Opioids Explaining to my doctor that I need more than the maximum dose just to not get sick?

[ChemicallyEnhanced]

I have a long history with opioids and have been dependent on them to varying degrees for eight years.
A few years ago I quit both methadone and heroin cold turkey but was immediately put on codeine as I have severe chronic pain. Codeine didn't do shit so I was on Tramadol for a while and then recently Dihydrocodeine.
I am prescribed 8 x 30mg DHC pills a day. I got by (with the odd morphine pill on bad days) but now I'm at the point where I need 12 pills a day just to not be in withdrawal. My GP said if I ever abuse it he would cut me off all opioids and that he would NEVER prescribe me anything as stronger as morphine upwards either way.

What can I say to him to explain the situation? I'm barely making it week-to-week with my prescription and that's with taking about 240 co-codamol a week, plus often a strip of codeine 30's off my grandpa and sometimes a few morphine 60's off my neighbour.
The thing is, while I DO absolutely abuse opioids sometimes due to depression I am still in considerable pain all of them time because I need something like morphine or oxy for the pain levels.

I just feel really trapped. How can I get him to understand my levels of both dependency and pain and that I NEED either stronger opioids or at least something like a gabapentinoid* (which I have been refused many times)
Something slow-release for background pain would be ideal. I'd sell my soul for even the lowest dose fentanyl patch.

*I have arthritis, slipped discs and sciatica so gabapentinoids make sense.

 

[Painful One]

That is a hard situation my friend. I would NOT tell him that you are now needing 12 pills of your prescription a day to just not be out of withdrawal. He prescribed you eight a day. He even told you straight up that if you ever abused them he would cut you off and cut you off cold he would. To save your life!

Opiate addiction is no easy thing to deal with. I know. When I have gotten my tolerance jacked up high, I just had to bite the bullet and stick to my prescribed dosage no matter what until my tolerance dropped back down and it will and does. It just takes some sleepless nights and yeah withdrawal but it is not nearly as bad when you have something. Compared to nothing!

I attempted to get my doctor to raise my dosage when I was in this same boat and he freaking slammed me with a speech about “studies show that opiates don’t help chronic pain“, would not listen to a word I said and told me this is your last prescription then you can either taper down to 60 mg a day and keep tapering down and off or go on suboxone. Those were my choices! And this was after I burst out in tears and begged him not to cut me off cold turkey because that is what he was going to do!

I am having no problem getting Gabapentin. Have a look at some of my posts and maybe you can adapt your own scenario to get those prescribed. They help with withdrawal totally. I don’t think you would even notice dropping back down if you had Gabapentin.
It is good stuff. You just have to find the right dose for you. But it works wonders. A lot of my pain has cleared up!

Heed my warning. I was scared shitless thinking about not even having the prescription I did have!
Which we are lucky to have! He made that quite clear! I couldn’t budge him and I can usually get people and doctors to do anything I want. I couldn’t use my looks on him, my sweetness, nothing!

 

[GetMeOutOfThisCRAP]

You're more likely to get gabapentin prescribed than the chance of him increasing your dosage from what it seems like.

Inevitably, even with your pain factor wouldn't your body adjust *in time* to the doses you are prescribed? I mean it's going to be an unbearable time period but people have cut back with success and maintained a once low dose.

I'm sorry this is happening to you. It's a terrible time to have chronic pain because of the epidemic doctors created and now people who legitimate need them to function on a daily basis are being limited/cut off.

I know this is a god awful recommendation for a forum that's strictly HR.. but proceed with caution on this suggestion. Have you ever looked into poppy tea? When people are desperate for answers and even desperate enough to flock to street dope H for their true chronic pain--I'd recommend seed tea over heroin. However the withdrawal is notoriously horrible beyond words. But if you can't find a solution, some people do benefit from seed tea. Again, this is probably a horrible suggestion.

 

[sekio]

*I have arthritis, slipped discs and sciatica

NSAIDs can be very useful in "textbook" inflammatory conditions such as those... in fact ibuprofen was initially developed as, specifically, a better drug for arthritis pain than aspirin. Try naproxen or diclofenac (with meals, maybe a PPI - ask your doctor about long term use) - there's a good amount of evidence that it can be equally as effective as opioids, and can also potentiate opioids together.

 

[Hezman94]

Have fun with that in on more than the recommended guidelines and im never in enough relief thanks to my abuse of meds in the pastdoctors are right they will give me more but then I'll need more in the EDT fee months

 

[KnowsNotWhatItMean]

Have you ever looked into poppy tea? When people are desperate for answers and even desperate enough to flock to street dope H for their true chronic pain--I'd recommend seed tea over heroin. However the withdrawal is notoriously horrible beyond words. But if you can't find a solution, some people do benefit from seed tea. Again, this is probably a horrible suggestion.

I doubt it, even if you were totally naive with zero tolerance, and all you did for a while was tea you would develop enough tolerance to not be feeling anything from it anymore before you could ever get hooked enough to leave you with more severe of withdrawls. Maybe just enough to make you keep doing it, but that's about it. I don't think it's in the same ballpark. Sure you can try it, hopefully I'm wrong.

 

[Wilson Wilson]

No way will an NHS GP prescribe past the max dose as given by NICE especially for a patient who has a history of opioid addiction. Truthfully you're lucky to be getting the DHC script in the first place with a recorded history of addiction. If you tell your doctor this you will have your script taken off you 100%.

Try to use something like kratom to take the edge off as you reduce your DHC dose back to your scripted level.

As for gabapentin I'm not too sure, since it got made a controlled drug some CCG's basically treat it the same as opioids anyway. I genuinely know someone, with morphine addiction on his record, who was moved from gabapentin back to Oramorph because gabapentin was made a controlled drug. I shit you not.

But to be clear OP shouldn't expect this to happen if the GP has outright said they will not script anything above DHC. Stick to supplementing with kratom and that.

 

[KnowsNotWhatItMean]

All you can do is get back to your prescribed medicine and if you manage not to be taking other stuff alongside to it for a while, your prescription might at least become effective again and keeping it as effective is probably easier said than done for a reason, sadly enough it only gets as effective as you make it.

 

[KnowsNotWhatItMean]

It's understandable that your prescribed medication was probably not working well enough in the first place, but I'm sure that the bare minimum is at least better than this, you'll probably agree with me. It's not even expected to be working "as it's supposed to" only because of it's very nature. It's tricky to balance between apreciateing a minimal relief and sinking into a never ending wormhole, it's just a reality's toll. But as long as it is being prescribed to you, I'd say your best bet is to stick to treating it that way. Another kind of therapy, while still not being clearly determined right now, could become necessary.

 

[Zonxx]

Be honest. explain you're in pain and need more. it is not enough.

stay safe
~zonxx

 

[Keif' Richards]

I usually don't like threads that concern dealing with prescribers, but I understand your situation and I really feel you could benefit from some advice. Your best course of action would be to find some avenue of making your current regimen work for you. There are a lot of prescribing guidelines out right now that make it pretty difficult to access the upper echelons of Opioids unless you have a severe and documented need. It's my opinion that by adding other analgesic substances like Kratom, you are only going to further increase your tolerance in a negative way. It's my understanding that Mitragynine is itself an Opioid and I don't want you to end up, weeks from now, saying that both your Codeine and Kratom together no longer work and you're desperate to figure out a solution.

I understand that Gabapentinoids are not immediately available through your prescriber, but I really think that they are a good bet for helping reduce your pain to manageable levels. If you make a case to your prescriber and he is still unwilling to prescribe, is it possible that you can see a different doctor? I am implying being totally up front about it. Your pain is not controlled and you want to try something to change it, yet your doctor will not facilitate. Seems reasonable to me.,

Also, what is your experience with Cannabis? I'm a major advocate for medical Cannabis for mental and physical pain. It works great and you don't have to be overly concerned about addiction/dependence/withdrawal. I don't mean "have you ever smoked weed?", I mean, do you have a good, legitimate source with a few different options with whom you can brainstorm? Myself and many others find that edible Cannabis is most effective for pain and a lot of people just enjoy edibles (tinctures, drops, capsules, food etc) due to their ease of administration. If it is an issue of not being able to find any/the right kind, send me a message and maybe we can figure something out in your area!

 

[G_Chem]

Yea man the simple fact is you have been using more than what you are prescribed (an extra few codeine 30’s here, morphine 60’s there, etc) so of course you feel like you need more.

The doc told you straight he’d cut you off if your abusing opioids, in his eyes right now you are. Your only option at this point is to stop all opioids except the ones your actually supposed to take. Expect withdrawal because, yes you have been taking more than prescribed so of course you’ll feel in WD..

To be honest this posts stinks to high heaven of a person who’s going down a bad road of opiate addiction right now.. It’s not the maximum limit on prescribed dosages that’s the problem, it’s your outside use of other opioids.

-GC

 

[KnowsNotWhatItMean]

It’s not the maximum limit on prescribed dosages that’s the problem, it’s your outside use of other opioids.

Yeah he already knows that...

 

[G_Chem]

It didn’t seem like it based on the OP.. He’s asking for advice on how to get more opiates from a doctor that told him he’d cut him off if he abused, because he abused opiates. What else can be said besides the obvious?...

Do you have any advice better? What can he tell his doctor to get more? Why does he feel he NEEDS more (all caps by him) when even all the extra codeine and morphine isn’t enough?.. Is a few extra DHC really gonna make a difference?

I feel the other posts are doing a discervice by not laying it out straight.. There’s no advice that can really be given besides “suck it up and ride it out unless you want to lose ALL of your script and be forced to rely solely on thecstreet.”

-GC

 

[GetMeOutOfThisCRAP]

I doubt it, even if you were totally naive with zero tolerance, and all you did for a while was tea you would develop enough tolerance to not be feeling anything from it anymore before you could ever get hooked enough to leave you with more severe of withdrawls. Maybe just enough to make you keep doing it, but that's about it. I don't think it's in the same ballpark. Sure you can try it, hopefully I'm wrong.

You're right, but OP sounds desperate for help as the chronic pain sounds unbearable for this time period.

Throwing in kratom on top of what you have know will definitely at least help a little. Why is gabapentin treated like oxycodone? I thought it was nearly impossible to overdose on gabapentin. Or maybe there is a dangerous combo with gaba that is overlooked until now? Gabapentin used to be the hot topic--now it's hard to get your hands on via perscription. I don't get it lol. I suppose maybe some have succumbed to siezures from not properly tapering off the gaba script and maybe the drug was no longer viewed as relatively harmless. I did get the impression when BL was talking about it so frequently that it was a harmless drug. I'm probably wrong.

 

[Wilson Wilson]

Why is gabapentin treated like oxycodone? I thought it was nearly impossible to overdose on gabapentin. Or maybe there is a dangerous combo with gaba that is overlooked until now? Gabapentin used to be the hot topic--now it's hard to get your hands on via perscription. I don't get it lol. I suppose maybe some have succumbed to siezures from not properly tapering off the gaba script and maybe the drug was no longer viewed as relatively harmless. I did get the impression when BL was talking about it so frequently that it was a harmless drug. I'm probably wrong.

Gabapentin and pregabalin are both addictive drugs in their own right with a large list of side effects, they're certainly not harmless. The scripts used to be easy to get because they were uncontrolled. In the UK (where me and OP both live) pregabalin was generally the more common script of the two and was just thrown at people without any warnings of its addiction potential or side effects.

This went on for years until the NHS realised hang on a minute people are abusing this stuff. Reports were filed and eventually the government made it a controlled drug (but they took years to get around to it and only did it right after Pfizer's patent expired, read into that what you will). Once a drug becomes controlled, the NHS becomes a lot more wary about prescribing it, particularly to people with a history of drug addiction.

It will always vary depending on your local CCG, and therefore comes down to the ol' postcode lottery, but many CCG's suddenly get very strict about newly controlled drugs. That's why you have stories like people with a history of morphine addiction getting put back on morphine from gabapentin. Also when tramadol was first made a controlled drug, a different CCG decided to pull all tramadol scripts and replace them with codeine, DHC, or morphine depending on the patient.

Not really surprising that gabapeninoids are harder to get now they are controlled drugs and recognised drugs of abuse. It does vary depending on your local CCG and therefore on the postcode lottery, so it might be worth bringing up to the GP anyway, but now it's controlled I wouldn't expect too much.

This is always the pattern for scripts: new drug comes out, docs buy into the hype from the pharma company pushing it and hand it out to everyone, eventually realise it's not a miracle drug, it gets controlled, scripts get cut down and replaced with other drugs, new drug comes out, rinse and repeat...

 

[GetMeOutOfThisCRAP]

Gabapentin and pregabalin are both addictive drugs in their own right with a large list of side effects, they're certainly not harmless. The scripts used to be easy to get because they were uncontrolled. In the UK (where me and OP both live) pregabalin was generally the more common script of the two and was just thrown at people without any warnings of its addiction potential or side effects.

This went on for years until the NHS realised hang on a minute people are abusing this stuff. Reports were filed and eventually the government made it a controlled drug (but they took years to get around to it and only did it right after Pfizer's patent expired, read into that what you will). Once a drug becomes controlled, the NHS becomes a lot more wary about prescribing it, particularly to people with a history of drug addiction.

It will always vary depending on your local CCG, and therefore comes down to the ol' postcode lottery, but many CCG's suddenly get very strict about newly controlled drugs. That's why you have stories like people with a history of morphine addiction getting put back on morphine from gabapentin. Also when tramadol was first made a controlled drug, a different CCG decided to pull all tramadol scripts and replace them with codeine, DHC, or morphine depending on the patient.

Not really surprising that gabapeninoids are harder to get now they are controlled drugs and recognised drugs of abuse. It does vary depending on your local CCG and therefore on the postcode lottery, so it might be worth bringing up to the GP anyway, but now it's controlled I wouldn't expect too much.

This is always the pattern for scripts: new drug comes out, docs buy into the hype from the pharma company pushing it and hand it out to everyone, eventually realise it's not a miracle drug, it gets controlled, scripts get cut down and replaced with other drugs, new drug comes out, rinse and repeat...

Ah I see and understand it--but seems backwards imo. I think opioids are way more devastating than gabapentin lol

 

[Wilson Wilson]

Ah I see and understand it--but seems backwards imo. I think opioids are way more devastating than gabapentin lol

Oh yeah it is backwards. That's why I told the story, because it makes no sense. Moving someone from gabapentin to morphine when they have a record of morphine addiction is insane.

The reason for it though is because Oramorph 10mg/5ml is not a controlled drug. Morphine in general is, but that specific preparation is only schedule 5 (any other type of morphine is schedule 2) which effectively makes it a regular POM like SSRI's. So you get some GP's willing to prescribe it pretty freely.

 

[GetMeOutOfThisCRAP]

Oh yeah it is backwards. That's why I told the story, because it makes no sense. Moving someone from gabapentin to morphine when they have a record of morphine addiction is insane.

The reason for it though is because Oramorph 10mg/5ml is not a controlled drug. Morphine in general is, but that specific preparation is only schedule 5 (any other type of morphine is schedule 2) which effectively makes it a regular POM like SSRI's. So you get some GP's willing to prescribe it pretty freely.

I'm moving to your country for the morphine asap.

 

[Phaelyon]

I have a long history with opioids and have been dependent on them to varying degrees for eight years.
A few years ago I quit both methadone and heroin cold turkey but was immediately put on codeine as I have severe chronic pain. Codeine didn't do shit so I was on Tramadol for a while and then recently Dihydrocodeine.
I am prescribed 8 x 30mg DHC pills a day. I got by (with the odd morphine pill on bad days) but now I'm at the point where I need 12 pills a day just to not be in withdrawal. My GP said if I ever abuse it he would cut me off all opioids and that he would NEVER prescribe me anything as stronger as morphine upwards either way.

What can I say to him to explain the situation? I'm barely making it week-to-week with my prescription and that's with taking about 240 co-codamol a week, plus often a strip of codeine 30's off my grandpa and sometimes a few morphine 60's off my neighbour.
The thing is, while I DO absolutely abuse opioids sometimes due to depression I am still in considerable pain all of them time because I need something like morphine or oxy for the pain levels.

I just feel really trapped. How can I get him to understand my levels of both dependency and pain and that I NEED either stronger opioids or at least something like a gabapentinoid* (which I have been refused many times)
Something slow-release for background pain would be ideal. I'd sell my soul for even the lowest dose fentanyl patch.

*I have arthritis, slipped discs and sciatica so gabapentinoids make sense.

I've been on 240mg DHC for the past 5 yrs since coming off a 13yr methadone program.and i had similar issues with tolerance. What i do to reducey tolerance is once a month i quit taking DHC and instead tske 2mg of subutex sublingually for a week. It takes 4 days of abstinence from.DHC to reduce tolerance by 50% so i throw in.another 3 days ie. 7 days total just to.be sure. Subutex does have a limited cross tolerance with DHC but this method works for me. So after a week when i go back to taking my DHC i get a nice buzz when.i chew up my 2 x 120s and wash down with a cuppa coffee in the morning. I get a buzz of 240mg dhc every morning for another month or so , sometimes 2 months. And when i notice reduced.euphoria i.phone my mate and pick up 7 x 2mg subutex to do my tolerance reduction procedure.. I have also.used poppy tea to lower my DHC tolerance and it works too. I think switching to any new opioid for at least a week helps reset tolerance to your opioid of.choice..