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    Old 03-14-2005, 08:17 PM   #1
    germanshelley
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    How to separate pain from addiction to meds?

    My friend needs high doses of pain meds (up to 13 hydrocodone a day, plus a patch--then methodone, now dilaudid)--overall she's been on constant meds at high doses for several years, due to severely deteriorated discs. But I've read that each of these meds is addicting, even after only a few days, so what would years do?

    It's not just that she's taking so much, but she has several red flags for abusing the meds-- taking too many and running out early-- ending up in the ER for a shot or IV, etc.....driving when she shouldn't, slurring her words, falling asleep while cooking, and etc. But she is so adamant about all of that being "normal" behavior, that it's nearly impossible to talk to her about it. Her response is " So you want me to be in pain?" And of course I don't. One time at the ER, when they asked her what she'd taken, she didn't tell them about the two hydrocodone she'd just taken before we got there--instead just told them her regular meds. The gave her a shot of Dilaudid 4mg, I think, which gave her a total of that plus the 2 hydrocodone, plus the patch and the methadone. After all that, she walks out under her own steam, and even thinks she can drive home.

    Am I wrong in thinking there's a problem? is it none of my business? I'm just worried about her and I would so appreciate any comments/advice anyone has.

    thanks,

     
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    Old 03-15-2005, 05:48 AM   #2
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    Re: How to separate pain from addiction to meds?

    I'm sure that the folks on the pain management board will be able to help.

     
    Old 03-15-2005, 09:50 AM   #3
    Justin1977
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    Re: How to separate pain from addiction to meds?

    Quote:
    Originally Posted by windysan
    I'm sure that the folks on the pain management board will be able to help.
    Or since he/she is worried about the friend being ADDICTED we here at the ADDICTION board could give our 2 cents.

    To answer your question is impossible for us. How much pain your friend is in is impossible for you to know. She has a real problem that requires pain medication. Maybe she needs more than the doctor is prescribing which is why she runs out early. Or it could be that she is taking extra for that extra feel good. There is no way for us to answer that if you who sees her all the time cant even answer it. I can tell you that opiates are very addictive but they are the most effective pain medicine there is. Every rose has its thorn.

     
    Old 03-15-2005, 10:55 AM   #4
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    Re: How to separate pain from addiction to meds?

    I don't get involved with the pain/addiction thing. The pain management board has lots of folks with the same problems(pain/meds). I have no answers regarding that Catch22. Good luck and I hope those at the pain management board can help...they've been there.

     
    Old 03-15-2005, 11:59 AM   #5
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    Re: How to separate pain from addiction to meds?

    thank you both for your answers. Justin, there is a lot of wisdom in what you said. I will definitely read the pain management boards.

    Thanks.

     
    Old 03-15-2005, 04:12 PM   #6
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    Re: How to separate pain from addiction to meds?

    Please do read the pain management board. There is a HUGE difference between physical DEPENDENCE and ADDICTION.

    I am a chronic pain patient. I take many pain meds every day to function. If someone who had never taken anything took what I take in one day they would be in bed asleep for a very long time. I am NOT addicted to these drugs. I am however DEPENDENT on them. If I stopped them cold turkey I'd be in a world of withdrawls but I do not take them to get high.

    Most cp patients do not abuse thier meds. One thing tho that brought up a red flag for me in your post was that she wasn't truthful with the ER doc about the meds she'd taken. If they knew about them they probably would not have given her 4mg dose. BUT, on the other hand, how many times has she been to this same ER? If she's been there many times and they know her, they may know more about her situation than you. If she ER shops, then she may have a problem.

    Really, check out the PM board. Lots of us struggle with the stigma from our families/friends who insist we are addicts when we really are not...just physically dependent.

    Good luck to you and your friend.
    Angela

     
    Old 03-15-2005, 07:20 PM   #7
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    Re: How to separate pain from addiction to meds?

    Angela, what would you say are the main differences between dependence and addiction? how do you know the difference?

    Would dependence be if I take high doses, but exactly as my doctor tells me, and can have conversations about side effects without becoming defensive....

    and addiction could be exactly the same situation, but I take more than I should and lie about it, if I hoard pain prescriptions that I or my children don't use up and use them without telling my doctor--if I get prescriptions from my OB (vicodan for a bladder surgery) but don't tell my Pain management doctor and then take them with my pain meds without his knowledge? stuff like that?

     
    Old 03-15-2005, 07:58 PM   #8
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    Re: How to separate pain from addiction to meds?

    German:
    Addicts take pain meds to get a "high" or a euphoric feeling. NOT to get pain relief. If you are taking narcs for pain, you become physically dependent on the medication. Your body is used to having the medication, and if you were to abruptly stop, would have more significant pain because your body does not produce endorphins as it once did because is used to getting relief from an external source (a pill). So, withdrawl would be significant if you were to stop cold turkey as the poster above suggests.

    A person who is ADDICTED to pain meds would also go through withdrawl, but not feel increased pain levels-- having never felt pain to begin with-- because your body reacts physiologically in the same way. But someone who is ADDICITED uses purely for the high.

    If you demonstrate addictive behavior... phening for narcotics to get that high, hoarding narcotics, lying to get medication, then that makes you an addict. This is why there is a difference between those of us who take narcotics to relieve pain and try to function "normally." For example, when I take narcotics for my pain, I DON'T feel a euphoric high as I might have years ago when I drank too much, or took a narcotic when I didn't experience pain, etc. Does this make sense to you? I hope so.

    Regards,
    CancerDad

     
    Old 03-15-2005, 11:32 PM   #9
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    Re: How to separate pain from addiction to meds?

    Addiction
    "Addiction" is a sociologic term which refers to compulsive drug use, psychological dependence, and continuing use despite harm. Neither physical dependence nor tolerance are sufficient to define "addiction." In the past as well as in present day language "addiction" is frequently and incorrectly equated with physical dependence and withdrawal. "Addiction" and related terms such as "addict" are used in narcotic control laws and are sometimes inappropriately defined to include physical dependence, thereby confusing pain patients with addicts.

    Tolerance
    "Tolerance" refers to the physical adaptation of the body to an opioid, resulting in the need to increase the dose to achieve the same effect, as in "analgesic tolerance", or as in the reduction in a response (such as sedation) with repeated administration of drug.

    Physical dependence
    "Physical dependence" also describes the physical adaptation of the body to the presence of an opioid; it is characterized by signs of withdrawal when use of an opioid is stopped abruptly, or when an opioid antagonist is administered to an individual who has been on chronic opioid therapy.

    Psychological dependence
    "Psychological dependence" is a behavioral pattern characterized by a compulsion to obtain a drug for mood altering effects.

    Narcotic
    "Narcotic" is a legal, not a scientific term which denotes some of the drugs that are controlled under the Single Convention on Narcotic Drugs, 1961, and the U.S. Controlled Substances Act (CSA). Under the Single Convention and CSA, substances such as the opioids are classified as narcotics. Marijuana and cocaine are also legally classified as "narcotics." When discussing pain relief, we avoid use of "narcotic", preferring "opiate" or "opioid".

    [url]http://www.medsch.wisc.***/painpolicy/glossary.htm[/url]

     
    Old 03-16-2005, 10:18 AM   #10
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    Re: How to separate pain from addiction to meds?

    Hi Wes:
    "Opiate" or "opioid" are not necessarily accurate terms when discussing pain relief... there are other compounds that are non-opioid and used for pain control. Opioid and Opiate merely suggest that an opioid receptor is activated in the body to control pain.
    Other pain relievers, such as non-steroidal anti-inflammatory drugs DO NOT activate opioid receptor, but do help to relieve pain in other ways.

    I don't believe we were discussing legal definitions of what one colloquially refers to when he/she is describing someone who is "addicted" to or "dependent" upon a drug. Although the definitions you post defining "physical dependence" and "psychological dependence" come close to defining a sterotypical understanding of "addiction." However, I think it is important to keep in mind that when we refer to addiction, there is almost always a component of physical dependence as well. This is a physiologic consequence as we are all human.

    Regards,
    CancerDad

     
    Old 03-16-2005, 10:27 AM   #11
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    Re: How to separate pain from addiction to meds?

    Hi Shelley,

    Welcome to PM board! You have every right to be concerned about your friend. From what you posted, it sounds like your friend has an addiction problem. I can't begin to say how much pain she's in; but I can't imagine any dr. Rxing that many different pain meds at one time. She needs to get into see a PM specialist and an addiction recover specialist to get some help. Maybe she's under medicated but if she's falling asleep while cooking along with the other things you've described, probably not. She needs to come to grips with her problem(s). There are a lot of other ways of treating CP caused by DDD that she should look into, but first she HAS to admit to herself that she has a problem and them start being honest (not forgetting to mention all her meds.) with the drs. Then she can get on the road to receiving relief from the pain rather than just popping another pill or heading off to the ER. One day she may be able to handle opiate treatment but it sure doesn't sound like a good thing now. If she's as high as you say, don't allow her to drive, the life you save could be your own!
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    Ken
    Peripheral Neuropathy, Chronic Pain, IBS-C, Esophageal Spasms

     
    Old 03-16-2005, 01:03 PM   #12
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    Re: How to separate pain from addiction to meds?

    Heres an excerpt of another post I made in Septemer on this board regarding this very same subject. You can come up with many definitions of addiction versus dependance as the words themselves can be applied in many different ways. This is what I've found for these words when using them in discussions such as this one:

    There is a HUGE difference between addiction and physical dependance. Check out the Pain Mangement board.

    I suffer from chronic pain and while I'm physically dependant on the pain meds I am NOT addicted to them.

    Addiction is defined as: Habitual psychological and physiological dependence on a substance or practice beyond one's voluntary control. This means that you take something to get "high", or you take more pain meds than you need to control your pain or as directed by your doctor. If you are addicted you will come up short on your meds toward the end of the month or when refill time comes around b/c you are taking too many to get high. You may doctor shop, or get to the point of trying to find the meds on the street or over the internet. The pain med "high" will take control of your life.

    Dependance is defined as: The state of being dependent, as for support. This means that you take pain meds to control PAIN. Not to get high. You don't end up short at the end of the month (or whenever you are due for a refill). You don't get "high".

    Please don't think that because you need to take a medication for pain that you are automatically and "addict". NOT TRUE.

    This has nothing to do with tolerance. True chronic pain sufferers do acheive a tolerance over time to certain medications. A good Pain Management doc will titrate you up to the dose that works best for you and keep you there. When and if (and I do mean if, b/c not ALL cp'rs become tolerant to thier dosage), the doc will reevaluate you and possibly switch meds.

    A good relationship and good communication to your doc is essential to combat chronic pain. Please research more on the subject and do check out the Pain Management board on this site.

    I am really tired of being labled and addict because I take meds for chronic pain that allow me to live my life.


    Take care all
    Angela

     
    Old 03-16-2005, 01:46 PM   #13
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    Re: How to separate pain from addiction to meds?

    Pseudoaddiction

    Pattern of drug-seeking behavior of pain patients who are receiving inadequate pain management that can be mistaken for addiction.

     
    Old 03-16-2005, 03:14 PM   #14
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    Re: How to separate pain from addiction to meds?

    Quote:
    Originally Posted by RubySlippers
    Heres an excerpt of another post I made in Septemer on this board regarding this very same subject. You can come up with many definitions of addiction versus dependance as the words themselves can be applied in many different ways. This is what I've found for these words when using them in discussions such as this one:

    There is a HUGE difference between addiction and physical dependance. Check out the Pain Mangement board.

    I suffer from chronic pain and while I'm physically dependant on the pain meds I am NOT addicted to them.

    Addiction is defined as: Habitual psychological and physiological dependence on a substance or practice beyond one's voluntary control. This means that you take something to get "high", or you take more pain meds than you need to control your pain or as directed by your doctor. If you are addicted you will come up short on your meds toward the end of the month or when refill time comes around b/c you are taking too many to get high. You may doctor shop, or get to the point of trying to find the meds on the street or over the internet. The pain med "high" will take control of your life.

    Dependance is defined as: The state of being dependent, as for support. This means that you take pain meds to control PAIN. Not to get high. You don't end up short at the end of the month (or whenever you are due for a refill). You don't get "high".

    Please don't think that because you need to take a medication for pain that you are automatically and "addict". NOT TRUE.

    This has nothing to do with tolerance. True chronic pain sufferers do acheive a tolerance over time to certain medications. A good Pain Management doc will titrate you up to the dose that works best for you and keep you there. When and if (and I do mean if, b/c not ALL cp'rs become tolerant to thier dosage), the doc will reevaluate you and possibly switch meds.

    A good relationship and good communication to your doc is essential to combat chronic pain. Please research more on the subject and do check out the Pain Management board on this site.

    I am really tired of being labled and addict because I take meds for chronic pain that allow me to live my life.


    Take care all
    Angela
    Angela:
    Am I missing something? You seem very defensive about your right to take medication to ease your pain and allow you to function "normally." (whatever that is!!) Rightly so. I don't see anyone disagreeing with you on that point. The vast majority of us take the time and effort to type on these boards b/c we ARE CP patients TOO, and require medication to function.

    I understand that you may be offended that someone may question your requirements for medications, again rightly so, but aren't we talking about Shelly's friend who is demonstrating sterotypical psychological addictive behavior...lying about the medications she requires, overdosing to the point of falling asleep during a conversation, etc. I thought that was the topic of discussion. Forgive me if I'm mistaken.

    God Bless,
    CancerDad

     
    Old 03-16-2005, 04:11 PM   #15
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    Re: How to separate pain from addiction to meds?

    CancerDad,

    OOPS! No, you aren't missing anything

    I just cut and pasted from an earlier post in which I thought I deliniated the difference between addiction and dependance pretty well....that thread was getting a bit hostile and I believe the moderator locked it because of that.

    Nothing on this thread is intimidating me at all I'm not the kind of person to get rattled at the drop of a hat (which it does sound like after reading the cut and paste post.....

    I probablly should have toned the cut and paste down a bit but didn't have the time. We chronic pain sufferers have to face the gambit of "talks", "sermons", "just worried relatives", etc., all the time and sometimes it does get frustrating....I WAS very frustrated with that thread...and a lot of times with folks who mean well but have no idea what it is to live my life day in day out but think they know what's best because the only research they have done is what they have seen in the news (and of course that's all bad and sensationalized to the max to enhance the story).


    Very sorry if I offended anyone....was not my intention and I hope Shelly's friend gets the help she needs.

    LOL to your jest to whatever "Normal" is!!

    Sorry again...can I be let out of the dog house now??

    Angela

     
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