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    Old 09-06-2004, 02:20 PM   #1
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    Chronic pain for Addict of Opiates

    I have had chronic pain from Fibromyaligia , diverticulitus , diabetes and several bad disks and also scholosis sp. I am also a addict of opiates and abused them for several years. They would elevate my mood and keep my depression at bay so I became attached to them both physically and emotionally. I range from pain 2-10 on any given occasion.
    I decided the first of june to try the opiate Suboxone for people with a dependcy with opiates. It acts a lot like Metadone. Well I have been completely off all opiates for 21 days. I am going to post to you the same question I asked on the Addiction forum.

    Today has been a tough day for me. Day 21. I am in chronic pain in about every joint in my body. My depression always gets worse as the physical pain does. I am in a catch 22 and really am lost at what to do.

    Here is me thinking out loud. I know in my mind that I could continue down this road with opiates. I have proved that to myself. It is hard but I have went through the hardest part already. However, All the time I was on Suboxone I had very little depression and low pain. My quality of life seemed so much better and I never thought about abusing. It seems to have a ceiling effect and the tolerence does not seem to be a issue like other forms of opiates. Anyone you know of on the Sub ever over long term have to increase dosage due to tolerence?

    I know I can't go back to Suboxone but maybe Subotex might be the solution. I always was afraid that I would have a major attack of very severe pain which happens several times a year . It lands me in the hospitol on IV narcs to control the pain. I mean it is the laying in the floor begging to die pain. It is due to diverticulitus of the colon and the cramps are un-bearable. I have had three cases this year. Two I caught in time and one that left me in the hospital for a week. The Suboxone you can not add other opiates to or it will send you in withdrawels. That is not the case with Sudotex. If I was on it and had to go to the hospital they could give me IV narcs for pain.

    I have done a thorough research of the drugs and some doctors are using both for pain control. The only way I would even consider this road is if my Sub doctor would RX me for pain management and not addiction. I really feel after a lot of soul searching and talking to other chronic pain people and the concensus is the real difference is the abuse part. I am addicted to AD's but does that make me a addict?? I don't abuse it, I take it just like HBP pill.

    My question would be am I a big failure for not continuing the road to sobriety or am I wanting to just be able to feel like going bike riding with my daughter. I sure can't in the condition I am today.

    Anyone who reads this please give me your thoughts on this as I see my Sub doctor this week.

    thanks much,

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    Old 09-06-2004, 07:03 PM   #2
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    Re: Chronic pain for Addict of Opiates

    Let me ask you this:
    Do you take your meds when you don't need them?
    Do you run out of medications early?
    Do you take more than you need at one time?
    Bottom line do you abuse drugs and take them for what they are not inteded for but instead take them to get high in the same manner someone might drink to get drunk?

    If you said yes to the items above then yes you have an addiction problem.

    Or do you just like how the meds make you feel but take them for the pain?

    If you said no to the above and yes that you take them when needed but do like the side effect that doesn't necessarily make you an addict.

    I guess what I'm having a hard time figuring out is that you haven't really clearly defined in my mind that you are or are not an addict. Some medications to cause a better mood, others like Morphine make you awfully tired. Each drug reacts different to each person, but I've always felt if you fell within that area of you take the drug to stop the pain then you aren't abusing it. Until you clearly define that I'm not sure there will be a right answer.

    It also sounds as though you have psychological addiction more than anything. I can tell you that any one of here taking narcotics if we stop them suddenly we would in fact have the same withdrawals any addict would, this does not make us an addict. If your body craves the medication then yes. I still feel you have really confused the terms dependance and addiction. And if you talk to addiction individuals who do not have chronic pain they will not understand or care to hear the difference because to them, and to many, addiction is addiction no matter if it is dependance or real addiction.

    You've indicated you feel better and are less depressed when you take your medication yes? This is a sign of depression, you might be better off being on the appropriate medication for that in addition to your pain medication. I can tell you that Lexapro does give you a feel good feeling, it does put you in a great mood and it is supposed to do that, it is afterall an antidepressant and that one just seems to work that way with most individuals. Just because those are in fact the side effects doesn't mean the person taking them is anymore addicted to them they a person who takes medication to control pain is.

    You have another problem, you are in pain, severe pain. Pain that most people can not for the life of them ever imagine having day in and day out. Some people think it's the end of the world when they get a hang nail, they need to try to go through what we do every single day of our lives.
    The truth is you have a right to a normal life just in the same way a person who has depression has a right to a normal life, or any other illness one takes medicine for. It doesn't make them an addict, if it does then most of the population are addicts.

    If in fact you are a true addict then what you need to do is get some good counseling from someone who understands both sides, not just addiction but pain as well. And make a decision on what is best for you. It is apparent you do not want to live the rest of your life in pain, I know I don't want to. If your level of addiction is more of psychological one then you can in fact deal with that and still take pain medications regardless of what some individuals are leading you to believe.

    Bottom line is you are not a failure if your pain is greater than what you percieve to be your addiction and you start taking medications AS DIRECTED and even monitored if you need. A pain free or reduced pain life is better than a sober painful one.

    Let me reiterate, I am not condoning the abuse of any medication period, I am saying if you can take your medications as directed for your pain, even if you need someone else to keep your meds and help you do this, you are not a failure. Do not ever let anyone tell you that. Especially a former addict who has never suffered like you do every day of your life


    Old 09-07-2004, 08:30 AM   #3
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    Re: Chronic pain for Addict of Opiates

    ';Hey Fisherman, Sounds like your doing the right thing, researching the meds, talking to folks in adddiction forums or NA programs, have an addictionologist.

    Mixing opiate agonist and antagonist together to prevent abuse isn't a new concept, they have done it with Talwyn in the 70's, Nubain and Stadol are both mixed agonist/antagonist. The new generation of these meds are Buprenex, suboxone and subutex. They all have opiate agonist qualities and antagonist qualities. The antagoinist is what creates the ceiling, but it's more than just a can't get higfher ceiling but also a safety ceiling. Buprenex isn't even new, It's been sold in Tablet form for years in other countries under the name temgesic.

    I would have to do more research about the specifics of Suboxone and subutex, But if the med is pretty much abuse proof, your able to cmply with instructions and they improve the quality of yourt life, non of those things are indicators of addiction. Yes many meds cause physical dependence, that just means you an't stop taking them abruptly, You don't usually become addicted to AD's if you mean antidepressants, No you shouldn't stop taking them abruptly or you may experience some very negative consequences like serritonin syndrome or rebound of severe depression. That doesn't meet the criteria of what addiction is and your doc should be explaining the difference between addiction and physical dependnece, especially if your seeing for addiction issues. It's great there is a med available when compliance is harder for a patient, and underlying issues like depression and panin can certainly make them hard, a history of addiction makes it a little harder from the management stage, but the answer is, most docs will give a patient a chance even with a history of addiction, The worst junkie in the worls could get hit by a bus and need PM for the rest of his life.

    Whether he chooses to abuse his meds,and engage in addictive behavior, like doc shop, internet purchases, drinking on top and other things to enhance some type of buzz, then here is an addiction problem going on. But physical dependence is just a consequence of using particular meds, I go off the BP meds and My BP goes up, It's not an addiction. It doesn't cause cravings or destructive beghavior.

    Pain management is about improving the quality of your life, I don't recall that being one of the predictors or indicatoprs of addiction. Having been down the road, you know the only way to maintain a high from any drug is to continue to increase doses and frequency. No reasonable doc is going to allow this, If you find yourself in a situation where your finmd a doc is a soft touch and gives you anything you sk for, you do the same as you would when trying to say no to alcohol and walk out of the bar, or walk away from the friends that want to party with you. The soft touch doc isno different to an addict in recovery than there old friends that want you to party with them.

    You also have to or have recognized you can get pain relief withoput feeling warm and fuzzie and buzzzed. The idea of long acting meds is to reduce the quick onset and slow the termination so you don't feel it come on and wear off and feel the need to redose. Are you a candidate for treatment with these meds, absolutely, does it interfere with your sobriety, absolutely not. If this med improves your quality of life, allows you to function, prevents you from needing to self medicate or abuse, nothing there sounds like addictive behavior. No doc shoppping, no heoarding, no injecting or snortng and not asociating the way a med makes you feel with a high other than the relief of pain. The high is the first to go nomatter whether your abusing or taking it as directed for pain. People that asociate the buzz with anelgesia are going to run into trouble. People that can accept the anelgesia without the need for a buzz, people that can complly, etc would not be classified as an addict in the PM world.

    I know a few folks in the AA and NA world and there views conflict, some say a dose of nyquill nobody how sick you are is a slip, some think pain meds after surgery for a heroin addict is a slip. That's an incrediably high stantard to hold anyone too. If you need medicine to denie yourself everything beneficial when there are no negatives other than some pointys of view doesn't make sense to me.

    You know you have a predisposition, hopefully you have a support network in place and can recognize when your own behavior starts to slip past looking for relief. Do I think there are people with addiction histories capable of taking meds responsability, when there are no longer an active addict, absolutely.

    Suboxone really isn't like emth in the way that folks can either do a 21 day detox or chose to go to meth maint. meth maint is just maint of an opiate habbit, there are no opiate antagonist in methadone, you cantake other piates with it, you won't get the same buzz, presumably, but it in no way interferes with anelgesia of other opiates. Suboxon is more of a antibuse for opiates, It has little oiate properties and very high opiate antagomnist properties which would prevent a buzz from abusing opiates. The receptors are blocked so opiates can't bind. It's not that you would go through withdrawal if you took opiates while on suboxone but they just wouldn't work, but opiate antagomnist do have anelgesic properties, that's why they have combined them with opiate agonsit. The combination seems to work, it does have a ceiling but abuse potential is low. That's why they came out with Subutex and Buprenex, stadol,nubain and Talwyn NX.

    Purdues first efffort to make OxyC abuse proof was to add Naltrexone "narcan". IN small amounts the naltexone shouldn't interfere with anelgesia when taking orally but if crushed and injected there is enough to block the recpors, This is how TalwynNX works. Unfortunately they haven't figured the right equation with OxyC to make this work and not loose too much anelgesic properties. I'm sureit's just a matter of finding the right equation or they may combine it with a small amount of one of the newer antagonist to vcurb abuse.

    But I think you confusing addiction with simple physical dependence. You can be dependent and have your life improve and not be addicted, you can't be addicted and expect an adiction to make improvements in your quality of life and if your addicted your likely physicaly dependnet, but simple dependence doesn't equate to addiction without he behavior and other determining factors which are all destructive. Has Suboxone been destructive in any way to your life?

    Subutex just has more opiate agonsit meaning more pain relief and not as much antagomsit that it prevents any opiate from binding to a receptor, It still has a ceiling effect, but if it redcues half your pain, your doing better than many CP patents and haven't given up subriety iIMO, Keep doing what your doing as far as meeeting and support for the addiction issues and depression, but don't et the need for anelgesia, in about the safest form for an addict to make you feel like an addict for needing it to function. It can be discontinued much easier than methadone, that's another big difference between MMT and using Sub or Bup. Your not tied to it or experience withdrawal just as severe as any opiate like with meth.
    Good luck and welcome, Dave

    Old 09-07-2004, 09:05 AM   #4
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    Re: Chronic pain for Addict of Opiates

    Hey Fisherman, Here is the difference for folks reading along that don't know what these meds are.
    SUBOXONE sublingual tablets contain buprenorphine HCl and naloxone HCl dihydrate at a ratio of 4:1 buprenorphine: naloxone (ratio of free bases).

    SUBUTEX sublingual tablets contain buprenorphine HCl.

    Buprenorphine is a partial agonist at the mu-opioid receptor and an antagonist at the kappa-opioid receptor. Naloxone is an antagonist at the mu-opioid receptor.

    The suboxone, because it contains a powerul antagonist, Naltrexone "Narcan" if you take opiate while on Suboxone the naltrexone will block all the opiate receptors, But Subutex is strictly a trade name for oral Buprenex, TM Buprenex has only been aproved in our country for about 2 years, BUt it has opiod mu and kappa receptor action that will provide anelgesia, antagonist can also provide anelgesia as long as you don't give them to someone dependent on opiates, there is enough antogist action in Bup to block enough recptors t cause a problem n a depoendent patient.

    Now tha you "fisherman " have detoxed with suboxone, you are no longer physically dependent, Bup or tablet form Subutex has anelgesic and antagonist propertes but the antagonist isn't as strong as neltrexone, so all the opiate agonist properties are not blocked. But you do have a ceiling so the ceiling makes it pretty much abuse proof. There are PM docs that prescribe either injectable Bup 3-4 times a day, or now they have Subutex which is just oral Bup, same as mexican Temgesic. You do want to avoid other antagonsit agents while taking bup or subutex, but you can take pure agonist/opiates for flair ups should this become an isue with the DVT and other problems you have.

    It all comes down to what do you think, what are you comfortable with and would you be able to cacth yourself should a problem arise. Usually if there is a known problem, more steps are placed to ensure compliance. More frequent apts, smaller days supply dispensed, drug testing, continued counseling, etc. It means more hoops to jump through but it doesn't mean it's shouldn't be made available and you wouldn't be able to use it. After prooving your ability to comply some of the strings may be loosened or if your not comfortable, let them know you want to continue with a stricter regemin that includes these things to help ensure you remain compliant and understand that this may be your last and only chance.

    After all I went through, years of surgery, no pain meds, being told to live with it , it's all in your head, etc. I look at my PM now as my last chance , although in reality I'm sure I could find another doc to take over the pump Unless of course I was abusing or endangering myself. I've just always looked at the meds as the last option and If I do something stupid I can end up with nothing and bed ridden for life over what, a few Norco you can purchase over the internet, or some soft touch quack, I have to much to loose to risk it over a few vicodin or even a percocet that wouldn't last even a few weeks because of my present tolerance.

    You have to do what's right for you but needing to take a pill to control BP, Diabetes, depression or pain, doesn't mean your addicted, even when the consequence is withdrawal.

    Addiction is about your behavior and motives. If your compliant and your only motive is pain relief, I would say keep the sobriety chip and keep counting those days you are still sobor. Congrats on completing the Suboxone detox and stay clean. But you can treat your medical conditions if that's all your doing without the guilt of feeling or being dependent.
    JMO, Dave

    I thought this excerpt might make you feel more comfortable about Bup or subutex/

    Buprenorphine hydrochloride is a partial agonist of the morphine type; i.e., it has certain opioid properties which may lead to psychic dependence of the morphine type due to an opiate-like euphoric component of the drug. Direct dependence studies have shown little physical dependence upon withdrawal of the drug. However, caution should be used in prescribing to individuals who are known to be drug abusers or ex-narcotic addicts. The drug may not substitute in acutely dependent narcotic addicts due to its antagonist component and may induce withdrawal symptoms.

    Last edited by Shoreline; 09-07-2004 at 09:24 AM.

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