What constitutes addiction?

[hyphenate]

I have several major chronic illnesses, including diabetes II, fibromyalgia, neuropathy, sciatica and arthritis.  Lately, I've been falling a lot, and my doctor attributes it to the neuropathy, but I'm not so sure.  I also have a torturous time climbing steps, as well as stabbing cramps and pain in my legs.  Leg and thigh weakness is profound, and progressive.

Regardless, I wake up in pain, and I go to bed at night with severe pain.  Up until recently, I was taking 1 Tylenol #3 at bedtime which helped to lessen the nighttime pain, and in another way, helped to ease the morning pain as well.

My new doctor (I recently switched) doesn't believe in long term opiate painkillers, and took me off the Tylenol #3.  Since then, I have been suffering endlessly, and by the time I go to bed at night, I'm so exhausted from fighting the pain that I can't think straight, and I dread the mornings as I wake up with back pain, shoulder and neck pain, and leg cramps and pain as well.

I have some pain meds from other periods of time that I have not taken, but feel now that I need to use them.  I have both hydrocodone (Vicodin) and oxycodone (Percocet), and have only used them when it was necessary, because they have always made me nauseous.  I have cut them all in half to take them, and know that I need to take them with food, and just before I lie down for the night.

Could I be addicted to my pain medication?  I would hate to think that I might be straddling the line between necessity and addiction.  I never take them unless I am suffering, and lately, that seems to be all the time because of my progressing conditions, and the constant falling I am doing.  (Right now, I'm falling an average of three times a week)  I seem to get bruises or sprains every time I fall--yesterday's fall has left additional pain in both hands and arms.  On one fall, I ended up bruising a rib, and on another, I secured a black and blue mark that covered about 1/2 of my shin area.  (I also bruise quite easily)

This is the only time I take one of the opiate painkillers at all.  I have refused painkillers in the past because of the side effects, but now I really need to alleviate the pains I'm currently dealing with.

Thanks for your help.

[ggin35]

I could be wrong but it doesn't sound to me like your an addict at all. If you try your best to avid pain pills and only use them when you are really in pain I don't think it's addiction. You might have a habit of taking them when you go to bed and when you wake up but that is not addiction. If you start taking more and more and develope a tolerance and take them when you don't even need them, that's addiction. Others may not agree with me but that's what I think. Hope you get to feeling better!

[Journeymann]

I was just discussing that with my wife.   I don't have chronic pain, so I need to get off of the pills.   But in the case of a valid medical condition unrelated to addiction, you really need to start asking open minded questions about quality of life and pain and social attitudes towards drugs.   Drugs are tools, in my opinion.   Your house is a tool, it protects you from the environment, enhancing your quality of life as well as increasing the extent of it.   Some people become shut-ins.   They stay inside too much, often not exercising in the process, becoming unhealthy.   Are houses bad or is those people's use of houses inappropriate?   Taking the metaphor further:   Some people have health problems which make it unwise to spend much time outside (say they are dangerously sensitive to pollen or even insect stings).   These people face the same impending health issues that face someone who is psychologically a shut-in; however, the seriousness of their other issues outweighs the detriments of being inside all of the time.   Drugs are like that.   Which is worse: you are high all the time or you are hurting all the time?   I think the answer is different for everyone.   I think that for some people, saying that they are "addicted" to pain medication is like saying a diabetic is "addicted" to insulin.   Frankly, dude, listening to your story, I wouldn't begrudge you a steady supply of dope.   lol.   Maybe that's wrong, but it's just the way I feel.

[tomanypills]

I agree with the others,if you take them regularly you will become physically dependant but you dont sound like an addict,,gl

[tztlady]

Ditto to what the others said.  If I had vikes or percs sitting on a shelf, trust me, my mind would "invent" a reason to use them.  Your body may become physcially addicted but you don't sound like an addict.

[Lookyhere]

Hello and i read your post,
I am sorry that you are in pain and fall too.
Can i ask you one question?
How come when you mention Tylenol #3 you didnt specify that it was codeine, like you did for vicodin (hydrocod.) and percocet(oxycod.)?
I am just curios.
And also, what made you seek out this website?
You know, people that do not suffer from addiction usually don't wonder weather they are addicts or not.
Good Luck and welcome to forum.

[DutchessGolden]

Often people do not completely understand the difference between dependency and addiction. Your body is probably physically dependent on the opiates meaning you will have withdrawals if you stop taking them suddenly beause your body is not producing a normal amount of its own natural opiates. Addiction refers more to your thoughts and your behavior towars those thoughts. An addict is usually physically dependent and will do things that are hightly inappropriate and/ or illegal to obtain the medication if they do not have any. If you were out of mediation, and in withdrawals, you might be suprised at what lengths that many will go to. It is almost impossible to understand unless you have been in withdrawal.

Your doctor does not sound as if he/she is taking very good care of you. You have a number of illnesses that are going to cause chronic and very severe pain. Codeine is a weak opiate but if it helps with the pain that's what your doctor should be giving you. I do not like to give my patients medication with too much acetaminophen(tylenol) in them because it is so hard on the liver and can be very toxic to the liver and each of your medications contain tylenol. The percocet should be 10mg oxycodone/ 350, 500 or 700mg tylenol. The tylenol 3 is 30mg codeine/ 300mg. tylenol. And vicodin should either be 5mg hydroodone/ 500mg tylenol or 7.5mg hydrocodone/ 750mg tylenol. May I ask why you switched doctors? Have you tried any other medications besides opiates and how effective were they? Is the tylenol 3 most effective for you? More and more doctors are beginning to prescribe opiates without tylenol like oxycodone or oxtcontin, codeine, and morphine, and I do the same. My husband is a doctor at a methadone clinic and over 80% of the patients are both HIV and hepatitis C positive so their livers are already so compromised that even a safe dose of tylenol can cause severe liver toxicity (hepatoxicity). And since many of them get pills off of the street, a good number of them have died taking too many vicodin or percocet in one day. Opiates are extremely addictive but are also incredibly safe for the body unlike tylenol. If the  tylenol 3's work the best you should talk to your doctor about a pure form of codeine. There are pills and liquids available of pure codeine. This can also be very effective when used together with an NSAID like motrin, naproxen or mobic-mobic is especially effective in treating arthritis pain. Muscle relaxers might be another good option to look into like flexeril, any of these can be used along with codeine or another opiate.

I know many like to control pain through any painkillers they can to avoid opiates but opiates really are much safer on your body than tylenol, NSAID's and even some muscle relaxants. Obviously those who engage in addictive behaviors with opiates might want to go in a different direction, but that is a personal choice for each to deal with in themselves. With so many illnesses, I am more concerned with your health. And yes many, many doctors are still completely ignorant of the damage that tylenol and NSAID's can and will do to the body. It seems to be a little known fact that those like yourself taking a normal dose of opioid painkillers, including morphine, do not often build too muh of a tolerance and do not often become addicted. Over the past 30 years opiates and even benzodiazepines (xanax, ativan, valium) have been shown to prolong life in chronic patients (terminal cancers, tumors, MS, FM (which you have), and other chronic conditions. Opiates do supress the immune systen to a certain extent in some people. So healing can take longer than usual. However, when weighing that against the liver damage, and damage to other vital organs like kidneys and pancreas that occurs with some other medications, immune supression really is no big deal especially when there are extremely simple ways to keep your immune system up and working normally and even above mormal while on opiates.

xoxo- D.

[hyphenate]

Thanks for the reply!

In answer to your questions, I switched doctors because my old doctor wasn't helping me.  I had been seeing the resident, but my primary care doctor was just as bad--I told him when he first became my doctor several things, including that I wanted to be an equal partner in my health choices, and then he proceeded to never really allow that.  Whenever there were blood tests, I specifically asked over and over again for lab test results, and I was ignored.  And despite confirmation of my fibro and arthritis, he kept harping on the diabetes to the extent that everything "wrong" with me was blamed solely on the diabetes and everything else was ignored.  It's very hard to get answers when your doctor focuses on one thing to the exclusion of everything else.  At the very end, the EMG results indicated that it was abnormal, and the findings concluded that it was all related to the neuropathy and therefore the diabetes, and he didn't even offer me any treatment for it.  I walked out of his office saying that too many doctors (including him) thought of diabetes as the new "fat" diagnosis--something I had been subjected to since I was an adolescent--the old "if you lost weight you wouldn't have _______(fill in the blank)."  Having diabetes should not be an end-all diagnosis, and as a result of their attitude and my own stubborn streak, I went off my insulin for several months, allowing my glucose level to soar.  I decided that I was sick and tired of being treated like an idiot, and that's when I switched, and have become a patient at the Joslin Clinic instead of the in-house diabetic clinic, because they, too, were treating me like an idiot.  I'm a lot happier now with the new clinic and doctors, except for my new primary's attitude toward pain meds.  In addition, I asked for a referral to the neurologist, and they told me no.  That was the final straw.

I take a  lot of medications right now.  For the fibro, I take 1 50mg amitriptyline and 1 10mg cyclobenzaprine at bedtime, 1 500mg naproxen twice a day, Effexor XR 150mg at bedtime, 2 gabapentin at bedtime (I know I should be taking 3 a day, but they make me so sleepy that it's difficult to function and the doctor suggested two at bedtime instead), Innopran, Lipitor and a few others.  Sometimes I try to function without most of them, but some are difficult to miss because of the withdrawal symptoms or the effects of why I'm taking something in the first place!.  The amitriptyline and cyclobenzaprine I have taken for many years--when I was first diagnosed with the fibro, the amitriptyline was the first medication I was given.  (BTW: I interchange generic and Brand names because you get used to calling them by one thing when a generic is substituted for the brand, and mostly use the brand name if there is no generic available)

The new doctor prescribed Ambien to see if a good night's sleep would help alleviate the pain, but it seems to only make me more frustrated.  

As far as the opiates are concerned, the Vicodin and Percocet were originally prescribed quite a while back because of acute (and therefore temporary) problems.  After one or two doses of the Vicodin, for example, I decided the nausea and vomiting were too nasty for me to take the pain pills, so they were never used after that.  It didn't even matter which opiate they were, I was nauseated.  When I had my angioplasty, my doctor gave me IV Dilaudid, and I puked my guts out for the rest of the night, so it wasn't just a conscious thing.

The Tylenol #3 was the first one that didn't evoke nausea or vomiting.  I noticed a major difference in the mornings when I took them--the stiffness and aching were lessened, and I could function better.  That kind of change was welcomed.  

Up until the problems with my legs and the constant fallilng I'm doing now, I rarely took more than the NSAIDS for pain.  So it's a whole new scenario for me.  And the reason I have been worried about addiction is because addictive personalities run in the family, as my biological mother was an alcoholic and other members of the family also had drinking problems.  (I was adopted within the family--my adoptive father was my bio mother's brother)   I don't drink myself, so that's not a concern, but with the reputation for addiction being high with narcotics, I'm afraid to keep taking them, even though I feel they're helpful for me.  It's worried me that I'm so annoyed at the doctor stopping the Tylenol #3 on me and if I'm trying to justify taking them.

If there were an alternative, I would be happy to try it--I'm open to alternate treatments if I can afford them (I'm on disability), and feel a great deal of relief from such things as massage therapy.  

Thanks again for your post--it's very much appreciated!

Mary