Hey Vicki, The difference between using alcohol as a medical remedy, if it actaully was one, would be completely different from using because of an addiction.
There is no psychological craving for alcohol if it's medicine, Just as there is no psychological craving to tripple my own dose to get high.
Addiction is destructive, Physcical dependence is just a physiclological rsponse to using specific meds.
My dad would probably have a problem using alcohol, mentally that is. But it's not a realsistic anology.
Lets say he was a rcovering heroin addict that was hit by a bus. He's been clean 14 years and inviolved in NA and AA.
Now reason for using the meds is purely physical and to improve quality of life, The addict should be given a chance and the addict should give the meds a chance. If the only reason to use the meds is toget high, then no, he shouldn't use them, But by depriving himself the use of meds for fear of relapse, what else is he depriving himself, you and your kids of.
It's certainly not better to remain disabled and non functional strictlky to maintain the claim of sobriety. CP patients don't get high on their meds, If they are attempting to, it will show. Running out early, going through withdrawal, buying additional meds from the street and the internet.Doc shopping, forging scripts, taking twice as many pills because one works well, two must work better. That's addicticve behavior, you would recognize it, so would he. Meds will onlyrstore so much function in some cases.
No dose of meds would allow me to stand or walk a sales floor 12 hours a day, even with meds walking for an hour is brutal. BUt If I were to deprive myself of pain meds, I would be depriving my wife and child of any possible benefit they could have due to lack of understanding between addiction and physical dependence. How long would it take for him to become so depressed, that you became worn out and he decided to give up, all for the sake of being able to claim I'm sober. It's foolish.
Nothing about addiction is positive, When opiates are used as directed with the understanding there is a limit on what he can take daily and a limit oion what they can actually do for you they improve quality of life. Nothing about addiction improves anyones quality of life.
My dad is very involved in AA and hithe first 2 years I got the get off the dope speach, untill he came to the hospital after the heart attack, sat and talked with me and thought they had discontinued the opiates. They hadn't, I was taking the normal dose, and he had no clue, not because I can hide the side effects, but simply because I became acomamdated to the side effects, had used the same dose for the previous year and all the warm fuzies and all the anoying side effects disapear. Even if the first few days he's groggy after a dose change, doesn't mean he's getting high. That will disapear and he will seem just as normal as anyone else.
I understand he's alergic to morphine, But anything they can put in the pump he can take orally or by transdermal patch, He will develop the same tolerance to the euphoric effects and many of the other side effects. If he's realistic about how much relief the meds can give, his actions 14 years ago have nothing to do with his actions now.
Lets say Pallidine hits the market this month. It already has FDA aproval and they are likely just working on the marketing stradagy or are going to sell the distribution rights to another company. Paladine is the newest LA med, It's a 24 hour Dilaudid tablet, similar to 24 hour versions of morphine like Kadian or Avinza. It can't be broken down, crushed, chewed or injected, It maintains a constant and smoth level so there is no high from going up and down every 3-4 hours with short acting meds,because of the slower onset, the slow termination and the constant level of in his system.
He becomes acommadated to any euphoric effect and simply gets the anelgesic effects from the med. Only someone with a great misunderstanding of what addiction is and how destructive it can be would try to convince you that physical dependence is the same thing as addiction. If the dependence improves quality of life, Improves function, allows him to participate and make a contribution to the house, even if it's simply being able to sit and listen and talk with you without every thought being about how much pain he is in it's a hgge benefit with minimal negatives, refusing orals just deprives you and him from having as much of a normal life as possible.
The masking of pain is not an issue, You learn with chronic pain, every increase from activity doesn't need an increase in pain meds, doesn't need an Xray to look for changes, It's just something that is always there. The pain he has now, is not a warning that if he turns his head to fast he will be paralyzed, That pain signal is simply part of the gateway theory of pain, It contues after the acute phase, Is interpreted by a different part of the brain and actucal physiological changes occur from acute to chronic pain.
The whole idea of long acting meds is to reduce the frequent dosing, clock watching, trying to squeeze activity into a 2 hour window, and to maintain a costant serum level because it's easier to keep pain in chack than to bring a high level down.
The reason the do the psych eval and trial fo the pump is to try to weed out people that are not suited and don't respond or will never be satisfied with what the pump can do. He could just as easily use the pump to get high by asking for never ending increases in dose. Say they put a pump in, make several adjustments and he says he can live with that. 4 months later he's asking for an increase, not because the pain increased but because the good feelings addict want from meds have decreased. An addict can abuse the pump and his doctor just as easly as if he were on orals.
There have ben cases of addicts removing the opiate from the resevoir with a needle and injecting into a vein to get high, they have all died because it's so stupid and reckless but it's classic addictive behavior, never being satisfied and no care or concern of safety. But if he adjust the pump or adjust oral meds to a level at which his pain is manageble, increases functon and mproves the quality of everyones life, there isn't a single indicator of addiction.
Being alergic to morphine only limits himn from using morphine, codeine and heroin. All the other opioids are synthetic and it's highly unlikely he would be allergic to them all.
The duragesic patch for instance is a patch that delivers X amount of Fentanyl for 48-72 hours, He has no control over the amount it deleivers, It's based on the size of the patch, and once the right dose is found and the right timing, because most people can't last 72 hours, He can maintain Duragesic and have no control over it.
If you wake up and find him applying hot compresses to the patch in order to cause faster release, then that would be addictive behavior, using the med to get high. Any med delivered in any fashion can be abused. It's all about why he is using them, his expectations being reasonable and the benefits outweighing the negaitive side effects. Constipation may limt a dose, urinary retention may limit a dose, sweating may limit a dose. with any form of delivery.
A trial of IT meds, that he won't use orally and doesn't even know if the med will help or to what point it helps could be time consuming, he will remain in pain untill the pump is adjusted properly, he may have to switch meds from dilauauid, to fenatnyl , to carfentanyl,affentanyl or suffentanyl, then try adding baclofin or clonidine or bupivicaine.
It would be nice not to have to take meds and worry about addiction, It would be even better if the meds didn't cause physical dependnece, But if the pump runs out, before he can refill, he will experience withdrawal the same way someone on oral meds does.