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Old 10-25-2007, 08:36 PM   #1
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percproblem HB User
Detox or Subutox???? HELP

Hello,
I know this is really, really long- But i need your HELP

I am 29 and i always have been clinically depressed anda little bi-bipolar. About 4 years ago i had a collapsed lung and had to have surgery where i was on a morphine drip. I left the hospital with a bottle of Percocet and a doctor who refilled them for me because of my pain. I slowy weaned myself off. Very hard!!!!!!

Then I had three herniated discs and once again i had percocet.
I noticed the whole time while taking it that i not only didn't feel "high", i felt "NORMAL". For the first time in my life i felt totally not depressed. No anxiety. It was great. I felt like a normal functioning person of society.
But I know that i can't live off them for the rest of my life. It has already been 3 years and my body has built up quite the tolerance to them.

I finally found a doctor who is a psycho-pharmocologist who specializes in what prescriptions actually do to your brain. He completely agreed with me and said that Percocet is an anti-depressant, anti-anxiety medicine and so on. Unfortunately it is not FDA approved to treat depression. So i have to try to get off them (unless I moved to Europe where they are over the counter)
Weaning me off them this time has not been going well. He suggested 2 other option.

Go to a week long detox
or go on Bupronol? or Sbutex?

Can someone PLEASe tell me what it is that thet exactly do to you for a week when you go to the hospital to detox?
Do they just watch you flip out? Or do they give you something to calm you down? Can you make phonecalls? Is it like jail?

ALso, Once going on Subutex can you get off of it or do you have to take it for the rest of your life and can a Dr. give it to me or is it like the methadone clinics where you have to go everday?

PLease, PLease help......

 
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Old 10-25-2007, 09:43 PM   #2
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FullCircle08 HB User
Re: Detox or Subutox???? HELP

Perc --first --you are not alone. Almost all of us are in the same situation. Reading your post actually put a smile on my face because it put another piece in the "human" puzzle I am trying to figure out for myself. I have self medicated for my depression for 10 years (hence the FULL CIRCLE) --this pain med has been our drug for years. Self medicated. Crazy. Once I get off this crap (in day 5 of detox) I am going to focus on what medication to take to curb the depression. I was given Prozac last summer , but threw it away. Thanks for the post.

 
Old 10-25-2007, 10:42 PM   #3
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Re: Detox or Subutox???? HELP

Percproblem,

I am not the most knowledgeable person on this board, and I certainly can't tell you what you should do, only you can make that decision. But I can try to give you some more information to help you make you decision.

Percocet is a fairly strong opiate, and a cold turkey detox from it will not be fun. You will feel like you have the worst flu you have ever had, and that's putting it lightly. Additionally, since you already suffer from depression/bipolar disorder, you'll find detox exacerbates these greatly. Depression alone is very difficult to manage, but detox depression is even greater. If you are not taking anything for depression, you really need to look into this before detoxing, not just for the detoxing process, but for treating the depression afterwards, so you won't go back to using percs. If you detox in a hospital setting they will give you some medications to try to help, but there's really just not that much they can give. The best thing about this method though is, boom, you are over and done, no long dragging it out.

Subutex or suboxone is gotten from a physician, not like at a methadone clinic. Some people use for only a short one to two week time frame to detox from the opiate they are on to reduce withdrawals. Most stay on it longer, I've read anywhere from 6 months to 2 or three years. If you stay on it that long, you'll eventually have to detox from it, but supposedly it is much easier than all of the other opiates. The good thing is, while you're on it, you eel what it's like to be "normal" again, no cravings, etc., learn to live without the percs. Maybe that will give you time to address your depression and bipolar disorder too.

I don't know. Just some thoughts. Whatever you do though, getting clean is the right thing, so good for you.

Bridget

 
Old 10-26-2007, 12:39 AM   #4
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brasshopper HB User
Re: Detox or Subutox???? HELP

Whether you can get off Bupe or Subutox is dependent on your personality and whether you are addicted or physically dependent because of the pain treatment, as well as your physical nature. I can't tell based on what you wrote, and would not be compentent to judge you in any case.

Do some web searches of "Addiction" and compare them to "physically dependent", and see which describes you. Ask your loved ones for their opinion.

One question is, "Are you still in pain?" Despite the side effects, if you are in pain, the meds are likely still indicated.

If you need to be detoxed and you are not addicted, or you are well motivated, well, lots of people do that at home. I just did, four weeks ago, to do a narcotics holiday since I had developed tolerance for the meds I was on to the point where they simply stopped working at any dose (fentanyl, oxycodone). I made up a taper schedule for myself that took about three weeks and which was based on what I had on hand. One of my pain doctors says that a 30 day holiday will allow the mu receptor count to return to normal and I will get pain relief from doses that are a lot lower than my old doses. I am still noting cognitive changes and physical changes in week four. I feel almost as good as I did on the narcotics (since I had thoroughly adjusted to them) except for the pain. My reality is that off the narcotics I am in a ton of pain. (5(short bursts)-8 on the 10 scale, burning pain all over my body) plus cervical pain.

So, after seven years of increasing doses, I am putting up with seven weeks of discomfort and pain - to be able to take smaller doses and to have them effective and maybe to be able to get relief from breakthrough pain. I had seven years of fair comfort. Not a horrible trade. With better techniques I might have had 10 years.

But I would recommend that you talk to your doctor about a taper schedule. Try to get the doctor to make it a month to six weeks, it will be a lot more comfortable than a 1-2 week taper.

If you feel like you need psychological help, well, decide what sort of program you want or need - there are programs that do not treat pain patients who have taken meds according to instructions and who need a holiday or who want to investigate what life is like or alternate pain modalities without narcotics as addicts. I have a personal bias - I'm an atheist and don't feel like there is a higher power for me than my own will, so a 12 step program would not be for me. I called a lot of programs - and most simply did not differentiate between physical dependence and addiction, or they did not have the facilities to deal with someone who was in chronic pain, or they were simply not interested in treating me, since I was not an addict and I was not an appropriate candidate for their pseudo-medicine and intense psychological treatment/torture/12 stepping.

I called a number of programs before I decided to do it at home. I was never able to find a program that was not oriented to treating addicts. I found one on the web, in California, but I decided to just do it at home. One issue was the cost. I'm hoping that by the next time I do this it does not cost $5000 for a bupe prescription, and that they have dropped the requirement that the doctor referr you to "therapy" if they are not treating you for addiction.

Don't go into an addiction program unless you have decided that you are addicted. Pain programs are more appropriate.

But the reality for me, at least, is that I have already talked about my history to my pain doc, as well as the amount of pain I am in during my holiday, and the plan is that I will go back on narcotics once the 30 day holiday is over. Not, of course, at the same doses I was at, a milligram an hour of fentanyl would kill me.

I had thought that the narcotics had become completely ineffective on my base pain level, and I was completely wrong. They had become partially ineffective on my breakthrough pain, but they were effective on my base pain. A medication holiday allows you to look at your pain with a clear mind and to remember why you put up with the narcotics. There is also some likelihood that you will say, "heck, the pain is just as bad with narcotics as without them. Why take them?"

That is not my case, but it is something you have to consider. I have heard of this anecdotally.

As to whether you can get off Subutox, of course, the drug maker would like Subutox to be a lifetime thing, but there are many doctors doing six week decreasing dose detoxes on Subutox. People who get Subutox for lifetime use are the same sort of person who gets methadone for lifetime use.

If you really want to be on narcotics, you could always declare yourself an addict and go to a community methadone program. The people at a methadone program can use the drug to maintain your addiction, legally, just like a subutox doctor can use that drug to maintain your addiction. If you are married, Subutox has less effect on testosterone levels and therefore your libido. It is a big step, legally, for someone to declare themselves an addict if they have no felony convictions.

So, are you still in pain? If so, talk to your doctor about a month holiday to get off the percocet. Perhaps not to stay off of it, but to reduce your tolerance. Frankly, if you are taking percocet and not, say, oxycontin, your doses are simply not that high. Percocet has a tylenol component - which you have to keep under 4 grams a day. If you are taking 10/325s, the strongest I have seen, you would be limited 12 pills, or to 120 mg/day. If you are taking 10/750s, well, that means that more than 5 a day would be over the 4 gram limit. That would be 50 mg of oxycodone, max. When I last looked, a few years ago, the 10/325s were not available generically. 50 mg/day is not a small dose but not as much as a single oxy 80. Think about why Rush Limbaugh went deaf while he was abusing the mixed narcotic/NSAID/Acetominophen drugs. I was taking 240 mg/day of oxycodone (3 80 mg oxy) with the fentanyl.

So, are you still in pain? If so, talk to your doctor about your pain, not your depression or other side effects. In today's environment, no one is going off label for oxycodone unless all standard drugs fail and the need for the off label use is well documented. If you are not in pain, well, there may well be better drugs for depression and bipolar disorder, although they are probably just as addictive and just as likely to cause dependence, and in some cases even more sommnolesence than the narcotics...but they are non narcotic so they are better for you, right? (That was a joke.) One possibility is Cymbalta, which is an antidepressant with a pain indication. It works for many people but it does cause physical dependence and some people find that the smallest available pills are not small enough for a taper, and the detox effects, like irregular heartbeat require that they resume taking it -- but it is non-narcotic so it is better for you. If you find that you can't detox from a single 30 mg capsule, talk to your doctor about a prescription for a compounding pharmacist, who can make you smaller capsules. Also, some people find that Cymbalta works for a while and then they need to change drugs to another SSRI, essentially the same sort of thing that happens with the Percocet. Talk to your doctor, and, seriously, if you feel suicidal, call a crisis service or 911 right away.

But if you are in pain, your doctor might want to rotate you to hydromorphone, maybe 5 or 10 mg Opana. or he might want to shift you to something else. As one doctor told me, when you have an effective dose and it stops working. the first reaction should be rotation to an equipotent dose of some other drug, before dose escalation.

This is a tactic to try and beat tolerance. If you rotate drugs, they may go through different metabolic paths, or hit different variations of the brain receptors and that might allow you to use a less drug than you would need if you kept on the same drug.

The other reality is that with holidays and rotation, if you are in pain, you can stay on narcotics for a very long time. The big issue is dose escalation. A good doctor can help you with that.

I wish you luck. And I might consider getting a second opinion, although you have to be careful of "doctor shopping". In Florida, you are doctor shopping if more than one doctor is prescribing narcotics at the same time for the same indication. As far as I can tell, all your chronic pain is the same indication while acute conditions (kidney stones, for example) are different indications. So when you change doctors, you have to make sure that there is a handoff. But you can see another doctor so long as that doctor does not prescribe narcotics for you or coordinates the prescriptions with your regular narcotics prescribing doctor. Or, if you like the second doctor's proposed treatment plan better, you can make sure that both doctors know you are transferring your care. There may be similar rules in other states.

 
Old 10-26-2007, 11:03 AM   #5
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Sweetie31 HB User
Thumbs up Re: Detox or Subutox???? HELP

Dear Percproblem,

I didn't read alot of the other responses you received because everyone has there own opinion. Let me start by saying.....I am on Day 6 FREE of Percocet 10mg after 6 years! As a chronic pain patient I was up to 8 daily....and my concern was "well how will I treat my pain after I get off?" but then I needed to allow myself to take the FULL PLATE of issues I had in front of me and SLOWLY pick away at the situations one by one - logically!
First situation was, I am on percocet and it needs to stop because it is not a "chosen method" of treating pain by other doctors and it was soon to be stopped once my very own pain doc (who I trusted, who prescribed them to me for 6 yrs) was leaving his practice! NOW, I found this board and read alot-almost TOO MUCH....and I asked the same question....out of FEAR! I was so afraid to detox & withdraw! However, only YOU can make a decision for yourself which road you want to go down? Two choices here.....#1, trade off the percocet for a "substitue" drug to not have the withdraw - my thought....why trade one drug for another that would eventually OWN ME again too??? Then I thought....OH NO I WILL DETOX....but what if #2 I tapered lower & lower each day down to the day I planned to stop...maybe it wouldn't be like "everyone elses" nightmarish stories? Yes they are frightening!!!! I learned, Everyone is different! Everyones body will react somewhat the same (symptoms wise-possibly) BUT....My mind was DETERMINED TO STOP....So I lowered, and tolerated & adjusted - it wasn't easy but..I accepted it and therefore wasn't as nightmarish as I thought it would be?? Yes, while I lowered my dose it wasn't comfortable.....but I NEEDED to do it! If you are honest with your physician, maybe they can give you a lower dose, or if you already have them.....just decrease gradually for a few days......lower & lower and then plan a day to stop & COMMIT to it!
I unexpectedly stopped though!! I had lowered my dose for a week or so then last Saturday night I took my last dose (but only 5mg) and decided to see what happened the next day if I didn't take a dose? I kept tylenol, advil, immodium & pepto on hand along with vitamins just in case....but After 24 hours I thought...I can't see taking another dose NOW! I waited again......I ended up working while doing this too!!! Next thing you know, another day passed, and another......now today is day 6...made it through the battle but...still have to pick off the pain situation on the less full plate. You can do it ...set your mind to it and you can do anything!

My best to you! Good Luck....S

 
Old 10-26-2007, 04:29 PM   #6
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percproblem HB User
Smile Re: Detox or Subutox???? HELP

I just wanted to say thank you to everyone who posted a reply. This was the first time i used this site and i wasn't sure what to expect. I feel very encouraged today after reading all your words!
Everyone had the same theme in their reply, "That i can do it!"

So thank you so much!
I will let you know how it turns out!

 
Old 10-26-2007, 11:16 PM   #7
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JJC81 HB User
Re: Detox or Subutox???? HELP

Subuxone has been working great for me. I have been on it for the past five months. I don't know your using history well enough to say if you qualify as a good candidate for the treatment. I respect everyone's opinion, but let me tell you what didn't work for me in the past. I tried over and over again gradually decreasing the amount of opiates i was taking. For an addict, this is just not a wise method. We tried on our own hundreds of times, but the cycle just kept going and the consequences just kept coming. You should def. talk to a certified chemical dependency counselor. Just look one up and give them a call. It can stay anonymous. They will point you in the right direction. Just know that there is plenty of help out there. If you find that trying on your own just isn't working, pick up a phone. My prayers are with you. Best of luck

 
Old 10-27-2007, 08:19 PM   #8
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maggie0704 HB User
Re: Detox or Subutox???? HELP

Quote:
Originally Posted by percproblem View Post
Hello,
I noticed the whole time while taking it that i not only didn't feel "high", i felt "NORMAL". For the first time in my life i felt totally not depressed. No anxiety. It was great. I felt like a normal functioning person of society.
Can someone PLEASe tell me what it is that thet exactly do to you for a week when you go to the hospital to detox?
Do they just watch you flip out? Or do they give you something to calm you down? Can you make phonecalls? Is it like jail?
..
It's me again, i wanted to respond to this post also. You are SOOO much like me it isn't even funny! I also feel "less depressed" and "normal person in society" when on opiates. I have suffered w/depression since teenager, AND have chronic daily headache/migraines and opiates "fix" both. But i want to have a baby and nothing is allowed to be taken while pregnant.
Although i have to admit, when i was taking Lorcets daily (5yrs ago), they began to work against me. At first, for a good 6 months, i felt great and had no depression, no pain and could do things all day long and not feel so tired that i had to nap all the time. It was the greatest time of my life,,,,i finally felt "normal". Then i began to feel worse on them,,once they started to wear of thru the day, i felt worse than ever. More depressed and had to get more in me to make it thru day. It was messing w/me mentally big time.
That may be why your up to so many a day....not just bcuz of pain tolerance, but mentally you begin to need more to feel that "buzz" of normalcey. But being on the sub., for me, was different. I never needed to increase dose, it's not meant to be increased and taking more doesn't make you feel any better. So i was able to stay at my dose for 9 months and never craved pain meds. or had issues w/feeling like crap every day.
For me, it helped me live a normal life for that time and not feel like i was constantly worrying how i was going to get "more" pills to cover me thru the week/month/etc......
And as far as rehab, i went to a rehab for 10 days a few yrs ago. I was forced into it, but after a few days i acknowledged i had a problem and found great help/support there. It's not like a jail, more like a boarding school (?)
You can't make any calls usually for first 3-4 days, but i was so sick those days i just slept whole time. Then u usually are going to meetings 8-9hrs a day. So it's exhausting, but u can rest when needed. I was sick as a dog and only did what i could handle (coming off Methadone) and they were fine with that. Looking back, i wish i would have stayed longer and not left so soon - and of course NOW i don't have money to go and do this. Now it would be more appreciated and i would take it more seriously.
Depends on which rehab u go to.....it's not easy though. They are usually strict and keep u going all day. They usually do let u rest the first 2 days, knowing your knocked out from everything hitting u so hard. But then again, i had been taken off Adderall at the time and hadn't slept in weeks so they did allow a little more time for me to "sleep it off". It's not a hotel, and it is tough to make it thru each day being in there by yourself with strangers....but those strangers could prove to be your strongest supporters and life long friends. I would go in a heartbeat if i could afford it.
So if u choose against sub., then i'd suggest going to rehab. If your truely ready, it can be the best decision you've ever made to go.

 
Old 10-27-2007, 08:36 PM   #9
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percproblem HB User
Re: Detox or Subutox???? HELP

HI Maggie,
I really appreciate your writing back. It was great. I do need more and more to make it through the day. And i also noticed now that (and this is something that is totally the opposite of my personality) that after 2 hours when i really need another one, i become very angry. I have always been a very easygoing, non-confrontational person. And now i slowly have been noticing a change in my personality. Granted that i have been addicted on and off for about 3 years but i think it has finally caught up to me.
I am now very quick to yell, or be annoyed or flip out. God help that person who cuts me off on the highway.
I am even like this with my family.

My mom knows, and she is a huge support to me. Unfortunately she lives 2 hours away. i have 2 older sisters who knew, but they don't know that i went back to it again.

I don;t think rehab is an option anymore for me right now. I live on my own and i am BROKE. I also, can't take any time off from work right now.
When it comes to the Sub. I keep trying to do research on it on the internet and today i talked to my dr. I feel like i would be trading one addiction for another. IS that the case? Can you stop taking the sub?

I also get worried because i want to go back to school in January into the Oriental Medicine field. ( i think learning other ways of handling pain will be good for me). and i am worried that if an insurance company sees that script for sub that it would affect my career possibly one day because then they would know i was an opiate addict.

I guess the only option i have is tapering off. Of course, that requires a strong will and i don't know if i have that.

Sorry if i am rambling. I think i need sleep.

 
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