Your opinion

[Marina44]

Hi doctor-
I was on Norco and Kadian for about 2 years, I never abused my medication and took less than prescribed.  I decided I did not want to be on opiates anymore-I have a pinched nerve in my neck and it is chronic and causes problems about 4-6 times a year for up to two months at a time.  I went on Suboxone for about 1.5 month and got off-my experience has been I feel great but when I do have pain, I really want to take Norco, my doctor gave me Robaxin, which helps but sometimes I feel like I want to take the Norco when I am having a bad day-I am just afraid I will get dependent again.

I have been off of the Suboxone almost two months and between that time I have taken some Norco.  I still have Suboxone left so after the Norco-I have taken some small slivers of an 8 mg tablet so I don't get the cravings to take the pills again. Will I get hooked on the Suboxone if I do this? I feel guilty when I take the Norco and I remember you said it takes about 2 months for your receptors to get back to normal.  I feel like I haven't let myself be off the Norco for two months.  Do you think I can take the Norco once in a while and not get dependent and /or have withdrawls again?  I feel pretty good mood wise and energy wise, when I was coming off of the Suboxone I did go through withdrawls for about 3 weeks.  Am I playing with fire by taking the Suboxone again after I take the Norco?

[Jeffrey T Junig, MD PhD]

Marina, I think you know the answer to your question!  Understand, though, that if you are accurate in your self-assessment, then I have no idea what goes on in the mind of your species!  I cannot really relate, because I have never been anywhere close to a situation where I could control my use of opiates.

It seems that like bad news and bad movies, messages come in threes.  My last message or two were along this same line-- people who believed they were 'physically dependent' and not addicted.  I wonder, though, in your case as well.  Just because you weren't addicted for several years, does not mean you are not addicted NOW.  And I worry about a couple things you wrote-- that you felt guilty for what you are doing with the Suboxone, for example.  Also, it seems from your writing that this was not a case of a person taking NSAIDS for moderate pain, ice or heat for worse pain, and opiates for the severest pain... it sounds more like a case of taking a bit of opiate on a 'bad day'-- which may have been bad because of pain 'in part', but also bad for other reasons.  

I will leave the decision over the state of your 'dependence' to you.  But to answer your question about Suboxone-- yes, you are playing with fire.  The ceiling effect that is by now well known occurs relatively early with Suboxone... or late with buprenorphine, depending how you view it.  Buprenorphine is a 'microgram' drug;  it is given in a dose of 20 micrograms to treat severe pain.  When you take a sliver of a Suboxone tablet, say one eighth of a tab, you are taking 1000 micrograms!  That is a small sliver of Suboxone, but a huge dose of buprenorphine.  The ceiling occurs around 2-4 mg (2000-4000 micrograms), so when you take a sliver of buprenorphine you are near the maximal dose-- equal to taking 30 mg of methadone or 50 mg of oxycodone.  Buprenorphine sticks around a long time, so it has the potential to push your tolerance up with one or two doses.

We really could use a lower-dosed formulation of buprenorphine, to help with tapering and to use to treat pain.  Anyone out there own a pharmaceutical company?

[12gauge]

Can't answer your questions about Suboxone.  However, I can suggest something natural that I take for chronic pain - "Red Tart Cherry Juice CONCENTRATE"  Had to CAP the concentrate as most folks I've talked with seemingly don't hear that part.  It's been publicized in medical journals as having good properties for chronic pain.  I take it daily.  You can find it at a local grocery in the produce, or at a health food store.  

And just to make the joke - once you find it's effective, and you no longer need your norco's - mail 'em to me. :)  Sorry, couldn't resist.

[Marina44]

Thank you for letting me know about the Suboxone-I hope I don't go through w/d-I have been taking a sliver here and there for about 10 days sometimes missing a day.  I thought I was helping myself by not taking the Norco again-today will be my last day of slivers-Thanks again doctor!!!!!!!!!

[yoyoyo333]

I have a question regarding my boyfriends addiction to oxycontin. He has used for 5 years, abused prescription and at one point he had taken about 40 oxys 20mg. I dont believe its that much on a daily basis but very high doses. He also crushes and snorts them. I have a question on the long term effects of this abuse. Everything I could find were vague. I am referring to other than withdrawl symptoms. He goes through being sick for about a week or two a month every month for years. I notice certian things when he isnt going through coming down and being sick. His breathing at night when sleeping is scary. It sounds like someone is drowning heavy breathing like gasping for air and what seems like forever but prob 30secs to a min without breathing and then deep breathing like u cant catch your breath. Movement that actually pushes bed away from the wall like mini seizures. He has said there were a few times that he was going to call ambulance cause he thought he might be having a heartattack and I just have this feeling that if he continues to do this something bad is going to happen soon