The EADD Maintenance and After-care Thread

[Eveleivibe]

Hiya Everyone,

I've checked with the mods n it seems we don't have a thread designated to maintenance n after-care of addiction. I was thinking of creating a separate suboxone n methadone thread but thought-well we have those threads in Other Drugs, along with detailed information on the first post.

I thought, that as a lot of people here tend to only stay around EADD, n that there are a few of us trying to deal with addictions, that a thread here would be beneficial in discussing local services n what-not. We all know that the services in the UK differ to those in America n other countries - and that it can be somewhat difficult in discussing this with others who do not understand out system n how it works. I feel, that in this respect advice could be better delivered n shared with one another.

I saw one member yesterday, thinking of going onto suboxone n this sort of threat would be perfect for them to get advice from other like- minded people.

This thread is not only for discussion of maintenance but what you are doing, and advice / suggestions for others in addiction-aftercare. For instance, one person may feel that 12-step meetings is a solution for them while another may believe in counselling. Some may believe in full abstinence from ALL mood enhancing substances while another may feel that they just need to stay away from their drug of choice (DoC)
EG someone giving up opiates may still choose to use stims.

When trying to overcome addiction, there are a number of different options available to people and they either choose one or more than one option.

• Register with a DSP and get on a maintenance script - suboxone or methadone
• Narcotics Anonymous (NA)
• Alcoholics Anonymous (AA)
• SMART recovery
• Residential Rehab and / Sober Living House
• Counselling or Therapy
• Intuitive Recovery or other small, local courses on addiction.

Also good luck to anyone who is fighting this fight right now. We CAN n WILL beat this.

Evey

 

[curious_24]

Do you think suboxone treatment is suitable for someone on a 1500mg per day (approx 5 years in) codeine addiction? I've tried cold turkey, tried tapering and I just don't have the willpower to go it alone. My entire day is planned around codeine, then after my last dose I'm already looking forward to waking up the next morning so I can have more.

 

[THECATINTHEHAT]

That's a pretty extreme amount of codeine to be using, but I'm still not sure moving to buprenorphine is advisable as it's a step up in opiate strength really. I can see some potential benefits in that you would only have to dose once a day but you would have to go through the whole process of spending months on daily supervised dosage which will probably be just as much of a hassle if not more. Being on a script is fucking hassle too, you still have constant worries about there being a problem with it, you're tied down to a pharmacy every day of your life, if you want to go anywhere or do anything it has to be planned ahead and okayed by your key worker...I just don't see it being worth the effort.

I doubt any doctor would move you onto bupe for codeine addiction either.

If I were you I would just start slowly tapering down.

I'm currently on 24mg bupe daily maintainance and a diazepam reduction script currently at 25mg daily. Just been taken off supervised dosage after almost three months of almost perfect behaviour. I now pick up daily but take unsupervised and pick up for fri, sat and sun on friday so I can spend my weekends away without having to plan a change of chemist for supervised consumption if I want to go somewhere for the weekend.

 

[Shambles]

I doubt any doctor would move you onto bupe for codeine addiction either.

I wouldn't be quite so sure of that myself...

It's really hard to say whether bupe could help in a situation like that. Clearly it is a step up in terms of potency - a big step up at that - but that's not the whole story. For me bupe has specific benefits to it over and above basic stuff like stopping me feeling ill. The routine it brings can be very useful in and of itself but perhaps the biggest factor for me is the way it kills my cravings for other opies. I need to drag me arse up to the chemist everyday (or did when I was scripted at least) which has some benefits simply in doing that - getting me out the house even if only to have minor chit-chat with the pharmacist. Mostly the bonus comes from not having the desire to use other opies though. Partly cos I know I can't cos I'd but put into instawithdrawal, mostly cos I just don't get the urge any more. You are still addicted to a strong opioid and will still have to taper and quit at some point though.

I'd suggest it depends on how your codeine use is affecting your life. Does you use of codeine have significant effect on the rest of your life? Are you having to hide your use or do things you otherwise wouldn't in order to keep to your regime? I realise that with codeine it's unlikely to be at robbing grannies in the street stuff but things like needing to take time off work cos the postman didn't come or maybe miss a day with friends or family for similar reasons or just down to being fukked. If things are at that type of level I can see sense in switching to a regular, monitored bupe script. It is still a big step up in terms of potency though and obviously what goes up... You do still have to taper and quit. Especially with current governmental guidelines on getting people off script ASAP. It's not something that you can rely on for too long but if you are wanting to quit it could be an option.

I'd suggest speaking to your GP initially. I know they are not always the most understanding but they can refer you to a specialist clinic in your area. Some clinics are fine with people self-referring, others are not. Go straight to the clinic if you have the option would be my advice - very few GPs I've known have wanted to go near cases of addiction and DSPs tend to be much more understanding and flexible and more likely to be able to deal with your personal circumstance rather than just throw a textbook at you and hope for the best.

 

[curious_24]

Thanks for the insight dudes. Shambles, a lot of what you said definitely rings true with my current situation. Only last week I had to rejig my work shift (without giving them any notice) as I'd almost run out of codeine over the bank holiday and therefore HAD to be home at 10:45 on Wednesday to meet Mr Postman and relieve him of my linctus. I'm gonna have to do something similar this Tuesday as one of my pharmacies hasn't dispatched on time and therefore Monday's last dose will be the last of my linctus until Tuesday's post arrives. I start work at 9 and earliest that the post turns up is half 10.

It would be an absolute fucking weight off my mind to be able to stop having to plan my life around online pharmacies and Royal Mail. There's always the risk of a parcel not arriving on time, which means a trip to the only pharmacy within 30 miles that'll sell linctus OTC. Then there's the panic over what I'll do if they refuse me. It's never happened yet, but my luck can't hold out much longer. I've probably bought 20+ bottles in the last year so I'm definitely on borrowed time.

The big thing for me is controlling the cravings. I'm sure I could do a cluck if it was just the physical part. The fact is, I'm obsessed with codeine to the point that it's on my mind 24/7. If I could take something that would remove this craving, it would literally change my life.

One thing that's clear is that I definitely have a lot of thinking to do. I can't carry on like this for much longer as the stress is just getting too much to cope with.

 

[THECATINTHEHAT]

The long half life of bupe could be useful in getting you out of the mindset of not 'using', but could you go through ~3 months of supervised dosing when you probably don't have a chemist that opens before 9am near you and you probably need to be at work?

It could be useful, and maybe a doctor would consider prescribing it, that was pure speculation really. There are a lot of things to be taken in to consideration though.

 

[Shambles]

One thing that's clear is that I definitely have a lot of thinking to do. I can't carry on like this for much longer as the stress is just getting too much to cope with.

If the latter is true the former certainly is. It's not for me of for anybody else to say but that does sound to me like an addiction. One thing to be sure of with addictions is that they don't improve left to their own devices. At some point you do have to actively take it on. Whether that is simply a case of tapering and w/d from it ans relying on will-power and determination or whether outside help is more suited is really not for me to say. I would say it is easier with help though.

When a drug becomes so much a part of life that life begins to revolve around it and rely on it there is a problem of some kind there I'd say. There are a number of options to approach any such problems ranging from cold turkey and will power though to extended maintenance and regular sessions with a drug counsellor. Those would be your decisions to make but I get the idea you're seeing just what addiction actually entails - the way it creeps and infects other aspects of life previously unrelated. It doesn't get better and it doesn't just go away. It can get very, very much worse or it can stay at a manageable level for years on end. I suspect once it's in place it eventually wins sooner or later though if you don't at some point fight back. It's really not for me or anybody else to say but I will say that I wish I'd taken things more seriously when I was swigging bottles of cough mixture daily.

Think on things but don't let it overly concern you. Addiction can be overcome but does have to be recognised for what it is first. The NA folk do have that bit right. Apologies if sounding all doom and gloomy - I have a bit of a thing for people who are perhaps reaching a certain point of realisation that recreation isn't even in the picture anymore - it's just maintaining to keep head above water and monkey from back. You don't have to live with that stress. There are options. There are no easy choices or decisions in such matters though. It's all hard. It's very rewarding too... sooner or later... but is a very hard thing initially. It's well worth it all though. Slavery is slavery and addiction is slavery. Nobody wants the yoke around their neck nor the shackles around their feet. It's demeaning and dehumanising. It's no fun anymore is what it is. No fun at all.

Ack. Rambling. I blame the drugs. You'll be dandy, Curious. If it really is getting too much then I would recommend speaking to your GP if you get along with him/her or try calling your local DSP. They can help in any number of ways - not all involve scripts but it's always a possibility if appropriate in your situation. I go a bit funny when it comes to addiction matters cos... reasons are obvious but when people appear to be teetering a bit I go doubly funny about it. I wouldn't wish addiction on anybody and anything anybody can do to get themselves out at the earliest possible stage the better cos it only gets worse. Can get a helluva lot worse.

 

[THECATINTHEHAT]

^^^^^^

All good stuff.

I don't think there is any question of whether there is 'addiction' at work in this case though, it doesn't sound like teetering on the edge to me. It sounds like full blown active addiction. If you've been using a substance for five years, are physically dependant on it, running away from work to score and your 'entire day is planned around codeine' you DEFINITELY have a drug problem and as mentioned above I would suggest telling your doctor. Just be completely honest about the whole situation and they will most likely just refer you straight to the local drug and alcohol services so you can be assesed. They can then work out what your options are and you can form a plan with them as to how to regain control of your life.

 

[Shambles]

I mean 'teetering on the brink' in the sense that codeine can spiral. It was what started me off on the junky trail. Once you've gotten the taste for opies there is a tendency to hop from one to another until you end up deciding that heroin actually works out cheapest and most effective. Which it really does at first as I'm sure anybody who's been that route would agree. Looking back at my own history I see several points where I saw glimpses of what was happening but chose to ignore them. Was still having a lotta fun for the most part. As I said, I do get a bit funny around addiction stuff sometimes - that would be especially when all luvved up on post-dins pills

 

[curious_24]

Thanks so much for your thoughts. It really does mean a lot when coming from someone who's been there, done it and bought the proverbial.

I'm fully aware that I'm coping with an addiction here. I think I realised that a couple of years ago. It just seems so easy to push the withdrawal to next week/month because this month isn't convenient for whatever reason. There's always an excuse and there always will be, I understand this.

Luckily, I have a supportive wife and apart from the codeine, life's going ok. I've read so many times that someone will only quit when they truly want to. I think my problem is that I've not yet hit MY version of rock bottom (perhaps not as rock bottomy as that of other people with different circumstances). I'm still enjoying the drug and it isn't causing too many issues other than the wasted money and undue stress.

Ah, I don't know. I'm sure it'll all work out in the end, right? Right??

Edit -

Once you've gotten the taste for opies there is a tendency to hop from one to another until you end up deciding that heroin actually works out cheapest and most effective.

I've already had to suppress this very thought. Scary.

 

[Eveleivibe]

Wow lots of comments. I never expected this thread to take off so soon. Sorry I've not yet read them but will tomorrow n offer any advice that I can.

Take care,
Evey xxxx

 

[Shambles]

I've already had to suppress this very thought. Scary.

That would be partially your choices to make it all work out and partially blind luck lending a helping hand. I have no idea if it all works out in the end cos I've not gotten to the end myself yet. It's certainly a damn sight better than it used to be though.

I'm not always so sure about the "rock bottom" thing. There are moments like that I can point to in myself... but that's the point - there are several of them and none of them made a difference individually. It's the weight of it all that gets me. It's not so very hard to bounce back from even the most horrific of situations and just keep on going cos that's what we all do. At some point it just felt like I was going round in circles and those circles were getting smaller and the curve more pronounced. Circles became spirals. Not the kinda spirals I used to like so much though.

It is completely true that nobody can force or make another deal with those issues - it absolutely does have to come from within. It's far harder to deal with a situation when it's not a huge and all-consuming problem than when it is I suspect. At some point all the options are taken away and you just have to do what you have to do. Heading that point off at the pass is a far trickier thing. It's a thing worth trying for in my opinion but that's cos I never did head it off and I did run out of options. I am much better for it but if anybody can avoid getting to such points I'd recommend doing so.

As long as you are thinking at each step of the way - really thinking - it's still a decision to a greater or lesser extent. Always worth remembering that if a person happens to dig themselves into a big ol' hole they can choose to use that spade to dig footholds out rather than keep digging down.

 

[Eveleivibe]

That's a pretty extreme amount of codeine to be using, but I'm still not sure moving to buprenorphine is advisable as it's a step up in opiate strength really. I can see some potential benefits in that you would only have to dose once a day but you would have to go through the whole process of spending months on daily supervised dosage which will probably be just as much of a hassle if not more. Being on a script is fucking hassle too, you still have constant worries about there being a problem with it, you're tied down to a pharmacy every day of your life, if you want to go anywhere or do anything it has to be planned ahead and okayed by your key worker...I just don't see it being worth the effort.

I doubt any doctor would move you onto bupe for codeine addiction either.

If I were you I would just start slowly tapering down.

I'm currently on 24mg bupe daily maintainance and a diazepam reduction script currently at 25mg daily. Just been taken off supervised dosage after almost three months of almost perfect behaviour. I now pick up daily but take unsupervised and pick up for fri, sat and sun on friday so I can spend my weekends away without having to plan a change of chemist for supervised consumption if I want to go somewhere for the weekend.

Owen makes valid points if you need to take into consideration before you make your choice. Suboxone is very strong, a lot stronger than codeine. Like with any form of medication there are side affects. I could tell you my side affects but they may differ for you n as I'm also on citalopram n other varying factors such as age n gender, I cannot put it down to suboxone alone.

However, if you are like me n are struggling with the PSYCHOLOGICAL aspects of addictio, you've tried everything n it hasn't worked then suboxone MAY be an option for you. Ignore any judgement about subs only being meant for strong opiates - people who say this stuff are referring to the PHYSICAL aspects of addiction. And if you ask most people they will say that they psychological aspects of addiction are most crippling n soul-destroying.

Yes there's the fear of withdrawal n suboxone takes the withdrawals away - but as hard as it may seen withdrawals are the least of the addicts' worry, in MY opinion (and please note that it is only an opinion), fear of withdrawals is an excuse---another way in which our addict self whispers to us to continue the addiction.

All that aside, are you really wanting off codeine? Are people trying to force you off it? What is driving you to want to quit codeine? For instance, financial, health, enough being enough, nagging etc? It's not just a case of going on suboxone maintance. Subs are a tool n without other tool its like a house being made with bricks alone, no malta etc. all that hard being for nothing as the house crashes back down to the ground with a massive THUD.
AA
Suboxone is a tool which needs to be ised in conjunction with others such as counselling, NA/AA, other forms of group therapy etc.

Most people now that I'm on suboxone for codeine addiction n in some ways I'm glad while others I regret it. It's good to see a key worker to have someone to talk to, I've had counselling, joined a local recovery group, and completed a few course. One I didn't complete called Intuitive Recovery because he want to force me off suboxone n I wasn't ready for that.

Lastly I'd like to apologise to you. When you PMd me with this question awhile back, I kind of fobbed you off, thinking you were a troll trying to wind me up. I'm sincerely sorry that I got you wrong.

All the best - and please balance up all the pros n cons of going onto suboxone maintenance before you do it. If there's a way you can taper off then please try that route. I understand how hard this is. A lot laugh at codeine addiction but I've had ex-heroin addicts talk to me about their current codeine n express how it is just as bad for them because of the psychological aspects of addiction being worst than the physical aspects of addiction.

Good day!
Evey xxxx

 

[HouseFever]

I dont really understand why subs is good to come of Codeine. Codeine is a weak as fuck opiate. And subs are a strong opiod. It seems like its just replacing an addiction with one which is much worse right? I didnt know codeine WDs were even bad? Did you even feel anything off codeine?

 

[curious_24]

Thanks again for all the help and advice. I think I'm gonna try a slow taper. Thinking about it, I used to take around 1800mg and currently I'm using around 1400mg, so I've already cut down my usage by 20% or so.

My next goal is to try to manage on two bottles a day, which is 1200mg. Shouldn't be too difficult should it?

 

[Shambles]

Self-tapering is always a good option if you can manage it. Just remember it's not a race - you can take however long you need - some prefer to get it over with relatively quickly and put up with the rather bumpy landing, others would rather avoid as much discomfort as possible and wean off much more slowly. It's really a personal thing (as long as circumstances allow the choice). I've always found codeine w/d are unusually hard on the gut given their relative lowness on the opi ladder. That's not to say codeine is a "lesser opioid" (it's not - it converts to morphine amongst other substances) but it seems a lot harder on the gut than many far stronger opies I've used. If going for a swifter taper that involves relatively large drops in dose I suspect loperamide would be especially good to stave off the cramping which can be pretty frikkin nasty in my experience.

Other than that it does ultimately come down to sticking to the taper. Personally I like to split it into stages where I'll stop the taper and hold steady on a dose for a few days to let body adjust and kinda get its breath back (in a manner of speaking). I find drawn-out tapers kinda exhausting and it does feel a bit relentless sometimes and - like any addict - I do likes me a reward so I consider that reward to be staying at a certain level whilst symptoms start to normalise and I feel more or less as I did before embarking on the taper. Once mental and physical energies have recovered a bit I'll go down the next step. That's just me - everybody tackles these things in their own way - but if it's likely to be a rather long and drawn-out taper it might be something to consider cos there tends to be one of those lil voices that pulls in the other direction - "Just skip it today and take double - you've done really well so far it won't make any difference cos it's only one day..." and the like. Better to level off and feel "normal" than throw in larger doses which can really screw with the w/d symptoms and a big spike in feeling shitty tends to result in reverting to previous levels which is just annoying cos you have to do it all over again.

Most importantly I'd say don't get disheartened - it can feel like an endless slog and it can certainly feel like it will never end and things will never be right and that the whole thing is pointless so you may as well just accept the addict thing and live with it - plenty do after all. I don't think anybody with a truly free choice would choose to be addicted to anything. I find it's not necessarily cravings as such that get me it's the giving in and giving up thing - the acceptance of it - that's the real problem. Individual cravings do pass fairly quickly if you don't give in to them but - speaking only for myself obviously but I suspect not especially uncommon - it's that lil voice again that whispers all the time saying fighting against it is pointless and there's really nothing wrong anyway. It can be very disheartening, but it is telling porkies. There is something wrong and it is never pointless to fight back.

 

[Shambles]

I dont really understand why subs is good to come of Codeine. Codeine is a weak as fuck opiate. And subs are a strong opiod. It seems like its just replacing an addiction with one which is much worse right? I didnt know codeine WDs were even bad? Did you even feel anything off codeine?

Codeine is a full agonist, bupe is a partial agonist. It has a opioid blocking effect whilst also preventing w/d symptoms and this combined effect seems to help a great deal with cravings and desires for other opioids. Maybe not for everybody in every situation but for those it does work for it works really well and is an excellent opioid for maintenance and tapering. It is a lot stronger than codeine but 1800mg of codeine per day is a shitload of codeine - that's 180mg or so of morphine plus all the other opioids metabolised from codeine. Bupe is also much longer-acting and - as with benzos - you generally go from shorter-acting ones to longer-acting ones when tapering. Personally I find bupe w/d less unpleasant that codeine w/d but that's just me and some people would certainly put them the other way around. As Evey says, it's a tool and it's not suitable for all jobs but it's a very useful tool for the right job. Whether or not this particular situation is the right job is really for Curious to decide perhaps in conjunction with an addiction specialist if needs be. Well, it kinda has to be in conjunction with an addiction specialist cos it's them wot prescribes it.

 

[HouseFever]

Cheers Shambles. That makes a lot of sense especially regarding the duration of bupe. Bupe seems like it has a lot more recreational value than codeine which would make a lot of people start abusing it. I thought a taper would be better of a weak opie like codeine.

 

[curious_24]

Some people get a hell of a lot more out of codeine then others. It seems to be a real YMMV drug. At the risk of sounding like a broken record, in the early days I would get a nice warm feeling from 2 x 8mg co-codomols.

My taper is going to be very long and drawn out to try to minimise/avoid withdrawals much possible. There's no real urgency so as long as I'm moving in the right direction, I'll get there in the end. My only issue is avoiding the temptation of the fourth daily dose. It usually makes me feel tired and shitty, but it's always a temptation, especially if the third dose didn't give me the effects I was looking for.

I'm feeling very optimistic now, thanks to you lot. I can do this!

 

[Shambles]

Cheers Shambles. That makes a lot of sense especially regarding the duration of bupe. Bupe seems like it has a lot more recreational value than codeine which would make a lot of people start abusing it. I thought a taper would be better of a weak opie like codeine.

Bupe does have a lot of abuse and/or recreational value for sure. It is a factor to bear in mind when considering it - perhaps especially so if stepping up a few levels in potency rather than coming from something a bit closer in terms of strength. It's often used to replace methadone for the final stages of opioid maintenance treatment. Methadone w/d are especially brutal and bupe far less so and with the partial agonist bit too many find it far easier to quit than methadone. For somebody who doesn't generally use strong opies there's always gonna be temptation to use the bupe recreationally cos it is a very nice opi - one of my faves if I could choose from any - and that is something to watch out for. There's no point switching to bupe purely to abuse it - you may as well just start buying heroin if you're gonna do that. Perhaps not but you are defeating the purpose of switching in the first place - certainly if a bit of experimentation and playing with it has the undesired effect of simply massively increasing tolerance and burning through your script leaving you suddenly in a lot worse place than you came from.

Having said that, bupe scripts are very strictly monitored these days (certainly are in my experience anyway). You have to take it in front of the pharmacist and stand there with it under your tongue til dissolved (took a good half hour for me - I got to know the stock on the chemist shelves better than the assistants probably 8)) and give him/her a good looksee about your mouth afterwards to prove it's all gone. This can go on for months before they'll even consider letting you take any home with you so you don't have to go to the chemist every single day. There's a fair chance somebody coming from codeine to bupe is gonna be fukked for the first few days whilst they adjust to their dose but that's hardly a great torment - it levels off pretty soon once you find your level. Apparently it's best to use doses in a particular range to gain the most craving-blocking effect. Not so high that it kinda starts blocking itself (which feels really weird and not entirely pleasant) and not so low it's relatively easy to overcome the block by taking a shitload of full agonist opies of choice.

Somewhere in the middle you get a bit of a sweet spot where you feel physically fine and cravings just don't seem to happen much if at all. You just feel normal which is no bad thing compared to all the ups and downs that come with opi abuse. It's nice to just feel okay for prolonged periods without worrying about any of the addict stuff you know you'd be having to deal with otherwise. Just picking up a script instead of hanging around your doorflap waiting for the postie and praying he is bringing you something, or having to hustle up money and spend half of it trying to get through to dealers who just leave you hanging around waiting for hours - getting away from all that is a big thing all by itself and really helps psychologically. Bupe is just a very good drug to maintain on. Very steady and does everything you need to keep you steady. Potency is not the only factor to take into account when tackling an addiction - there are a whole bundle of interrelated issues that need consideration.

I'm feeling very optimistic now, thanks to you lot. I can do this!

Good to hear - and you certainly can