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Managing pain meds without becoming addicted
Hi there...I'm new to this site.I was wondering if there is anyone out there who has to take the pain meds (duragesic,etc.) in order to get relief from their chronic pain,yet is able to not become addicted.I realize that one's tolerance will increease thereby requiring more meds and/or a higher dose,but how do you NOT become mentally addictive to these drugs?!?!I am so frustrated as I have been on opiod medication for approx.17-18 years,1st starting off with vicodin then finally on duragesic&oxycodone for the breakthrough pain.I feel so guilty taking my meds but literally cannot function without them.Any help/suggestions?Thank you~A
Jaybay is correct. Cocaine is NOT an opiate and should not even be related to pain medications such as opiates. There are so many CP Pt's that will not even take opiates because of the stigma attached and to equate cocaine with opiates used by legitimate chronic pain Pt's creates even more problems.
Cocaine is an illegal drug that is not used for pain management in any way.
I just wanted to make this clear.
Cocaine is an illegal drug that is not used for pain management in any way.
I just wanted to make this clear.
Great posts, everyone! Jaybay, I think you covered every angle of it. I have only known a few addicts in my life, but I have seen that they can't help it. It's so easy for us to make a moral judgement against someone because we don't understand why they do what they do.
My doctors haven't really gotten into addiction except when I first started on opiate therapy and I was worried, like most people, that I would become addicted.
I have learned much more on this forum than I have learned in 2 solid years of PM from the doctors.
Tomskat- I had a friend who's mother had an addiction problem and was on the Fentanyl patch. He would keep the patches at her house or his in a lock box and he would bring her a new patch on the change day. He would also randomly stop by to make sure she was using it as prescribed. That was good for her because she never knew when he would be stopping by. On the other hand, one time I went with him to "stop by" and she had abused the patch and was near passed out. We had to bring her to the hospital. But she knew the consequences and her doctor dropped her dose because of the incident. I'm sure that if it happened again they would cut her off completely.
It's definetly difficult for a child to have to be responsible for the parent, but at the same time, if the family member really needs the help and it works for both parties, it can really work.
Another thing is that I have found that after using the same med for a while there is almost no "euphoria" except if I have to take it later than my next dose, etc. So after a while it just pain relief.
I hope you find a good way to manage your meds. I think we are all a little worried at first but after a while it's just like taking any other medicine.
My doctors haven't really gotten into addiction except when I first started on opiate therapy and I was worried, like most people, that I would become addicted.
I have learned much more on this forum than I have learned in 2 solid years of PM from the doctors.
Tomskat- I had a friend who's mother had an addiction problem and was on the Fentanyl patch. He would keep the patches at her house or his in a lock box and he would bring her a new patch on the change day. He would also randomly stop by to make sure she was using it as prescribed. That was good for her because she never knew when he would be stopping by. On the other hand, one time I went with him to "stop by" and she had abused the patch and was near passed out. We had to bring her to the hospital. But she knew the consequences and her doctor dropped her dose because of the incident. I'm sure that if it happened again they would cut her off completely.
It's definetly difficult for a child to have to be responsible for the parent, but at the same time, if the family member really needs the help and it works for both parties, it can really work.
Another thing is that I have found that after using the same med for a while there is almost no "euphoria" except if I have to take it later than my next dose, etc. So after a while it just pain relief.
I hope you find a good way to manage your meds. I think we are all a little worried at first but after a while it's just like taking any other medicine.
Just a general FYI - cocaine is not an opiate. The danger here is the addictive behavior encompassing a new class of drugs, in this case narcotics. Some psychologists believe that a person with addiction issues will have problems with about any substance that works in the brain whether it's speed, opiates or alcohol. It's the old, "once an addict always an addict" credo with a corollary: once addicted to one drug; always potentionally addicted to ALL drugs.
Certainly any addiction issues in a patient's history should be discussed with the pain doctor prior to going into opiate therapy, but there are too many reasons for secrecy - some valid, some a result of the addiction itself. Many doctors won't treat patients with a history of addiction, so the patient keeps his mouth shut and risks relapse. Some doctors will taken on such patients but with severe restrictions that sometimes make opiate therapy more trouble than it's worth. Relapse and a return to street drugs in search of pain management is a huge risk. Expecting an addict to dispense medication as prescribed just doesn't work, and the patient is often doomed to relapse. Is that the patient's fault or the doctor's fault or society's fault? I have no idea.
The question of treating an addict with chronic pain is a terrible conundrum for patient and doctor alike. In my personal opinion, an addict deserves pain relief just like any other patient. We're still talking about a human being in pain, but since some of that pain is mental (addiction) society sees that person as having a moral character deficiency rather than a medical problem. While an addict's associated behavior like lying and stealing certainly does run contrary to acceptable societal norms, those behaviors are the result of active addiction rather than something "wrong" with the patient's character. Blaming an addict for "being weak" or "bad" is like blaming that person for the color of his eyes. Ask anyone on the Substance Abuse forum. Not one of those people woke up one day saying, "I'm going to go steal some money and find some (insert drug here) and become an addict." Addiction is not a personal choice that someone conciously makes.
It's also unfortunate that opiates are the best weapon we have in the pain arsenal and often addicts are refused pain relief. Society believes addiction to be a bigger problem than chronic pain. I recall a neighbor who was a former addict and died of AIDS in the early 1990's. His doctors refused to give him morphine because he used to be an addict. That kind of thing happens all the time and those doctors should be drummed the profession.
I honestly don't know what the answer is for treating an addict's pain. We have a member here in exactly this situation who has worked out a good treatment plan with a doctor willing to work with him. If I remember correctly, pain is treated with non-narcotic means at home, but if it gets horrific he can be treated with opiates at the hospital. Of course, it helps that his medical condition can be verified with imaging studies so there is no chance of conning the doctors and hospital staff.
Sometimes an addict's spouse or significant other is "deputized" into dispensing medication exactly as prescribed. If the addict is not in solid recovery at that point, this can be disastrous for both the addict and the spouse. An active addict will still search the house high and low to find that bottle of pills and overindulge or badger the spouse for more. The spouse ends up playing DEA cop, resentment and frustration builds, and eventually the entire relationship explodes under the pressure. It's a tremendous responsibility for a spouse, who usually doesn't understand much about addiction or chronic pain to begin with. How many of us would finally break down if we tried to manage the dose for a spouse in that position? Could any of us last forever in the face of our loved one begging and pleading for "just a little more" because the pain is unbearable?
Sorry about the treatise. LOL! I've read so much about addiction and chronic pain over the years but still haven't found any easy answers to this question. The one thing I've learned is that doctors really need to spend more time educating their patients about addictive behavior and physical dependence. Most docs don't explain WHY a patient should beware of giving in to that temptation to "just take an extra pill." Great discussion. I'd love to hear more from other members about how their pain docs approach addiction issues - if they bother to address it at all. Is the relationship an educational one or is it "do as I say because I am the almighty doctor?"
Certainly any addiction issues in a patient's history should be discussed with the pain doctor prior to going into opiate therapy, but there are too many reasons for secrecy - some valid, some a result of the addiction itself. Many doctors won't treat patients with a history of addiction, so the patient keeps his mouth shut and risks relapse. Some doctors will taken on such patients but with severe restrictions that sometimes make opiate therapy more trouble than it's worth. Relapse and a return to street drugs in search of pain management is a huge risk. Expecting an addict to dispense medication as prescribed just doesn't work, and the patient is often doomed to relapse. Is that the patient's fault or the doctor's fault or society's fault? I have no idea.
The question of treating an addict with chronic pain is a terrible conundrum for patient and doctor alike. In my personal opinion, an addict deserves pain relief just like any other patient. We're still talking about a human being in pain, but since some of that pain is mental (addiction) society sees that person as having a moral character deficiency rather than a medical problem. While an addict's associated behavior like lying and stealing certainly does run contrary to acceptable societal norms, those behaviors are the result of active addiction rather than something "wrong" with the patient's character. Blaming an addict for "being weak" or "bad" is like blaming that person for the color of his eyes. Ask anyone on the Substance Abuse forum. Not one of those people woke up one day saying, "I'm going to go steal some money and find some (insert drug here) and become an addict." Addiction is not a personal choice that someone conciously makes.
It's also unfortunate that opiates are the best weapon we have in the pain arsenal and often addicts are refused pain relief. Society believes addiction to be a bigger problem than chronic pain. I recall a neighbor who was a former addict and died of AIDS in the early 1990's. His doctors refused to give him morphine because he used to be an addict. That kind of thing happens all the time and those doctors should be drummed the profession.
I honestly don't know what the answer is for treating an addict's pain. We have a member here in exactly this situation who has worked out a good treatment plan with a doctor willing to work with him. If I remember correctly, pain is treated with non-narcotic means at home, but if it gets horrific he can be treated with opiates at the hospital. Of course, it helps that his medical condition can be verified with imaging studies so there is no chance of conning the doctors and hospital staff.
Sometimes an addict's spouse or significant other is "deputized" into dispensing medication exactly as prescribed. If the addict is not in solid recovery at that point, this can be disastrous for both the addict and the spouse. An active addict will still search the house high and low to find that bottle of pills and overindulge or badger the spouse for more. The spouse ends up playing DEA cop, resentment and frustration builds, and eventually the entire relationship explodes under the pressure. It's a tremendous responsibility for a spouse, who usually doesn't understand much about addiction or chronic pain to begin with. How many of us would finally break down if we tried to manage the dose for a spouse in that position? Could any of us last forever in the face of our loved one begging and pleading for "just a little more" because the pain is unbearable?
Sorry about the treatise. LOL! I've read so much about addiction and chronic pain over the years but still haven't found any easy answers to this question. The one thing I've learned is that doctors really need to spend more time educating their patients about addictive behavior and physical dependence. Most docs don't explain WHY a patient should beware of giving in to that temptation to "just take an extra pill." Great discussion. I'd love to hear more from other members about how their pain docs approach addiction issues - if they bother to address it at all. Is the relationship an educational one or is it "do as I say because I am the almighty doctor?"
Hi Tomskat,
You asked some good questions...one I am not sure I can answer correctly.
I know little about the details of addiction. According to your profile page you are clean and sober from Coke. I don't honestly know if you can be addicted to one opiate and not have problems with another. If you were an alcoholic I could tell you that if beer was your choice of drinks it wouldn't help you to change to whisky...you'd just change your drink of choice and still be addiction to alcohol. So does that mean that you can be an addict with one opiate and not another?? I don't honestly know but my guess would be no. You'll have addiction issues with all opiates.
Most statistics say that less than 4% of chronic pain patients ever become addicts. There is a new study out by a trusted and well know national clinic that claims that figure is actually only 1%. That is not the general public, that's only the chronic pain patients.
For the most part, chronic pain patients do have a dependency on their opiates and we all have a physical dependancy. We'll experience withdrawals just as an addict does. Or body doesn't know the difference.
I don't have a craving nor have I ever misused my perscription drugs. What I do know is that some of us have the addiction gene...rather that's drugs or alcohol. I am blessed that I do not have that gene. My best friend's husband is an ADOA counselor, a recovering alcoholic. He hasn't had a drink in over 23 years. He tells me that some ppl, most ppl will never be addicts. It's a disease that you either have or you don't.
But these are all things I am sure you have heard before. You have no reason to feel guilty about responsibly taking an opiate to control chronic pain. There's no shame in that. If you abuse them then hang you head...because abusers make it tough for every legitimate chronic pain patient. Only you know that response to those questions.
My heart goes out to you in your struggle to control you pain. It's difficult in every respect. We are here to offer our support. We're good listeners. :) Please feel free to ask additional questions and join in responding to posts.
I wish you the very best and will look forward to hearing from you again.
Take Care,
~Tuck.
You asked some good questions...one I am not sure I can answer correctly.
I know little about the details of addiction. According to your profile page you are clean and sober from Coke. I don't honestly know if you can be addicted to one opiate and not have problems with another. If you were an alcoholic I could tell you that if beer was your choice of drinks it wouldn't help you to change to whisky...you'd just change your drink of choice and still be addiction to alcohol. So does that mean that you can be an addict with one opiate and not another?? I don't honestly know but my guess would be no. You'll have addiction issues with all opiates.
Most statistics say that less than 4% of chronic pain patients ever become addicts. There is a new study out by a trusted and well know national clinic that claims that figure is actually only 1%. That is not the general public, that's only the chronic pain patients.
For the most part, chronic pain patients do have a dependency on their opiates and we all have a physical dependancy. We'll experience withdrawals just as an addict does. Or body doesn't know the difference.
I don't have a craving nor have I ever misused my perscription drugs. What I do know is that some of us have the addiction gene...rather that's drugs or alcohol. I am blessed that I do not have that gene. My best friend's husband is an ADOA counselor, a recovering alcoholic. He hasn't had a drink in over 23 years. He tells me that some ppl, most ppl will never be addicts. It's a disease that you either have or you don't.
But these are all things I am sure you have heard before. You have no reason to feel guilty about responsibly taking an opiate to control chronic pain. There's no shame in that. If you abuse them then hang you head...because abusers make it tough for every legitimate chronic pain patient. Only you know that response to those questions.
My heart goes out to you in your struggle to control you pain. It's difficult in every respect. We are here to offer our support. We're good listeners. :) Please feel free to ask additional questions and join in responding to posts.
I wish you the very best and will look forward to hearing from you again.
Take Care,
~Tuck.
Hi Tomskat,
Even though you aren't new to MH you are, as you said, new to this Forum and I want to welcome you to the Pain Management Forum. :) We are VERY glad that you have come to this Forum and want to be sure, even thought you probably already DO know, that there are NO Doctors on this Forum. All of us are, just like you, CP Patients.
I've read many of your posts on the SA Forum and realize that you've been fighting this battle for many years now. You are to be ADMIRED for being able to pull yourself off of some of the "drugs" that you have. I know from your posts that you are still struggling BUT you will win the battle again!!
You need to be HONEST with your Doctor's IF you don't want to keep fighting this battle with your Prescription meds also. I don't know if it IS possible for you to be able to take this medication without being addicted to it because of what you have gone through. You may have to make some tough choices here about whether you continue this battle or put up with the pain and get off of the Narcotics and deal ONLY with the OTC's and the treatments that are available through your PM Doctors. Does your PM Doctor KNOW about your background? I don't know if it's possible for you to just say I'm addicted to this drug BUT I won't be addicted to this other one. Do you understand what I'm saying? If they know then they can help you so that you won't become dependent on them also. I hope that you will be up front with them so that they can help you.
Like you, I'm on the Fentanyl Patch and the Percocet for BT meds. As you know the Fentanyl is a VERY strong Opiod and I'm concerned about you as you yourself are. I can tell by your post.
PLEASE get some help from your Doctor's as I'd hate for you to have problems because of the Fentanyl. Also, PLEASE be up front with your Doctor's if you haven't. I know that you have severe pain but they need to have the whole story in order to be able to help you and not HURT you!!! Let them guide you through this.
I wish you the best of luck and please keep us updated as to how you are doing......Sherry
Even though you aren't new to MH you are, as you said, new to this Forum and I want to welcome you to the Pain Management Forum. :) We are VERY glad that you have come to this Forum and want to be sure, even thought you probably already DO know, that there are NO Doctors on this Forum. All of us are, just like you, CP Patients.
I've read many of your posts on the SA Forum and realize that you've been fighting this battle for many years now. You are to be ADMIRED for being able to pull yourself off of some of the "drugs" that you have. I know from your posts that you are still struggling BUT you will win the battle again!!
You need to be HONEST with your Doctor's IF you don't want to keep fighting this battle with your Prescription meds also. I don't know if it IS possible for you to be able to take this medication without being addicted to it because of what you have gone through. You may have to make some tough choices here about whether you continue this battle or put up with the pain and get off of the Narcotics and deal ONLY with the OTC's and the treatments that are available through your PM Doctors. Does your PM Doctor KNOW about your background? I don't know if it's possible for you to just say I'm addicted to this drug BUT I won't be addicted to this other one. Do you understand what I'm saying? If they know then they can help you so that you won't become dependent on them also. I hope that you will be up front with them so that they can help you.
Like you, I'm on the Fentanyl Patch and the Percocet for BT meds. As you know the Fentanyl is a VERY strong Opiod and I'm concerned about you as you yourself are. I can tell by your post.
PLEASE get some help from your Doctor's as I'd hate for you to have problems because of the Fentanyl. Also, PLEASE be up front with your Doctor's if you haven't. I know that you have severe pain but they need to have the whole story in order to be able to help you and not HURT you!!! Let them guide you through this.
I wish you the best of luck and please keep us updated as to how you are doing......Sherry
Are you worried about addiction for yourself? Unless you are taking more than prescribed or craving a "high" from your meds, then you aren't addicted. That is a psychological problem and completely different from the physical tolerance and dependence that are normal for people on opiate therapy.
Certainly the addiction monster can be "awakened" and take unsuspecting patients quite by surprise, but everything I've read says that the vast majority of chronic pain patients take meds as prescribed and do not become pscyhologically addicted. It's a tough issue for doctors and patients since secrecy is such a huge part of addiction. In my personal opinion, the practice of pain management has swung way too far in the direction of treating every patient as a potential addict when the studies clearly indicate it's not that big of a problem. But that's another topic for another day. :-)
Since you do need the meds to function, and it doesn't sound like you're self-medicating even after all these years, why do you feel so guilty about it? If you were diabetic and needed insulin to function you wouldn't feel guity, right? Opiate therapy in responsible hands is no different.
There are ways to deal with tolerance so a patient doesn't have to keep increasing the dose. Sometimes a switch to a completely different opiate for a few months can help reset the brain's opiate receptors. When the patient is returned to the preferred medication, the dose can be lowered. Another strategy is to take an opiate vacation. The doctor tapers the patient down to a very low dose or completely off all opiates for a while. Obviously, that isn't always feasible, but if you stand the misery for a few weeks you'll find a lower dose to be more effective for having taken a break.
Hope that helps a bit. If I've completely misunderstood and you believe yourself to be addicted, just set me straight! There's also a great Substance Abuse forum here at Med Help that might be of interest to you, and it has tons of great info - and people! - that should help you better understand addiction. :-)
Certainly the addiction monster can be "awakened" and take unsuspecting patients quite by surprise, but everything I've read says that the vast majority of chronic pain patients take meds as prescribed and do not become pscyhologically addicted. It's a tough issue for doctors and patients since secrecy is such a huge part of addiction. In my personal opinion, the practice of pain management has swung way too far in the direction of treating every patient as a potential addict when the studies clearly indicate it's not that big of a problem. But that's another topic for another day. :-)
Since you do need the meds to function, and it doesn't sound like you're self-medicating even after all these years, why do you feel so guilty about it? If you were diabetic and needed insulin to function you wouldn't feel guity, right? Opiate therapy in responsible hands is no different.
There are ways to deal with tolerance so a patient doesn't have to keep increasing the dose. Sometimes a switch to a completely different opiate for a few months can help reset the brain's opiate receptors. When the patient is returned to the preferred medication, the dose can be lowered. Another strategy is to take an opiate vacation. The doctor tapers the patient down to a very low dose or completely off all opiates for a while. Obviously, that isn't always feasible, but if you stand the misery for a few weeks you'll find a lower dose to be more effective for having taken a break.
Hope that helps a bit. If I've completely misunderstood and you believe yourself to be addicted, just set me straight! There's also a great Substance Abuse forum here at Med Help that might be of interest to you, and it has tons of great info - and people! - that should help you better understand addiction. :-)
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