Opioids im highly opiate tolerant and my dentist is lettin me write my own pain script

[josedequeso]

Hello, this is my first post by me a brand new member. I'm extremely happy to be asking this question too and hopefully receive well needed input...Ive been a heroin/opiate enthusiast/addict for roughly 7 years now. About 6 months ago I gave that life all up and did the rehab thing but also decided that a medicated assistance treatment would be my best bet for continued success after leaving inpatient treatment. I have been on a methadone program the past 6-7 months slowly building my daily dose up to a stable 100 mg per day unchanged for the past two months and feeling content on that dose. After years of hard living on and off the street as a gutter punk junkie, my health had deteriorated in numerous ways, most noticeably in my teeth. Within the past month I've been to docs and dentists to try and undue as much of the damage possible that I put my body through.

So here is the main thing, along with numerous fillings, the dentist needs a couple of abscessed teeth pulled requiring me to be sedated in order to get it done. I made the oral surgeon aware of my past as an addict and to my surprise he was far from condescending and judgmental. This attitude being a major departure from most health care professionals I've dealt with in the past. On top of the cordial and respectful attitude of him and has staff it blew my mind that he was including my opinion in discussing with me the best plan of action to go with. Btw all of this cordialness and lack of being looked down upon as the scum of society in the deep south where I reside in South Carolina...

Here now is the crux of my questions...The dentist specifically asked me what pain killer regimen I thought would be best for me considering my astronomically high tolerance for opiates. During the sedation i will receive fentanyl, ketamine and temazepam (I believe that's the benzo that will be used) which is just fine with me lol but as far as post-op pain maintenance he was inclined to go the route I had suggested which was OxyMorphone for the breakthrough pain rather than the standard vicoden they send most patients out the door with or in the case of people with history of addictive behavior such as me, absolutely nothing. First off I was shocked he actually listened to me and my dilemma rather than the normal medical protocol that would do nothing considering my massively high opiate tolerance. Secondly the fact he didn't just dismiss me as a drug seeking junkie actually reaffirmed my faith in the health care profession. (just a little bit though mind you, it'll take a few more interactions with doctors with human decency to completely change my opinion lol)

So my question is...I am asking anyone who might know what be best to tell this dentist to write on his prescription pad when I see him for the actual procedure in 3 weeks. Mind you I want the best bang for my buck, i.e. the most milligrams of oxymorphone (my personnel fav) or whatever opiate medication might be recommended by you guys to actually breakthrough the 100mg of methadone daily. All the while trying not to ask for the proverbial moon and blowing the golden opportunity that I have here and him see the classic "drug seeking behavior". What should I tell him my short term pain mgmt opiate should be and at what dose. I'm thinking 100 mgs of the Oxymorphone IR per day for however many days he wants to give me but tell me if you think that's way too much and I should cut my request down in order to get something at least rather than a big ol' nothing...and btw any suggestions are welcome on how to make the most of this golden situation I got coming my way

Please and thank yous...

 

[tacodude]

I was barely able to have 60 mg of oxymorphone via 10 mg six a day, but had oxycodone er 60 in the morning then 30 at lunch and 30 at night as Maitlinance. In my opinion this would be the best option and picking up the Roxanne ir generic that are little white pills that dissolve on contract with water no crush and draw up well.

 

[ovo1024]

I'm guessing you plan to abuse these? I'd say go with 8mg dilaudids. Or as you mentioned oxymorphone. Btw that combination of fentynal, ketamine, and temezapam sounds intense. Would definitely be a death sentence in someone who isn't under professional care lol

 

[josedequeso]

Yea lol I do indeed plannin on having a post "dental surgery" party with the goodies I get sent home with...I been a good boy for a while abstaining for some time so I imagine a weekend of lettin loose and abusin some dils or opanas would be ok. And plus it'll be nice to actually obtain those pills through legitimate legal means lol. And yes that cocktail that the dentist will be givin me while I'm there fentanyl, ketamine and temazepam (all on an IV drip mind you) plus my daily methadone should kick in right around the same time the procedure starts lol..should make for an interesting quasi-consciousness out of body experience...

Ive not done any of the strong opioids including the beloved "morphones" since starting on methadone maintenance, so I'm hoping that these prescribed PKs can cut through my normal methadone daily dose tolerance, my gut feeling says it shouldn't be a problem but if anyone reading this thinks those particular drugs won't cut through please do lemme know and i'll have up the ante with the oral surgeon for whatever else may be stronger. considering he seems inclined to write what I ask him to write, he'll oblige.

Really though regardless of what he gives me I really would prefer the instant release version of it and my impression is that when docs hear that they tend to think its 'drug seeking behavior'...guess I just gotta be smooth. Does anyone know the best way to explain to a doctor that you would prefer an IR over and XR without having an ulterior motive??

 

[xtcgrrrl]

Frankly, I'm envious. Your dentist seems like a real gem, don't let go of any doctors/dentists who have this enlightened attitude towards ex-druggies! I really wish I could find one for myself! I have legitimate pain issues but my past as a recreational drug user follows me everywhere and I'm lucky to get prescribed so much as a handful of Tramadol when I need it. If I were you, I would actually request the "morphones" as you put it, but in this case the more knowledgeable you can seem about the prescriptions and their effects on you should be what you need to inform the doctor about as per what he should prescribe. and I am sure you are PLENTY knowledgeable about these medicines. If you can make a case for the IR as opposed to the ER, such as by indicating that IR may better interact with what you are currently prescribed (methadone and everything else) that might impress the dentist so that he will be more inclined to accede to your request. Just point out how the effectiveness of the desired medications will be impacted by everything else you're taking and that you really are trying to put your life back on track but at the same time you would prefer not to suffer through the pain of the extractions. Dental pain can be agonizing...and do be sure to thank the doctor for having such an open mind and non-judgemental attitude to one who has this kind of issue in their past. Be grateful! There is so much prejudice in the medical world towards those of us who have this type of thing in our pasts! I think expressing your gratitude, for one thing, will go a long way, especially when you mention that nobody really ASKS to become an addict...yes, we've made some bad choices, but some people believe that people can be genetically predisposed towards drug-seeking behavior...i.e., it's something we're born with, the same as having curly hair or freckles. Well, that's my 2 cents...

 

[svacheme3]

Well as others have mentioned this guy is a hero. My last dentist I told him the tylenol with codeine wasn't cutting it and i was in severe pain last time, so he wrote me a script for just plain tylenol. So return the respect he's giving you and don't try to get a protocol that's going to get him flagged even if he will actually write it. Go for more days over more per day, because an extremely high daily dose out of the blue isn't just a problem for his paperwork, it will raise the pharmacists eyebrows too since I don't think you're going to one of the ones that cater to pain management people. One time a friend tried to fill 150 80s at CVS at night because he just got the money and the "special" pharmacy was closed. CVS called the police because of the amount and because he paid in cash.
I wouldn't go past 5 a day on the 10mg oxymorphone IRs for a couple weeks. Given how he's already treating you getting IRs shouldn't be an issue, just explain you want better responsiveness for your pain and don't want to be medicated around the clock if not needed; it's also a good indicator he'd be receptive to you explaining that you started low but it not's working a few days later to get more, also a better strategy than asking for huge amounts at once. Just be warned though, even doctors who don't balk when their patient knows a few things about abusable prescriptions, they do tend to just substitute the particular drug you ask for just to not give you what you want.. that's what always happens to me, even after doctors ask and I reply with MD-level knowledge and language about the recommended protocols.


Edit: Also, have you used oxymorphone while on large methadone doses before? I don't know about methadone, but oxymorphone has some weird cross-tolerance issues with people on massive doses of other opiates. 70-80mg at once of IV oxymorphone, for example, gave me a fantastic rush, but I was straight back to dopesick in 5-10 minutes when I was trying to substitute it for a 800-1600mg a day oxy habit, but back when I had a 150-300mg a day habit and synth'd some in the years before opana, 10mg was amazing and lasted hours.

 

[Speed King]

This type of posting is not allowed. Closed.

 

[Speed King]

This thread has a valid point, but it needs to be addressed with more harm reduction in mind, for other viewers. Thanks.

 

[mike.vick]

Yea lol I do indeed plannin on having a post "dental surgery" party with the goodies I get sent home with...I been a good boy for a while abstaining for some time so I imagine a weekend of lettin loose and abusin some dils or opanas would be ok. And plus it'll be nice to actually obtain those pills through legitimate legal means lol. And yes that cocktail that the dentist will be givin me while I'm there fentanyl, ketamine and temazepam (all on an IV drip mind you) plus my daily methadone should kick in right around the same time the procedure starts lol..should make for an interesting quasi-consciousness out of body experience...

Ive not done any of the strong opioids including the beloved "morphones" since starting on methadone maintenance, so I'm hoping that these prescribed PKs can cut through my normal methadone daily dose tolerance, my gut feeling says it shouldn't be a problem but if anyone reading this thinks those particular drugs won't cut through please do lemme know and i'll have up the ante with the oral surgeon for whatever else may be stronger. considering he seems inclined to write what I ask him to write, he'll oblige.

Really though regardless of what he gives me I really would prefer the instant release version of it and my impression is that when docs hear that they tend to think its 'drug seeking behavior'...guess I just gotta be smooth. Does anyone know the best way to explain to a doctor that you would prefer an IR over and XR without having an ulterior motive??

That would be fucked if methadone blocked your other opiates.

 

[mike.vick]

In b4 close, BTW I had a super cool family-dentist in South Carolina who was way into conspiracy theories and smoking weed.

 

[Speed King]

It's too bad the past is gone, but I had to have 4 wisdom teeth out. Early 90's, but whatever they were iv'ing you and saying"count backward from 10". By the time you hit 7, everything goes stain glass then black. What feels like a second later, the doctors and nurses are grinning from ear to ear, while you ask if they started yet. You can't feel shit and he says" take two of these now.

They were fuckin' t3's.

To this day, that was the least pain I ever felt.
Would you guess that the iv may have been a barb?

 

[mike.vick]

^^^ Probably propafol. There are plenty of anesthetics that are not able to accessed by the people on the streets.
I have had a few surgeriers requiring general anesthetics where I didn't remember shit - the first was terrible, the other two were great.
Aren't T3s just 30mg codeine and tylenol?

 

[Speed King]

Yep. There was no hangover and it came on too quick in a trippy sort of way for it to be propafol. I'll have to look it up. But yes t3's.
They were just great. I'll have to do some research. The last time I had propafol, I had to get rid of a hangover.

 

[gmlifer]

Nice to see this dentist still gives you faith in the medical world. YOU however are proving why other docs are correct in their assumptions. Good luck, hope he gets you the high you're looking for.

 

[OntarioGuy]

I dunno man, I'm on 110 mgs of methadone once daily right now, and was on it a year ago when I had kidney stones and bladder stones...I was in so much pain and IV fentanyl and IV morphine weren't working at all (mind u the doses were pretty low, like 200-300 mcgs and 20-30 mgs respectively but I had multiple shots of both) but they did nothing for the pain, no euphoria, and I had missed my methadone dose that day too.
They ended up giving me 30 mgs of IV ketamine. Followed by 20 mgs every 10-15 minutes which worked excellent for the pain....so my methadone had raised my tolerance so much I couldn't get pain relief from conventional opioids....

Also about 2 years ago my dad was getting HydromorphContin so I saved up 4 of the 30 mg capsules. I skipped my 120 mg (at the time) methadone dose for 2 days, on the third day I mixed up all 4 capsules and IV'd all 120 mgs of hydromorphone.....the rush was sub par, I used to get a better rush from 12-16 mgs before I started methadone....so little rush, virtually no high, and I still craved my methadone! I still felt shitty not having taken it for 2 days or whatever...I ended up just drinking a bottle of methadone an hour or 2 later.(this gave me a better buzz then the Hydromorph!)

So to me, opioids on methadone is pointless, maybe u will be different I don't know, but I personally would just take meds properly for pain and not waste my time trying to get high

 

[svacheme3]

Ah yes as I learned last year kidney stones are the type of pain the opiates are absolutely useless for at any dose. Did loads and loads of h trying to help the pain but was still screaming in agony, and I wasn't on methadone or subs either so there were no blocking issues. Having never experienced pain like that before I went to the ER. Yelling and moaning in agony the nurse saw my track marks and was all "what's wrong, you in withdrawal? want painkillers? huh?". So I came back with "damnit I don't want any painkillers at all I just did a whole bunch of h". She then immediately realized it was serious and I got sent for imaging, ultrasound, and a couple other things within 10 minutes.

 

[josedequeso]

Well as others have mentioned this guy is a hero. My last dentist I told him the tylenol with codeine wasn't cutting it and i was in severe pain last time, so he wrote me a script for just plain tylenol. So return the respect he's giving you and don't try to get a protocol that's going to get him flagged even if he will actually write it. Go for more days over more per day, because an extremely high daily dose out of the blue isn't just a problem for his paperwork, it will raise the pharmacists eyebrows too since I don't think you're going to one of the ones that cater to pain management people. One time a friend tried to fill 150 80s at CVS at night because he just got the money and the "special" pharmacy was closed. CVS called the police because of the amount and because he paid in cash.
I wouldn't go past 5 a day on the 10mg oxymorphone IRs for a couple weeks. Given how he's already treating you getting IRs shouldn't be an issue, just explain you want better responsiveness for your pain and don't want to be medicated around the clock if not needed; it's also a good indicator he'd be receptive to you explaining that you started low but it not's working a few days later to get more, also a better strategy than asking for huge amounts at once. Just be warned though, even doctors who don't balk when their patient knows a few things about abusable prescriptions, they do tend to just substitute the particular drug you ask for just to not give you what you want.. that's what always happens to me, even after doctors ask and I reply with MD-level knowledge and language about the recommended protocols.


Edit: Also, have you used oxymorphone while on large methadone doses before? I don't know about methadone, but oxymorphone has some weird cross-tolerance issues with people on massive doses of other opiates. 70-80mg at once of IV oxymorphone, for example, gave me a fantastic rush, but I was straight back to dopesick in 5-10 minutes when I was trying to substitute it for a 800-1600mg a day oxy habit, but back when I had a 150-300mg a day habit and synth'd some in the years before opana, 10mg was amazing and lasted hours.

Good call. I'm thinkin that a script of 5 or 6 of the ten mg IR oxymorphone a day would be fine and Id be happy with that. And thats actually a real good reason I could use to tell him for my preference for IR. After all my years of abuse of opiates I never did deal with medical professionals. I always just had different guys around town who had diverted pks or just h and of course I never had to convince them of anything to get a certain rx or higher milligram lol. So this is my first go around with docs and I am actually surprised I got one who is so trusting of me and I def don't want it to seem like I'm abusing his trust and have him reneg on this post op plan. So sticking with that plan sounds like the thing to do. Come early January after the operation I'll know exactly how much I'll be sent home with. And as you brought up I'll have to be careful and see where the best pharmacy around here would be to get it filled.

And no Ive never taken oxymorphone while on methadone. Ive taken oxymorphone before while having a pretty high h habit and it did feel like i was right back to being sick like no more than 45 minutes later...but who knows it might be different this time around since Ill be on a 'steady' methadone dose even though it is worse for raising tolerance. As far as using this opportunity for pleasure rather than pain killing, If all i get is a killer rush from iv'ing the IR tens and then fade back to the way I normally feel from methadone maintenance then Ill be plenty happy. My main goal from all this is just to have a reminder of the 'good ol days,' and to do it through legitimate legal means.

Nice to see this dentist still gives you faith in the medical world. YOU however are proving why other docs are correct in their assumptions. Good luck, hope he gets you the high you're looking for.

I started this original post being in a jovial mood mainly because, like others have experienced, I found a doc who is compassionate of my situation and did not immediately just throw me in a lot with some who might actually just be drug seeking for recreation use, not medical use. Its exhilarating to know that after this painful operation the dental surgeon isn't gonna just say to take some midol and put an ice pack on it. This guy is a great dude and realized that typical protocol wasn't gonna cut it for my post op pain. It was entirely his own idea as he asked me what i thought would work best for me considering my opiate tolerance. He even joked saying 'vicoden wasnt gonna cut it' followed by a deep laugh when discussing my options. So off the cuff I said I thought oxymorphone would work best for breakthrough pain and breaking through the wall of tolerance my methadone has created. And after reading some other peoples' opinion that luckily seemed to be the right opiate to answer with.

Also I must add about this situation is that I was entirely forthright with my med history and any other question he asked and he absolutely respected me for doing so. I even went so far as to explain my experience with past addictions and that I'm currently on a methadone program for over a year now. That being said, I want something to manage the pain which my baseline daily methadone dose wouldn't do on its own, but also the oxymorphone hopefully I can catch a nice rush I haven't felt in quite some time. If after this op I feel no pain and I got a nice high goin, well, then I'll be a happy camper.

And like what someone else wrote, I am definitely going to thank the doctor for the respect and courtesy he has afforded me this entire process.

 

[Shaleh]

I'm from the same state and also worked in this field prior and it will be an xmas miracle if you walk out the door with oxymorphone (10mg or higher).

I'm also very weary of a dentist wanted to do conscious sedation with fent/keta in a non medical setting. Most dentist do CS with diazapam or other benzo related drug. Most dentist in this state only write 5-10mg of oxycodone/hydro or tylenol 3.

Good luck with all this.

 

[LucidSDreamr]

why would a any doctor risk going to jail and getting sued by giving excess pills to a known abuser when there is even a small chance they could OD and kill themselves or a friend....something about this thread makes no sense.

I've had docs let me pick my dosage of fentanyl...but they were under the impression that i wasn't an abuser

 

[tacodude]

Don't over explain the it thing. It's CDC guideline to prescribe ir for short term opiate use and only a week's worth at a time. If anything express you want it, but only when the pains unbearable and you can't handle it, which of course will be all day at least at first so using all your days doses for the first few days without going over the prescribed daily amount wouldn't be a surprise. Don't push hard and just know what to expect and what not to ask for.