Fentanyl WD's

[bigalspal]

Hi Dr.
I have read everything about your remarkable story!
You are my inspiration.
Here's what i'm going through. I've been a long time opiate user. Since 1980.
Thankfully I only really like Hydrocodone. Of course I started on Darvocet.
I have had trouble with my back & neck & have had 2 surgeries.
BUT, I kept taking the drugs waaay after the really bad pain was gone.
I finally ended up with a Doc who decided to put me on Darvocet & Fentanyl Patches.
I was only on the 25mg patch for one month & on the 50 mg patch for one month. It almost killed me! I lost 19 pounds in 2 months! It messed up my mind.
I was taking about 16 Darvocet a day as well.
My question is: this is day 8 of the Fentanyl. This is day 2 off the Darvocet. The last 5 days(I hope my math is right) I was cutting the Darvocet in half and really sticking to taking a half of one every 6 to 7 hrs as needed..
I feel really pretty good. I have not had a Darvocet in 2 days. I have insomnia & intense malaise.
Maybe a little axiety in my stomach. I have a few Valium (no history of Benzo abuse) & take only one at night but it only helps me sleep maybe 2 or 3 hrs.
Do you think the Fentanyl is out of my system by day 8??
I have 4 halfs of Darvocet left. I'm afraid to throw them out, even though I have not taken them in 2 days. I'm afraid the really bad WD's might come back.
Is the worst over? Can I or SHOULD I throw them away?
My Doc said I could not do this WD's & said I would be back. I do not WANT to go back.
I can't go to NA. I went for YEARS & it seemed that I always got sicker. I even married a man I met at a meeting & we are divorced. I am now married to a "normal man for 16 years. He's very worried but supportive.
So what should I do?
Thank you!  

[seawench2002]

A related discussion, Itching!  Can I stop safely after 5 days? was started.

[bigalspal]

Thanks for answering me.
I wanted to let you know about my user name. "Bigalspal" is the elephant from the University of Alabama. He's the mascot! If you check my profile page, you will find I live in Alabama, I list Alabama Football as my intrest. So, while I agree with you on most everything you said, I had to laugh at that one! ROOOOOLL TIDE!
Anyway, you are right on about my personality.
I've not been diagnosed with borderline personality disorder, but have been diagnosed from PTSD. I was sexually abused many times through out my life.
I was an unwanted child born to to teenage parents. Father ran off, Mother spent her life blaming me for lack of accomplishment in Her life. She married 3 more times & I have 2 half-brothers who I was raised with. They are both addicts as well. Both still using.
I was the "target" child for most of the abuse.
No history of alcohol or drug abuse in our home. Just resentment & indifference.
Unfortunatly, I married 4 times too. My last marriage has lasted over 16 yrs.
It's been a lot of work, but my husband & I are determined to stick it out through my addiction.
You are absolutly right, I looked for my bio father over & over again through relationships.
I did meet my bio father at the age of 24. After 2 weeks of getting to know him he backed me up into a corner & kissed me. Not a father -daughter kiss, but a sexual one. I cut ties right away & it devestated me! Used for a long time after that.
The first time I went into in-patient treatment was in 1988. I've been in & out of treatment for years. I live in a small town & we have only 1 NA meeting. The AA folks won't let me talk about my drugs, so I helped start the NA meeting. I was the treasurer for 7 years!
No one would take the responsibility. I even came in to a business meeting & set the money, records ect down & said this job is supposed to rotate & someone else will have to take it! Noone would! I picked it back up & kept doing it. We had no real sobriety in our meetings. I kept getting a year & I would relaspe. I've read the BIG Book cover to cover, as well as the NA book. I've done the steps over & over. I sent my mother a 9th step admends (she lives in Indiana) & I was told by her sister that she tore it up! That hurt! I was clean again after a relaspe & my Mother called me & asked me if I wanted to go to Italy with her on an 8 day tour. My husband BEGGED me not to go, but I thought just maybe she was ready to have a relationship with me. HA! We got into a fight & she told me that she only asked me to go because her current husband told her to ask me & that if abortion was legal in 1957 I would not be here!
As soon as the plane landed I found some narcotics & off I went again. So, yes you are right. I AM hyper- sesitive to what people think about me. If I believe I don't measure up, I cover those feelings with opiates.
I was going to one on one therapy until I lost my job.
I hope to get back soon. I know I need it. I think that's one of the reasons I keep failing in NA. As you go around the room, you can't really get to the root cause of the reason why you use. I know that's what a sponsor is for. Problem is that when I was going to our only NA meeting in this VERY small town, there were only a handful of women & I had more time than them! They needed me! No way was I gonna ask a MAN to be my sponsor! I'm not stupid, I know my history with men.
The nearest NA meeting is 40 miles from my house one way. I have to pay my mortgage at the moment FIRST since I was laid off my job. I'll be honest. I HATE NA & AA after what I went through.
So, what do you think about me now????
Thanks!
BIGALSPAL

[J T Junig, MD PhD]

Thank you for your nice comments 'alspal', but be careful finding inspiration in the living-- my story is not yet complete, and I don't know how inspiring it will be by the end! If you are game I will first address the 'chemical' questions, then point out something that you are doing that is a hallmark of 'us addicts', and finally, use a couple things that you said to try to 'guess' where your issues lie, and where I think your attention would best be focused.  For 'lurkers', this will be, by far, my 'best post' of the evening-- so don't read anything else but this one!  (I'm trying to get myself fired up for one more paragraph or two at a time past my bedtime!).

Fentanyl is 'short acting' when injected, but only because it spreads from the blood compartment into the fat compartment of the body.  After having patches for a couple months, your system gets literally 'filled' with fentanyl.  Getting it cleared from your body will depend on your percentage of body fat, your metabolic rate, and the ability of your liver to break down the fentanyl.  I would imagine that fentanyl could be found in your body for a month or so after stopping it, but the last couple weeks it would be in very low concentrations-- too low to measure by the standard urine tests out there, and too low to have much of an affect on you.

OK... hallmark of addiction... I often see posts here and in the community forums that are complete fantasy-- the 'I want to be normal again' fantasy.  Sorry to rain on that parade, but there is little chance of coming out on top with that wish.  First, the addict usually has this image of the progression into addiction that is not accurate-- that they were basically a 'non-addict', who then made some wrong decisions or poor choices (or got some bad advice from a doc) leading to opiate addiction;  that if they just stop taking the opiates they will be that 'old person' again.

First of all, the addict usually was engaging in addictive thinking and behavior long before using substances;  the use of the substances is often a CONSEQUENCE of addictive thinking and behavior, rather than the other way around.  The point is that the person was an addict already-- even before the heavy opiate use.  Second, even if the person was a complete 'non-addict' until starting substances, the effects of active addiction are profound and generally life-long.  That is why your doc says 'you will be back'-- because in reality, almost everybody does come back.  Before Suboxone, opiate dependence generally followed a pattern of active use punctuated by episodes of sobriety.  Opiate dependence is a 'disease characterized by repeated relapse'.  Meetings will keep a person clean (usually), but when a person stops attending meetings, relapse generally follows.

This feeds into an article I have been meaning to write about the 'disease theory of addiction' and how Suboxone fits that model very nicely.  Were I in your shoes, I would consider doing what other people do with chronic illness-- manage it with the best medications available, which for opiate dependence would be buprenorphine or Suboxone.  I realize that some people will be angered by this idea-- but this is my 'best opinion' based on my own 16 years as an opiate addict, my own experiences in traditional residential treatment, and my experiences treating hundreds of opiate addicts with and without Suboxone.  It is NOT a 'substitution' of one drug for another;  rather, the buprenorphine treats addiction itself, which is the obsessive relationship with opiates.  No other drug does that to near the extend as does buprenorphine, and it appears that buprenorphine is safe in chronic use.  As for the trouble people have 'getting off of it', I say 'so what-- it isn't a good idea to stop it anyway!'

OK, now for the psychiatry guessing game...  you gave a number of hints that demonstrated something about your personality-- and that 'something' is that you tend to be more affected by the perceptions of you by others, particularly by men, than by your own perceptions of yourself.  I base that on:  
-your initial comment about my being an inspiration for you-- that somehow MY experiences were more difficult or inspiring than your OWN successes in getting through life;
-Your user name, 'bigalspal'-- that you identified yourself not according to just YOUR interests, but rather in relation to another person-- a man;
-You 'violated' the standard rule about avoiding relationships during the first year of recovery or avoiding 'recovery romances', suggesting that the 'draw' to be attached to a man was more powerful than your 'intellectual mind';
-you make reference to the opinion of your chances held by your doctor--  some people wouldn't care at all about what their doc's opinion was!;
-something else that is subtle that I can't quite put my finger on.

Anyway, I hope you are being a good sport... but I would suggest that you pay attention to the aspects of your personality that crave attachment to another person;  there might be a touch of 'borderline' about you, which is VERY common with opiate addicts;  with borderline personalities, the person has a chronic feeling of emptiness that CANNOT be filled, but the person will try to fill it over and over, with drugs, relationships...   If this is you, you would be particularly at risk at times when you are lonely, at times when you are fighting with your spouse, at times when your parents visit (as that will trigger the feelings that made you the way your are)...

I would suggest spending some time in front of a mirror each day saying 'hi' to yourself, and learning to smile to yourself when you handle something well. Avoid the negative self-talk if you can;  do a nightly inventory, but stick to what you did well, and complement yourself-- because you deserve it.  You will likely have enough negative stuff already, so just add the positive thoughts.  

I am a little concerned by the 'fantasy' part-- that you can avoid NA and simply avoid using.  It is worth a try, but make a promise to yourself that should you relapse, just find a GOOD Suboxone doctor and treat your addiction like the chronic illness that it is.  Get it under control quickly, before it causes any destruction.

Thanks again for your kind words, and I wish you the best,

Jeff