How to avoid addiction while on pain management?

[bluedom]

The pain posts reminded me of how life was before I went on the opiates. I suffered about 9 months of pain before that continually increased. In the last few months, my back muscles started to spasm, and this was when tears would roll out while I waited for what seemed like forever for the spasm to end. Of course walking suffered but in my view the worst part of pain or any other invalid condition is when you can't wipe your own arse on the toilet (I'm lucky enough to be married to an awesome woman). THAT is the utter indignity.

I don't have much of a problem with blazelate's comments though. I am lucky enough to have compassionate doctors, but chronic pain is somewhat like addiction. Unless you've experienced it, it's hard to say what it is like. There was a time in my life when I was more like that, able to say "I can tough this out". The fact I can't now isn't a good condition to be in at all and I'd trade all the opiates in the world to be healthy enough to just say "I can tough this pain out."

It's a different universe right now. Funny how your mind seems to forget all the bad stuff when it's done (at least mien does).

 

[paranoid android]

Bupe isint a good painkiller? I thought it would be. Hmm I know in Australia they sometimes use buprenorphine patches for pain and i was going to recomend it to a friend of mine down there who is having trouble with hydromorphine (not controlling the pain very well, it seems to be making her depression worse, etc) but maybe i won't now. She has a much lower opioid tolerance then i do but i don't want her to wind up in even more pain then she is now.

Ive heard that it has more anti-depressant properties then other opioids is there any truth to this at all?

Sorry for going way off topic OP

 

[Khadijah]

Bupe isint a good painkiller? I thought it would be. Hmm I know in Australia they sometimes use buprenorphine patches for pain and i was going to recomend it to a friend of mine down there who is having trouble with hydromorphine (not controlling the pain very well, it seems to be making her depression worse, etc) but maybe i won't now. She has a much lower opioid tolerance then i do but i don't want her to wind up in even more pain then she is now.

Ive heard that it has more anti-depressant properties then other opioids is there any truth to this at all?

Sorry for going way off topic OP

Its a fucking terrible painkiller, P_A, it really just sucks, its total crap.

Not only that but for me, and for lots of people I know who had been on it, it was the OPPOSITE of an anti depressant. And i aint sayin I was depressed becuz I was off dope at the times I was on it. i mean like i was MORE depressed ON the shit, than I was when i was dopesick with no bupe.

If you took away the physical part of it..like say that we aint talking about the physical pain of WD but just comparing the emotional state of bein on or off bupe, i would rather choose being off it.

Seriously the shit was like a super-suicide-depressant. It was fuckin HORRIBLE. The shit just made me wanna kill my damn self, and it wasnt the PAWS or the withdrawal or the fact that i was sad that i didnt have dope. it was like taking bupe actually made me more depressed than I was when i was just kickin without it. It was weird shit.

I know it helps a LOT Of people....I know that for many people, bupe is the drug that helped them get off dope and get a normal life...so for them, I am glad that it helped them...but for me? Fuck. I hate that shit with a fuckin PASSION. Its the most useless, worthless, crap-ass piece of shit waste of time and money that I ever dealt with. I aint got enough words to describe how horrible it was for me to be on it. In constant, constant pain (that was before i found a doctor who put me on medication) always MISERABLY depressed and on the verge of just jumpin into the middle of route 80 everyday, fuck,it was just terrible. I despise that shit. I would never recommend it for pain, or anti-depressant, to anybody.

I know that some people it helps just like the methadone that Im on been a god send to me and saved my life--that for some people it has that effect on them. So im glad its like that for them.

But i CAN tell you that my experience with it being total shit for pain, aint a subjective one. I aint met many people at all who think its a good painkiller.

The only ones that i have talked to that did think it was helpful for pain, was people with low tolerances and low amounts of pain. Definatly not for people with chronic pain that needs PM. To switch somebody from somethin like opana or dilaudid to bupe, my god you would have to be outta your fuckin mind. (Not you, i mean any doctor that would do that.) For tapering maybe but for long term, maintained pain control? No way. It would never come even close to cuttin it in a million years.

 

[bluedom]

Bupe isint a good painkiller? I thought it would be. Hmm I know in Australia they sometimes use buprenorphine patches for pain and i was going to recomend it to a friend of mine down there who is having trouble with hydromorphine (not controlling the pain very well, it seems to be making her depression worse, etc) but maybe i won't now. She has a much lower opioid tolerance then i do but i don't want her to wind up in even more pain then she is now.

Ive heard that it has more anti-depressant properties then other opioids is there any truth to this at all?

Sorry for going way off topic OP

No worries man. I can answer that theoretically at least since it was considered for me. Buprenorphine is an alternative for those who don't want the fentanyl level potency and really for those who are either addicts or prone to addiction. (Some enlightened pain management doctors don't believe addiction necessarily rules out medication of pain by opiates.)

The transdermal patch is supposed to be good for chronic moderate pain. My pain level was determined to be too high for it. I'm not sure about pills actually but the patch is an interesting ROA.

--

Created a great fentanyl intranasal recipe though. To be posted on the fentanyl patch extraction thread started by Oxymorphone, but it involves nasal spray solution (the best is actually Nostrilla which contains dilute HCl), microlitres of (distilled) vinegar, IPA91, and hot water.

--

Now on 25mcg/hr patches! Pain fairly well controlled. Actually the patches + the IN extract if available commercially would preclude a need to extract the patches. I've now reduced my TOTAL fentanyl usage by 50% since I started 2.5 months ago with barely any WD and some pain treatable by celebrex/ibuprofen + tiazadine. So I'd say this isn't consistent with addictive behaviour.

 

[Sentience]

Chemical dependency is not possible to avoid....just dont be using it to get high....use OTHER drugs to get high. If you want to get high, smoke some weed. Dont fall back on pain meds to get high.

Use the pain meds as directed for their intended purpose, and if you must get high, use something different that is not so addictive...like weed.


Thats the best advice I can give....some level of dependency is not possible to avoid though....but you can keep it under control.

 

[dirtyoldman]

pain

Hi,

at a level you will be are addicted... at least physically.

but if it controls the pain and you're not abusing it's OK

 

[bluedom]

Well, I just want to revive this thread since I feel the urge to talk. So I'm still at the prescription of 37.5mcg/hr patches. But the patch I need to wear is 12.5mcg/hr. Yes, I've cut it all down to that but sometimes the pain can get ahead of me. Being the smart ass that I am, I've perfected the extraction system from the patches for intranasal use that I think helps me with some breakthrough pain and I shouldn't have done it but I've never gone over my prescription dosage per day (say) and definitely cumulatively. The thing is that I travel a lot and I plan to travel all over the world in Mar/Apr that'll just kill me which is why I'm holding on to the higher prescription patches. (Extracting stuff isn't easy anyway when you're on the road since it really involves heating and cooling with near pure alcohol.) The thing about the extraction is that even though I can get the more intense experience, for example, 1000mcg (1mg) of fentanyl intranasally in a short calibrated period***, I feel I waste a lot of it and that in the end, I probably throw away about half of the fentanyl that's in a patch. This simply has to do with the nature of the transdermal system which just sticks on there and keeps the delivery rather consistent over time after reaching a steady state, whereas with the intranasal use, even though the bioavailability is almost as high, most of it just slides down my throat and down the stomach where it's still 33% bioavailable (and I can feel it since my extractions are very good).

Anyways, yes, it's dependence, not addiction. But man, with the gabapentin, the stuff is really potentiated.

I've decided that however, until my travelling, I don't need the higher patch doses, so I'm just going to "taper down" myself in the next few days (this week) to just the patch and not the intranasal use anymore. Which is why I'm writing of course, just as a means of saying "okay, this is it." I'm setting myself in a situation where I have to do this (all my high concentration extractions will be completed this week so I have only very weak concentrations and I guess I could make them high again but it's a lot of work and little gain for the pain).

I'm worried somewhat about pain control since my stomach can't handle anymore celebrex or ibuprofen or anymore of these NSAIDs. No tylenol for me either. So opiates are all I have for pain control. Outside of pain control, I'm not worried about WD symptoms TOO much since I have the gabapentin (I swear I could just take that and stop the opiates all together and feel just fine) and the very weak extractions. But if anyone has any tips that's going to help me with the stop, I'd appreciate it. I'd say I have enough high IN extractions through Thu perhaps. I'll sleep all day Tue, and Tue night I have to prepare for a talk on Wed so it will be close to nonusing (yes, I can do this since I seem to have control over my use at least), and then I can take it easy the rest of the week and let the dice fall where it may. And then after Thu, it's very weak stuff and gapabentin plus my 12.5mcg/hr patches to get me through for another week or so until I start my travels (when I get a refill).

Like I said, mostly because I need to express something to someone. I should do one of these AA online meetings or some thing like that.

*** Finally, no matter what I do, my pain is never fully controlled. I mean I could prepare a 500mcg/ml solution and slowly use a couple of ml over an hour or so and that does wonders for my mood and pain and but that's getting the pain to between 1-3, never a 0. I think I have to fix my spine problem which won't occur until I return from my travels.

**** If there's any concern, I appreciate it. I'm a quantitative scientist (among other things) and I was trained to do wet work and what I am doing is better than "for government work".

 

[Lady Codone]

Taking high doses of pain meds daily will lead to physical dependence and withdrawal when stopping. There's not much that can be done about that. While withdrawal sucks, it's the psychological dependency that's likely to lead to behaviors typical of an addict, such as neglecting responsibilities, binging and overdosing. Using pain meds for the euphoria/relaxing high they give is way more likely to result in full-blown addiction than using them strictly as needed for severe pain.

The trick is in not justifying overuse of pain meds by telling yourself you need them when you mostly just want them. Chronic opiate use can lower your threshold for pain, which creates a vicious cycle in which you actually DO need them more often.

My best advice is to make a dosing schedule and stick to it, allowing for "emergency" doses during periods of intense pain only. Use other pain management methods (heat, OTC painkillers, marijuana, etc.) so less opiates are needed. Exercise regularly, even though it may hurt to do so, and don't push yourself beyond your physical limits.

 

[bluedom]

Thanks, words of wisdom I can never get tired of hearing. This is why've decided in a sense to hell with it and only keep a very low concentration mix of the fentanyl extracts and be done with the high concentration mix. I guess the only thing I dont know what to expect is when the higher concentration of fentanyl disappears from my body in terms of pain.

I've not gotten past the point of proper pain management yet (who does?) really but the problem as you say is that it is a vicious cycle due to tolerance. In many chronic pain situations it seems that the pain gets ahead of the tolerance, so then where's the out? No amount of drug is ever enough it would seem. So I'm determined to kind of step back at least just for now. My next refill is in 20 days and I can decide what to do the but for now I just need to know I can step back when needed (hopefully one day in the future it will be).

Taking high doses of pain meds daily will lead to physical dependence and withdrawal when stopping. There's not much that can be done about that. While withdrawal sucks, it's the psychological dependency that's likely to lead to behaviors typical of an addict, such as neglecting responsibilities, binging and overdosing. Using pain meds for the euphoria/relaxing high they give is way more likely to result in full-blown addiction than using them strictly as needed for severe pain.

The trick is in not justifying overuse of pain meds by telling yourself you need them when you mostly just want them. Chronic opiate use can lower your threshold for pain, which creates a vicious cycle in which you actually DO need them more often.

My best advice is to make a dosing schedule and stick to it, allowing for "emergency" doses during periods of intense pain only. Use other pain management methods (heat, OTC painkillers, marijuana, etc.) so less opiates are needed. Exercise regularly, even though it may hurt to do so, and don't push yourself beyond your physical limits.

I just decided to screw it, and took off my last 12.5mcg/hr patch and didn't put one on again and don't intend to (yay to every day or twice a day showers again . I have been tapering down the patches from 50mcg to 37.5 to 25 to 12.5 over the last 3 months without much problem with WD and some problem with pain (nothing compared to what I had when I first started and really the worst was when I pushed myself and that's what I believe never let me get away from the pain). And all I am doing with the last dose is prolonging the inevitable and increasing the intensity of my dependency (if that's possible, meaning that the longer I stay on a 12.5mcg/hr patch, I'm going further along the continuum from dependency toward addiction). I still have a few patches and fentanyl extracts left so it's not totally cold turkey but it will remove me from the need to use patches and then when I see my doctor I can decide what to do for the next month or two.

The last time I tried this, I got my abuse of pills under control and had a good Thanksgiving/Christmas of moderate use of my Fentanyl. Some nice people here helped me out. Hopefully the pain and WDs are manageable. But it did permanently cut my usage going from 130mg/day of opana to 37.5mcg/hr prescription and now to 12.5mcg/hr patch with some extracts. Let's see what happens this time.

And whatever little euphoria I used to get has lost its charm. Like all drugs. I think the warm "hug me" euphoric effect is best obtained I think the first time and then after longer breaks.

 

[panic in paradise]

^
this has been a thought thats stayed on my mind for a while now.
amongst other things drugs&PT, i take opiates; when i used, opiates were always something i would always keep an eye open for - but remained a chipper with it for the most part, everytime my tolerance got to high, it seemed a waste of, bliss..?

now with this reactive sero-negative spondoapathy autoimmune d/o, and a awful adverse reaction to a TNF-pain blocker(and many many other odd drugs), that has left me wasted and in 24/7 pain, i am on the things for life.
as well as TNF's and lastly Mmj.

now, after taking my dose of oxy, if i do start feeling a "high", it feels more like the lame expressions i would hear from people like my mom, "oh this is making me feel drunk and woozy". the difference between drunk inhibition, and opiate induced euphoria was stark to me. now though when it hits me i feel heavy, drunkish, bothered having to stop what im doing sometimes and wait, medicine-head like.
im not saying dysphoria, but more full of medicine rather then blissed.

from this i recall when i started smoking weed, and others did too, that i would explain to people who showed side-effects but not its high; that they couldnt feel it because they didnt know what to look for yet - sound mostly false...

with this situation though, the idea about the 1st few marijuana experiences and not knowing what to look for seems a bit validated. i or we taking the drugs for ire-tractable pain have a very strong drive and motivation behind our dependency, and its something that takes an impact on most everything we do everyday.
when relief to feel like you have value to your loved ones and society is your goal, the high does hamper your ability further to plan or perform the daily grind, so its relation is then one of a temporary inconvenience, frustration, or apathy.

ik, maybe our new association changes the overall physical perception of its effect.?.

 

[bluedom]

To part of your post, I say exactly. The "high" I feel is very zombie-like. Right now I'm tired from little and sleep and am using my "extract" and all it's doing is making me sleepy and holding me back from enjoying the company of my infant daughter (who's awake) and from doing my passions (which have slowed down a bit but many will argue I am so the opposite without it that I could afford to "slow down").

But the rest of what you write, I am trying to figure out what you mean (not said in a bad way). Not sure what you mean about weed since weed makes me feel really off. It induces anxiety and paranoia in me I think to a point that it's scary. If there's a drug that's really so NOT for me, it's weed and I have had decent experience with tinctures and cookies but just at the right dose. Too low, and it's pointless and too high, it's a disaster. I've thought that I was going to die from too much week (cookie, perhaps one more than I should've had but just 2 total). Same thing happened again a couple of years later with just one strong cookie and this time I was more aware that weed couldn't kill me but it was that same feeling, like I had been poisoned that I had taken something bad, etc. So yeah, you can say I had a bad trip with weed which I've not had with any other drug and I've tried a lot of them, including psychedelics.

Not sure also about this: "when relief to feel like you have value to your loved ones and society is your goal, the high does hamper your ability further to plan or perform the daily grind, so its relation is then one of a temporary inconvenience, frustration, or apathy."

?

It's the anxiety though, which I hope I can get some hydroxyzine for tomorrow. When the anxiety hits during WDs, the pain and the WD seem much worse than they really are. It's like the end of the world even with mild WD. I've found gabapentin so great for this BUT the tolerance for gabapentin is high and used at the wrong time, incorrectly, it isn't useful. (Meaning that there needs to be tolerance for it at the time the anxiety hits which I am trying to do by not using gapapentin very much until I start to go through WD which isn't going to happen quickly with the patches and also with the "dribbling" of the fentanyl extract I have---see the trap you get stuck in?)

But as others have said here, 12.5mcg/hr is NOT a lot, and even 50 isn't a lot and I have a reasonably clear schedule the next 10-20 days or so and now's the time for me to get out of this mess and at least regain my confidence.

I think time to hang out with my daughter.

 

[panic in paradise]

i was referring to marijuana to try and help establish more ground on how our minds perceive a mental drug induced affect.
the same with ones family, society, quality of life and self worth being contributing factors towards a chronic pain patients motivation, view of, and intention taking a substance. these goals are much different then achieving a high, this doesnt always happen so im not trying to bonify the placebo affect here or nothing; seeking, and expecting only a high; or to get 'well'.

IME at least, going through both of these mind-sets and situations, the euphoria does seem broken down as its not the goal, and prevents me from being comfortable at a dose range where the pain is manageable.
ATM, having to close an eye every so often to straighten out the sentences, is not cool, nor does it feel good, hahah.

~~~
but im not laying in bed grinding my teeth, being blinded with waves of bright white light wishing id vomit.

 

[bluedom]

Okay, it has been 75 hrs since I took off the patch, and no WD and feeling the bliss of a moderately high (2.5g) dose of gabapentin. I hope this works and I don't sometime experience the anxiety where I have to go to the ER!

I am going to call today to see my doctor which MAY mean I might get back on the drugs right away but right now I am not not on it and feel great and perhaps I should take a break but with my doc, I have to take the appointments I get (which can be today or two weeks away). (And once I get the prescription, it's a huge distraction to wait.

Suppose it is the case that I've managed to taper off, then what's a good plan to restart? Obviously taking it easy on the prescription pain killers would help but I tend to binge a bit. I've found binging and stopping works in terms of not developing a dependence.

Wish me luck. What a stupid situation to get into. (Not my choice this time, which is a good thing.)

 

[panic in paradise]

what im wanting to try, for all sensible reasons for long term/life long hopes in management with opioids, is Methadone and a simple short lived something/non-Oxy, for break-through pain, this in my research seems to be what people tolerate in the long-run.
i personally would not be comfortable with Fentanyl or a patch in general.
if you dont need opioids man, drop them asap! i honestly would, but it takes 3, Mmj, Humira, and Op's, so be it...
but to not have to worry or have them in your system would be great, and that under-stated surely.

you can do this, its this brutal week or so for so many better days!
im sorry you have to live with pain, but try and do what you can to manage your
quality of life as well. while knocked out in pain, or w/d, use that time and energy to learn, and explore your mind - you should have a deep specific energy to do so.


let us know how you are, no matter how awful - ehehe.

 

[bluedom]

"need" is subjective, no? I can live without them as long as I am inactive. But to carry my daughter and play with her like normal, to give my talks standing up for 2 hours straight, etc. I need some pain killers and I think I'm ruining my stomach from celebrex and ibuprofen. And like it or not, the fentanyl patches are very effective pain killers.

What I do is cutting edge science (so always learning and exploring), and I manage a group of 20-30 people doing it and we're in the middle of some great discoveries so I'm hypomanic with or without the opiates. Plus a few other projects. So the "extra energy" might just put me over the edge of anxiety.

But at 78hrs, I'd like to think I'm over the physical dependence. I might be psychologically dependent since I'm planning on the series of actions and words for my next doc's appointment. Of course if I was that dependent, I could've done this on Fri morning and not have put anything to test. I think I've made the right moves to date and effectively I am off the frigging patch with minimal pain thusfar.

But now I'm saying "now what?" I have this world trip to 4 countries in Mar/Apr that I somehow feel I'd be hard pressed to survive without opiates in terms of pain (all the flying and the bag carrying and just constantly moving around). I could resolve now to do without the opiates and then find in the middle of the trip that I am screwed. And I just don't have enough self will to have the prescription and not use it. I obviously do okay with not having the prescription in the first place (always have).

Anyways, I think it's the gabapentin that has let me get away without much WD. I could just take a lot more of it and just sleep, along with tiazedine. Just random anxiety attacks that happen during sleep...

 

[bluedom]

I am still doing good at 100 hrs. Very mild effects, if any at all. Not bad at all if I pulled off a really successful taper.

I get my refills again in days at the latest (perhaps today). Lots of fentanyl, opana. But this time I decide how I use it (if at all). The problem is future travel where the pain will not be easily tolerable and I need to be on top of my game.

 

[LectronicStim]

How are you doing ?

How are things going for you today? I do have a question for you. I read your entire thread and I can't quite understand why you want to go without the patch. You have what sounds like some pretty rough chronic pain that can and should be treated. It seems to me that the fentanyl patch is working very well for you. When you get off it completely you will suffer from the pain that has been blocked by the opiates. It's going to hurt you badly in the long run. Why stop?

 

[bluedom]

Thanks for asking! At ~120h, I am still doing well with the mildest of WDs like sneezing or sniffling. I had goose bumps for the first time, and a warm shower felt great for the first time. I just feel mostly weird, dysphoric even, and I've been sleeping a lot in a haze of gabapentin (to which I've developed utter tolerance---7g does absolutely nothing so I'm cutting that down), and tizanidene (I take this, gabapentin, and NSAIDs for pain outside of the opiates). So in a sense a lot of nervous energy but at the same time feeling like wanting to staying in bed. Poor appetite. Lots of nervous energy. Very little anxiety (maybe because I took 1.5mg of clonozepam at 48h off my last patch removal, I don't have any more).

But nothing so bad I can't get up and get stuff done if I need be. In fact, it's more the mind than the physical body. I'd say I'm doing pretty damn good compared to the first time I tried to just go from 50 to 25mcg/hr in one shot where I felt this crushing anxiety and felt like I was dying.

To answer your other question, to be completely honest, I've been addicted to alcohol before and that was a bad situation where I simply couldn't stop no matter what happened. I am and have been really afraid of something like that happening here so what I've been doing (and no one can say this is a good idea but it's what it is) is testing myself, stopping and starting, stopping and starting, to see if I can still stop using opiates. (As far as I am concerned, that's what separated my initial moderate alcohol use with abuse and later addiction---I simply could NOT stop drinking once I started without external detox).

So there you have it. That's why I want to see if I can get off the patch easily, because of my previous addiction to alcohol. I will get my patches again in a few days and I will probably use them and my pain issue should be resolved in about 3-4 months (hopefully without any surgeries---what I have is a complete curable condition but takes about a year) and then after that I hope to finally stop. So this is part of that saga.

Comments, thoughts on that welcome.

How are things going for you today? I do have a question for you. I read your entire thread and I can't quite understand why you want to go without the patch. You have what sounds like some pretty rough chronic pain that can and should be treated. It seems to me that the fentanyl patch is working very well for you. When you get off it completely you will suffer from the pain that has been blocked by the opiates. It's going to hurt you badly in the long run. Why stop?

 

[LectronicStim]

Patches? We don't need no stinking patches!!

I guess I can understand why you would be afraid of addiction given your past. However, if your treatment returns you to life with no pain you will need to come off the patches ayway. You will need (and probably want) to get off them regardless of your "test runs". You can then just do it safely with a step down and then maybe even cut the patches down to as small as 1/8th. I feel you might be putting yourself through the trouble of all these "test runs" for very little worthwhile gain. As you know, the fentanyl will get you in the long run if you just cut it off cold turkey. You mentioned earlier that you felt like you were dying when you just cut down from 50 to 25 MCG/hr. Hopefully your doctor is not so cruel as to expect for you to immediately stop with the patches when your pain is resolved otherwise.

Personally, I felt like I was dying when I was on the patch full time. It's been too long for me to remember the strength but man I felt like I was in WD contantly. I was sick for two months straight while trying that stuff out. I was prescribed the fentanyl because like others have mentioned I was taking a month of my percocet in less than three weeks and sometimes even quicker. After the patch debacle I was on methadone for a couple of years and it worked pretty well for at least 20 of the 24 months. There was very little of the misery associated with the waxing and waning of the transdermal patch. It's funny that you mentioned riding in the car because I almost always put my patch on my mid back or lower shoulder. When I sat back in the car seat I would get a major medicine boost in about 10 minutes. That fentanyl must process through the body very rapidly.

Anyhow, I wish you the best and I hope your treatment for your condition does indeed resolve your pain forever. Good luck.

 

[bluedom]

^Thanks!

At past 5 days, I am feeling amazingly dysphoric I have to say. I just want to sleep even though my mind is extremely active. So it's like I want to do hundreds of things (as usual) but my body doesn't want to respond. I guess this is what people say depression would would be like, but I'd go further and call it dysphoria. It took me effort to get up to write this email (and this is with the laptop on my bed) but once I started writing, it just flows though I'd like to stop and go back to sleep.

Is this normal?