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An open letter to policy makers and professionals alike:
Just change the name and address as appropriate
June 3, 2006 (sent via email) Dr. Nora D. Volkow, Director Dear Dr. Volkow,
Having just experienced withdrawal from physical dependence on prescription
narcotics, I have observed an opportunity for action on your part.
I had a difficult time obtaining clear information on how to withdraw after
months of use. As you well know the prescribing information merely state "Do
not discontinue suddenly," or "Talk to your physician before stopping."
That's not enough. Some doctors don't have the knowledge to prescribe and
advise properly.
As a result of my experience as summarized below I recommend that:
"No prescription for any narcotic will be written for an amount likely to
establish dependence without including log sheets for recording every dose
taken, a proforma withdrawal plan, titration tables, and contact information
for withdrawal assistance."
OR in the alternative that:
The above information be published widely including the internet for access by
the medical profession and patients alike.
You are certainly more cognizant of the data but I would guess that a
significant number of patients end up with addictive behavior simply due to a
lack of guidance on how to withdraw. I know that had I not done the math I
might very well have been increasing my dose when I thought I was decreasing!
For example, which is the lower dose: 7.5 milligrams every 7 hours or 5
milligrams every 4 hours? (answer at the end) Now calculate the dosing
options for reducing from 40 milligrams per day to 35, to 30, ... to zero.
My experience:
There is something visceral about the prospect of experiencing excruciating
pain. Humans are hard-wired in the brain to avoid it at all cost. My
shattered hip gave me a lesson in pain and the frantic search for relief
offered by narcotics. When my orthopedic surgeon went on vacation and my
Lortab® prescription (generic equivalent) supply started to dry up I was
scared! I had already gone through painful withdrawal from morphine after 4
days in the hospital, and hydromorphone and oxycodone after 9 days of
residential rehab. It seemed that there was no one that could really help.
Thankfully, my personal physician prescribed an adequate supply to get me
through the painful months of physical therapy and advised me how to wean
myself off the drugs. But I soon found that calculating the proper dosing
regime was fairly complex, particularly for someone on drugs. This personal
article includes the Excel spreadsheets and report forms that I used to manage
the dose.
The exact two-step process I used to detox may be found on this page:
http://www.positive-way.com/recovery/drug_withdrawal.htm I searched the internet extensively but could not find anything even close to this simple instruction. I think tables such as this are something you should consider developing and publishing as a resource for pharmacists, physicians and others to use.
There is obviously a need. More than 17% of adults over 60, wittingly or
not, abuse prescription drugs.[3]
Sometimes the simplest of tools can clear a path...
Answer to the question:
7.5 milligrams taken every 7 hours equals 25.7 milligrams per day
5 milligrams taken every 4 hours equals 30 milligrams per day
The dosing options are on the webpage noted above.
Thank you for your consideration. Sincerely yours,
Steven C. Martin
The reply from Director Volkow:
----- Original Message -----
From: Nora
Volkow
To: S. Martin
Sent: Sunday, June 04, 2006 12:35 PM
Subject: Re: Rx drug withdrawal information - problem or opportunity?
Dear Mr Martin: thanks for sharing with me your experience and thoughts on opiate medication withdrawal. I agree on the needs of standards to help those afflicted and their physicians. sincerely nora d volkow
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(c) 2006 - 2011 Steven C. Martin www.positive-way.com/recovery All rights reserved. |
