Am I addicted to Loritab 10/500

[Nowayout89]

I have been taking 1 Loritab 10/500 twice daily for 2 years for lower back pain( ruptured disc), bilateral CPS, and knee degeneration.  When I don't take them, I feel like I'm getting the flu, and really bad all over.  When I do take them, I will break them in half,  so really I'm taking 1/2 a pill 4 times a day.  Is the dose I've been taking and length of time, enough to have me dependent on this drug?  I would like to stop taking it altogether.  Would substituting regular Tylenol 500 help.  

[femmy29]

Hi dgreen,

Welcome to the MH Pain Management Community!

You have replied to a really old thread such that you may not get as many responses to your questions by posting here.  It is best to start a new thread and post your question that way.

I also deal with lower back pain from 1 bulging disk and 1 ruptured disc.  It took many years of trial and error to find the optimal solution.  At one point, the pain was so bad that I told the doctor that I didn't know how much longer I was going to be able to work and that disability leave is around the corner for me if this severe pain keeps up.

That opened the door for an additional MRI scan but this time of my lumbar spine and additional treatments.  I still have pain at times and now is one of those times, unfortunately.  But, the majority of the time my pain is well covered such that I can sleep a full 8 hours and do a lot more with my family and can concentrate on my work, not my pain when I go to work.

I would be persistent with your physician and state what you are beginning to not be able to tolerate, such as work as you talked about in your post.  If your physician still is unwilling to listen, it may be time to hire a new doctor.

I wish you the best of luck on your journey for pain relief and I hope that you find relief soon.

femmy

[dgreeny]

Bulging discs in lower back.i work full time and cannot stand the pain at times.BIG problem.i cannot get my doc or a doc to give me a good pain pill that acually works.they keep trying crap that dont work.any suggestions?please help

[Mollyrae]

I forgot to add, there is a substance abuse forum that would better answer your question.  There are others there who  can tell you better how to cut back.
Take care, Mollyrae

[Mollyrae]

Hi, this is an old post. If you would like to ask a question please start a new thread by hitting the : ask a question" tab and start a new post. Not many ppl will see it or respond here. Take care, Mollyrae

[mommy2saf]

I am 27 years old and I have been on loritabs(doctor prescriped..lol) for the past 3 years off and on i started taking them reguler about 1 1/2 years ago. at first I took half a day. then a whole one. In april my mother passed away and my physical pain was unbearable needless to say I am on 2 to 2 1/2 a day I want to cut back but my body hurts so bad. I try and suppliment but what is the best way to cut back to 1 a day. My mother was an addict and that is what caused her death an accidental overdose and I am very scared.

[Sajonna]

"I also like to put it in a different way

People who are using drugs and alcohol for uses other than a valid medical condition are running from life while those taking medication for pain or a psychological condition are running twords life."

This is great advice from TMA.  

I passed up an all expense paid trip to Hawaii a month ago all because I was afraid that if I went and did not have any pain meds with me I would ruin the trip for everyone (by not being able to participate in activities.)

I thought too, that I was becoming an addict until I had a long discussion with my doctor today.  I have a real long post in the Substance Abuse Forum.  They helped me alot on my taper..told me what to expect etc.  After my successful taper regular Tylenol did help for awhile. However the high heat and humidity brought my pain back.  When the weather cools off again (returns to normal) I will taper again.  I will never just STOP this medication abruptly.  That can cause more pain by just stopping it.

According to my doctor, he has most of his chronic pain patients either taper off for awhile or reduce dosage so they can get the maximum benefit from the meds.
While the Substance Abuse Forum people are helpful in understanding tapering and giving some alternatives to pain control during tapering, I think you might find more in common with people here when discussing your chronic pain.  Unfortunately, I never got a buzz or the high alot of the addicts got that took my same pain medication. I say that in a joking way (and not to start an argument.) I made some good friendships there and would help anyone over there in a heartbeat.

SJ

[Toomanyadvil]

Hi nowayout,

    If you can you may want to check out accupuncture. Some people swear by it as way of helping to control there pain.
If your interested in alternative health treatments that can lower inflamation please feel free to PM me as I would be happy to give you a few suffestions that have helped me.

I hope you are avle to find some ways to help treat your pain in a way your comfortable with.

TMA

[fibromama]

There is other options to pain mngmt,,my friend is going to get a implant in her back that blocks out all pain to the receptors,,I hope you are able to find your alternative to pain relief.  Take care and good luck.  :)

[Nowayout89]

I will try some other alternative,maybe surgery.  Over the counter pain med.  I would like to thank everyone that has responded to my question. All have been helpful.

[plmrsm8]

I am really now here.   Nowayout89,  If you went off loritab what woud you take for pain control.  Chronic pain can really wear a person out.  I have been living wih it since about 1995.  

[fibromama]

As a result of the confusion with the definition of addiction, and specifically with the assumption any type of physical dependence or tolerance is associated with addiction, states fail to establish the difference between intractable pain patients and drug addicts and between physicians and drug dealers. State medical board members need to understand that physical dependence and tolerance are not always associated with addiction, thus opioids taken for intractable pain rarely if ever result in addiction. Once this is done, overregulation and prosecution of legitimate physicians may subside to allow for more adequate intractable pain treatment.

[fibromama]

Ambiguous definition of addiction

According to the American Society of Addiction Medicine, "The clinical implications and appropriate management of physical dependence, tolerance and addiction differ. It is therefore important that clear definitions be established to facilitate identification and appropriate management of these occurrences.11,17

Because many members of state medical boards continue to believe that physical dependence and tolerance associated with opioid pain treatment is the same as addiction, numerous states’ regulations fail to recognize the difference between physiological responses to opioids for intractable pain and the physiological and psychological responses to recreational drug abuse.1,17

A survey conducted by The Pain and Policy Studies Group at the University of Wisconsin, confirmed state medical boards’ false belief that physiological responses to opioids are the same for addiction and intractable pain treatment. One question in the survey asked state medical board members to select terms that encompass the definition of addiction and physiological responses to opioid pain treatment. Physical dependence and tolerance held a large majority of the vote.

Table 1. Terms that state medical board members included within their definition of addiction. Each member was required to choose one or more of the following terms to define addiction: physical dependence, psychological dependence, tolerance, other, and don’t know.11 (A question from a survey conducted by The Pain and Policy Studies Group at University of Wisconsin)

Choose the terms that define addiction
physical dependence 85%
psychological dependence 71%
tolerance 41%
physical dependence only 10%
psychological dependence only 10%
tolerance only 1%

[fibromama]

Governments' and State Medical Boards' Perspectives
State Restrictions

Addiction
Opioid Dosage Unit Limitations
Multiple Copy Prescription Programs
Electronic Monitoring Systems
Falsely Perceived Illegality of Opioids for Intractable Pain

A. Addiction

To understand how addiction is ambiguously defined in state laws, we must first understand how addiction and its components are defined correctly.

The American Society of Addiction Medicine recently defined terms associated with addiction and the physiologic responses associated with opioid treatment for intractable pain. The terms defined below reflect current thought on the differences between addiction and opioid pain treatment.17

Physical dependence upon an opioid is a physiological state in which abrupt cessation of the opioid, or administration of an opioid antagonist, results in a withdrawal syndrome. Physical dependency on opioids is an expected occurrence in all individuals in the presence of continuous use of opioids for therapeutic or for nontherapeutic purposes. It does not, in and of itself, imply addiction.

Tolerance is a form of neuroadaptation to the effects of chronically administered opioids (or other medications) which is indicated by the need for increasing or more frequent doses of the medication to achieve the initial effects of the drug. Tolerance may occur both to the analgesic effects of opioids and to some of the unwanted side effects, such as respiratory depression, sedation, or nausea. The occurrence of tolerance is variable in occurrence, but it does not, in and of itself, imply addiction.

Addiction in the context of pain treatment with opioids is characterized by a persistent pattern of dysfunctional opioid use that may involve any or all of the following:

adverse consequences associated with the use of opioids
loss of control over the use of opioids
preoccupation with obtaining opioids, despite the presence of adequate analgesia
Individuals who have severe, unrelieved pain may become intensely focused on finding relief for their pain. Sometimes such patients may appear to observers to be preoccupied with obtaining opioids, but the preoccupation is with finding relief of pain, rather than using opioids per se. This phenomenon has been termed ‘pseudoaddiction’ in the pain literature.

[Mollyrae]

Well said.

[Melissa70817]

I believe when we think of an addict we think of the people we see on tv who will steal, prostitute, sell their possessions, put their children in danger, etc. to get a certain drug.  
When I was first diagnosed and given lortabs I wouldn't fill the prescriptions.  I was scared of becoming addicted,the fear of becoming an addict out weighed my desire to stop the pain.  I didn't want to become what we all think of as an addict.  As some of you know, after much talking with my doctor and him telling me that the pills are not going to work for me if they are sitting in the bottle, I decided to take them.  That was several years ago.
In my opinion all of us who are dependent on pain meds are addicts.  Not in the sense that we are going to steal, prostitute, sell off our possessions or put our children in danger.  I have taken double my dose of pain meds when I have a severe flare, in doing so it caused me to run out of my meds early.  For fear of sounding like an ADDICT I refused to call my doctor to let him know, instead I suffered and went through severe withdrawals.  My thought was, if I call and ask for something stronger or ask for a refill, what will I do if he takes them away all together, I don't want to go through that pain every single day so,  I went through withdrawals.  If any of you have ever gone through withdrawals it is exactly what you see on tv.  No, I didn't do any of the things that I have listed as what we believe an addict is but I did what I had to do to get out of pain within MY moral boundaries.  For me, I consider myself a dependent addict.  I think we all fear the word ADDICT because we don't want to consider ourselves as someone we see on tv.  I don't believe that any of us here abuse our meds to the point of being the person we see on tv, we just do what we have to do to control the pain we are in at the moment. If we were cured tomorrow of our illnesses and tried to get off of our pain medication, I believe a lot of us couldn't do it or it would be a very tough road.  The cravings for the opiate will be there for months and months, maybe even years, even after the withdrawal symptoms are gone.   We are all in a catch 22 situation.  We are dependent because we were put in the situation because of our illness but I would have to think that after taking the opiates for years, will cause an addiction that would/will be hard to beat if we were cured of our illnesses tomorrow.  

[Mollyrae]

You are so right and to the point. Opiates are addictive and we are addicted.

[sandee1818]

Physical dependence is a property of various classes of drugs, including opioids and corticosteroids. Once the body has become habituated to such drugs, abrupt cessation results in a recognizable withdrawal syndrome.  Full-blown withdrawal from steroids and alcohol is potentially fatal; withdrawal from opioids is uncomfortable but rarely dangerous. Some drugs of abuse are associated with a withdrawal syndrome; others (such as cocaine ) are not.  Withdrawal symptoms can be avoided by tapering the drug, as every practitioner who prescribes corticosteroids knows.   Physical dependence is a different phenomenon from addiction. Confusion arises because opioids can produce both physical dependence and addiction.  Pain patients treated chronically with opioids often become physically dependent, but only occasionally develop de novo addiction.  A prior history of drug or alcohol addiction or abuse increases the risk of addiction.  

            Drug addiction is a disease in which there are three elements

Loss of control (also called compulsive use) of a drug – the person uses more than intended, is unsuccessful in attempts to cut down, etc.
Continuation despite significant adverse consequences – disease or injury, job loss, relationship difficulties, arrest, etc.
Preoccupation or obsession – over obtaining, using, and recovering from the effects of the drug.


Signs of possible drug addiction in the medical setting may include:

Repeatedly using up the drug before the next refill (but see the section on pseudoaddiction below!)
Frequent requests for early refills, recurrent stories that the medication was lost, stolen, fell down the toilet,  was eaten by the dog, etc.
Abuse of illicit drugs
Selling prescription drugs
Injecting topical or oral medications  


Notice that the word addiction appears nowhere. Instead, the word has been replaced by the term dependency, so that opioid addiction is called opioid dependency, which is not at all the same thing as physical dependency on opioids.  This is why when discussing issues of opioid addiction versus physical dependency, it’s crucial to make the distinction.

[fibromama]

So a Diabetic who has to take there daily medication to live is an addict?

I am a nurse currently on SSI for my disability and may never go back to work.  I worked for a very long time with an addiction specialist in a local hospital.

If I were out of my pills for any amount of time Im going to go through withdrawals because my body is dependant on the drug,,Im not going to go through withdrawals because Im addicted to the drug.

Have you done any of your own research on the matter,,there is plenty out there.

[Tuckamore]

Good explanation. That's what I have been told by multiple physicians, in multiple disiplines and what I was taught as a nurse. Thank You, Tuck

[Toomanyadvil]

I also like to put it in a different way

People who are using drugs and alcohol for uses other than a valid medical condition are running from life while those taking medication for pain or a psychological condition are running twords life.

[Toomanyadvil]

What I was taught and put into practice as someone who specialized in addiction is that
the difference between addiction and dependance is psychological.
With addiction the person has a psychological compulsion to take the pills or whatever substance. That compulsion still exists despite negative consequence.
So for example, in college someone experiements with something. They like the effects and begin to use it more often which results in loss of there job, a failed relationship, a DWI, an arrest, etc..
But despite these negative consequences they cant stop taking it.Dependance is not a specific criteria for addiction.
There are many people who a binge users. Meaning they dont use it for a month or two but suddenly start and use it in excess for a certain amount if time. Then stop and the cycle continues. So the person never builds up a physical dependance to the drug.
Usually binges are frequent with cocain use and many times alcohol abuse.

With dependance, the psychological component is missing. The person is taking the medication in order to improve the physical pain. If the person is using it as prescribed there should be no negative consequences.
Because the med is taken on a daily basis the body become physically dependant on the meds. But there is no psychological component.
Without pain the person would have no compulsion or need to take the medication.
The psychological component of anxiety over losing the access to medication is normal and not considered psychological addiction but a direct result of Chronic Pain.

I hope that helps with a defenition a bit.

[fibromama]

Im going to use "pain pills' as the example

Someone who takes pain pills for non medical reasons but for pleasure and emotional numbness,, takes more than the normal prescribing amount and more often to get high is addicted and then becomes dependant.  
Someone who is dependant has a valid medical reason to take the pill, takes the pill exactly as prescribed and is physicaly in need of the pill.  

Taking a pill for longer than two months if you are in need and not using it for pleasure does not make you an addict it makes you dependant




I take pain medication for my severe pain, I am dissabled and have taken pain pills for a very long time,,I am not an addict and wouldnt like to be called an addict,,but I am dependant on these pills.


A child is dependant on there parents, but are they addicted

[Tuckamore]

Sandee's post is very similar to what my doc(s) have told me. There are different definitions (and forms) of addiction and dependence. I for one don't really care. I (and many others) cannot function without pain medication due to the severity of a mrdical condition.  I applied (and was hired) for a part time position (10 months ago) that required a drug rest. I was on pain medications at the time. I told the interviewer that I had a physicians RX for them. If you have the RX it should not interfer with if you are hired or not, as long as you are able to do the job and your medication would not put the company at risk, ie: driving a vehicle. Tuck

[fibromama]

The difference between a patient with opioid addiction and a patient who is dependent on opioids for chronic pain is simple. The opioid-dependent patient with chronic pain has improved function with his use of the drugs and the patient with opioid addiction does not.


here are some different web-sites that can explain in better detail the differences between the two.

http://abcnews.go.com/Health/LivingWithPain/story?id=4052249

http://health.discovery.com/centers/pain/medicine/med_addict.html