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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Alternative To Come Off Fentanyl Patch

I am very sorry to have taken your time & mine as I have no $ to pay for an answer. I will go back to researching on my own for the answers I seek I previously submitted my ? as to how I can survive coming off the fentanyl 50mcg patch(changed every 48hrs stead of 72) which I have been on for 8 yrs til medicaid stopped paying for it ! I only wanted advice for getting thru this & still take care of my 11 & 12 yr old gkids. And also a suggestion for another drug that would work for me & medicaid.
Mon, 29 Jun 2015
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Addiction Medicine Specialist,  's  Response
Narcotics by definition can be interchanged. A drug can be shown to interact with the narcotic system if it lowers narcotic craving and/or stops withdrawal from narcotics. So, another narcotic will substitute for fentanyl. The issues are timing of effect and how much effect. Fentanyl 50 is a moderate amount of narcotic, and a fair amount of a substitute will be needed. It is around the clock. For withdrawal prevention, having drug in the system all the time isn't needed, but for pain control maybe it is. BUT certainly a substantial part of the day has to be covered. A typical narcotic pill has about a 4 hr duration. 2 a day won't cover; 4 a day is getting more reasonable.
In a dependency treatment context: Methadone will substitute. Suboxone is a lower amount of narcotic effect and might be (slightly) rough for about 1 week. These are safe and monitored. Oxycodone is less safe. Methadone on the street or outside of an addiction clinic is surprisingly hazardous.
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Suggest Alternative To Come Off Fentanyl Patch

Narcotics by definition can be interchanged. A drug can be shown to interact with the narcotic system if it lowers narcotic craving and/or stops withdrawal from narcotics. So, another narcotic will substitute for fentanyl. The issues are timing of effect and how much effect. Fentanyl 50 is a moderate amount of narcotic, and a fair amount of a substitute will be needed. It is around the clock. For withdrawal prevention, having drug in the system all the time isn t needed, but for pain control maybe it is. BUT certainly a substantial part of the day has to be covered. A typical narcotic pill has about a 4 hr duration. 2 a day won t cover; 4 a day is getting more reasonable. In a dependency treatment context: Methadone will substitute. Suboxone is a lower amount of narcotic effect and might be (slightly) rough for about 1 week. These are safe and monitored. Oxycodone is less safe. Methadone on the street or outside of an addiction clinic is surprisingly hazardous.