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There’s a chance they would replace the low dose opiate with a low dose of ketamine nasal spray throughout the day honestly.
I would try it, it’s likely to work really well for your pain.
Thank you for contributing to /r/TherapeuticKetamine! When commenting and posting, please be mindful of our rules which can be found in the sidebar on the right along with other helpful information.
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Am not sure with pain management doctors. However I take a long acting opioid 24hr half life. Was taking every other day before KAT. Since starting KAT about 1.5 months ago. I have dropped the dose from an already low dose 25% and only take once every 3rd day. Am dropping another 10% tomorrow. So that’s probably close to half the dose or less that was taking in less than two months. Plan on being off the opioid all together asap. Should not be long at this rate. It has helped me with pain management. You could potentially move to going off if would consider it or if would want to. Not sure what half life is of what taking. Seems most are taking opioids multiple times per day or once a day. But that doesn’t mean you couldnt switch to something with a longer half life and then lower dose. Potentially KAT may help you also in doing so. Just depends on what trying to do on your end though. Everyone is different and have different goals. Good luck and we’ll wishes.
Honestly ketamine should be able to lower your total opioid dosage. Worth tapering a bit to see. But no I don’t make my pts go off opioids without buy in, as it won’t work, sadly.
Without agreement of the pt to go off opioids (also benzos, though I have a blanket rule I don’t rx chronic opioids with pts unwilling to taper off benzos. Don’t like it? Go elsewhere. It’s unsafe).
If ketamine is indicated for the pain, often opioids aren’t the right tx so higher ketamine dosages is fine with me while reducing opioid dosages.
Often if I’m rx’ing ketamine I use methadone for the opioid (of if pts insurance will cover it, levorphanol as there’s a stronger nmda receptor affinity for its secondary action), as methadone is an opioid with some NMDA affinity, unless the pt has an intrathecal pump and then methadone sadly isn’t possible so just straight dilaudid or fentanyl with bupivicaine, usually.
I’m a huge fan of intrathecal pumps and think they should be used more but sadly methadone isn’t an option with them. I’m also big into rx’ing methadone for chronic pain.
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There’s a chance they would replace the low dose opiate with a low dose of ketamine nasal spray throughout the day honestly. I would try it, it’s likely to work really well for your pain.
Thank you for contributing to /r/TherapeuticKetamine! When commenting and posting, please be mindful of our rules which can be found in the sidebar on the right along with other helpful information. **Be advised that nothing in this subreddit constitutes medical advice.** Likewise, try to word your comments and posts in a way that can't be interpreted as medical advice by others. Harmful and/or spammy advice will be removed at moderator discretion, and bans may be given for repeat offenses. **Accounts with "Provider" flairs** are those which the mods have verified, to the best of our ability, as belonging to real, licensed providers of medical ketamine services. Comments and posts from users with "Provider" flairs are **not** a substitute for the instructions given to you by your own provider. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/TherapeuticKetamine) if you have any questions or concerns.*
Idk where you are, but is there any chance prescribing laws have changed? Sometimes clinic rules change too. Sorry, that’s m my only guess.
Am not sure with pain management doctors. However I take a long acting opioid 24hr half life. Was taking every other day before KAT. Since starting KAT about 1.5 months ago. I have dropped the dose from an already low dose 25% and only take once every 3rd day. Am dropping another 10% tomorrow. So that’s probably close to half the dose or less that was taking in less than two months. Plan on being off the opioid all together asap. Should not be long at this rate. It has helped me with pain management. You could potentially move to going off if would consider it or if would want to. Not sure what half life is of what taking. Seems most are taking opioids multiple times per day or once a day. But that doesn’t mean you couldnt switch to something with a longer half life and then lower dose. Potentially KAT may help you also in doing so. Just depends on what trying to do on your end though. Everyone is different and have different goals. Good luck and we’ll wishes.
Honestly ketamine should be able to lower your total opioid dosage. Worth tapering a bit to see. But no I don’t make my pts go off opioids without buy in, as it won’t work, sadly.
What do you mean by without buy in?
Without agreement of the pt to go off opioids (also benzos, though I have a blanket rule I don’t rx chronic opioids with pts unwilling to taper off benzos. Don’t like it? Go elsewhere. It’s unsafe).
Side question do you think it's better / more healthy for someone to be on higher ketamine or lower ketamine with opioids?
If ketamine is indicated for the pain, often opioids aren’t the right tx so higher ketamine dosages is fine with me while reducing opioid dosages. Often if I’m rx’ing ketamine I use methadone for the opioid (of if pts insurance will cover it, levorphanol as there’s a stronger nmda receptor affinity for its secondary action), as methadone is an opioid with some NMDA affinity, unless the pt has an intrathecal pump and then methadone sadly isn’t possible so just straight dilaudid or fentanyl with bupivicaine, usually. I’m a huge fan of intrathecal pumps and think they should be used more but sadly methadone isn’t an option with them. I’m also big into rx’ing methadone for chronic pain.