I know she is not abusing it, she has been doagnosed with all sorts, but I have always wondered why she found it nesecary to take the "strong" painkillers all the time, not just when the pain was particularly bad. now I think about it the pain probrably seemed to get worse when she stopped taking them because of withdrawals not just the conditions she has. I will also try to understand what medication she is taking more and keep a better eye on the levels now I understand more about the potential for addiction :)
    thanks
     
    Last edited by a moderator: Nov 7, 2013
  13. wildwinds

    wildwinds Silver Member

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    I too have gone through codeine addiction, and it is certainly a very difficult habit to kick. Codeine is even more insidious than other opiates as it does seem like such a weak drug and yet it grabs onto you hard and won't let go.

    Anyway, I eventually sought treatment for my problem and am currently undergoing buprenorphine (subutex) maintenance therapy with the eventual goal of tapering down to nothing.

    Anyway enough about me, I wish you the very best in beating your addiction.
    Good Luck x
     
  14. trixel

    trixel Silver Member

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    Thank you so much, all of you who replied to this thread. These past days have been interesting to say the least.

    I have tried following the tapering plan Space Numpty so kindly made, and Sensible Trixel was in charge for about four days. I was doing quite well actually: I found out that taking 9 tablets, 3 in the morning and then 1 at a time during the day, plus the antihistamine at night, I wasn't in too much discomfort. So the day after I took 9 again, then 9 the third day and the fourth day I only took 8.
    After that, Greedy Trixel kicked Sensible out and, well, as you can imagine the remaining tablets lasted 7 days exactly.

    It was funny in a way, observing myself demolishing the stash and knowingly heading for a huge train wreck. I would say to myself: you are crazy, you know you are going to be in so much trouble. And answering: oh well, I will deal with it, what's new, stop being a crying baby for christ sake.
    One would think that at 52 I should be able to exercise some sort of moderation... not at all, not me! I am incapable of moderation.

    Anyway when I ran out of codeine I got in a panic so I took loads of everything I had, which was not a lot to start with, but in combination I managed to put myself in a state of stupor for 3 days.
    These last 3 days I have been taking less of everything and finally today I only took some pregabalin and will add the promethazine before going to bed.

    I am gobsmacked. I can't understand how it's possible that this time the withdrawal was so mild. I am checking myself constantly for symptoms. I can't believe that the pain is gone. Could it be the case that my body is still feeding off all the tablets I took last week?
    I am still constipated. This doesn't surprise me because I have been constipated for the last eight years so I guess it will take time to go back to normal. BUT the constipation is feeding my fear of the ugly withdrawal symptoms coming back with a vengeance.

    Apart from the fear, I feel ok. I get tired very easily, I am nervous, but overall I have to say that I feel blessed for how easy it was to go through it.
    It just doesn't make sense though; two months ago I was a wreck two days into the cold turkey and this time, compared, it was a walk in the park.

    I don't want to over-think, but one thing comes to my mind: in a few days a bagful of codeine will be waiting for me at the chemists'. So maybe my crafty brain is trying to convince me that after all I am not really dependent, that after all I can carry on gorging on these tablets for a few days every month... I wouldn't be surprised, my brain plays some incredible tricks lol

    I am sorry, this post is getting really too long to bear reading! I just wanted to answer to Diabolicaldoll's interesting question, on what is that keeps me attached to the codeine and my codeine addiction.
    I was in a lot of pain when I first started taking it, but the pain is bearable now, it has been mild for the last few years, I think. So it's not for the pain anymore for sure.
    I think codeine represents the last link to my past as a heroin user. Even knowing the misery and the violence heroin brought into my life I still remember the complete ecstasy. Even though I haven't touched the stuff for 27 years, I still remember it as if it was yesterday. I am still completely and hopelessly in love with it.
    In these last three years I have been stripping off layers of addictions, but this last one, the codeine, well it looks like it's so difficult to let go, even knowing how mild and dull its effects are, because it has kept me close to my primary addiction, heroin.
    Oh my, this is so pathetic, I actually feel sorry for myself now! I have thought about all this, but seeing it written down is something else, very hard to digest.
     
  15. Lunamia

    Lunamia Silver Member

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    I have read this thread a few times but haven't commented because it was too close to home - we appear to share a similar history in some ways Trixel.

    I can't really add much to the advice given, if I could, I wouldn't be here. But if you know the codeine will be there, then you won't stop. There is nothing crafty about the brain, it's just the same old story, we will always find a way to continue to use if we are not absolutely ready and determined to quit.

    I thought about this a lot too, just couldn't come to terms with the fact that I was dependent on codeine, referred to it as a "piss poor" opiate..you have kind of highlighted the reason why and it is a relief, albeit sad, to see someone else is the same.

    For all the pain I went through, for all the things I did to get it..part of me misses H still. Feeling the euphoria, the warmth, the freedom from care and the happiness that came from it reminds me of the very early days on Heroin before it went bad. Using Codeine reminds me of this, it feels like I have come home and I belong. Even when it wears off after zilch time, when I am on the toilet for the umpteenth time and I ache, when my eyes run, when I can't rest.. as soon as I take it all is ok with the world.

    I don't know the answer to this Trixel, how to get past this. To strip away the layers of one addiction or another and to be left with ..what? I will root for you to get there, to find the way to let go. It isn't simple, it is complex but it is obvious that to treat codeine dismissively is a serious mistake..both you and I and many others in a similar position have found out the hard way.

    I hope you make it through to the other side, I'll be thinking of you.
     
  16. cren

    cren Titanium Member Donating Member

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    how are you going now? I only just found your post. I am in the same position and I can understand the link from your heroin addiction to the codeine. I hope you are doing ok now. Please let me know how you are I am about to quit 20 years of codeine after using iv heroin and prescription opiates and I am really keen to see how you are
     
  17. trixel

    trixel Silver Member

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    I apologise for being so late in replying, cren, I didn't check this thread for a long time and wasn't expecting a new post on it. I hope you are doing ok.

    Until last November I was doing the usual, trying to taper with very bad results, then cold turkey with the help of whatever I could put my hands on.
    When I was in withdrawal I even tried a few RC, those pseudo-benzos they are selling. One of them, Etizolam, is legal in Italy, and years ago when I lived there I had my doctor prescribe it for me, but I wasn't happy at all with the effects; not everybody is the same and people swear by them as valium substitute, but for me they do NOTHING. They take a bit of edge off when you are panicking, and probably helped a bit with restless legs syndrome, but all in all I found the whole Research Chemical products quite poor and when I ran out of etizolam I didn't even bother buying again. I read reviews of customers, from those you'd expect something stellar and it makes me think that these reviewers have never tried anything stronger than fresh water.
    So if you expect etizolam to give you a break from the Withdrawals like I did, forget it.

    Then in December I decided to try Kratom to see if it helped with the withdrawal symptoms, I heard of it in many forums and to be honest I was sure it would be another no-help. I was gobsmacked at how good it actually is.
    The first time I took 3 grams of powder, which is a low dose. The day before I had taken the last codeine I had, 420mg of it, and I was quite worried. I didn't expect the kratom to cover my Withdrawals symptoms but that's exactly what happened.
    I stayed on a low dose of kratom, taking 3 grams twice a day. The only thing it didn't help at all with was the insomnia. I couldn't sleep at all, so I used anthistamine for sleep. I have two types and I alternate them to avoid them stop working.

    So, if you are still looking for a way to help you to face withdrawal, I can tell you that in my situation kratom helped where nothing else could.
    I must add that kratom is illegal in some countries, but I live in the UK where it is completely legal.
    It is an extremely gentle herb, so it doesn't do anything for me at recreational level. I suspect that one of the reasons is because of the heavy codeine use of the last years. I am ok with it and just immensely relieved to have found something that actually makes me forget about the next chemist goodie bag lol

    I am still on low doses, the maximum I have taken is 4.5 grams, and I only buy the powdered leaves. I am not interested in heavier products which, for what I read, tend to create dependency.
    Apart from eliminating completely the Withdrawals symptoms, it has helped immensely with my back pain. With two doses daily I am completely covered, no pain at all.
    When I take it in the morning it gives me a gentle mood lift and that means that for the first time in years I don't spend the morning in bed trying to find the strength and motivation to get up and do something with my day.
    I have had days when I didn't take anything at all, just to check how my body copes without codeine or kratom: I was in pain for my back therefore not in the best mood, but I didn't notice any withdrawal symptoms.

    Obviously my psychological addiction to opiates remains where it was before: center stage. I have no idea if I will ever be able to solve that, to find a way out of it. For now I am quite happy where I am, and the cravings for codeine have reduced to zero in normal days. I don't take antihistamines anymore to help sleep, usually, because most nights I manage to go to sleep without any help.

    I am sorry not to be able to tell you that all is well and opiates have gone from my life and my mind for good, I wish I could say that! The only thing I can say is: I found a way around the pain.
     
  18. rosielee

    rosielee Silver Member

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    i was hooked on heroin- then i went to methadone and then i went to codeine. its not as sever as you think. if you cut half a tablet off each day you come off in the end without much trouble. if you cut off at 6 or seven tablets then you will have trouble- even coming off of two is hard- you need to go right down to a half a tablet and then stop. i found the effects of codeine to be the same as the methadone really and it did me no good what so ever to take them- my doctor was wrong in telling me they were milder. your body hangs on to the smalles amounts of opiates really easy. you arent clean till you are existing on nothing. the only way i could do it was to keep tapering slowly. otherwise i would get tormented and obsessed with my symptoms and have no way to deal with them- until i was running to the cupboard to get that pain relief.