Oral surgery ..... Ultram ?

[Brighty]

My son is a recovering addict and needs to have oral surgery for impacted wisdom teeth. He is opiate addicted. I am afraid his addiction will be awakened if even tylenol with codeine is used for a day or two. What would you suggest.... Ultram was suggested by the referring dentist as what the oral surgeon would likely use. What exactly is Ultram and is it ok for a day or 2 in this type of situation. Do you have a better suggestion?

[Brighty to Dan]

Thanks Dan... no I don't need your sources... I am satisified that you know your stuff :-)) Is there a date that the BUP is to be available in pill form... and do you think this is a good idea?? It's rarely a good idea for addicts to hold meds.... but then again they hold oxy, vic and the likes... your thoughts are appreciated. Love, Brighty

[Frankinscense]

It is thought also that dopamine plays a role in opiate dependence. There are more neurotransmitters being compromised obviously than endorphins. Ibogaine. I do not know only what you know. Personally, I think serotonin only plays a small role in opiate addiction. I tried SSSRI's during a detox with methadone only to find it made me xtremly more hostile than usual and actually caused my withdrawals seem like a panic attack.
                                                                
Personally,I think buprenorphine is the closest thing to a drug that you described. It seems to increase endorphin stores and also dopamine. Dopamine also is compromised or depleted while abusing opiates. Bup. is much like all opiates causing excellent chronic pain relief with no sedation and low abuse potential. It's is a schedule five drug meaning very little abuse potential. Lastly due to its agonist/antagonistic properties it stops all cravings and withdrawal symptoms during detox. It also is a very good short term maint. drug.
Sincerely,
Dan...
ps. I have sources for my info if you need them.

[Brighty to Dan]

Hi Dan,

Just found your reply. Thank you for the excellent information. Also, I do enjoy your posts. The information you bring is of particular interest to me...specifically your explanations of opiate addiction and it's effect on the endorphin producing mechanisms. I am wondering..... there are so many medicines to increase serotonin levels... it's almost chic to take them ( lol)... you know... but what about non addictive meds that increase endorphin production....have you heard of anything like this ?? And would this possibly be the answer to relieve the cravings or the so called euphoric recall?? What about natural remedies?? I mean it sounds so simple but yet it's so baffling and complex. I realize that laam and methodone are maintenance for those who seem to have permanently damaged their endorphin production. It's a miracle for some. Yet, those remedies have various negative results for alot of people... from travelling to a clinic, to abuse possibilities and so on. And it appears they allow the endorphins to replenish over time. But I want to know what there is to just increase production the way zoloft and prozac do with serotonin.  Am I nuts or is there something wrong with a pharmaceutical industry that hasn't come up with this yet ??  What about herbs, or amino acids or something ?? I would also be curious to hear if you have much information on ibogaine success. I know it's illegal here but it reportedly causes a serotonin "glow".... so I am curious what serotonin has to do with opiate addiction. Does serotonin have an effect on endorphin production ?? Oh well, I guess I'm getting carried away with my questions. Best wishes, Brighty

[Frankinscense]

Opiate addiction is a disease of the endorphin receptors caused by long term opiate use or abuse. Opiates deplete stores of endorphins that cause cravings and withdrawals. Abstinense will allow the receptors to replinish stores allowing cravings to become tolerable. Its hard to say which pain reliever would be apropriate. I definitely would not deny someone of pain relief. Talwin NX would probably be ok. Some people become,and are predisposed to opiate addiction and are termed "endorphin challanged." These people are prescribed maintenance doses of LAAm or methadone as a medicine to stop cravings and allow endorphins stores to hopefully replinish  and  stop cravings. This procedure is usally done only after failures to abstain have failed. This procedure is known as opiate agonist therapies. Bupenorphine is also an excellent choice for abstinence and detoxification.
Sincerely,
Dan

[Brighty to Anyone who can reply]

I hope Joannie's son is ok after his wisdom teeth surgery. We just went through this a few weeks ago... the oral surgeon prescribed something... meperidine fortrel.. ??? I can't recall the name but it was supposed to be demerol with a muscle relaxant. Turns out she did not end up with that oral surgeon because he was not in our insurance network. Then the one who did the surgery prescribed a week of vicodin. I can't recall the dosage now, sorry. My husband and I were upset over relapse possibilities. Both oral surgeons swore their recommendations for pain relief were the norm and there was no chance of relapse... of course I don't know how they could know this. Then the director of the program decided to have her on a 48 hour course of Ultram and then move down to Naprosyn. We also learned that the Ultram had the potential to re-awaken the addiction. Our daughter was angry that she did not get the narcotics... I do realize she was in pain. How can she or we possibly know in situations like this what the correct course of action is ?? There was not one person who was in agreement with what to use. They only agreed with their own recommendation. No matter what search methods I have used I cannot seem to get a cut and dried reply. Is it the type of drug that matters, or the dosage or simply the length of time it's used ... ??? Do you understand my dilemma ?? I have no clue which of these drugs would have been the better option or why. Does someone know the answer?? Thanks for all your help. Love, Brighty

[Brighty to Tom]

Thanks for some good information. This is important when a surgery is needed. I am astounded how little the average doctor knows... so glad I come to this board. You know... everyone seems to be looking for doctors who are both addiction specialists and pain management specialists. Many seem to be either one or the other. What's wrong with a profession that doesn't automatically incorporate that either one must be educated as both ??? Pain meds are primarily addictive. I just saw a reply from the doc on the board telling someone it's hard to find a doctor who is an expert in both areas. &*^%$#@ Love, Brighty

[Brighty to LePetit and everyone]

You are RIGHT..... and the problem is this..... what is the best alternative for pain for the addict? I am curious about this Talwin and Torodol also.... I never heard of them from our dentist when we had to deal with this. In fact this is the first time I have really seen someone mention them as good drugs for opiate addicts. My question is the same as Joannies.... what are agonist and antagonits and how do they work in relation to pain and addiction? Why are most doctors prescribing narcotics for addict patients post surgery if they could just as easily prescribe this Talwin NX. I just asked someone I know who works in a doctor's office casually about Talwin NX and got this... that's heavy duty stuff and not too safe. My search on the net has not revealed in plain English what I would want to know about Talwin NX for dental and minor pain. Ultram attaches to an opiate receptor and that's the problem. Any extra information would be appreciated.

[Joannie to Brighty and the others]

They only used the Ultram for my son every 6 hours for 48 hours so that's 8 pills. Then he got downgraded to an anti-inflammatory. Would this short use re-awaken his opiate addiction ? They told me not to worry. I am though. He says he will be ok but he has lied about his addiction in the past. What do you think of this dose ?

[Joannie to JB and Tom]

AAAAArgh. Too late. He had the surgery same day due to an abscess and I did not get your reply in time. Why don't we hear more about this Talwin and the other one, Torodal ? I don't know what you mean by agonists and antagonists in opiate use. Also, he got Ultram every 6 hours for only 2 days. They said when that much pain is present that even narcotics act only on the pain and not on the addiction. The oral surgeon tried to tell me it was ok with alot of pain and very very short term use. What do you think of this ? I am praying he doesn't relapse. Please reply. Thanx.

[tom to Brighty and Joannie]

I used Talwin NX while actively addicted to and using Vicodin, an opiate agonist. Opiate agonists bind to the brain's opiate receptors and stimulate the receptors to cause the classic opiate effects of euphoria, pain relief, constipation, addiction, withdrawal, etc. Talwin is classified as a partial agonist with antagonist actions, as well. I found that taking Talwin while actively using pure opiate agonists like Vicodin put me into a mild withdrawal, even though I got pain relief from the drug. The net effect was that I had no desire whatever to use the talwin any more than I had to. Some people do, of course, get high from Talwin, but my experience was the opposite. From what I have been reading, buprenorphin provides considerable pain releif without causing the usual opiate euphoria or dependence. It's sold as Buprenex, but it is only available by injection.

[LePetitMort]

NO ULTRAM.  IF you do your research on the net,  it is addictive to those who are prone to opiate addiction.

[Brighty to Joannie]

I am clueless about this. My daughter had her teeth pulled  while in  a treatment program... she is still there. They used the Ultram the same way.. a little less than 2 days.. I went berzerk and told them she had to come off it and they stopped. I figured the pain issue was not as serious as the possibility for relapse and ruining her life. This is not a chronic pain issue for her so my attitude was that she may have to learn to deal with discomfort in order to stay true to recovery. Addicts seem to have a need to take something for any discomfort that comes down the road. That is not a pain issue in my opinion... it's an issue of the psychological reasons why they continue to use. You know... she didn't have heart surgery... so I decided to not allow her to have a prescription vacation. I don't think ANYONE can predict who will relapse. I mean... I can't figure if it has to do with the strength or dosages given to an addict in pain or simply that once something touches the opiate receptor... no matter how mild the strength or dose.. if that is the trigger to relapse. I used to post on this board questions about that brain chemical called THIQ that supposedly when pain is present if that renders the narcotic not to work on the addiction center of the brain. My questions were not only unanswered, they were removed from this board.... on 2 occasions. I think it's a theory that when the pain is present that narcotics for an addict can be safely used but it's not determined how long or short a time that may be. I can 't seem to find an accurate answer anywhere. Personally, it may be that my daughter was in a relapse frame of mind from the 2 days of Ultram... she says no.. but as you say they do lie .... so all I know is that she happened to be in a treatment program and that is really the factor that caused her not to. So the bottom line is that there may not be an accurate answer to the question about your son.... if it did trigger relapse feelings it will be up to him to use his recovery skills. And then again... maybe for HIM the 8 pills were not enough to trigger this. IT's just not an exact science from my observations. I pray he will be OK and hope that others will add their information to this. Love, Brighty

[PJ]

would ultram ease the withdrawl pains of oxycontin?

[tom to PJ]

only partially. oxy is a powerful narcotic on a par with morphine and demerol. You will still need to address the usual symptoms of the runs (use Immodium), muscle aches (hot baths), insomnia and anxiety (valium, xanax or valerian root). Take care.

[J.B. to Brian and Vicky]

I agree with the Talwin for pain. I had it for my sciatica some time ago along with Vistiril. Since then I've had Torodal(sp) which worked well, too. These were all administered IM so I don't know how they would work in pill form.

By the way, Has some hacker gotten in to these threads and caused havoc? Check out the thread Overdoses. Looks like the whole thing has been written in Greek or something. I don't know what is going on here anymore. And I'm not high either!

[tom to Joannie]

ultram is not an opiate in structure, but its effect on the brain is very much like an opiate. Ultram will feel and act like, say, codeine or vicodin. In trials, it was perceived by opiate addicts as an opiate. However, I hate the idea of your son going through oral surgery with no effective pain relief. I am not a doctor, but am experienced in the whole narcotics game. If it were me, I would ask for Talwin NX. Talwin NX is what is called an opiate partial antagonist. In other words, it's action on the brain is only mildly like that of opiate agonists such as vicodin (or Ultram).

Speaking as a 30-year rx opiate addict, I got significant pain relief from Talwin NX but did not enjoy the effect or crave it in any way. Ask your doctor or dentist about Talwin NX tablets. They're a potent pain killer that generally doesn't "wake the monster" of opiate addiction. Under your care with supervised use, I believe your son could use Talwin NX post-op without relapsing. Perhaps Dr Steve will back me up. Take care.