dilaudid help!!

[Swimmingdancer]

^I totally disagree with most of that. It's possible that he could have been addicted before, or addicted to something else, but I have known tons of people who developed addictions from being precribed pain meds. Being in pain certainly does not prevent you from misusing or injecting or make you immune to addiction. His doses are not at all "low", and even if they were, how would having a low dose prevent somone from wanting to inject?? Are you just trying to say he isn't injecting because of the pain but because of his addiction? Well of course. I highly doubt he is faking the pain, as no normal doctor is going to prescribe those kind of drugs to someone who can't prove their condition. But of course he could exaggerate the pain level to try to get more drugs. None of this speculation is helpful with the issues at hand though. People become addicted to drugs because their brain is predisposed to addiction, it matters not whether someone is a chronic pain patient or not. CPPs just tend to have access to stronger dependence-causing drugs which they have a reason to take, so may not realize their potential for addiction or can easily not realize that they are addicted. The OP's boyfriend clearly is misusing his meds and it's having an adverse impact on his life.

 

[potatohead]

yes. it is having an adverse impact on his life. and mine, for sure. and although i know that expressing anger and disappointment and all that is counterproductive, i feel resentful about all he has done that has negatively affected our relationship and our lives, separate and together. i feel sometimes like, why shouldn't he have to accept consequences for the things he has done? why do i have to tiptoe around issues because the way i choose to express myself is emotionally? i know the answers to those questions. i understand why it's important that i try to not be angry, criticize, express my disappointment, etc.

he also was a former heroin addict, so yes, he had past issues. in that past, which now is about three years ago, he has told me that he did develop a huge tolerance. he has been to rehab a few times and also spent time in jail for crimes committed related to his addiction. however, in the past year, he has had the dilaudid prescribed and that is the only thing he's been abusing/using. that i do believe. he has pretty much stopped trying to make me feel bad about not believing his suicide story...as much as he abused heroin in the past, that is certainly not where his tolerance is currently and i think he knows that it's not a believable thing to keep on with. as for him continuing to inject...i'm not sure about this. like i said, i doubt very much that the two needles i found (six months apart) are the only two he used. he will not admit to anything beyond what can be proven.

when this whole thing first started and i began to pick up on things, he would cry and he would talk to me about it and he would seem to really want to try. i really was understanding and supportive. i really did try to help him in a more productive way. but the things just kept happening. and the more things that happen, the less he talks to me or even acts like i factor in to anything. and the less i can trust him. and the less chance he or i or we have of getting any better. he has been on the couch for about a week and a half...the first week of which was due to his vomiting from the medication. i know no one can fix my relationship. and i know i can't fix him. i have decisions to make, i guess. he said he is going to fix it, but i don't know what that even means anymore. i told him if he is ready to do something about it and be real with me and take care of himself, i will be there for him 100%. i just can't deal with what is right now. and i can't tell you guys how much i appreciate you being so unbelievably thoughtful and helpful to me, a total stranger who just busts into a forum and screams for help. really...thank you.

 

[Swimmingdancer]

i feel sometimes like, why shouldn't he have to accept consequences for the things he has done? why do i have to tiptoe around issues because the way i choose to express myself is emotionally?

What do you mean by accepting the consequences? He is living with the consequences of his actions. If you mean the blame, blame is a really un-useful and damaging concept. And "shoulds" don't get you anywhere either. Of course it would be ideal if things were different, if you didn't have to worry about the effect your behaviour has on him, if he wasn't in this situation at all, if it seemed he was putting in more effort - but you have to deal with reality, not what "should" be. If you want to be with someone you have to accept them the way they are and realize that you can't change them, you can only change your own behaviour and how you allow yourself to react or be affected by them. It actually gives away your personal power to feel like someone else is making you feel these emotions. Now you can choose not to be with him, if it's just too hard for you, but if you're serious about sticking with him then all you can do is change your own thinking, the way that you treat him, and your expectations. You may be pleasantly surprised that that ends up changing the way he communicates with you. People who feel loved unconditionally are much more likely to be able to work on their addiction. That's what opioid addiction is really about, it makes us feel loved, probably a feeling we never got as a child, like the drug is just giving us a hug and making us feel secure, comforted, safe and happy. For many people when they try heroin etc, that's the first time they have ever felt that way in their life. Like that depression and fear and shame we've been carrying around has finally lifted. Who wouldn't want to feel that way if they had never felt that way naturally?

Did you read my post above? What do you think about therapy etc? You need some help and support in this too It's not easy to be in your situation.

 

[potatohead]

we discussed therapy together at one point, but it never happened and all this stuff kept on instead. i have my own therapist but haven't had an appt. for awhile and need to schedule one. rationally, i really do understand the idea that the only things we can change are things within ourselves...and that no one can change FOR me or because i want it. i also get that he is suffering consequences and that my own suffering, when it all boils down, is my choice. i guess i was just whining about the fact that, you're right, he doesn't seem to care at all about what it's doing to me and us. or him, really, right now. and i was also whining because it really feels sometimes like he did all this stuff but i am the one who has to change and adjust. it's a spoiled brat attitude, but also natural, i think, under the circumstances. i want so badly for there to just be something i can say that's going to turn it around. something i can do that would shine some light. i know there's nothing i can say or do because it's up to him. right now, i am sticking this out and hoping he actually does do something to fix it. i don't know how much i have in me. i am also in possession of an al-anon schedule...nar-anon meetings here are scarce...so i hope to get to one of those meetings soon enough.

 

[JamesBond007]

DUDE YOUR BF IS GOING TO DIE IF HE KEEPS EATING 80 dilaudids! thats insane! the most id eat at once if 6 or 8 at once thats if i really wanted to get messed up... holly shit thats CRAZY i hope hes ok and doesnt do that for real

 

[xxsicknessxx]

I think the answer simple he lied, try to get him on suboxone to get clean... or leave him

 

[lady_stardust]

I'm guessing he was a drug addict before. Chronic pain pt's do sometimes develop addictions, but as a CPP that's a relatively low dose IMO. CPP's also don't shoot drugs, especially when their prescribed doses are low enough that the temptation of the needle just isn't there. Infact the tempation of the needle comes when you're trying to get high and higher and higher and can't anymore, so you start shooting. I would bet a lot that he shot drugs before he was prescribed these meds and if he wasa drug addict who "developed pain" or has always had pain but "suddenly it got worse", then I'm sorry he's not really in pain, he's just making it up to get pills. Someone with his prescription and painlevel as a CPP would simply not shoot.

this post makes very little sense, if any. and it doesn't offer the OP much help either.

i'm a CPP, i've also been an addict - it is absolutly possible for a legit. CPP to also be addict, and visa versa, and it makes treating their pain more difficult.

have u ever used needles? if not, then what r basing your information on? u speak w/such authority, and i don't know what u r basing it on.

 

[puffj]

Sorry for bumping an older thread but I had to address a point. Yes CPP'r's can become physiologically dependent on their drugs just like they become dependent on them physically no matter what. The difference is the analgesic effects of opioids are not something that are built tolerance to very very fast. In other words he could have no problem staying on the same dose for years. The side effects that are the "high and euphoria" of the drug wear off as tolerance builds... so the real trick in identifying abusers is to see if they have every said their pain is at a comfortable level and than asked for a dosage increase the next time because of x y or z. And there is a lot of literature out there showing, nay, proving (peer reviewed passed) that cpp'r's don't become dependent on their drugs psychologically because they aren't chasing a high they're chasing pain relief and once they get to that dosage which affords them pain relief they rarely go up in dosage more than once every few years or so. Not to mention his doctor should be giving him UA's sending them off for GCMS's. Checking for sedation/track marks/low bp/ low heart rate etc etc. 300+ mg hydromorphone IV is outrageous. I can't even imagine how he preps that much since these drugs are CII's and can only be written 30 days at a time which means 2 8mg exalgo's and 6 4mg IR dilaudid's = 40mg of hydromorphone a day. 40mg x 30 days = 1200mg or roughly the equivalent of 5 8mg's a day to play around with. Now he could very well get together 300mg's but that would take soooooo much work to prep 300mg's from 8mg pills and he would absolutely have to be using multiple shots to get the job done.

Sounds like he really needs help. I have seen very very *very* few people beat hydromorphone (Dilaudid) or diamorphine (Heroin) once they start shooting it. And the ones that do beat it... they have relapses a lot. Our brains are not wired to get an insanely enormous opioid rush all at once within the period of 2 seconds. Doing so allows your brain (specifically the NAc) to be exposed to more pleasure than should be humanely possible which than obviously makes your brain believe that shooting drugs is the single most important thing in your life because shooting drugs gave you the best feeling in your life... feelings that are so much stronger than what any other normal sober human could even begin to wrap their heads around that it's almost always a lost cause. The best thing for him is to try to get off the needle. It's going to be really hard and it's going to be something he won't want to do but if you can make him want to do it for himself that's when your chances are higher. Shit I hate to advocate this but between the transition from the needle maybe have him dissolve his usual dosage in bacteriostatic water and than make a nasal spray out of it. He'll get the most BA from that route and while the rush won't be nearly anywhere near what he is used to it will be a nice step down. He'll still get some form of a rush via the nasal spray just not what he's used to from IV but it might just be enough to get him to stop the IVing. Once he's done the nasal spray a while have him gradually reduce his dosage and instead of dropping 300mg in the nasal spray have him drop 200mg in it. I've noticed on massive doses of opiates you can cut your dosage a lot more without any withdrawal than you can when you're on much lower doses. Also if he has gabapentin or lyrica at all, make sure he takes 300-900mg three times a day depending on how much he can tolerate the side effects. Gabapentin blocks opioid mediated release of dopamine making them feel not as euphoric and therefore less reinforcing. Gabapentin or Pregabalin (trade names are Neurontin and Lyrica respectively but Neurontin has a generic out so go for that) also appear to help down regulate and recouple your endorphin's with their respective g-protein receptors which is a fancy way of saying the brain gets back to homeostatis much faster and the likelihood of PAWS of any form drops significantly once he's made it through the physical part. that means he's not as likely to have cravings set off by depression and boredom that usually follow opiate detox. But the bottom line is he needs to get off the needle now. Have his doctor switch him to oxycontin so he can't shoot it or snort it (yes people here think they know how to defeat the new oxycontin heavy mole PEO matrix but they don't and they're just giving themselves cancer by smoking/shooting/snorting the butylated-hydroxytoulene (a carcinogen in Canada and the reason purdue had to release OxyNeo in Canada instead of what they released in the states.

Here's a list of drugs he SHOULD NOT HAVE ACCESS TOO AND TELL THE DOCTOR WHEN HE VISITS NEXT
Fentanyl in any form
Hydromorphone ER or IR
Oxycodone IR's
Oxymorphone ER (especially the generics) or IR
Zohydro ER (pure hydrocodone product but only available in doses up to 50mg which is not going to help anyone who takes more than 100mg morphine day)

There are always alternatives to opiates. The bottom line with opiate treatment is when you look at the patient in the future, has their quality of life increased or gone down since initiation of therapy. If it's the latter, the drugs aren't helping they're hurting. I would personally recommend that his doctor switch him to oxycontin since it's seemed to prove the hardest to abuse and he certainly can't IV them because the turn into a grits consistency the second they touch water. One thing you need to remember (because I know the doctor won't remember to tell him this) is that unlike the old abusable Oxycontin, the new one takes about 1.5 - 3 hours before it reaches maximum blood concentration so he should take it no more than an hour before he's supposed to take it (usually every 12hours but 8hrs isn't uncommon). The old Oxycontin's which used a biphasic release system called the AcroContin system (an initial immediate release bolus of medication and then a slowly dissolving polymethyl methacrylate co-polymer b which (in laymans terms) literally worked like a tootsie pop. You could just pop the pill in your mouth and it didn't gel it just dissolved slowly in PH independent environments until it was much smaller (like a tootsie pop which takes a while to disappear if you're sucking on it). That is the downside with the new formula... it takes anywhere from 1.5 to 3 hours to even start releasing medication so patients who depend on it to function and take their oxycontin every 12 hours on the dot are sitting there for about 1.5 to 3 hours in pain waiting for the med to kick in. Mention this to the doctor and when he disagree's because the reps told him otherwise ask him to tell you what the cMax tMax and AUC are for the reformulation. He won't be able to and if he says "same as the old version" he's lying or just isn't informed. Oxycontin was originally called Oxycontin because it was an oxycodone based controlled release tablet that used the release system purdue used on their original MS Contins except modified to bolus an immediate dose so patients got maximum relief within 30 minutes or so. Contin stands for continual release. Oxycontin obviously stands for oxycodone continuous release, and just incase you're curious the Contin system was what purdue used when marketing MS Contin and the AcroContin system was used in the original Oxycontin's. Anyways the new Oxycontins are literally impossible to abuse unless you just swallowed as many as you could since you just can't break the time release and if your friend has a 300+mg IV Dilaudid tolerance than no amount of Oxycontin (so long as he's prescribed an equipotent dosage) will allow him to overdose since unlike the dilaudid he can't break the time release and unlike the dilaudid he can't shoot it. That means even if he swallowed his whole bottle he wouldn't exactly get the entire bottle worth of medication all at once. He would get however many pills he swallowed to release over the period of 12 hours which means far less would be in his system since he can't break the pills and get all the oxycodone out at once. If he really has pain he should be fine with this option. If he's trying to abuse his meds you can bet he'll put up an argument about why he can't get Oxycontin (even though it's cheaper than exalgo). I mean your buddy's on the equivalent of 40mg Dilaudid per day right (which he is supposed to swallow not shoot)... which means his doc should switch him to an equipotent dosage of Oxycontin that I imagine will be around 80mg a day (so 1 40mg every 12 hours) if the doctor accounts for slight reduction in tolerance because he's rotating opiates... If not the equipotent dosage of Oxycontin PO (swallowed) to his 40mg of Dilaudid swallowed comes out to about 120mg... or one 60mg tablet every 12 hours. His doctor should not and will not be giving him the equivalent of any other drug to match the equipotency of the outrageous dilaudid abuse. just to put that into prespective... shooting 350mg of Dilaudid is equal to taking over 4,666mg of oxycodone... or 4.6 grams. That is insane. his doctor won't write it. His doctor will switch him (at your recommendation to a 'long acting medication that is less addictive because it is harder to abuse. Right now Oxycontin is the cheapest and the only extended release med that is very very hard to abuse and impossible to shoot (unless you want to get sepsis god forbid).

Anyways go to his appointment with him say you've heard wonders of a drug that works great and is safe and not as addictive because (and this is important) IT ISN'T AS REINFORCING AS THE OTHER DRUGS SINCE IT RELEASES SO SLOWELY AND CANNOT BE CRUSHED/BROKEN/SHOT.

Best of luck with you.

Keep him away from those drugs as they are abusable and while he's going down a bad road you sound like a really sweet person who just wants to help him. P

 

[notsureanymore]

It is definatley a cover story, ive told many of them! i have done dilaudid intraveinously for 8-10 years now and most of the time was doing 4-6 pills a shot 3-4 times a day. when i run out early which i try to avoid, i get tremendously sick.....diareah, vomiting, and that all around flu type symtoms. it gets all better when you get your new script. i am prescribed 180 8mg dilaudid and 60 60mg kadian(morphine) per month and i have to really be careful to not rut out! I take them for pain not for the high so its like being stuck between a rock and a hard place. by the way 80 dillys at one time will kill a human, im sure you would lose all your lung function and not be able to breath. i wish i had his supply though. hope it works out for him...............and you.

 

[puffj]

this post makes very little sense, if any. and it doesn't offer the OP much help either.

i'm a CPP, i've also been an addict - it is absolutly possible for a legit. CPP to also be addict, and visa versa, and it makes treating their pain more difficult.

have u ever used needles? if not, then what r basing your information on? u speak w/such authority, and i don't know what u r basing it on.

Go do some research and look at the rates that true CPP'ers abuse their meds versus those who take meds to get high and not pain relief. does it occasionally happen that CPP'ers become addicts... yes, but NO WHERE NEAR ANY OTHER RATE OF OPIOID USERS. I'm basing my information on research. PubMed Ebsco host, the new England journal of neurology. The journal of Palliative Medicine. The journal of psychologies of addiction and why there are far lower prevalence's of people who truly need pain meds for pain abusing their drugs, the journal of neuroscience and addiction etc etc. Stuff which is all published and has passed peer review because it is repeatable and observable every single time with the outcomes remaining very similar +- a few points. Stuff that you may or may not have access to unless you're in a med school... or you pay the $100 per article which I doubt. Idiot.

 

[puffj]

this post makes very little sense, if any. and it doesn't offer the OP much help either.

i'm a CPP, i've also been an addict - it is absolutly possible for a legit. CPP to also be addict, and visa versa, and it makes treating their pain more difficult.

have u ever used needles? if not, then what r basing your information on? u speak w/such authority, and i don't know what u r basing it on.

Jesus Christ lol. Does a doctor need to have a heart attack before he know how to perform open heart surgery? lol. Just because I've never used needles doesn't mean I don't have a far far far (let me emphasize that for you) A FAR FAR FAR greater understanding than you do of how this stuff works. Also are you kidding... did you even read the post I wrote or just not? The post you quoted from me even said in it that yes CPP'r's do become addicts occasionally... something you seemed to think I said never happened.

The internet was so much better in 95 when you had to be intelligent to understand how to use it. Good god.

 

[rld73]

Go do some research and look at the rates that true CPP'ers abuse their meds versus those who take meds to get high and not pain relief. does it occasionally happen that CPP'ers become addicts... yes, but NO WHERE NEAR ANY OTHER RATE OF OPIOID USERS. I'm basing my information on research. PubMed Ebsco host, the new England journal of neurology. The journal of Palliative Medicine. The journal of psychologies of addiction and why there are far lower prevalence's of people who truly need pain meds for pain abusing their drugs, the journal of neuroscience and addiction etc etc. Stuff which is all published and has passed peer review because it is repeatable and observable every single time with the outcomes remaining very similar +- a few points. Stuff that you may or may not have access to unless you're in a med school... or you pay the $100 per article which I doubt. Idiot.

Just speaking from personal experience here.. I never touched a needle until my doctor switched me from Oxycodone to Dilaudid.. I was literally taking the Dilaudid and still sick from withdrawals.. I did some searching on the internet and found out that the Bio-availability of Hydromorphone was garbage orally compared to Oxycodone.

Since then we have switched to Methadone for around the clock pain relief and Oxymorphone for breakthrough pain.. no more need for needles.. Do I think I was an "addict" when I was using the needle with my prescriptions.. for sure.. Do I think I am still an "addict" now that I take them as prescribed.. no.. I know I have a physical dependence on them.. but I no longer display "addict" behavior as I had to when Hydromorphone was my only form of pain control.

Just straight up saying that CPP'ers don't become addicts unless they were addicts beforehand is not right.. I think when someone is sick physically from not having enough medicine in them they will do things that they wouldn't normally do. I honestly don't even know why doctors prescribe Hydromorphone orally.. no one is taking it that way.. they have to know that.