How to avoid addiction while on pain management?

[bluedom]

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.

 

[blazelate]

Take a day off from that shit, try to deal with pain when you can, dont take the drugs unless you need.

You being on drugs alllll the time, when you try to stop makes the pain 10x worse. Try to learn to put up with the pain, people did it for ages before medicine became accessible.

 

[mymindisgoo]

you know what the doctors say, 'as long as you take it as prescribed you'll be fine' ! ha.

 

[Lolie]

Here chronic pain (now called persistent, long term pain) is treated using a biopsychosocial model, meaning that drugs (including the opiate anaelgesics) are only one part of the treatment plan. The objective isn't to eliminate the pain, it's to reduce it to tolerable levels, improve functioning, and enhance the patient's daily quality of life.

While you probably don't have access to a multi-disciplinary pain management team, your doctor might be able to guide you through developing a comprehensive pain management plan which incorporates additional strategies for managing your pain. These could include CBT based therapy, meditation, relaxation and visualisation, physical therapy and other exercise, distraction techniques, dietary and nutritional programmes, and a host of other therapies and techniques.

The addition of non-narcotic drugs to your medication schedule can also often allow you to get better results from your primary pain relievers at lower doses (current research is suggesting that there's a ceiling with narcotic pain-killers above which higher doses actually act to amplify pain).

It's becoming more common here for people to start a comprehensive pain management plan as early as possible precisely to avoid the situation of them being on escalating doses of narcotics for years and reaching a point where those drugs no longer provide adequate relief but significant tolerance has developed. Pain management teams are no longer regarded as a "last resort" here now but as a specialised service whose early involvement leads to significantly better outcomes for patients.

You're wise to consider the possibility of finding yourself addicted to your pain relievers after you the condition for which they're prescribed has been resolved. It's way easier to prevent developing a love affair with them than it would be to end one.

 

[Silenced]

you know what the doctors say, 'as long as you take it as prescribed you'll be fine' ! ha.

I think, for the most part... it's true. Too many people have addictive personalities and they need to keep themselves disciplined. If you use a regular dose, you don't get 'high'... While you might gain a physical dependence, that's much difference than the emotional attachment.... the love affair with the drug. The OP states that abuse is already present and that's where it starts. I quit years ago and I was using as prescribed as needed and not taking every time I could take. It's when you start taking two instead of one and every 3 hours instead of 4 and it just keeps getting worse does a true problem arise. I quit cold turkey after using for a period of time and I was fine and didn't go back for a couple years. Now, I love the pain relief and I always save enough to get through the month, BUT I get high every moment I can. I started taking more than I was supposed to and start loving the feeling. There's nothing more I'd love to do at the moment than stick a needle in my arm and feel heavenly... but it's just keeping myself disciplined enough to not make it a habit. I still have other battles with it, but that's just one place I don't want to be.

 

[paranoid android]

You will deveop physical dependance while on a decent dose of any opiate for a long enough time (it varies alot from person to person) but addiction is another matter. Many people do not develop any symptoms of addiction from taking opioids such as oxycodone, morphine, fentanyl, etc. But if youve had any type of addiction before and if you take the meds in a way seeking a high your risk for getting addicted definetely goes up. The fact that you eat or snort the gell out of the fentanyl patches is a red flag right there that you will run into trouble with addiction down the road.

In the name of harm reduction i cannot stress just how dangerous abusing fentanyl is. We have lost many BLers to fentanyl OD's and the only time i ever came close to ODing on a opioid was with fentanyl. So please do not eat, snort, smoke or in any other way abuse fentanyl. Take it for pain as prescribed because this stuff is too dangerous to fuck around with. Besides id rank fentanyl pretty low on my list of opioids in terms of euphoria. The high from fentanyl seems to be pretty hollow if that makes sense. Plus the nodding off without warning part is kinda scary and this happened to me a few times while i was on fentanyl for pain.

So yeah while i found fentanyl to be maybe the best opioid ive ever been on for pain i wouldnt even rank it as high as oxycodone in terms of euphoria.

 

[bluedom]

Thanks for all your nonjudgemental replies!

Yes, there is already what I call misuse. As Silenced says, I couldn't do what I am doing now with the pills before I was put on the patch. I'd go through a month's supply (130mg/oxymorphone per day) in about half. This was complicated because I had a tremendous amount of nausea caused by my other meds (which are horrible, not chemo but close to it) so I was throwing up half the stuff I was taking (or so I claimed, and most, if not all, of it was true---the main thing was that it was easy to justify any overuse or abuse). My doctor said he was concerned and I said I was too. So I said I wanted to cut down (this to me is one of the litmus tests about addiction) and he said okay and put me on the fentanyl patch at a total dose that, on an equivalent basis, was slightly less than what I was talking orally via the pills. I then cut down from the patch (first by 50% where I experienced pain and horrible WD and so I went back and cut down again) by 25% (so I ended up on a 37.5mcg/hr dosage instead of 50 and this time the drop down was smooth as cotton, largely unnoticed but not as smooth as silk either). So overall, I went from 130mg/day of oxymorphone to 37.5mg/hr of fentanyl within weeks and actually right now I am trying to get down to 25mcg/hr. Annoying part is just waiting to see if WD will hit since it takes anywhere from 3-6 days for the patch change to be noticed and 6-12 days for the new steady state to be attained. I figure staying at a particular patch dosage for several days or weeks will help my brain adjust to life without constant opiods, get my own endogenous opiod production going with as little stress as possible.

I think if I do all that, even if I misuse the remaining fentanyl in the patches, I'm still on a successful taper (and like I say above, I have been always able to taper off opiods, and I've always had a prescription for whatever I used). BUT:

paranoid android: thanks for your concern. I am scared of fentanyl also. I do have very precise (mcg/mcl) measuring devices and do this carefully (well, good enough for government work but definitely within a +/- 10 mcg tolerance and I'm probably on the conservative side). These are the drug-in-adhesive (not gel) patches. Also, my euphoria from fentanyl when I get it is very very good. Perhaps the "cleaner" nature of the fentanyl euphoria can make it seem sterile but it's there and it's long lasting when done orally (several hours) and it's a close call for me, for oxycodone and oxymorphone (intranasal).

I've no desire to wear multiple patches at the same time, and I am reluctant to save the patches. This is why I posted actually. My thoughts are as follows (and I know it is stupid to overthink/future trip like this but I'm not beating myself up in the head over it): If I cut down to 25 mcg/hr should I tell the doc? Should I stockpile the patches and let the doctor prescribe me the highest amount for as long as I can get it? Or should I use up the patches right away so I don't have a way to to use later (i.e., when I am done with my doctor, it ends for me)? If I save patches and want to just use them transdermally once my pain is gone, I also run the risk of dependency/addiction and this time there's no prescription to save me. What's the point of me saving up patches anyway? If I use it up now now, I'm forming a habit but at least it's done with when I am done with the pain management. (Edited: as I wrote and thought about this, and also read lacey k's message, I think saving up the fentanyl is a bad idea since then I'll have opiates in my system when I'm not supposed to be having them and that could bite me for a variety of reasons (such as getting into an accident) and I'd have no cover. Furthermore, right now what I am doing still keeps me under my prescription, just that since my patches have more than twice the amount of fentanyl left over even after use, and since I've extracted the fentanyl for immediate release, it's like being prescribed extra medications for breakthrough pain which I can get but have fortunately turned down for precisely this reason, that I will take those and STILL extract the fentanyl So yeah, my current plan is to be on the patches until my doctor lets me and then when it's done, it's done.)

Right now the euphoria I chase while I'm on the patch is doable in a non OCD way because I know I always come back to the patch, not zero. it seems to keep me on an even ground instead of the pills .where I always felt I had to pop another one and I always thought about going back to zero. Not so with the patch, for better or worse. The fentanyl from the patch extract (once 3-6 days) is used up in a few sessions. I can theoretically estimate the maximum fentanyl I could be ingesting and, and I can calculate what the exact amount there should be, and even knowing this, every single time I always do an escalation test. Personally I feel fentanyl is okay if treated properly and handled with care, like many other things I deal with.

So, blazelate: I am in some pain (even as I speak right now) and you can call me a wimp but I am definitely that when it comes to physical pain (I however can eat the hottest food in the world without a problem, perhaps all my pain tolerance receptors are in the tongue and stomach rather than elsewhere). The damage to my vertebrae is severe (about 25-50% of L4 and L5 have been eaten away) and the pain is constantly high and it was preventing from executing my plan to save the world, not to mention play with my family and my toddler---she still can't climb on me right now since if I have a compression fracture that injures nerves I risk becoming paraplegic. So I agree with you, I do take as much as off from the meds as possible, But that's my limit in terms of pain and practicality, i.e., I do stuff that helps everyone and it's sort of an excuse but it's true.

I do mix it with other meds to reduce the opiods sometimes but with the patch it's kind of moot since I'm on a steady state (and I think the patch is ingenious) and aside from getting an euphoria every 3 days plus once a month, that's it. I am very good with other things like exercise but I've been advised to take it easy and not move around a lot so I work from my computer 24/7. As lacey k says, if I could trade my pain and illness, as well as all the other associated drugs I take, so that I am completely without the need for medications, I'll take it (you definitely wouldn't want to be on all the other drugs I'm on).

Anyways, thanks guys. It was illuminating for me!

 

[Khadijah]

Take a day off from that shit, try to deal with pain when you can, dont take the drugs unless you need.

You being on drugs alllll the time, when you try to stop makes the pain 10x worse. Try to learn to put up with the pain, people did it for ages before medicine became accessible.

this is unfair and uneducated advice.

Have you ever had the type of pain that requires the kind of medication the OP is on? Do you have any idea how it feels to have pain so severe that it completely changes your life and your ability to live normally?

He wouldnt be taking them at ALL if he didnt need them.

Obviously you got no experience with this type of situation. you dont just "Put up with the pain" that cripples you from being able to walk normally, that keeps you awake all night, that hurts so fuckin bad that you cant even stand up off a chair without someone helping you or without almost breakin out into tears from how excruciating it is. It completely destroys your life, it makes you seriously consider suicide becuz you really cant bear to think about living like this for the rest of your life.

WHY, give me one good fuckin reason, WHY a person in that kind of pain should just "DEAL with it"?!?

This aint a guy with a fuckin toothache. This aint some "meditate and think positive thoughts" shit. You clearly aint qualified to speak on this subject and your reply makes you look horribly ignorant about pain management and why its done. To make a comment like you did, like people on PM are just a bunch of whiney babies who need to buck up and "Just deal with it" is so incredibly ignorant i cant even start or i would be here all day. SMDH.

and , for the record, "back in the day" there was lots of pain medications. Opium has been used since the beginning of civilization to treat pain. 200 years ago there was morphine to treat pain. 100 years ago there was heroin. and so on. You dont know wat youre talkin about.

There is absolutely ZERO reason why a person who is suffering in terrible pain, who legitimately requires medication, should "just not take the meds and deal with it". The entire reason we have pain management is to make life MANAGEABLE for the people whose lives would be unlivable without it. When you got that type of pain, the reason you on meds for so long, the reason you take them everyday, is becuz YOU NEED THEM ALL THE TIME!




To the OP....I dont really see a problem with the shit you are doing. For me, there is never anything left over. The dose Im scripted is less than I really need on most days, so i never take less than my prescribed dose, so i cant help you there as far as how did i use the leftover medication, there never was.

It sounds like you are using the leftover fent in the patches to help reduce your pain in a more effective way and not to get high. you enjoy the high that comes from it, but your primary reason seems like more pain relief, am i right? if im wrong ,then you may have some concerns here, but if its just to increase the effectiveness, i dont really see nothin wrong with that. your behavior aint compulsive and habit forming becuz you 'want to get more, more more , get high, yeeaaa" but just to help manage your pain instead of throwing out the leftovers. that dont sound like addictive behavior to me. IF the reason you doing it is becuz ur pain not becuz you tryin to get high, dont stress out over it.

i think that it aint always as black and white as it seems. if you are scripted oxys and sniff them from time to time to get more pain relief, is that addict behavior, imo, no. the reason you do it is more important than the actual act of doing it. the mindset and mentality behind it is the real issue. your brain dont sound like the addict brain to me, honestly. there is a few things there that might point that way but also things that point towards you not actin like an addict. i think you are in a fair spot right now, but i would have to read more of ur situation to give a real educated reply.

 

[paranoid android]

Saving some patches for actual pain or maybe extra to taper with wouldnt be a bad idea. Though in my opinion once you get down to 25UG patches and decide to taper from there switching to another long acting opiate such as morphine SR, oxycontin or whatever floats your boat would be the way to go. Fentanyl is super potent stuff so people tend to notice drops in doseage more then say with oxycodone. Also it's hard to taper when the patches only come in certain doses (do they make the 15ug patches where you live?) but with pills it's easier atleast in my experience. Granted i do know people that have tapered with the patches and havent had unbearable withdrawals.

Ive only been on fentanyl maybe 3 times or so for a few months at a time. My insurance does not cover fentanyl patches and they are rather expensive so i had to pay out of pocket. Ive only gone through mild fentanyl withdrawal but fuck it sucks bad. I have always switched over to morphine and have had no problems. I have heard of people who have been on really high doses of fentanyl for a long time (wearing 100ug patches plus another one with it) having very serious withdrawals that required hospitilization. But you have to remember these people where on them for years and at insane doses so i doubt very much you have to worry about that.

As for eating the patches there is no safe way to do it. Even if they are the non gell kind the fentanyl is not distributed equally so you can't really judge how much you are getting. So again i can't stress just how dangerous this is.

Also do you find at all that certain brand of fentanyl patches work better then others? When i was first put on the fent patches i was put on the ones with the gell in them and they worked great. I was then given another brand that didnt have the gell in them and i went right into severe withdrawal almost cold turkey withdrawal. It might as well have been cold turkey withdrawal actually. These patches must have been really weak because even though it was the same dose i was sick as a goddamn dog. I have heard of other people complain about certain brands of the non gell ones not working as well either so it seems not to be just me. After this happened and the fact that the patches with the gell in them are damn hard to find i decided they where not worth the hassle and went back on morphine SR.

Another thing i hate about the non gell patches you get here is that they seem to fall off a hell of alot easier. Ive had them fall off in the shower and while ive been exercising. I was once running on the tredmill and when i got off it i saw the patch stuck to the fucking tredmill

 

[Silenced]

paranoid, have you put any tape on yours? I've been using surgical tape to keep them on just because I'm paranoid that they'll fall off. I've had no problem when I've used tape.

I think fentanyl gives a great feeling. I'm feeling the best I've felt in 6 years. It's crazy how numb I am from it... This is better than IV morphine or dilaudid to me right now. No matter how much morphine I've used I've never felt this good... I'm almost wondering if I'm dead and in heaven. . I'm sure it'll wear off because this is a big push from my tolerance.

 

[paranoid android]

paranoid, have you put any tape on yours? I've been using surgical tape to keep them on just because I'm paranoid that they'll fall off. I've had no problem when I've used tape.

I think fentanyl gives a great feeling. I'm feeling the best I've felt in 6 years. It's crazy how numb I am from it... This is better than IV morphine or dilaudid to me right now. No matter how much morphine I've used I've never felt this good... I'm almost wondering if I'm dead and in heaven. . I'm sure it'll wear off because this is a big push from my tolerance.

Ya ive put surgical tape on mine but the fucking patches still fell off! Hell i even wrapped duct tape around it once to keep it from falling off. I would really recomend not doing that unless you want all the hairs on your arm pulled off and abunch of glue stuck to your arm lol. The patches especially the non gell ones don't seem to hold up too good to water or especially excessive sweating.

Fentanyl is a great drug for pain but it is seriously lacking in euphoria. No way can it even compare to IV morphine or even oral morphine much less IV dilaudid in terms of euphoria but thats just me. In fact i think it may have even added to my depression at times. Or perhaps it was just because it was the middle of winter and i was majorly depressed anyway. Looking back it was probably just depression because it was a very dark time in my life to say the least.

 

[Opioid420z]

Just because of your past history of alcoholism I would watch out... Have suboxone or subutex handy just incase for it is a very decent pain killer alone and just incase you run out. Try to potentiate your opioid medications with tools on this site. Pain sux and I feel you on this for I have tmj pain and it sucks after sustaining a hair line fracture. Thanks for that reply on my post bluedom, I wish you comfort and healing of your diagnosis. If your body allows you, try to keep your tolerance at a moderate level, yet this is difficult in most situations....

 

[Silenced]

Ya ive put surgical tape on mine but the fucking patches still fell off! Hell i even wrapped duct tape around it once to keep it from falling off. I would really recomend not doing that unless you want all the hairs on your arm pulled off and abunch of glue stuck to your arm lol. The patches especially the non gell ones don't seem to hold up too good to water or especially excessive sweating.

Fentanyl is a great drug for pain but it is seriously lacking in euphoria. No way can it even compare to IV morphine or even oral morphine much less IV dilaudid in terms of euphoria but thats just me. In fact i think it may have even added to my depression at times. Or perhaps it was just because it was the middle of winter and i was majorly depressed anyway. Looking back it was probably just depression because it was a very dark time in my life to say the least.

Errrr.... I think I've changed my mind just because of what I did earlier.
All I've got to say is.... that shit is scary!
I want to be numb, not necessarily dead!
But, yeah... it's not so much a euphoria as it is just not feeling anything.

 

[Opioid420z]

LOL!!!! Its like.... ohhhh wwwwhhhhaaaauuuuddd is that.... bloood??? ohhh... oh well.... so thats what that dent in the side of the wall is from... haha.. funny? not really... A buddy of mine woke up with a bump on his head... doesn't even remember...

 

[bluedom]

To the OP....I dont really see a problem with the shit you are doing. For me, there is never anything left over. The dose Im scripted is less than I really need on most days, so i never take less than my prescribed dose, so i cant help you there as far as how did i use the leftover medication, there never was.

It sounds like you are using the leftover fent in the patches to help reduce your pain in a more effective way and not to get high. you enjoy the high that comes from it, but your primary reason seems like more pain relief, am i right? if im wrong ,then you may have some concerns here, but if its just to increase the effectiveness, i dont really see nothin wrong with that. your behavior aint compulsive and habit forming becuz you 'want to get more, more more , get high, yeeaaa" but just to help manage your pain instead of throwing out the leftovers. that dont sound like addictive behavior to me. IF the reason you doing it is becuz ur pain not becuz you tryin to get high, dont stress out over it.

Thanks, I was thinking the same thing after my second post where I wondered if I should save patches or not tell my doc or whatever. Right now, I'm always motivated by pain relief but if I have patches and no pain, well, then, that stops being true. As long as I have pain, I have no reason to think I won't be properly treated, so there's no reason for me to have a large stockpile or be deceptive with my doctor at least excessively. He's pretty easy
except requiring me to see him once a month in person for a refill (apparently standard) and sometimes given my pharmacy's ability to refill, weekends, etc. this can put me on the edge.

The patches for me are really a pretty nonaddictive ROA even with the extractions since it's rather self limiting. I don't feel like going to the doctor and saying "I'm all out of patches" halfway through the month. I only extract used patches, and I use my patches on schedule as prescribed, so it's enough for some additional relief of every sort but my body doesn't question whether it is getting enough fentanyl or not.

Oh, I should say it has also been fantastic for my pain management, WAY better than popping pills (even ERs) all the time, etc. All the ups and downs are largely gone once I hit the steady state. Main change is during the time I drink my tea or the day I put it in my nasal spray bottle, but even then, I suspect that my effect is incremental.

I guess the closest "proper" equivalent way of doing it would be to get fentanyl IR preparations like the lollipop or spray, but hey, guess what, that's what I am doing. with the huge amount of fentanyl left over in each patch. Waste not want not I say.

So thanks for the kind support lacey k! After I posted the second time and reading blazelate's and your posts, I was thinking along the same lines. I don't believe this is an excuse or a rationalisation: I'm just using up all the fentanyl left in the patches using novel ROAs and methodology to alleviate my overall situation.

You're right about how it is without opiates. I suffered with this pain (increasing incrementally) for 9 months while a doctor, a physical therapist, and a chiropractor all thought I had a mechanical problem and did their best to fix it which probably only add to the pain (and I'm glad they didn't try too hard since they've rendered me a paraplegic) and then finally my new GP ran a battery of tests and the MRI showed my L4 and L5 vertebrae with holes like "swiss cheese" (pain doc's words), biopsy indicated it wasn't cancer and was treatable (a rare condition of a well known ID---PM me for more details), and I should be done with treatment for it (which is like a chemo for me) in another 5 months, and hopefully by then my back and vertebrae are healing up well on their own but if not, it's more surgery, but I have my fingers crossed.

 

[bluedom]

Saving some patches for actual pain or maybe extra to taper with wouldnt be a bad idea. Though in my opinion once you get down to 25UG patches and decide to taper from there switching to another long acting opiate such as morphine SR, oxycontin or whatever floats your boat would be the way to go. Fentanyl is super potent stuff so people tend to notice drops in doseage more then say with oxycodone. Also it's hard to taper when the patches only come in certain doses (do they make the 15ug patches where you live?) but with pills it's easier atleast in my experience. Granted i do know people that have tapered with the patches and havent had unbearable withdrawals.

Ive only been on fentanyl maybe 3 times or so for a few months at a time. My insurance does not cover fentanyl patches and they are rather expensive so i had to pay out of pocket. Ive only gone through mild fentanyl withdrawal but fuck it sucks bad. I have always switched over to morphine and have had no problems. I have heard of people who have been on really high doses of fentanyl for a long time (wearing 100ug patches plus another one with it) having very serious withdrawals that required hospitilization. But you have to remember these people where on them for years and at insane doses so i doubt very much you have to worry about that.

As for eating the patches there is no safe way to do it. Even if they are the non gell kind the fentanyl is not distributed equally so you can't really judge how much you are getting. So again i can't stress just how dangerous this is.

Also do you find at all that certain brand of fentanyl patches work better then others? When i was first put on the fent patches i was put on the ones with the gell in them and they worked great. I was then given another brand that didnt have the gell in them and i went right into severe withdrawal almost cold turkey withdrawal. It might as well have been cold turkey withdrawal actually. These patches must have been really weak because even though it was the same dose i was sick as a goddamn dog. I have heard of other people complain about certain brands of the non gell ones not working as well either so it seems not to be just me. After this happened and the fact that the patches with the gell in them are damn hard to find i decided they where not worth the hassle and went back on morphine SR.

Another thing i hate about the non gell patches you get here is that they seem to fall off a hell of alot easier. Ive had them fall off in the shower and while ive been exercising. I was once running on the tredmill and when i got off it i saw the patch stuck to the fucking tredmill

Lots of points there, thanks! I'll answer your last question first since I feel I can help the most there. The best patches in terms of fentanyl content is the Sandoz ones (URL below) which have twice the amount of the Mylan brand. So a Sandoz patch contains 4.2mg fentanyl for a 25mcg/hr patch size and Mylan is about 2.5mg total I think. But the Mylan patches are fairly smaller (by 25%) and stick very well! My prescription is for a 48 hour change, and it's rare for me to get the Sandoz one to stick for longer than that (which is okay, since it will have ~3mg!! of fentanyl left over) but the Mylan patch will readily stick for 80 or more hours. I never let water touch my patch---when I shower I put a piece of plastic around it (like the cut side of a ziploc bag) and tape it very tight with tape they use for IVs, etc. If it's hot, place a tissue on top of it to absorb the surroundoung moisture. If all else fails, just tape it back with tape. If you don't get it to stick properly the first time, tape is your best option. But I've taped a patch only 2-3 times and that too just when I started with it.

I've been on opiates for 5 months and on fentanyl for 2+ months.

Okay, back to your first point: I do have 12.5mcg/hr patches, which is how I have my current dosage of 37.5mcg/hr (soon hopefully 25mcg/hr, dropping down as I write). The patches in my view are ingenious and perhaps the best (only?) way to taper down for me. I can't taper down with pills (well maybe I can but I'd need to get a refill every day so no matter what, I don't go off schedule). With patches, I've gone from a high dose of oxymorphone to 50mcg/hr, and then to 37.5mcg/hr without any problems whatsoever. I used gabapentin efficiently BTW to do this (that drug is also quite amazing). High gabapentin doses around the days I expected the drop to hit me (which is really 3-6 days after the dose change) did the trick. Let's see if it'll do it again, I'm kinda excited about seeing what'll happen.

So consecutive use of patches leads to a steady state concentration of fentanyl with very mild variation (as the docs say and how I feel). This means I'm getting a near constant dose of pain killers and I've gotten good enough at it to know when and how much it'll vary most of the time (exercise, sitting in the front seat in a car when it's sunny outside, etc. will slightly elevant dosage and cold can be paradoxical). So any drop in patch change will be far more gradual than doing a similar thing with oral pills. But even then, when I dropped to 25mcg/hr from 50, it was too much for me. I'm talk about trying to do a taper with perhaps no more than 5% inconvenience. (I feel harsh tapers can lead to craving down the road, so I think it's extremely important to let your brain get really used to a new dosage level before heading down again. When I do this, it to me means I'm going to be okay short
AND long term, no PAWS, no depression, etc. I say this based on previous opiate tapers (not with patch though).

What I'll do when I get to 12.5mcg/hr is uncertain. Because of the kinetics of these transdermal systems, you can manipulate the steady state by putting the patch and on and off (this is some work) so you effectively lower the average dose very very slowly. This is the key thing to remember: The 12mcg/hr is an AVERAGE flux, based on average skin and average temperature and average time. At any given moment it could be going up or down but it likely will be steady if you've been on that dosage for a while as I say above.

An easier way to do is to just cut the patch (either physically or effectively). The patches I have are drug in adhesive patches and I'm pretty sure I can keep cutting the 12.5mcg/hrs down to a tiny amount if necessary (ad I will). Main thing to do is decide what to do with the exposed end, which I believe I can fold up a bit (or leave the protective film in place and tape the whole thing). Again, I repeat these are NOT the gel or reservoir patches, these are patches where the drug is indeed uniformly distributed across the area of the patch. That is the logic by which it works (see the packaging insert, see patent for this). This is the info for the patch I use, I recommend people experimenting with these patches to read this carefully:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=11064

Anyways, about oral use, as I said, it's not the gel patch but I can extract the total fentanyl that is present in a patch in a solution and distribute the fentanyl very evenly in there. I mean I can create a 50ml solution with the fentanyl distributed evenly in it and have a very good idea of how much it contains and then just ingest it. See Oxymorphone's fentanyl extraction thread on this very site. I agree it's extremely dangerous but for me it's an acceptable risk since I have training doing this sort of stuff.

paranoid, have you put any tape on yours? I've been using surgical tape to keep them on just because I'm paranoid that they'll fall off. I've had no problem when I've used tape.

I think fentanyl gives a great feeling. I'm feeling the best I've felt in 6 years. It's crazy how numb I am from it... This is better than IV morphine or dilaudid to me right now. No matter how much morphine I've used I've never felt this good... I'm almost wondering if I'm dead and in heaven. . I'm sure it'll wear off because this is a big push from my tolerance.

Yep, it will build tolerance up faster than oxycodone or oxymorphone (I rank them in that order). Each has its own euphoria when you achieve it which isn't guaranteed for me. It's mot guaranteed in that order too. I guess I can say I'll almost achieve the promise of opiates with oxycodone but with opana and fentanyl, it can be hit and miss. With fentanyl, since it's so powerful, you should always miss by going under and if you miss, you can't redose for an appropriate time. So...

I do feel a definite sense of well being, sense of calmness, etc. I should mention I am also on gabapentin which by itself has these feelings too. So together they seem to go very well.

 

[Khadijah]

Just because of your past history of alcoholism I would watch out... Have suboxone or subutex handy just incase for it is a very decent pain killer alone and just incase you run out. Try to potentiate your opioid medications with tools on this site. Pain sux and I feel you on this for I have tmj pain and it sucks after sustaining a hair line fracture. Thanks for that reply on my post bluedom, I wish you comfort and healing of your diagnosis. If your body allows you, try to keep your tolerance at a moderate level, yet this is difficult in most situations....

I wouldnt agree with you that bupe is good for pain...And I aint meaning to down play your pain at all or say "oh your pain aint shit" or nothing like that. But, I aint sure that the pain of TMJ and a fracture is quite on the level of the kinda crippling pain that you can have when you got spinal issues. the bupe mighta worked pretty good for you but it aint very effective at all when it comes to serious pain, ive never met somebody who had severe injuries that really affected their life, to get any kind of relief from bupe....thats just my experience, i know its used alot over in the UK as a painkiller but IMO its shit for pain. So just pointin out that while it might be helpful to certain kinds of pain when you got the major league shit that basically totally disables you from livin a normal life without huge amounts of heavy duty pk's, bupe aint gonna do shit.

 

[stuckinaloop]

Bupe is terrible as a pain reliever.

 

[Opioid420z]

Yea...... Definately not for serious pain an not for somebody with a tolerance. I just wish they made bupe easier to take then those dame orange things. Not to switch up.....

 

[phenethylo J]

Take a day off from that shit, try to deal with pain when you can, dont take the drugs unless you need.

You being on drugs alllll the time, when you try to stop makes the pain 10x worse. Try to learn to put up with the pain, people did it for ages before medicine became accessible.

this is unfair and uneducated advice.

Have you ever had the type of pain that requires the kind of medication the OP is on? Do you have any idea how it feels to have pain so severe that it completely changes your life and your ability to live normally?

He wouldnt be taking them at ALL if he didnt need them.

Obviously you got no experience with this type of situation. you dont just "Put up with the pain" that cripples you from being able to walk normally, that keeps you awake all night, that hurts so fuckin bad that you cant even stand up off a chair without someone helping you or without almost breakin out into tears from how excruciating it is. It completely destroys your life, it makes you seriously consider suicide becuz you really cant bear to think about living like this for the rest of your life.

WHY, give me one good fuckin reason, WHY a person in that kind of pain should just "DEAL with it"?!?

This aint a guy with a fuckin toothache. This aint some "meditate and think positive thoughts" shit. You clearly aint qualified to speak on this subject and your reply makes you look horribly ignorant about pain management and why its done. To make a comment like you did, like people on PM are just a bunch of whiney babies who need to buck up and "Just deal with it" is so incredibly ignorant i cant even start or i would be here all day. SMDH.

and , for the record, "back in the day" there was lots of pain medications. Opium has been used since the beginning of civilization to treat pain. 200 years ago there was morphine to treat pain. 100 years ago there was heroin. and so on. You dont know wat youre talkin about.

There is absolutely ZERO reason why a person who is suffering in terrible pain, who legitimately requires medication, should "just not take the meds and deal with it". The entire reason we have pain management is to make life MANAGEABLE for the people whose lives would be unlivable without it. When you got that type of pain, the reason you on meds for so long, the reason you take them everyday, is becuz YOU NEED THEM ALL THE TIME!

That is 100% true, you took the words right out my mouth lacey. I have to deal with horribe constant chronic pain in my entire body every day and have to be on opietes all the time. Because of my condition they are medications that I need to live my life. It annoys me when people say just go with the pain. There is a world of differnces between being actualy adicted to a drug and your body being phyicaly dependent on it.