Questions about long term opiate use

[aaronpgh]

Greetings! I am new to the forum but have been reading various posts about opiates for a while and, with the recent media furor about them, have a few questions about my own situation. I have done as much of my own research as I can but it is difficult to know what is real medical data and what is drug manufacturer marketing. It appears that bluelighters have an extensive knowledge base and thus I thought this might be the best place to pose my questions. Please forgive me if this is long and rambling but I just want to give you as complete a picture as possible so you can hopefully help me understand what I do (and do not) have to fear from prescription opiates. I apologize in advance if any of these questions seem silly or have already been answered elsewhere. I am genuinely trying to find answers to them or I would not take up your time here.

I am 35, 5'6" tall, weigh about 140 lbs and have an autoinflammatory disease that causes joint pain, myalgia, fevers and just general misery. I won't bore you with the details because I know this is not a medical forum but the quick summary is that it is the result of a genetic mutation and I will live with this for the rest of my life. The default treatment for this is sulfasalazine but, me being allergic to sulfa drugs, the only treatment available to me presently are steroids, NSAIDs and opiates. I do not have an addictive personality and never have. I am the type of person that can drink every night (in moderation; if I have more than 2 drinks I'll vomit and thus have never been the type of person to overdo it on anything except on very rare occasion) for a month and then decide I've had enough and it no longer appeals to me. I have never worried or been concerned about addiction to anything in the past because thee was never anything I enjoyed so much that I couldn't give it up but all of this talk about how addictive opiates are has me second guessing myself.

First of all let me state that I am not in horrible pain and the pain I have is nothing I cannot live with most of the time. In fact, I probably really do not need opiates like someone with truly terrible chronic pain does but where they have great value for me is in sleeping at night; it is very difficult for me to sleep most nights because it's a dull, constant, aching type of pain in the joints. I roll around a lot in search of a position that does not hurt. As a result, NSAIDs are fine during the day but if I take them at night I usually get woken up by horrible heartburn or acid reflux because they don't sit well on the stomach if you're lying down and thus defeats the purpose. I typically take an opiate at bedtime because in addition to numbing the pain it puts me right to sleep. What I take is either a single 10mg Percocet or a single 7.5mg Norco (I alternate because I do not want to get too used to one or the other and risk dependency) and have done so for about 3 years now. I have never felt the need or desire to take more nor have I ever taken more than 1 of either of these in a 24 hour period. In fact I am so paranoid at this point about dependency and addiction after hearing about it over and over again with the recent media coverage about the "opioid epidemic" that I will only take them each night for 1 week and then switch to steroids for 1 week and keep alternating. My doc gives me 45 of either of these for a 90 day period (it's not that she would not give me more, it's that I only ask for this amount in order to force myself to stick to alternating each week). I would just stick with steroids (honestly if there was a drug that made me feel good all the time, it's steroids, mainly Prednisone and Dexamethasone - I feel like a million bucks with either of these) but taking steroids all the time causes worse problems in that they can shut off your body's ability to make its own cortisone, make infections worse and more prevalent, moon face, etc so I just alternate. Opiates do not make me euphoric if we are going by a textbook definition of "a sense of intense excitement or happiness." What they do make me feel is numb, calm and sleepy. From that perspective they appeal to me in that I am a fairly nervous/anxious person (I fidget a lot, pick at my cuticles, bite my lip etc) and they do calm me down which is a nice feeling since I rarely get it. I have no problem giving them up for the 1-2 week periods where I travel and just take steroids but I do look forward to going back to them, mainly because I sleep very, very hard with them and calm down which I do enjoy. My only other experience with opiates was when I was in the hospital a few years ago with an obstructed kidney stone and they were giving me 1mg IV Dilaudid every 4 hours for 3 days and even then I was mostly throwing up after each injection. To make things more complicated, my last liver panel showed that my AST levels are about triple what they should be which is consistent with too much NSAID use and my physician has recommended pure Oxycodone 10mg IR instead of Percocet in order to eliminate the NSAID in the mixture.

So I guess my questions are as follows:

1) Am I in danger of becoming dependent or addicted to opiates based on the dosage, frequencies and sensations described above or am I just paranoid?
2) Would switching from 10mg Percocet to 10mg Oxycodone IR (again, 1 per 24 hour period for 1 week on/1 week off) be any more or less likely to cause dependency?
3) I have read in this forum and others that once your brain is introduced to opiates that it is forever changed and you will never be the same. Is this just for opiate receptors? Is it only at high dosages? Is it killing off cells and/or affecting IQ? i.e. Are opiates in the dosages I am taking making me dumber or otherwise doing permanent damage?
4) Does having a drink before bed and taking one of these opiates (just one or two drinks, not getting inebriated) increase the likelihood of doing some kind of permanent damage or increasing dependence? I want to understand what this mixture is doing to my brain and body.
5) My physician has assured me that if I was going to have a problem with pills, I would have by now and that I need to not worry so much about it and just take it when I need it. The media, however, is indicating that it could sneak up on me at any time and before you know it I'll be under an overpass with a sign begging for money for heroin and you need to abandon all opiate use immediately. Which is right? Is it, as I suspect, somewhere in the middle?
6) Does anyone know of a non-narcotic, non-barbiturate anti-anxiety medication that can take the edge off without making you groggy or altering your brain chemistry to make you dependent?

Thanks and sorry again for the long post. Feel free to point me other thread(s) if this has already been covered.

 

[Alex000]

It seems as if you are worrying too much, on the whole. I can't imagine your pattern of opiate use or your relationship with opiates changing so suddenly as you seem to think is a possibility. Now, let me make it clear that opiates are quite often insidiously addictive and habits can mature into very large things, but I would doubt someone like you will find yourself under a bridge, broken and dysfunctional by some huge and unforeseen addiction issues. If you don't have an addictive personality by nature, that is a part of the battle, but anyone theoretically can become addicted, which is obviously different than dependent. Physical dependence will result with chronic and everyday opiate use, yes, and even coming off of them after having been used for actual pain for a given period of time can be psychologically challenging because opiates are psychoactive, they do produce an intense sense of numb comfort, they do relieve of stress of body and mind. Just know them for what they are and employ practices of responsible use.

To answer your questions, now;

1) Am I in danger of becoming dependent or addicted to opiates based on the dosage, frequencies and sensations described above or am I just paranoid?

- In short, anyone is potentially at risk, but based on how you, particularly, explain your use of them, I would not consider you naturally drawn toward opiates, as I am, for example, and as are many others. But, know what you are using them for. You indicate that they help a good night's sleep because they help with pain, and you recognize they put you in a state of rest and comfort and ease. That is what opiates do, obviously, but if you want to be quite cautious, only use as much as you need to ease the actual physical pain so that the edge is taken off.

2) Would switching from 10mg Percocet to 10mg Oxycodone IR (again, 1 per 24 hour period for 1 week on/1 week off) be any more or less likely to cause dependency?

- In either form, you receive the same amount of the opiate, oxycodone, which is the only agent of possible dependence. With Percocet you are taking both acetaminophen (APAP) and oxycodone whereas with the oxycodone IR formulation you are just saving yourself from the APAP which does take a toll on the liver. Therefore, it would be preferable in that case, and there would be no actually higher risk of dependence, but the oxycodone IR formula is easier to 'abuse' because of this; if you take it as you take the Percocet, though, it is the same but healthier for your body if you want to stick with oxycodone, that is. You might find straight codeine (without APAP or an NSAID) to be potentially a bit less euphoric in nature than oxycodone, at the same time being able to provide you with likely enough pain relief to help you sleep some, and also less likely to cause sleep interruption than oxycodone. You see, opiates can and do keep some people up, with oxycodone being particularly stimulating for some; some say hydrocodone does the same to them, but usually it is agreed that codeine and morphine, for that matter, are more naturally sedating and less stimulating.

3) I have read in this forum and others that once your brain is introduced to opiates that it is forever changed and you will never be the same. Is this just for opiate receptors? Is it only at high dosages? Is it killing off cells and/or affecting IQ? i.e. Are opiates in the dosages I am taking making me dumber or otherwise doing permanent damage?

- I know that in dealing with longer term and larger opiate dependence, it is not uncommon to experience symptoms of post acute withdrawal syndrome (PAWS), which can last for several months to perhaps even a year or two, potentially. When I refer to longer term and larger opiate dependence, I am talking about the likes of a few years of dealing with a fairly significant opiate habit. The symptoms of PAWS are both physical and psychological, potentially. Do not consider, however, that this is a chronic state of what the acute withdrawal period normally is, but rather more the process of getting use to life without opiates in a psychological sense as well as the process of the body and brain actually resetting its endogenous opioid system. Otherwise, I highly doubt the use you are talking about for yourself will be in any way truly damaging to your actual intelligence, nor do I suspect much neurotoxicity with most natural (morphine and codeine, notably) or semi-synthetic opiates (hydrocodone and oxycodone fall into this category) - that said, don't go crazy and I don't see an issue in the issue of killing actual brain cells. I am now curious as to what you've read on BL, before, however about potentially doing as much.

4) Does having a drink before bed and taking one of these opiates (just one or two drinks, not getting inebriated) increase the likelihood of doing some kind of permanent damage or increasing dependence? I want to understand what this mixture is doing to my brain and body.

- Actually, this is a mixture I wouldn't recommend, just because it is unnecessary and is not productive to the efficacy (or enjoyment, in my opinion) of the opiate. Consider that the alcohol will not at all help your nighttime gastrointestinal symptoms, but will make them worse. Also, consider that I believe opiates to be quite unhealthy to the GI tract, for MANY reasons. My mother, actually, was diagnosed with the very unusual esophageal cancer at the age of about 30 or 31 after having been an opiate addict for five or six years - I do believe it is possible for the opiates to have played some role in that because they do slow down the process of digestion and elimination, and they will do this even at lower doses. I am not suggesting it is an unacceptable risk, especially because you are not dosing high doses on a daily basis. The best you can do is eat healthfully, keep your body active and your gut running well. Certain stool softeners can be helpful, and even a natural laxative might be beneficial to keep you cleaned out, as with anyone taking opiates. But, back to alcohol and opiates - I just wouldn't, not for your stomach, the rest of your GI tract, your liver, and especially with your history of heavy NSAID use.

5) My physician has assured me that if I was going to have a problem with pills, I would have by now and that I need to not worry so much about it and just take it when I need it. The media, however, is indicating that it could sneak up on me at any time and before you know it I'll be under an overpass with a sign begging for money for heroin and you need to abandon all opiate use immediately. Which is right? Is it, as I suspect, somewhere in the middle?

Don't be cocksure that addiction can't touch you, because it can, but be sure enough in your abilities to control yourself with these types of drugs as you have been for three years, you said. I mean, yes, it is a valid thing to worry about, but your doctor is right in that you are a bit too hung up on the potential of sudden or spontaneous addiction issues. Here is what the media doesn't tell you - one habit is not the next, and it is true some people spiral into deeper addictions because of any number of variables in their particular cases.

6) Does anyone know of a non-narcotic, non-barbiturate anti-anxiety medication that can take the edge off without making you groggy or altering your brain chemistry to make you dependent?

I absolutely and 100 % recommend you look into treating the ails of your body and mind with cannabis, if you don't already. If you do already, consider improving your treatment to include particular cannabis products which work best for you and your conditions. Educate yourself on the matter and experiment with different cannabis products, smoked, vaped, eaten, etc. of various different strains, each with different profiles of cannabinoids and terpenes (the naturally active chemicals as well as aromatherapeutic compounds found in cannabis - and of them, there are hundreds of different types and sub-types adding to the nuances of therapeutic and medical effects each strain renders). I have, personally, found it to be a greatly relaxing medicine, myself, using it now more than ever after having detoxed off benzodiazepines a couple months back after having had a hefty benzodiazepine habit for about 5 years. I will say cannabis is healthier and easier on the mind and body, by far, than benzodiazepines are, especially when you need a medicine you can use all of the time without worrying about issues of dependence or the other issues that come along with many pharmaceutical sedatives and similar drugs which work on GABA.

I hope this helps some.