Sorry for the long post. Maybe it's just therapeutic to write. Please read and advise if you have time.
I'm writing because I'm in pain management caused by vertebrae that look like "swiss cheese". More likely, they will fuse and heal, but if I'm unlucky, I will require surgery. I'm prescribed 15 fentanyl patch pairs per month, with a per pair dosage of 37.5mcg/hr. The management is going well so I'm in this odd spot because I have all these powerful substances at my disposal and I am worried about my tendency to "experiment". The left over fentanyl in the patches is what is appealing (from a mad scientist viewpoint) to experiment with.
I am not so worried right now that I feel I will doctor shop or order stuff over the Internet or buy stuff on the street but I acknowledge anything's possible. I feel my current use is largely about pain and mitigating it and feeling the occasional euphoria (which is usually less often than the instances of breakthrough pain). Managing the pain management or metamanagement, if you know what I mean. But I am afraid of getting into habits that may later cause trouble when my prescription stops being refilled.
So what I'd know is any tips on avoiding trouble from people who've been there, with some idea of my situation. By this I mean near optimal pain management with left over medication, and the question is if they took it (whether to take it is already too late), how they stopped (or not) and what tricks they used from making it a habit or addiction. Particularly clever ideas are good. All constructive replies (even judgemental ones) will be read. Please do keep in mind that I've experienced brief addiction to alcohol (17+ months alcohol free, about 2 years of alcoholic drinking and no more than 4 years of total drinking at age nearing 40, i.e., first drop of alcohol was around 35 and nothing serious until 2 years later) and have a good feel for what addiction feels like and right now this isn't it but I don't want this to become that. I'm pretty sure current models of addiction promoted by treatment centres based on the AA model are not completely right (though they do have some good parts I think). I definitely don't think addiction to one substance automatically makes you an addict for another substance though all addictions I think do have a similar pathology. I've been prescribed opiates at several other times in the past (back, teeth) and while I've always deviated from the prescription (usually used more at first and less at last), I've also tapered off as the need for the prescription went away without problems *.
In a simple sense, until my doctor says there's reason to worry or to taper off, this is kind of unresolvable and perhaps why I'm frustrated and conflicted. My doctor did say I was going through pills too fast and put me on the patch at 50mcg/hr (from 130mg of oxymorphone). I then voluntarily reduced my dosage by 25%. From his end, he's very satisfied. I've stuck with this even though the previous dose on the patch was exceeding what I needed and I've had several opportunities to go back but haven't. I probably need about another 5% bump from where I am in terms of perfect pain management but I can of course live where I am also.
What I am then doing is using my prescriptions in a way that is optimal for me but probably not as intended. Two patches are never used at the same time but the left over fentanyl is extracted and ingested orally or intranasally. The former provides a long lasting euphoric "everything is good" feeling that lasts several hours for one simple extraction. The latter I'm still experimenting with but it's fantastic. After many trials and thinking I'm getting better at figuring out what's right or works for me. Yes, I am supercareful. But I can say that short bursts of opiates intranasally is more effective with a small quantity that is half or less than an immediate release pill. (When I tapered down 25% on my prescription, the dose from this activity also was reduced by 25% of course.)
So at this point I've never gone over my prescription and until I do I'd say no lines have been crossed. My pain is rather constant and I've been told taking opiates for pain is different from recreational use and it does indeed feel like I'm taking ibuprofen and not something addictive. I am highly dependent of course, if I stop using the patches, I'll face hell, but there really is no craving. I think this is because I'm on the patches always so I feel that if I take something extra it's just a boost but when the boost is done, it's not like I'm at zero (or depressed or whatever), I have something going on still. So either psychologically or really, my mind is in this state (this is my theory).
Anyways, one thing that could happen is that I might be prolonging the amount of time on opiates because I like them. As long as these are the only negative outcomes I can live with it. My way of handling it would be a really really slow taper so my body gets used to life without it without really knowing it (having done it before I know it can be done). My biggest fear is that I will keep doing this for a few months and then when it's finally time to get off I'll find it hard to and do something stupid (it doesn't worry me to stop messing around obviously but it does worry me enough to post). The stupidest thing would be going back to drinking which I don't feel like doing at all and feel I've totally put behind but as they say about alcohol, cunning baffling powerful. (I do find AA useful and have used it to my benefit but
don't buy into it as a way of life where it becomes just another addiction.)
--
* As I wrote this, I realised that "taperability" is telling. One of the first tests for someone suspected of drinking, for example, I think is to tell them to cut down. If they can't, then I believe there's already a problem (i.e., the addiction pathology is in place). As of now, luckily, I don't seem to have this problem with opiates. I can actually TAPER down which I know many people think is hard or even impossible. It's not easy for me either but I can do it with discipline repeatedly something I NEVER could do with alcohol. Before you guys yell "denial" or "rationalising", I'm just stating a honest observation, something someone who knows me would say.
I'm writing because I'm in pain management caused by vertebrae that look like "swiss cheese". More likely, they will fuse and heal, but if I'm unlucky, I will require surgery. I'm prescribed 15 fentanyl patch pairs per month, with a per pair dosage of 37.5mcg/hr. The management is going well so I'm in this odd spot because I have all these powerful substances at my disposal and I am worried about my tendency to "experiment". The left over fentanyl in the patches is what is appealing (from a mad scientist viewpoint) to experiment with.
I am not so worried right now that I feel I will doctor shop or order stuff over the Internet or buy stuff on the street but I acknowledge anything's possible. I feel my current use is largely about pain and mitigating it and feeling the occasional euphoria (which is usually less often than the instances of breakthrough pain). Managing the pain management or metamanagement, if you know what I mean. But I am afraid of getting into habits that may later cause trouble when my prescription stops being refilled.
So what I'd know is any tips on avoiding trouble from people who've been there, with some idea of my situation. By this I mean near optimal pain management with left over medication, and the question is if they took it (whether to take it is already too late), how they stopped (or not) and what tricks they used from making it a habit or addiction. Particularly clever ideas are good. All constructive replies (even judgemental ones) will be read. Please do keep in mind that I've experienced brief addiction to alcohol (17+ months alcohol free, about 2 years of alcoholic drinking and no more than 4 years of total drinking at age nearing 40, i.e., first drop of alcohol was around 35 and nothing serious until 2 years later) and have a good feel for what addiction feels like and right now this isn't it but I don't want this to become that. I'm pretty sure current models of addiction promoted by treatment centres based on the AA model are not completely right (though they do have some good parts I think). I definitely don't think addiction to one substance automatically makes you an addict for another substance though all addictions I think do have a similar pathology. I've been prescribed opiates at several other times in the past (back, teeth) and while I've always deviated from the prescription (usually used more at first and less at last), I've also tapered off as the need for the prescription went away without problems *.
In a simple sense, until my doctor says there's reason to worry or to taper off, this is kind of unresolvable and perhaps why I'm frustrated and conflicted. My doctor did say I was going through pills too fast and put me on the patch at 50mcg/hr (from 130mg of oxymorphone). I then voluntarily reduced my dosage by 25%. From his end, he's very satisfied. I've stuck with this even though the previous dose on the patch was exceeding what I needed and I've had several opportunities to go back but haven't. I probably need about another 5% bump from where I am in terms of perfect pain management but I can of course live where I am also.
What I am then doing is using my prescriptions in a way that is optimal for me but probably not as intended. Two patches are never used at the same time but the left over fentanyl is extracted and ingested orally or intranasally. The former provides a long lasting euphoric "everything is good" feeling that lasts several hours for one simple extraction. The latter I'm still experimenting with but it's fantastic. After many trials and thinking I'm getting better at figuring out what's right or works for me. Yes, I am supercareful. But I can say that short bursts of opiates intranasally is more effective with a small quantity that is half or less than an immediate release pill. (When I tapered down 25% on my prescription, the dose from this activity also was reduced by 25% of course.)
So at this point I've never gone over my prescription and until I do I'd say no lines have been crossed. My pain is rather constant and I've been told taking opiates for pain is different from recreational use and it does indeed feel like I'm taking ibuprofen and not something addictive. I am highly dependent of course, if I stop using the patches, I'll face hell, but there really is no craving. I think this is because I'm on the patches always so I feel that if I take something extra it's just a boost but when the boost is done, it's not like I'm at zero (or depressed or whatever), I have something going on still. So either psychologically or really, my mind is in this state (this is my theory).
Anyways, one thing that could happen is that I might be prolonging the amount of time on opiates because I like them. As long as these are the only negative outcomes I can live with it. My way of handling it would be a really really slow taper so my body gets used to life without it without really knowing it (having done it before I know it can be done). My biggest fear is that I will keep doing this for a few months and then when it's finally time to get off I'll find it hard to and do something stupid (it doesn't worry me to stop messing around obviously but it does worry me enough to post). The stupidest thing would be going back to drinking which I don't feel like doing at all and feel I've totally put behind but as they say about alcohol, cunning baffling powerful. (I do find AA useful and have used it to my benefit but
don't buy into it as a way of life where it becomes just another addiction.)
--
* As I wrote this, I realised that "taperability" is telling. One of the first tests for someone suspected of drinking, for example, I think is to tell them to cut down. If they can't, then I believe there's already a problem (i.e., the addiction pathology is in place). As of now, luckily, I don't seem to have this problem with opiates. I can actually TAPER down which I know many people think is hard or even impossible. It's not easy for me either but I can do it with discipline repeatedly something I NEVER could do with alcohol. Before you guys yell "denial" or "rationalising", I'm just stating a honest observation, something someone who knows me would say.