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Opioids Help dealin with pain management for the first time

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Area57

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May 29, 2015
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Hi. I have a pretty decent opiate tolerance. Unfortunately I was hit by a car and broke my pelvis. Now I am in the hospital and in a semi state of withdrawal because they don't want to give me as much painkillers as my tolerance requires.


I had surgery a couple of days ago and have an epidural. Well I think that might be the only thing keeping me sane but today against my wishes they stopped the epidural so in a couple of hours i will be able to feel my hip again.


How do I interact with the nurses and pain dr without appearing to be drug seeking? I'm not trying to get high. I actually am totally focused on getting better and this is probably a good opportunity once my leg heals to get back on suboxone maintenance. There aren't any available Drs in my town and none that take my insurance. But the surgeon here said that he wanted me to promise not to do any dirty street drugs. He said once I didn't need prescription opiates for pain their referral to a suboxone dr carries weight and I could maybe get in which would be good. This may be a good chance for me.


In the meantime I need to recover so I can walk again. That means I need to figure out this tricky world of pain management.


So far I am on 40mg oxy three times a day. 8mg oral dilaudid which I know doesn't have a good absorbtion rate and if I need it which I do one four mg oral dilaudid every three hours and some mystery fentanyl shot. It took me a while to figure this out tho. I was in mild withdrawal because the started me on less and it's still not that much with my tolerance but it's getting better.


How do I request the as needed medications without looking like a drug seeker? How do I get the dr to increase the dose so when I get home I'm not in too much pain? How do I get the dr to keep me on a high dose for a while instead of trying to taper me off quickly? And lastly I have one more choice to go home with.


The pain dr said I could have a fentanyl patch that lasts three days instead of oxys. This morning not ever having had much fentanyl I said let's stay on oxys. I don't know which is better? Thoughts?


Oh and lastly. Does this sound like large doses? Do I have a high tolerance?

With a large or I don't know how high my tolerance is comparatively but I found that it was so high it became very difficult to transition back to suboxone. That is my goal after the pain stops. Which choice will be easiest to transition to suboxone. If I can make the transition I do very well on suboxone maintenance. I would like my life back. But from somewhat high I'v H use one day I just noticed I had trouble getting back on subs. So hopefully and I think I read people on prescription pain medicine have and easier time and I will also probably be tapering too. Thanks for the help. Sorry about the long thread.
 
Run from fentanyl. Tell your doctor you don't want an insane tolerance or to die like Prince
 
That's a good point. Does fentanyl raise your tolerance more? I can definitely feel my tolerance is lower in the week I have been here.

I forgot got they also gave me gabapentin. I'm prescribed klonopin and take one a day usually. Any bad reactions? Do I want gabapentin? I feel a little out of it this morning and I did yesterday too. And the only difference is the gabapentin. They doubled that today. Do I want it? Could it be what's making me foggy? I know it isn't the opiates because I know what the feel like and I haven't had and bentos since last night and I know what they feel like too. Hmm.
 
The Gaba is likely causing the new grogginess you're feeling. Being holed up at hospital is a great opportunity to lower your opioid tolerance. If you are scripted the amounts you're talking about (Oxy & Dilaudid) then I see no reason why they wouldn't simply have you on that amount or that it will be a hard thing to question or query with your surgeon or pain doctor.

I would simply ask why you are not being scripted the amount of painkiller you would normally be on if that's what was previously prescribed. They may want you on less so you can pass stools more easily given your recent surgery, or that they don't want you too numb so they can gauge the success of the surgery/healing etc....I don' know.

It may be the case that your pain Dr feels that you should be on less after colleagues commented to them the amounts seem quite high and that there is a little more of a back-peddle on what they've been prescribing. Either way, use this opportunity to allow that tolerance to come down.

I see no reason why the transition to subs should be bad, I had a seamless transition from 240-400mg oxycodone to 6mgs of sub...I increased the sub dose in an attempt to control my pain but it just can't do it being the partial agonist it is. It's possible that I am going to transition back to opioids to see what's what with regards to my pain/quality of life. The only thing I was told was to wait 24hrs after my last dose of oxy before coming in for my first 2mg strip, waited 30mins to see if PWD was an issue, which it wasn't so I then took another 4mgs at their request and I reckon it would hold me all the time.
 
i think SKR is mistaken or maybe I am. You weren't scripted any pain meds prior to your accident is that correct? Your tolerance is only as high as it is because you were using heroin or other opiates prior to your accident, is that what we're to understand?

another question I had was did you mention to the pain dr that you were previously using heroin or getting opiates off the street because it sorted of sounded like you did because the dr made you promise not to use "dirty drugs" when you get out of the hospital.

you asked if your tolerance was high. you're taking 120mg of oxy daily, 8mg of diladud but you didn't specify how often, you also mention you can take 4 mg diladud every 3 hours and also some fentenyl shot but again you didn't mention the frequency. I would say YES, that's a pretty high tolerance in my opinion.

either way, there's really no easy way to tell the pain dr that you need more meds. only thing you can really do is inform them that they don't seem to be helping or that maybe after only a few hours your pain returns. make sure you're specific with what type of pain it is, piercing, stabbing, sharp, is it constant, does it come in waves, anything to be precise so that it actually sounds like you're describing real pain vs just saying "oh, im in pain". just mention you're concerned about managing your pain after you leave the hospital and you're concerned you won't be receiving adequate pain relief because you don't feel you're receiving adequate pain relief now while you're in the hospital.

you probably made the right call turning down the fentenyl. i would suggest you take the gabapentin for after you leave the hospital. it can be a great med for dealing with opiate withdrawal. in my experience it seemed to dull my opiate high so i wouldn't take it with your opiates unless inside the hospital and they watch you take it, otherwise just store it in your bag or something but that's my opinion.

good luck and i hope your pain is better managed for you
 
Thank you both for the responses. The second person has it right. I think I agree about the gaba. Good to have but not something I want right now. I want to be pretty alert to do physical therapy and talk to Drs and nurses and get better. I don't know if it's a weird drug or not but ssris like Prozac make me feel weird. I really only want to take opiates and benzodiazepines because both of those seem normal to me. Not that it's good to be addicted to opiates I don't mean but I'm just saying.

Dilaudid is 8mg every 6hours. But by mouth you can tell you really don't absorb it well through the stomach. I read bioavailability of about 30%. That sounds about right since I had a dilaudid button when I came in and they had the amount lower.

Im not complaining about the pain dr. He seems cool and good. I just want to be a good patient and treated like everyone else so I get better.

How owe much pain is normal after an injury? How well can they manage it? Should I expect it to be low or still high even with painkillers?
 
SKR and mazda01 great posts! I agree that the doses you're at are quite hefty but most likely determined by labwork when you went in initially. A typical starting dose of dilaudid is 1mg IV or 2mg oral and not combined with other painkillers. Oxy is generally 5mg every 4-6 hours, sometimes 10mg to start. And fentanyl is more commonly used just prior to surgery and in post op recovery though if you were on benzos and not receiving them it may be you're getting them with the fentanyl to ward off seizures. The suboxone offer is quite nice and it sounds like you're in a really great place despite you feeling rough. The day after surgery is always the hardest for me when everything feels sore and the surgical meds are wore off. The recovery time depends on your specifics and the work that was done and the size of the insicion(s). Honestly if your doc already casually brought up the h then I think a straightforward conversation would be ideal and share your concerns even if it's using again or what to do and who to call if you feel you hurt bad enough and want to. I think it was kind how it was brought up. Remember concerns not requests. Obviously more pain meds at home are desired. Focus on the plan not the prescriptions. It's support you need most after all. Some doctors would look down on a user and treat with the bare minimum and send you home with next to nothing of nothing ideal. Do you have support at home? The first week or two rest is best and getting around may be tough. It must've been a rough getting hit but considering all things going right so far maybe it was a blessing in disguise and what nearly killed you is going to save you. Feel better soon!
 
This thread makes me think. As an addict, we need to lie to our doctors in order to get the treatment we need. This is terrible.

I hope you can get on suboxone. It may be just what you need to get your life on track. I would most definitely take it up with your doctor for the referral.

What level is your pain (1-10 scale). What level is your withdrawal while on the pain meds (1-10 scale). What withdrawal symptoms are you experiencing, and if you are experiencing symptoms can they be chalked up to just having surgery?
 
I went honest with my surgeon before operation to my spinal cord and he just wanted to make sure if the amounts I was being prescribed were actually consumed by myself and I just had to give urine screening with amounts checked instead of just exposure for opioids.

Surgeon said that it was nice to be honest as they would have had problems with anesthesia because of my tolerance and now they could just use different method from the start.

After the surgery when waking up I was still getting an infusion of ketamine and after it was done I got my prescribed amounts of Oxycontin (80mg twice a day) and got 15mg oxycodone IM when needed. If I remember right during the first 24h after the surgery I took ten of those shots meaning total of 310mg oxycodone for that day. Nearly each of the nurses would quadruple check if those amounts were right as they had used to give patients 5mg IM shots few times a day and dispense 5mg or 10mg Oxycontins twice a day.

I would just tell about my tolerance and tell that I still have that much pain as the tolerance is different than opiate naive patient's tolerance. Nothing will justify giving more than what is advised for opiate naive patient unless the patient has tolerance. If patient has tolerance he will be given either more of the drug being used or fentanyl because it is more potent.

For acute pain the analgesic effect doesn't always come hand in hand with other CNS effects meaning that double the dose won't give double the analgesic effect and double the respiratory depression but instead will give higher respiratory depression and therefore they must use fentanyl for acute pain for opiate tolerant patients.
 
Wow thanks guys! Yes. Maybe a blessing in disguise! But it sure hurts today!

i guess i would have to say they all seemed more happy that as soon as I saw a dr or nurse I told them. I went from really no cost knowing my secret to probably 15 people now including my mom who has been here so much I couldn't keep it a secret! Well. I have to say the surgeon in particular at first didn't seem super happy but then I promised I wouldn't go home and inject and would follow the prescribed plan and now everybody treats me really well. Maybe they say something about me in the break room. Who knows. But I'm the model patient in so many other ways. I try to do everything the ask.

Hopefully I heal quickly and the pain dr doesn't cut me off too quickly.
 
Yeah you'd need to be honest about your previous addiction and your tolerance if you want them to raise the pain meds. Also, fentanyl is alot better for dealing with pain than oxy. Im sorry you were hit by a vehicle. I was recently hit by a car too and it did alot of damage to me as well.
 
^Yeah I agree that's great news A57, and you can bet your arse to a barn dance they would have had a chat about your case especially regarding your opiate tolerance. My wife is a clinical nurse specialized in cardio-thoracics so heart and lungs, and she is always able to spot some poor ass patient like me who is a user or who has tolerance and recommends to their Dr's that they increase the patients opioids/opiates to ensure you are comfortable. Junksters get hurt too and getting hurt means you're in pain. She's no 'push over' nurse, in fact she's quite the hard task master but she will always get the info she needs from the patient and makes a deal with them...."if you can be honest with me then I'll go into bat for you with your Dr's and push and persuade for an adequate level of relief via pain med"....with a husband like me she cannot morally watch her patient suffer more than is necessary.....and good Dr's and Nurses know that if a patient is suffering then this can and often will impact on how well and quickly the patient will recover, especially post surgery.

What she doesn't like is dishonesty and for your girlfriend to come onto the ward and inject heroin into your canular, only to have you OD if the next nurse who doesn't know what you're doing doesn't kill you with your next shot of morphine (though you're in the right place for an OD but who wants to be Narcanned post surgery?!!!
 
Ooooo narcanned post surgery. Ick. Well. I'm released but not at my house for maybe a week. I have stairs. Ok. I'll keep to my agreement to not inject dirty street drugs. I'm not swearing off them forever. I mean I hope I get a script for three plus months and then suboxone. But it's so tough sometimes so one day at a time.

I finally stopped feeling wds once they got the dose to 3 x 40 mg oxy ER brand name if it matters
8mg dilaudid 4x daily
4 mg dilaudid as needed every three hours. I took this most of the time but not all

however they sent me home with a prescription for somewhat less. Just a little.
2x daily 40mg oxy
4mg dilaudid as needed up to every three hours not a months worth like the oxy. I got 75.

soooo.....can I call the dr and say the medicine was better when I took oxy 3x a day or should I just drop it and make it work.

One thing i was thinking to maximize effectiveness is fire the dilaudid. It's just so week orally. I'm not a sniffer. I think I didn't crush it up enough and I tried 8mg that way and can't say for sure it was better than orally. Maybe a little more but shorter lasting? It's hard to say. None of these doses make me high. They are just effectively managing the pain and keeping wd away.

If I fire dilaudid how much do you recommend? I have had dilaudid before not prescribed and I only fired it but that was a long time ago. I remember I thought dilaudid and oxy together was very close if not better than H. I don't know which I would pick if given the choice. Probably dilaudid. At this point I would say my tolerance is at 40mg oxy and 8mg dilaudid orally every six hours not high but no wd.

So I don't know how to interpret what they sent me home with. I mean. For being an admitted "you know what" that is super cool of them, so I don't want to let them down and am appreciative of everything they did. But at the same time I would like to call and ask if I can take the oxy every three hours.

Do do you think that's ok? Do you think they will continue to prescribe for a couple months as I recover? Or is this a one time deal? If I fire the dilly it will be much more efficient right? I think just firing the Dilly's maybe the 8mg four times a day would hold me. Dilly's I know are shorter lasting but should keep wd away for six hours right? I guess that is my biggest concern right now. Wd.

thanks so much for the help.
 
Re: Is fentanyl worse for your tolerance than oxycodone, etc.

A very simple (over simplified, but holds true in the vast majority of cases) rule to follow is:

The lower the minimum dose, the higher the tolerance it will cause.

So yes, fentanyl will cause much worse tolerance than oxycodone.
 
Does dilaudid raise tolerance? One thing I really try to do is not raise my tolerance. Especially if I am going to get back on suboxone, I believe keeping my tolerance as low as possible will help. I know the dosage I am on is high, but I really estimate that when I first got there I had about 25/50% higher tolerance. I could feel it going down. I had a dilaudid button at 3mg an hour iv and 3x24 is 73 but I didn't push it every ten so maybe was taking 50mg dilaudid IV when I got there. So now I am at 40mg dilaudid but oral with a bioavailability of what 30%? So maybe 16mg and the three 40mg oxy. Not sure how oxy converts to dilaudid. But anyways. I shouldn't get bogged down in the minutia. I've read about lots of people taking hundreds of mg of oxy a day. I don't know. Just trying to manage pain, get better quick and make sure I don't run out early taking more than the dr prescribed. He did me a huge favor. He really helped me. His reputation is in his surgeries. He wants me to succeed. No doubt why he did proscribe medication. He wants me to get better. Thanks you to all who have helped. At my lowest, I had more friends than I thought and the medical field, at least this hospital was stellar. Very efficient, caring and thorough. They even did an uktrasound to check for blood clots.
 
Yes, in my experience Dilaudid raises tolerance more quickly than oxycodone.

I used to do around 320mg oxycodone/day. This is like when I was 17.

Suboxone is one of the worst ones for tolerance. Do yourself a favor and take the lowest dose possible.
 
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