Opioids Opiate vs. Disease symptoms

[Foreigner]

I have a severe inflammatory disease that is extremely painful, that I am using morphine to ease. I take 5mg of morphine every 4-5 hours, and when there is severe breakthrough pain I take 1mg dilaudid. I know you're all going to laugh and say that's nothing, but I'm a sensitive person and trust me those amounts are more than enough.

I'm at a point in my recovery where I'm wondering if some of my symptoms are due to prolonged opiate use (been about a month now), or my condition itself.

I have inflammatory bowel which means I have frequent bowel movements of blood and pus. I find that the opiates reduce the frequency of diarrhea, but then in the middle of the night when I naturally skip a dose of morphine because I'm sleeping, I wake up with a lot of urgency and pain. My nights are usually difficult for this reason. I also have been having really crazy, disjointed dreams.

I'm at the point where it's hard to start my day unless I take 1 morphine + 1 dilaudid. Then I "feel good" and can eat breakfast, get a shower, and do what I need to do. Without the drugs, I feel a general sense of pain, not being able to move, and my mood is just very low.

My friend was driving me around to do errands yesterday since I can't drive (I'm in a wheelchair right now). I took my combo before leaving the house and we were having a grand time. Then it started to wear off before we got home and I suddenly became intolerant of everything: people, traffic, even my friend herself. And of course I started having bowel pain.

The bowel pain itself is so psychologically destructive that I must, must, must block it at all costs. In August I became suicidal from the pain.

So in a nutshell, when I take the opiates I feel like I can do anything and that life is going to be OK. When I miss doses, it feels like the opposite.

I have gone entire days without taking anything because the pain was manageable, so it's not like I get serious withdrawals. But I'm wondering if I'm looking at some addiction/dependence signs here? Is this is a legit pain situation or am I walking the fine line between pain treatment and taking opiates "just because"?

I'm asking all this because I know how insidious opiate addiction is. It can creep in. You can think you're in control and then one day you find yourself not being able to function without the drugs.

 

[tacodude]

You will probably have OIC that you are not feeling as much causing IBS type irritation. You also probably will have a slight dependency even at such a low dose as your usage is regular. I assume your use is orally as 5 mg oral isn't much, but 5 mg IV would actually be close to a 15 mg oral dose.

You probably have a light dependency. You won't have severe withdrawals, but probably discontinuation syndrome a bit when the pain returns as well as the apathy goes away and the irritability that was so easy to shut out is now over flooding. It is like you were filling a bottle of water with the irritability and now you are pouring it out, but it doesn't sound like you filled it up and it exploded leading to anger even through apathy.

I hope this makes sense let me know if anything doesn't. Also there is a difference between addiction and dependency... It doesn't sound like you are a "addict" and we all have addictive mindsets it is just the human experience. The dependency is the real bitch though as managing it is the main rationalization that causes the spiral downwards between addiction and dependency.

You can always plan a few days to take it easy, get a bunch of weed, maybe some ketamine, and just push yourself through a few days of not using. When I went in patient using a phenobarbital regimen I used 16 mg about 3-4x a day for 5 days with ropinirole 1 mg 3x a day and clonodine 0.5 mg at first for the 5 days and then I started going up to 1 mg after I left. I am sure you know well enough to figure out a good regimen for yourself to stop for a few days if you are really concerned about it being too much of a problem.

Edit/ opiates don't necessarily create IBS or trigger it, but when you go from having opiod induced constipation to not you definitely will notice the difference in movement and being more gassy as well as backed up of course. I could imagine one with IBS would have some discomfort stopping use of opiods after OIC develops a bit\/

I would recommend listening to toothpastedogs advice though about involving the medical professional.

 

[Jabberwocky]

Do you see a gastroenterologist Foreigner? What does your doctor think?

I haven't heard of opioid use exacerbating IBS, but this sounds like something to have medical professionals involved with for sure.

In terms of the medication, I have definitely heard longer acting opioids being more useful.

In terms of dependency and whatnot, it would help to know how long you've been taking the morphine like this, how long/often you have taken/take hydromorphone for it, and what your prior history of issues with drug use (if any) have been like.

 

[Foreigner]

I'm not asking if opioids are causing my IBD. (IBS and IBD are completely different diseases. IBD is life threatening. I have IBD.)

I'm saying that I can't tell if some of my symptoms are from opiate use waxing and waning, or my condition itself.

Let me boil it down to one question...

How do I tell if I am forming dependence to opiates at these doses? What are the signs?

I've been taking 5mg every 5 hours for 3 weeks, and I take 1mg dilaudid sporadically when the pain suddenly gets very intense. I don't have a history of opiate addiction, but every time my IBD flares I end up on opiates.

My doctors are OK with what's going on. They know nothing else stops the pain for me, and that I'm a responsible user. Besides that, my doctors are pretty useless and I have to figure out my health shit on my own.

 

[tacodude]

I only said IBS type irritation such as an overactive bowel. I never said you had it.

That said it seems you know the mental signs as you're worried, but physically try going 12 if not 24 hours without any. You will know then as you'll have at least minor withdrawal symptoms (prone to goosebumps, excess yawning, skin temperatures feel off, and if any worse sweating as well as joint pain that doesn't exists on or off it) if not severe. If you can't go more than 6 hours without I would say a dependency developed.

Whether it is severe or not is another story as well as if it's better on or off in your situation. Another issue is with it the dependency development is progressing or at a standstill. There are lots of factors in this that really needs to be discussed with someone in person.

I would suggest the break and using the COWS (clinical opioid withdrawal scale) to rate your symptoms and if you can have someone else do it. You should also try to schedule when you can take the dilaudid as it is the same dependency as you know. Taking it randomly is what creates a tolerance while taking it on schedule if done right creates a stable dependency.

 

[BeachBum4u]

I too take pain meds for chronic pain and I can tell you from first hand experience that when I'm needing my next dose, my bowels will definitely loosen up considerly. In fact it's the only time I, can usually go. So what I'm saying is don't be too alarmed this sort of thing is happening to you as well. Also, yes even pain patients who take their medication as prescribed do sometimes enjoy the "boost" they can provide. Don't feel guilty about it as long as you are playing by rules. Good luck!

 

[tacodude]

Beachbum I'll just point out it's not about feeling guilty it's about helping concerned about the fact it's becoming not just a dependency, but a possible problem for a serious health issue.

That being said you did describe what I'm talking about pretty much on point with the between doses.

 

[Båtmannen]

If you don't use more than 30 mg per day and you can go a day without getting WD ... it's safe to say that the dependence isn't severe.

And having a little addiction to opiates is way better than suffering from permanent pain. My ex doctor, a professor and expert on pain, once conducted a study/report and came to the conclusion that people with permanent pain has the worst level of quality of life of all patients - including those whose faces have burned up. I'm not sure I believe that but at least is provides clues about how devastating pain can be.


If I were you, I'd switch to buprenorphine, if possible. For two reasons mainly:
1) it's much, much cheaper (in most places);
2) you'll only need to take it once per day instead every 4-5 h.

And also:
3) it's easier to taper off.;
4) it will have less of an impact on your motor skills, when you're used to it.

And if you use it illegally
5) the punishment is usually less severe

And lastly ... if you or someone close to you would want to kill themselves (god forbid!), it's much, much harder with buprenorphine than with morphine.

 

[Foreigner]

I agree 100%... pain is brutal. You start to become deranged and reality begins to crumble. It doesn't matter how intelligent or rational you are, it turns you into little more than a reactionary animal. I had no idea pain could be this way until I started experiencing it, and I treated pain patients for years. I saw their anguish but nothing has taught me more than experiencing it myself.

Thanks for the buprenorphine suggestion, but I won't do that for a couple of reasons. One is that I'm at the point where I don't need 24/7 pain relief, but only as needed. I still need it often, but at least with morphine I have the choice. The second reason is that I've heard and read that buprenorphine is stronger than morphine. I don't think I can handle that.

So... an update... I am officially dependent. I stopped taking opiates for 48 hours and I suffered. Extreme fatigue and malaise, hot and cold sweats, nausea and abdominal cramping unrelated to my IBD, headache, insomnia, weird pains and aches in my body I haven't felt before, sleeping a lot more and having a harder time getting out of bed. It fucking sucked. I had to take morphine today for my pain, but I'm hoping that a reduced schedule will at least help a bit. I didn't know what to do for myself when I was experiencing withdrawals. I tried CBD oil but it didn't do much.

Getting really fed up with this shit.

 

[George27]

I find that the opiates reduce the frequency of diarrhea

Yes they do.
But if the goal is this, you can go as well with loperamide