Harm Reduction The Pain Management Mega Thread Version 4

[BigG]

Haha!! Mate if you can find any of Britain's spoils you can keep them!!....we dont have any left. Once ruled 1/3 or the globe with the biggest empire the world has ever seen........now flat broke!!!

Ive t tried literally everything too and it is a battle between side effects and effective analgesia as you say. Lyrica is terrible for giving u that drunk, dizzy feeling. Why people abuse it I dont know as it makes u feel like shit. A couple of weeks ago I ran out of methadone a day early and took a double dose of lyrica and got sent home from work as apparently I was sitting at me desk drooling at the mouth and incoherent!!!. Luckily one of the paramedics I work for had seen that before with lyrica and took me home.....fucking horrible drug.

 

[Whosajiggawaaa]

Haha!! Mate if you can find any of Britain's spoils you can keep them!!....we dont have any left. Once ruled 1/3 or the globe with the biggest empire the world has ever seen........now flat broke!!!

Ive t tried literally everything too and it is a battle between side effects and effective analgesia as you say. Lyrica is terrible for giving u that drunk, dizzy feeling. Why people abuse it I dont know as it makes u feel like shit. A couple of weeks ago I ran out of methadone a day early and took a double dose of lyrica and got sent home from work as apparently I was sitting at me desk drooling at the mouth and incoherent!!!. Luckily one of the paramedics I work for had seen that before with lyrica and took me home.....fucking horrible drug.

You seen the pack insert ? definitely the most side effect's I've ever seen.

 

[dopemaster]

^
I think Lyrica works ok in moderation. You should keep in mind that it is for nerve pain, so it might not help at all if you are not experiencing nerve pain.

With a lot of medication less is more, it just depends on the medicine. As far as oxycodone/oxycontin I know people do get that strong of a dose sometimes and it is necessary for some people. Even being at 60mgs of Oxycodone IR and 60 mgs of Opana/Oxymorphone often times doctors will tell me that's a large dose. Once I tell them about my injuries the doctor usually says something like "Oh wow with an injuries, like that I can understand why it takes so much medication, I am sorry you are in such a position."

But the initial reaction of just about everyone is that of surprise when they find out I am on the amount of pain medication I am on. It takes what it takes to ease the pain. I never get anywhere close to even half my pain stopped, but I find my life much easier being on the medications. Being on pain medication is most certainly a double-edged sword and can cause suffering to the person taking it. It is most certainly not a position to envy.

You should never feel ashamed or like a junkie being on pain medication if you are in pain. Also just because you need a large dose that shouldn't make you any different than someone who takes a small dose. Everyone experiences pain and relief differently and often times people who are not in pain just do not understand.

I avoid telling people I am on pain medication IRL. Often times people ask me if I would like to sell it or if they can borrow some or some bullshit like that. People have gotten angry when I refuse to sell my medication, but the thing is I actually need it and why would I want to commit a crime on someone else's behalf and cut myself short. If I want to be a smartass I will say "I would be happy to pop your elbow out and hit it with a baseball bat until it is nice and shattered, then you can be in my shoes."

I really despise people who act like you owe them something if you are receiving pain medication and if word gets out that you have that medication those type of people will gravitate towards you. Even if its a friend who does that, they are not really being a good friend. I actually have had to end some friendships just because people I knew wanted my medication and well they are not getting any of it. It can be so annoying to be asked for your medication. Its sad that if you were friends with someone before you get on the medication that they will relentlessly ask you for it and become quite angry.

So I find its best to keep the matter private. Of course people will find out, but I will often say that I no longer take the medication. It seems as though people feel rather entitled when it comes to drugs. People often don't understand or care that someone actually needs their medication. Often times they assume that you are an addict or you get the medication to sell. I find that people often times think that of anyone who goes to a pain clinic. Its a nasty stereotype.

As with all stereotypes there is a bit of truth. The last time I was at my clinic a woman who was at least 80 years old made a deal to sell her medication to another patient in the lobby. She didn't care that both my mother and I could hear the conversation. I am pretty sure she would have sold some to me had I asked her to. All the same often times they have detectives hanging out in the clinics busting people doing that very thing. They pose as both sellers and people wanting to buy pills.

Its just a sad thing that people get themselves in situations where they buy or sell medicine, but its a reality and I for one am glad not to be in that situation. I don't think the measures such as TRF formulations and busting drug peddlers really solves the problem. Sometimes people are under-medicated or they cannot afford their co-pay. I think it would be better for the authorities to address the root of the problem instead of going after the people that are victimized. Often times people are in serious physical and mental pain and they turn to illicit drug use to cope. Those type of people need help, but its not really the responsibility of someone who receives medication to help them.

Pain clinics and patients are often demonized in the media and that's just wrong. I really don't like people to make assumptions about me based on what type of medication I need to be able to write, type, and drive a vehicle. I feel if the media keeps hyping a problem it makes it worse. I think the TRF formulas are more about corporate greed (i.e. extending patents) than actually helping people.

There has been a public outcry for all sorts of nasty shite to be put in medications. I don't know where people get off with suggesting things such as naxalone should be put in peoples pills so they don't crush them up. Its bad enough how bad the TRF pills are for the patients. I think the people in charge have their priorities wrong when the patients come second to preventing abuse. I think its really up to parents to educate their kids about drugs and for junkies to be adults about their problems and address them instead of just blaming someone else. It seems as though people have trouble taking responsibility for their own decisions.

Sorry this was a bit of a rant, but all of my post is directly related to what chronic pain patients go through on a daily basis. I guess what I am saying is that it is just straight up wrong to treat people in pain like they are criminals and I also really do not like medication to be altered in the name of harm reduction when its really about money. I just feel as though chronic pain patients are often demonized, stereotyped, and treated like criminals and that is just uncalled for. The sins of some shouldn't be the burden of many.

 

[Whosajiggawaaa]

^

My one friend ask's me to trade my oxy for his benzos or chronic, I've never done it in all these years. May look like I have a lot but every single pill is precious cos of what it does (let me lead a relatively normal life). I under play my dosage for that reason too.

This thread in the midst of all the other post's in OD, doesn't lend itself to credibility of genuine pain patients - neutral observation.

Also I've found most of the mods of OD are pretty socially spastic with the exception of tricomb, he's alright.

A neutral observation and a subjective one.

Gonna go study, got no pain but nauseous as fuck sigh.

 

[spiritsage]

Hello all, I am a newbie(on this board) looking for some help. I'm disabled, on SS, with degenerative arthritis, no cartilage in left knee, 50% right, compression fracture of L1. I've been on hydromorphone for about 2 1/2 years....the same dose of three 4mg pills/day for the last 18 months. Regulatory/medical policy environment keeps getting tighter. I've survived by improving my bioavailability, first with plugging, then snorting(surprised it was better). Now my condition seems to be moving into my hips and the current dose does very little to help.
So I'm exploring other treatments- prolotherapy and PRP- both are injection therapies which show promise for long term pain relief. at least continuing to avoid joint reconstruction(which I can't even afford the co-pays for); neither of these therapies is covered by Medicare...but they may be within reach.
I have a doctors appt 10/11. No matter what I have told him in the past he has been unwilling to go beyond 12mg for either tolerance or increased pain issues...he may refer me to a pain management specialist...but the wait for them here is running 12 months. I'm totally stressed.
Looking for any input...some new form of creative approach with my doc. Any and all input greatly appreciated. mahalo.

 

[xtcgrrrl]

Hello to dopemaster, nice to see a familiar screen name on this thread. Not so nice to hear that you're in all this pain, however tomorrow I go to my first physical therapy session but what I'm looking forward to most is I get to pick up my MEDICINE!!! Yes I ran out of Tramadol 1 day early and today I had none. I tried to make it through the day on just Neurontin but Neurontin doesn't seem to affect me the same way anymore. I wonder what I should do? I was thinking either I could stop taking it for a week then start again and see if it works better OR I can ask my doctor for Lyrica instead. What do you guys think? Anyway, by the end of the day I was in so much pain by the time I got home from my therapy appointment (psychotherapy not PT) I couldn't walk up to my bedroom (2 flights of stairs) so I had my husband bring me my Bali and I did a toss n wash. That helped a LITTLE...soooo looking forward to tomorrow. I'm also anxious because I keep thinking what if there's some reason I can't get the refill? Arghhhhh...stupid monkey brain. Stupid pain. Anyway I just wanted to check in and now I'll go back and read the thread, because I probably totally derailed it (oops)

 

[Whosajiggawaaa]

Hello all, I am a newbie(on this board) looking for some help. I'm disabled, on SS, with degenerative arthritis, no cartilage in left knee, 50% right, compression fracture of L1. I've been on hydromorphone for about 2 1/2 years....the same dose of three 4mg pills/day for the last 18 months. Regulatory/medical policy environment keeps getting tighter. I've survived by improving my bioavailability, first with plugging, then snorting(surprised it was better). Now my condition seems to be moving into my hips and the current dose does very little to help.
So I'm exploring other treatments- prolotherapy and PRP- both are injection therapies which show promise for long term pain relief. at least continuing to avoid joint reconstruction(which I can't even afford the co-pays for); neither of these therapies is covered by Medicare...but they may be within reach.
I have a doctors appt 10/11. No matter what I have told him in the past he has been unwilling to go beyond 12mg for either tolerance or increased pain issues...he may refer me to a pain management specialist...but the wait for them here is running 12 months. I'm totally stressed.
Looking for any input...some new form of creative approach with my doc. Any and all input greatly appreciated. mahalo.

I'd stay away from spinal fusions if they on the cards no too many people who've had that make it worse. My last surgery was a very bad experience, 5 hour op on my arm and a 6 day pain ridden hospital stay (living hell), so my advice will be subjective.

Having long term pain relief without meds is the ultimate goal, but you should way in the pros and cons on the various methods to achieve this, the cons of staying on meds, the cons of surgery and the pros of both. That's how I'd approach it.

Hello to dopemaster, nice to see a familiar screen name on this thread. Not so nice to hear that you're in all this pain, however tomorrow I go to my first physical therapy session but what I'm looking forward to most is I get to pick up my MEDICINE!!! Yes I ran out of Tramadol 1 day early and today I had none. I tried to make it through the day on just Neurontin but Neurontin doesn't seem to affect me the same way anymore. I wonder what I should do? I was thinking either I could stop taking it for a week then start again and see if it works better OR I can ask my doctor for Lyrica instead. What do you guys think? Anyway, by the end of the day I was in so much pain by the time I got home from my therapy appointment (psychotherapy not PT) I couldn't walk up to my bedroom (2 flights of stairs) so I had my husband bring me my Bali and I did a toss n wash. That helped a LITTLE...soooo looking forward to tomorrow. I'm also anxious because I keep thinking what if there's some reason I can't get the refill? Arghhhhh...stupid monkey brain. Stupid pain. Anyway I just wanted to check in and now I'll go back and read the thread, because I probably totally derailed it (oops)

I wish I could get excited about picking up Tramadol. I don't even get excited when I pick up my 160 Oxy pills and capsules, in fact the opposite, tired of it.

 

[Reverend Random]

For those who don't know about this yet, I recently saw an interesting Israeli documentary about the many new medicinal applications of cannabis, and among those several for pain management. Who knows, maybe it'll be of some help to anyone reading this. It was certainly interesting, even if you can't use it yourself.

 

[BigG]

Feeling rather down today. The combo of 180mg methadone and 10mg Valium im on at the moment is making me Soooo.tired and im STILL in horrible pain. Supposed to have a date tomorrow nite with a beutiful girl I just met but dont even feel like doing that............but I will tho anyway......damn she's hot!!!!! Looks like that Mila-whatshername off resident evil.

UPDATE.... had a great time Saturday nite.....anazing what a few pints of Stella Artois on top of ur methadone and diazepam will do for ur pain (yes I know its dangerous!!). Plus this girl was smoking hot!!! I know this sounds like irrelevant rambling but when your mental state improves and you feel happier I think it has a profound effect on your perception of your pain levels.......imo anyway

 

[BigG]

You seen the pack insert ? definitely the most side effect's I've ever seen.

I know mate...usually they are required by law to show EVERY possibleside effect but categorise them into how likely you are to sufder from them...like 1 in 10 people or 1 in 100 etc. But with Lyrica even the list of very common side effects is huge and soe of them are really unpleasant like unable to stand or talk.....fucking horrible

 

[Whosajiggawaaa]

Feeling rather down today. The combo of 180mg methadone and 10mg Valium im on at the moment is making me Soooo.tired and im STILL in horrible pain. Supposed to have a date tomorrow nite with a beutiful girl I just met but dont even feel like doing that............but I will tho anyway......damn she's hot!!!!! Looks like that Mila-whatshername off resident evil.

UPDATE.... had a great time Saturday nite.....anazing what a few pints of Stella Artois on top of ur methadone and diazepam will do for ur pain (yes I know its dangerous!!). Plus this girl was smoking hot!!! I know this sounds like irrelevant rambling but when your mental state improves and you feel happier I think it has a profound effect on your perception of your pain levels.......imo anyway

Well its a week an a half till my degree finals ( if I pass em all I'll have my post grad) and i haven't touched a book (i usually leave it late though, this is pushing it though). Slept horribly last night, only going on my meds, need a sleep.

Know what you mean about not wanting to do things because of pain/depression from the pain. The things I've turned down over the last 2 years would make normal physically healthy me cry. My friends still send me courtesy invites though even though they know i'll probs reject em, which is nice.

I see you're on methodone, is this good for pain (neuropthaic and mechanical and myofascial) ? Maybe less addictive than oxy ?

Edit: Nvm see you said still in pain after 180 mgs - that's pretty ridiculous. That's like 1000 of mgs of oxy if im not mistaken.

Grrr so tired. Feel it in the pit of my stomach.

 

[dopemaster]

^
180 mgs of methadone is a heavy dose. Maybe its not the right medication for you?

IME I was on a large dose of morphine and I switched to Opana and it worked much better. As far as equivalency my dose of Opana is a bit lower. All the same the Opana works much better on my pain. It however can be very uncomfortable to switch medications.

I really didn't enjoy switching off of Morphine to Opana and even had wd's from the switch. I wouldn't want to go through that again, but it worked out well in the long run because I am so much more comfortable on the Opana. I was having some nasty side effects from the morphine, which were mainly constipation and drowsiness.

But my point was that if that large of a dose isn't cutting it that maybe you are not on the best medication for you. Everyone's body is different. What works for one person might not work for another person. Best of luck on getting your pain under control.

 

[BigG]

Yeah methadone is A NMDA agonist so it helps neuropathic pain quite well. Its obviously a potent mu receptor agonist to so is one of the better opiates for pain. Mate ive had to ask my doc to pick up my pills daily to try to limit my consumption somewhat as I was taking 500-600mg a day and then when I ran out suffering hideous wds. The conversion from methadone to other opiates using conventional opiate equivalence conversion tables is tricky as the plasma levels of methadone achieved vary tremendously from patient to patient for given dose as does its half life. Usually in pain management to convert from methadone to the equivalent dose of morphine and then from morphine to the other opiate I.e. oxy, fentanyl etc. The thing is ive tried every (and I do mean EVERY) other opiate available and after my recent failure with fentanyl, methadone is the end of the road.....thats why I want off altogether

 

[Slum Survivor]

yeah Israel is VERY smart to decrminalize the research and study of marijuana. thats something the us could have taken the lead in... but no, stupid bureaucracy prevents that.
marijuana is very important to me for pain. each strain/phenotype is different tho, most naive folks dont realize that part.


ugh... ive got a Q

im on suboxone right now, about 2-3mg a day. I have horrible, and random sciatica issues and lower back problems. lots of leg and back pain. its intense.

my question is: im getting desperate about the pain. the subs arent cutting it... would it be worth discussing this with my sub dr and see about maybe switching over to methadone within reason?

im on subs for opiate addiction as well, not just pain.

i just cant even be a productive person or anything like this... only thing that helps is when i have a strong opiate(or at least enough of a weak one) to relieve the pain. like if i shoot dope when in extreme pain... it helps way more than i would have expected. its like being at the hospital in horrible pain and finally getting pain meds thru IV.

wouldnt methadone be a possibility here??

 

[Professer]

How old are you? What condition do you have? Perhaps your spine pain comes from uneven leg lengths ? Myself had uneven pelvic bones one taller than the other, causing me to sit/stand with a curved spine... had major surgery to fix it but it collapsed 2 months later.. now im looking at surgery #3 because without having symetry back i will always be in chronic pain... its been the bane of my life

I do have over rotated hips that make me pigeon footed. If I stand with my feet pointing straight my knees point inward. My back docs have ignored this when I bring it up to them, just tell me my MRI shows nothing major, and never asked me any questions about my condition or anything. They did the same thing when I mention my car accident from last year when I mention it. Just offer me a injection to my spine (yikes, that's a last resort for me) and pass me off to their equally unhelpful pain docs.

I am doing a bit better now after jumping through their hoops and suffering for so long. Got rx's for zanaflex and lyric, the latter helping the most. Here's a post I made earlier that goes into more details about my update.

http://www.bluelight.ru/vb/threads/...The-People?p=11887730&viewfull=1#post11887730
I'm hoping I can manage to start physical therapy now and see how my condition improves. Either way, I'm so weak the PT is needed and will help the muscle problems. No idea about the spine or hips though. Thanks to all who've read/posted or given any consideration to my struggles. It helps to have peers here and your support.

It's very upsetting how useless these doctors have been. My condition/case is really complex and a result of years of problems building up. A MRI pic of my spine says nothing about my past health problems or other problems with my body. It's unreal... and the co-pay we have to pay for every damn visit for little to no help is ridiculous. This back center is supposed to be a renown top establishment in our area. My ass...

Just wanted to mention. Dopemaster: great post. I enjoyed reading it, some good
perspective and truth to it.

 

[MrsMorphine]

^

My one friend ask's me to trade my oxy for his benzos or chronic, I've never done it in all these years. May look like I have a lot but every single pill is precious cos of what it does (let me lead a relatively normal life). I under play my dosage for that reason too.

This thread in the midst of all the other post's in OD, doesn't lend itself to credibility of genuine pain patients - neutral observation.

Also I've found most of the mods of OD are pretty socially spastic with the exception of tricomb, he's alright.

A neutral observation and a subjective one.

Gonna go study, got no pain but nauseous as fuck sigh.

Regarding the nausea, Zofran (ondasetron) can be a big, big help... at least it has been for me. Even better than Phenergan (promethazine) tablets or suppositories.

The doctor who first prescribed Zofran for opioid-related nausea told me that it has originally been meant for cancer patients, but now, he said, "it's for regular people, too." (Sick as I was, I got a bang out of being considered a "regular person" for once.) Zofran is a pleasant-tasting tablet that goes under the tongue, is available in generic, and has had no side effects that I could detect.

Maybe it would help?

 

[Professer]

A close one of mine is rx'd nexium for any nausea for his methadone. I might suggest he mentions Zofran with his doc.

I've tried it when trying to abuse meds in the past. Didn't remember it doing much. I still vomited. The person I mentioned above still gets nausea at times with his 'done/nexium. I think his poor diet and habits are more the problem. He consumes excessive amounts of aspartame which he adds to everything, among other weird habits.

And I must say, this lyrica really is seeming to help a ton. Leg pains are mostly diminished nds my body muscle pains/tightness are reduced. I hadn't even increased my dose yet as I expected would be necessary. Will see how it works on its own tomorrow without the zanaflex I was rx'd too. It seems best left out to take as needed for bad days with the spasms and such. I'm impressed how well I'm feeling tonight. I didn't even take my small opioid maintenance dose tonight - finally seems like I have a chance to drop that.

Or maybe I'll need the zanaflex (?) daily as rx'd. I'm just happy having something that actually helps. Opioids and the other stuff they gave me weren't doing crap.

 

[Whosajiggawaaa]

A close one of mine is rx'd nexium for any nausea for his methadone. I might suggest he mentions Zofran with his doc.

I've tried it when trying to abuse meds in the past. Didn't remember it doing much. I still vomited. The person I mentioned above still gets nausea at times with his 'done/nexium. I think his poor diet and habits are more the problem. He consumes excessive amounts of aspartame which he adds to everything, among other weird habits.

And I must say, this lyrica really is seeming to help a ton. Leg pains are mostly diminished nds my body muscle pains/tightness are reduced. I hadn't even increased my dose yet as I expected would be necessary. Will see how it works on its own tomorrow without the zanaflex I was rx'd too. It seems best left out to take as needed for bad days with the spasms and such. I'm impressed how well I'm feeling tonight. I didn't even take my small opioid maintenance dose tonight - finally seems like I have a chance to drop that.

Or maybe I'll need the zanaflex (?) daily as rx'd. I'm just happy having something that actually helps. Opioids and the other stuff they gave me weren't doing crap.

That's great news about Lyrica helping. If I could find something with less stigma than oxy and worked as well I'd be over the moon!

Yeah I remember Zofran (zofer) here, never really tried it, also got the it's for cancer patients schtick. I find cyclizine to be the most helpful out of all the OTC anti-histamines that and cinnerizine (spelling) together, errase my nausea, no matter how bad.

yeah Israel is VERY smart to decrminalize the research and study of marijuana. thats something the us could have taken the lead in... but no, stupid bureaucracy prevents that.
marijuana is very important to me for pain. each strain/phenotype is different tho, most naive folks dont realize that part.


ugh... ive got a Q

im on suboxone right now, about 2-3mg a day. I have horrible, and random sciatica issues and lower back problems. lots of leg and back pain. its intense.

my question is: im getting desperate about the pain. the subs arent cutting it... would it be worth discussing this with my sub dr and see about maybe switching over to methadone within reason?

im on subs for opiate addiction as well, not just pain.

i just cant even be a productive person or anything like this... only thing that helps is when i have a strong opiate(or at least enough of a weak one) to relieve the pain. like if i shoot dope when in extreme pain... it helps way more than i would have expected. its like being at the hospital in horrible pain and finally getting pain meds thru IV.

wouldnt methadone be a possibility here??

I'm not sure if a sub Dr is the right Dr for this, they are so addiction geared they'll probably view it as drug seeking behaviour ( I am generalising here though). You need a compassionate pain specialist or even a good gp, but compassionate is essential.

Yeah methadone is A NMDA agonist so it helps neuropathic pain quite well. Its obviously a potent mu receptor agonist to so is one of the better opiates for pain. Mate ive had to ask my doc to pick up my pills daily to try to limit my consumption somewhat as I was taking 500-600mg a day and then when I ran out suffering hideous wds. The conversion from methadone to other opiates using conventional opiate equivalence conversion tables is tricky as the plasma levels of methadone achieved vary tremendously from patient to patient for given dose as does its half life. Usually in pain management to convert from methadone to the equivalent dose of morphine and then from morphine to the other opiate I.e. oxy, fentanyl etc. The thing is ive tried every (and I do mean EVERY) other opiate available and after my recent failure with fentanyl, methadone is the end of the road.....thats why I want off altogether

Wow, 500 mg - 600 mg of done. Finally someone who can relate to my doses! Doesn't seem much more promising than oxy from a compulsive use/(pseudo)addictiveness. I like the thought of it being long acting and being much, much easier on the wallet. Hmmm wonder whether I should ask my Dr when I see him later this week to try it out. Agree about converting, tried converting to the patch (fent) and it was hell , tried switching to Jurnista (24 hour long release hydromorphone) also not fun - think the dose might have been a bit low though.

 

[2010SterlingGT]

Ok so just to follow up regarding my experience with Oxymorphone. The generic 40mg ER's are waaaaaaaaaaaaay better than those plastic pieces of shit the name brand is pushing out. Granted the name brand did work eventually. The name brand 40mg ER took nearly 3 hours to start working. The solid plastic binder destroyed my stomach. I would get the worst heartburn I have ever had and it would last around 10 hours. The pain relief worked well and I would say my pain levels were reduced from a 5.5 to <1. I did on several occasions see undigested pieces in my stool. I think to myself WTF were they thinking when they made this plastic binder?!?

I switched to the generic brand. It took 45 minutes for the pain relieving effects to kick in. Zero heartburn. The pain relief is equal to if not slightly better than the name brand.

 

[Whosajiggawaaa]

Ok so just to follow up regarding my experience with Oxymorphone. The generic 40mg ER's are waaaaaaaaaaaaay better than those plastic pieces of shit the name brand is pushing out. Granted the name brand did work eventually. The name brand 40mg ER took nearly 3 hours to start working. The solid plastic binder destroyed my stomach. I would get the worst heartburn I have ever had and it would last around 10 hours. The pain relief worked well and I would say my pain levels were reduced from a 5.5 to <1. I did on several occasions see undigested pieces in my stool. I think to myself WTF were they thinking when they made this plastic binder?!?

I switched to the generic brand. It took 45 minutes for the pain relieving effects to kick in. Zero heartburn. The pain relief is equal to if not slightly better than the name brand.

It's VERY rare that I find a generic works better than a branded medication. You sure you don't prefer the generic because you can crush it/defeat the time release ?