Opioids PM - Switching from Oxymorphone and Zoloft to Subutex

[muvolution]

Ok, so for various reasons I have become extremely dissatisfied with my Pain Management treatment, and I have been on various anti-depressant medications, none of which have worked. I have an appointment with a Psychiatrist who is liscenced to prescribed subutex/ suboxone about a month out.
My hope is that the Subutex will work better for my pain ( I need about double what I'm currently getting for Pain Management to be effective. I don't think it is reasonable for my doctor to expect me to be at a "5 out of 10" all the time instead of a 8-9 out of 10 on the pain scale. I would feel much better at like a 2 or 3 on the pain scale. Also, I have run through so many anti-depressants of so many types I have lost track and none have worked, so I am hoping that Subutex will work for me (there have been multiple drug trials showing Bupe to be effective for cases of clinical depression which are unresponsive to traditional treatments).
So... I am not going to present this to my doctor as an issue of opiate dependence (yes I have become dependent over time, but I can stop without significant withdrawal symptoms - I don't seek out drugs when I am out, so I would say I am "dependent", not an "addict") but rather as an issue of improper pain management and a desire to go into a clinical "grey area" with one pill taking the place of two for treatment of pain and depression.

Suggestions? Thoughts? Do you think I will be successful?
Doses are 100mg Zoloft/ day and 30 mg Opana IR/ day (10mg every 8 hours)
I am 170lbs, adult male, don't rink or smoke, enjoy some marijuana once in a while (though I'm legal since this is Colorado) Other drugs are 10mg Diazapam twice a day.

What do you guys think? Thanks...

 

[hydrochron]

So if you want my opinion it would be a terrible idea, you should go find a new Dr., that knows how to control your pain and depression.

 

[Captain.Heroin]

You are going to want to take a fairly decent amount of time to taper off of sertraline.

Yeah I think buprenorphine could work quite well for you. Oxymorphone tends to be a very hard to quit using opiate though, keep this in mind. You will want to taper very carefully with oxymorphone as well.

 

[hydrochron]

Ok so your trying to manage pain and depression. Suboxone does help with depression, however full agonist work even better. And depending on what kind of pain you have it might not work for that.

Have you thought of trying methadone?

 

[jamesBrown]

Ok so your trying to manage pain and depression. Suboxone does help with depression, however full agonist work even better. And depending on what kind of pain you have it might not work for that.

Have you thought of trying methadone?

thats interesting.....ive never heard of methadone being used for depression. I guess since its an opiate(and a full-agonist) it would work to some extent atleast, just like any opiate can cause anti-depressant qualities.

 

[BlueberryfishY]

The Subutex/Suboxone will work very well for anti-depressant problems, on the other hand.. with you being on Opana it probably won't do much if anything for pain, also it's a good thing you aren't on a high dose of Opana cause that would make things MUCH worse.

Give tramadol a try, i went thru all the anti-depressants you have and none of them worked, only tramadol. so give it a try, it might help a bit with the pain you have also since it's sort of an Opiate, but very very weak.

Strange that the Opana isn't helping with the pain/depression, but i assume you eat them as prescribed and don't abuse them as Opana is amazing insulfated for pain and depression, but yeah even though you are on 30mg'a a day of Opana wean off them very slowly cause the withdrawals are very intense.

I wouldn't advise on trying methadone for anti-depressant, give tramadol a try first, you should have no problem getting that prescribed, i think you can even order it online, but anyway hope it works out and all, good luck.

 

[BlueberryfishY]

You are going to want to take a fairly decent amount of time to taper off of sertraline.

Yeah I think buprenorphine could work quite well for you. Oxymorphone tends to be a very hard to quit using opiate though, keep this in mind. You will want to taper very carefully with oxymorphone as well.

^^ Very true, even the sertraline had horrid withdrawals if stopped quickly. brain zaps, twitches, and extreme rebound depression, so like ch said take it slow with that.

 

[muvolution]

You are going to want to take a fairly decent amount of time to taper off of sertraline.

Yeah I think buprenorphine could work quite well for you. Oxymorphone tends to be a very hard to quit using opiate though, keep this in mind. You will want to taper very carefully with oxymorphone as well.

yeah, I've actually already started my taper and am down below 50mg. I have been on and off so many SSRI's SNRI's an tetra/ tricyclics that I am pretty used to the taper, and actually find it really helpful to quit at about 1/4 my dose, switch to tramadol for about 8 days and then quit completely, I have never experienced significant antidepressant discontinuation syndrome using this method. I don't know, it just works for me.
As far as OM, I have been running out about 7-10 days early because, well, my pain isn't being managed properly so every month I withdrawal from it, and actually don't really experience significant Acute Opiate Withdrawals anymore. The PAWS can be kinda uncomfortable though.
I have no idea why. My body chemistry is weird. I think it has something to do with being an endurance athlete with fairly low body fat.

I really appreciate the responses, keep the suggestions coming.

I have considered methadone, but if I am going to stay on a full agonist, I'd rather it be OM. It is Thebaine derived, and I can tell that it has some anti-depressant properties, but I'm not about to ask a Doc who isn't a PM expert to prescribe me 60mg of instant-release Oxymorphone/ day.

As far as switching doctors, my orthopedist only works with one PM clinic and I can only move around within the practice, and they dictate that I get drug-screens every 2-3 months which cost $500 per and insurance only pays about $225 of that. It's rediculous...

I guess switching to a new PM doctor and having her chew me out about my pain not being that bad (how would she fucking know???), tell me that 60mg OM was WAY too much, and having her halve my daily dose right off the bat, as well as a full interrogation about my PM history going back 2 years (I don't know what pills I was on two fucking years ago or how much, what an unreasonable expectation) was just the tipping point and I want nothing to do with these fucking people anymore.
I guess because my injuries were sustained while skating professionally they aren't as valid as some 50 year old who hurt himself on the job or someone of a similar age who hurt themselves playing football or some other fucking All-American bullshit like that.

 

[muvolution]

Blueberryfish,

Thanks for the response.
I've tried Tramadol pretty extensively and it works well for AD but doesn't do much for the pain, and I hit my daily max (400mg) pretty quickly. Nycunta makes me very sick. I don't know why the PM doc is such a bitch (i think it's because her name is Gretchen, what a terrible name) but I have shown great flexibility and willingness to try new things.

As a note, I do occasionally insuffulate the OM when the pain becomes unbearable. And yes, I could def. see how it would be the fucking bomb recreationally, but I try to keep it strictly medical as much as possible.

 

[Captain.Heroin]

Ok so your trying to manage pain and depression. Suboxone does help with depression, however full agonist work even better. And depending on what kind of pain you have it might not work for that.

Have you thought of trying methadone?

Buprenorphine has better antidepressant qualities than full agonists IMO.

Full agonists tend to make people edgy and aggressive.

 

[muvolution]

CH, or anyone else, have you experienced depression and find that the Bupe helps, or do you feel relatively normal and it just gives you a sort of "mood lift"(whatever the fuck that means)?

As far as insuffulating OM, i'm sure I could switch to using it nasally and stay on my current regimen, but i'd really rather get proper treatment. Do ya'll think it's even worth the hassle?

 

[Cane2theLeft]

^I don't have personal experience but 'feeling relatively normal and it giving some sort of mood lift' seems to be a fairly accurate description of what people who experience some AD effects of bupe have reported... but this effect isn't universal and probably more common with lower doses.

If you need to legitimately manage your pain, I can't discourage you forcefully enough from insufflating your medications. Whether you intend to abuse them or not, the peaks and valleys alone that this will cause will encourage abuse... this is from one CP patient to another.

Keep in mind, you can take tramadol with the buprenorphine and many report even better antidepressant effects from the combination *as well as* synergistic analgesic effects.

Methadone of course is always an option, but for obvious reasons (liquid handcuffs... ) I'd pursue other avenues first.

If the depression is really problematic, I suggest talking to someone to try to work on alternative coping strategies and delving more into the origin... even if you *think* you know why you're depressed, often times people are off base or even when they're right, talking to someone can still change their perspective and be beneficial.

I'd give similar advice for the pain- there are LOTS of ways to manage pain instead of or as compliment to opioids and I'm sure you haven't exhausted every single avenue.

 

[SkagKush]

bupe has worked for depression for me, dont get me wrong im not diagnosed depressed.....

but im not ever down really, i dont need to worry about getting sick.. etc.

life is good.

 

[muvolution]

for those of you who said that bupe has worked for depression for you, are you on Subutex or Suboxone? I am worried about effects from the naloxone in the Suboxone.

 

[hurtin4certain]

Strange that the Opana isn't helping with the pain/depression, but i assume you eat them as prescribed and don't abuse them as Opana is amazing insulfated for pain and depression, but yeah even though you are on 30mg'a a day of Opana wean off them very slowly cause the withdrawals are very intense.

I can concur with this statement. those sent me through absolute
hell last sunday, monday and tuesday. never have felt like that before. roxy's, hydro's etc dont do that to me.

 

[hydrochron]

Buprenorphine has better antidepressant qualities than full agonists IMO.

Full agonists tend to make people edgy and aggressive.

That's interesting, I actually got edgy /aggresive on suboxone quite often, which is one of the reasons why I quit. Somtimes I get it with full agonist, very interesting point though, I do not like getting opiate rage at all, it's my down fall when i'm around people if I get it.

Suboxone does work for depressed people though, so i'm not going to argue that. But it doesn't really work for pain, and I also think that the anti-depresent effects are from taking smaller doses.

I wouldn't recommend any opiate for deppression as that's a terrible idea, I would aim to control the pain first, and any anti-deppresent effect from the opiate would be a benefit imo. Get your pain under control so that you can live your life, that will help. Then see a expert that specializes in this.

And 60mg's of oxymorphone isn't "to much" Have you ever thought of taking oxycodone and oxymorphone? That's another option, if you just want a higher dose I would suggest taking the time released version, and having the instant release for break through.

Peace

 

[Missykins]

Subutex and Suboxone are not labeled for the treatment of chronic pain, but I think that some doctors use it extra-label for this purpose. There has been some discussion to approve these drugs for the treatment of chronic pain, but, to the best of my knowledge, the prescribing label indicates that Suboxone and Subutex are prescribed/approved for opioid dependence. Transdermal buprenorphine is available in Europe and under FDA review in the United States which will be really helpful.

I think that the suggestion that you try methadone for your chronic pain is a good one. As far as an antidepressant goes, unless I missed something in your post, there are a lot more drugs that you could try for that. I wouldn't recommend an opiate for depression, but I know that some doctors use Subutex for depression (these doctors would have to go through the same certification process). Perhaps the mild anti-depressant effect that is seen in patients taking Suboxone/Subutex comes from the treatment of their addiction rather than depression per se. Have you considered that it is your pain that makes you depressed? Perhaps when that is adequately treated your mood will improve.

 

[jamesBrown]

for those of you who said that bupe has worked for depression for you, are you on Subutex or Suboxone? I am worried about effects from the naloxone in the Suboxone.

Suboxone worked WONDERS for depression for me. Not only did it give me energy, but it gave me a feeling of having a "better outlook" on life in general, and I felt like I had more reasons to wake up in the morning(not reasons related to dosing drugs), and it gave me mild euphoria on a daily basis at doses lower than 2mg's/day in incriments of 0.5mg's.
Also, I think part of the anti-depressant qualities of the suboxone were related to the fact that this drug had saved my life and allowed me to start living a more productive lifestyle again without having the ups and downs of heroin addiction. But I can guarantee you that this wasnt the only source of the anti-depressant qualities, like I said earlier, it actually had physiological effects on me that made me "less depressed" for lack of a better description.
I wasnt necessarily "depressed" but everyone experiences bad times in there life where they sometimes have long periods where they have a harder time finding happiness in living, and the suboxone definitely helped counteract this effect.
I noticed no effect whatsoever from the naloxone....just my experience. I have heard of some people having problems with the naloxone, but not me, and not most the people who I talk to that are on suboxone maintanence.

Subutex and Suboxone are not labeled for the treatment of chronic pain. Transdermal buprenorphine is available in Europe and under FDA review in the United States which will be really helpful.

This is very true, but there is in fact a drug directly produced, marketed, and prescribed for pain that utilizes nothing but buprenorphine, and that drug is Temgesic.
Just thought I would throw that out there....might be of some help, dunno.

 

[muvolution]

Subutex and Suboxone are not labeled for the treatment of chronic pain. Transdermal buprenorphine is available in Europe and under FDA review in the United States which will be really helpful.

I think that the suggestion that you try methadone for your chronic pain is a good one. As far as an antidepressant goes, unless I missed something in your post, there are a lot more drugs that you could try for that. I wouldn't recommend an opiate for depression. Have you considered that it is your pain that makes you depressed? Perhaps when that is adequately treated your mood will improve.

nah, i've been depressed for quite a while - since before my injuries.
Prozac, Zoloft, Remeron, Lexapro, Wellbutrin, Paxil, Celexa, Effexor, I'm damn sick and tired of them and none seem to work.
The best thing for me has been bio-feedback therapy and meditation, and I do this daily, but it doesn't totally do it.
Talk therapy doesn't really work for me - I have a fairly open mind, but most shrinks are just fuckin quacks.

I know subutex isn't labeled for treatment of Pain, but any drug can be prescribed by any doctor for any condition in this great country. I am looking for a doctor who will work with me in this grey area.
The OM works well for pain, I just don't get enough of it and I am tied to this PM clinic by insurance and my orthopedist. My primary care physician wont work with me on my pain, and my orthopedist will only refer me to this one clinic. (It is a very reputable clinic, not a pill mill, which I appreciate, but there is a happy medium between the two)
I don't know - the PM doctor I've been seeing is just such a fucking piece of shit that due to my anxiety and depression I would seriously rather cease treatment than continue seeing her.

 

[Missykins]

This is very true, but there is in fact a drug directly produced, marketed, and prescribed for pain that utilizes nothing but buprenorphine, and that drug is Temgesic.
Just thought I would throw that out there....might be of some help, dunno.

Specifically, Subutex is the legend brand of buprenorphine in an oral, disintegrating tablet form made by Reckitt Benckis. Buprenorphine is also available in other forms such as Buprenex (injectable) and Temgesic.