Discussions that mention morphine

Pain Management board


Hey Jay - I have been a chronic pain patient for the past seven years. For about two years up until about 5 months ago now (or so I think) I was having trouble taking my vicodin as prescribed. Major trouble. I finally came clean with my doctor's about it and because I cannot go OFF opiates due to my pain condition they referred me to a PM doctor that put me on methadone. I too thought sub was only for addiction and was also not meant for long-term use? I might be wrong on that.

Anyway, the methadone has worked wonders for me. I started at 30mg and was up to 50mg (back to 40 now but that is a different story in a different thread) and that was working really well for me. It works better for my pain than ANY other drug I have used in the past seven years, and I am pretty sure I have tried almost all of them. I know it is different for everyone but I have several friends on the boards here that use methadone for pain with great success.

The methadone also does NOT get me high so I have no desire to abuse it in any way. It's like I take it and I still feel completely "normal" (he he he, normal for me that is...) but my pain goes away. It's great. No buzzy head feeling, no nothing. It's liek I didn't take anything at all and the pain just started fading. It has also completely nixed my desire for the buzz I used to get from other opiates. I don't even THINK abou the vicodin or oxycodone, etc.... Also when I had some major torn ligaments and had to be hospitalized it was great because they were able to give me IV morphine and did NOT get buzzed off of it because of the methadone. I was really worried about getting that "good" old feeling back and having cravings kick back in. Well it didn't happen at all. I got out of the hosptial and went right back to my normal methadone routine with no added cravings or anything. It has been great. I feel like I have at least somewhat of a normal life back. The pain is never 100% gone but it is the best it's ever been. And I don't have to feel like I am in a coma half the time due to my meds being so heavy.

Did you talk to your doctor at all about methadone? I'm just curious because everyone seems to be saying that sub is ONLY used for addcition. I'm concerned that your doctor is going to put you on the sub and then try to wean you off completely and then you will be left at square one with no more addiction but still a ton of pain? It just seems weird that they are using this for addiction/chronic pain long-term.... My doctors told me that methadone was teh best drug for that sort of double edged problem. Granted I'm sure each doc has their own opinion. Just reading all the other posts I'm concerned that maybe they are really just trying to get you off everything. And that won't work if you have CP? One of my doc's tried to do that with me originally putting me on 10mg of methadone. Which is a "nothing" dose according to my current PM doctor. He said he was treating my pain but really he was trying to get me off opiates period. I was naive and had no idea until I complained to my OTHER doctor because the 10mg was doing nothing for my pain. She freaked that my dosage was so low and that is when I got in with my current PM doctor who told me that the "normal" starting dose of methadone is no lower than 30mg normally. Adn I completely trusted that previous doctor. Until it showed up in his notes that he ws trying to get me off teh opiates all together. My gyno was none to happy due to the fact that she is the one who has diagnosed my chronic pain and knows the details of it etc.... The other doc was primary though and handled my pain meds. So I went about 2 months like that in pain thinking something was wrong with ME because I thought methadone was supposed to work well according to the doctor.

I'm not saying your doctor is lying to you. I'm just saying that sometims they try to do what they think is "best" for us and are not always up front about it. I have had it happen to me several times over the past sseven years with all my different doctors. If everyone is saying that Sub is only used to treat addiction and that it is only APPROVED to be used to treat addiction and is not recommended to use long term for chronic pain then I think you need to talk to your doctor rigth away about what their plan actually is for you. LONG TERM. That was the mistake I made. I just put my trust in them completely. NOW I have a long term plan. The methadone for the next five years, then surgery. Has your doctor given you anything like that? If not, you need them to sit down with you and go over what their plan is. I would just hate to see you end up surprised like I did when all of a sudden they keep DROPPING your dosage on you and you are in more and more pain.

Let me know what happens of if you have already discussed long term plans etc.... As a fellow patient who has had both addiction/chronic pain problems I am interested in what is happenign with your treatment.

Tina :)
Okay, some people here seem very confused about the whole Buprenorphine thing. Buprenorphine comes in many forms, like Buprenex for pain and Suboxone and Subutex for opioid depenence (you should never say the word addict/addiction, it's very demeaning because your labeling a person by their illness). In the US, Buprenorphine in the forms Suboxone and Subutex is only FDA approved for opioid dependence, but it is used off label for depression that isnt helped by anti-deppresants and chronic pain. The doctor must have an "X" in the beginning of his DEA number to prescribe it for dependence, and they can only have up to 100 patients at a time, but for chronic pain they dont need that "X" in their DEA number (but lots of pharmacists are confused about this fact). Buprenorphine is 25-50 times stronger then morphine, it's a very STONG narcotic, and it does have a 32mg peak, but 32mg is EXTREMELY stong. It's used in micrograms for chronic pain, They're right now in the US doing clinical trieals on the patch that will be FDA approved JUST for chonic pain. The Suboxone formula has the naloxone in it, and it's just their to stop abuse (it only activates when crushed and snorted or injected) otherwise it has no effect and just passes through as nothing with absorbed under the tongue. And when used for chronic pain it's taken in smaller doses more often during the day (like 1-4mg every 3-4 hours). They are planning on having oxycodone and morphine mixed with naloxone/naltrexone to stop abuse and tolerence in the near future.

I really think people are put off by the the fact that it has nalxone in it, cause they think they will go into withdrawals, which they wont if taken properly. Chronic pain doctors are prescribing these meds more and more cause they love the fact it cant abused and you cant build a tolerence to it. I swear by it for my chronic pain, and I have used every other pain med under the sun (fentanyl patches with actiq, oxycotin, oxycodone, mscontin, kadian, methadone, diladid) and the only thing I've found for my pain to work wonderfully is Suboxone. IT works very fast, within 10-15 minutes I have releif since it goes straight into the blood stream from under the tongue. It is one of the most expensive pain meds out their, but worth every penny. And saying it's weak is beyond wrong, it is extremely stong, you have to remember that every 8mg pill equals around 200mg-400mgs of morphine, so it's nothing to play around with. You have to be in withdrawals to start it cause of it's strong binding abilities and it over powers other narcotics and can make someone go into withdrawals if they have other pain meds in their system when starting it for the first time and has nothing to do with the naloxone.

I hope I cleared some stuff up, if theirs anymore questions just ask, I've done lots of research in Buprenorphine and know it forward and backwards. I think it's an awesome drug that has a bad reputation which is too bad. But I will always be an advocate for it cause it has helped turn my life around (I never misused my meds so I dont take it for opioid dependence) but helped my pain alot.

-degus
Lovemydegus, I think that all makes sense, but should note that I think it does make sense to separate opioid dependence from addiction in treatment with bupe because it affects whether or not the doctor needs to have the special license to prescribe it (e.g., not needed if it is being prescribed for opioid dependence secondary to chronic pain, but it the license is required if it is being prescribed for addiction). Also, I think when people consider it to be a weak opioid they mean that mean that above a certain amount (depending on who you ask, 2-8 mg), it has no increase in analgesic activity, and thus isn't suitable for anyone who needs, or could foreseeably require, more than 150 mg of morphine equivalent per day. For example, bupe is a poor choice for anyone who needs to have surgeries or other procedures on a regular basis. You're absolutely right that the naloxone component (unfortunately) really confuses people.
your right mark76. It would be a bad choice if you need several surgeries. But when someone is on suboxone and needs surgery, a planned one, then they susually discontinue the suboxone and give you other pain meds to help with pain and withrawal, and they continue the other pain meds til one is recovered from surgery. NOW an unexpected, emergency surgery is a whole diffrent situation. Theyhave to give you very large amounts of pain meds by IV and monitor your breathing til it rips the buprenorphine off the receptors, and that can be ALOT from what I've heard. I have to carry around as pecial card with me at all times that my doctor gave me incase of an emergency, in how I should be treated for pain and they have a 800 number the ER doctors can call to get more info on treatment including my doctor's phone number.

And as with any pain med, it works for some, but not for all, thats a sure thing. But I guess I'm just the person that this med was perfect for, cause it gives such immediate releif, unlike with methadone, which I was taking before the Suboxone, I would have to wait up to an hour or more for any releif. But all the side effects are the same as any other pain med, actually exactly almost the same side effects.

And people like me, who dont need any surgeries in the near future (I will need some eventually due to failing back prolly) so right now it's just pain releif I'm after.

But I really wonder if their will be an outrage when the morphine and oxycodone come out with the formula mixed with naloxone/naltrexone. I can see people getting upset over it, I dont know why, but I can. I think this is a wonderful thing, something to help misuse and tolerence, but yet epople will prolly find a reason to freak out over it.....

-degu