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PostPosted: Mon Feb 27, 2012 2:11 am 
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Since the age of 13, I have been taking opiates IN MODERATION for chronic pain. I started with morphine (and the occasional hydromorphone), and since an MVA approximately three years ago (I am now 19), this was briefly supplemented with oxycodone. Once again, it must be emphasised that my opiate use was and is firmly in the responsible zone.

As someone who has been on every opiate available, I have formed preferences as to which is best, and I flatly refuse to take others. The classic opiates are the best; these include (dia)morphine, hydromorphone, oxycodone, and fentanyl, although I will not take fentanyl patches due to the O/D risk. I will not take pethidine (demerol) or anileridine (leritine) for their neurotoxicity or tramadol or tapentadol for their thymoleptic (SSRI) activity. I have taken methadone for cough that would not go away and later suffered my first and last episode of drug withdrawal; I liked methadone but hated the very long withdrawal period. I have experience with ketobemidone (ketogan), dextromoramide (palfium), and dipipanone (diconal), but none beats the classic opiates.

I was referred to a doctor who treats primarily addiction cases, but this fellow (who I shall call Dr Smith, because that's his name :D ) agreed to treat my pain even though no addiction existed, then or now. He is a certified neurologist BTW. His favourite opioids, in order of preference, are buprenorphine and hydromorphone. Score! I originally insisted on hydromorphone, my favourite opioid. However, Dr Smith refused to supply it unless buprenorphine was first trialled, and I was quickly started on 14-16 mg of Suboxone.

Now, let it here be said that, in the UK, Suboxone (or a version thereof) is used to treat pain, not just the patches. For marketing reasons, the pain version is called TEMGESIC and is priced lower than SUBOXONE. Temgesic is available in 200 µg, 400 µg, and 2 mg versions; Suboxone is available in 400 µg, 2 mg, and 8 mg versions. Both contain the same ingredients in the same ratios: 4:1 buprenorphine/naloxone. The naloxone is included, not as common myth has us believe, so as to discourage abuse by the intravenous route, but to discourage the primary side-effect of opioids (included in morphine and in oxycodone for the same reasons), namely, difficulties in the lower digestive tract. This is due to buprenorphine binding almost irreversibly to receptors; naloxone will not dislodge it in any way approaching reliable (more on this later). For pain, Temgesic is taken four times a day; it is favoured especially in cases of laryngeal malignancy. Canadian doctors have not yet learned of this excellent use of buprenorphine and provide it for that most insidious killer, addiction, only.

Except Dr Smith, apparently. He put me on buprenorphine for my pain, and it has quickly become my opiate OF CHOICE. Sure, it might not offer instant relief, but I'd much rather relief that lasts. Dr Smith, however, was ignorant of the appropriate manner to dose Suboxone in chronic pain; he prescribed it to be used in the time-honoured protocol for addiction management: once per day, supervised. I had issue with this and will now be permitted to dose it in the British fashion, four times per day, self-supervised. This allows for dose variation, which Dr Smith dislikes intensely, but I favour (narcotics are addictive, after all, and it is nice to take a holiday once in a while). My prescribed dose is 14-16 mg, but I don't take this much as a rule.

There's a bit of a problem, though. Buprenorphine is an excellent anti-depressant and anxiolytic. It is better than morphine and oxycodone in this respect, and it rivals hydromorphone, my formerly favourite opiate, in its characteristic euphoria. One part of me likes, nay, LOVES this. No aggression, no anxiety, sleep better, driving skills improved. I haven't ever felt better. However, a part of me hates feeling better. Somehow I feel like it's a sin to feel this happiness, although it differs in no way from the happiness of the common man. I wake up feeling fine, too. Then I read the horror stories of withdrawal and on a recent trip to Finland saw the sadness of being a slave to the familiar white hexagons... heroin has been displaced by buprenorphine, and now I know why.

I am on pain blockers (injectable Marcaine) and on toradol, an oral NSAID. What do I do to handle my pain and depression? Should I listen to my instincts and take buprenorphine, the fix for my troubles? Or do I clench my teeth and live through this shit? Toradol is known to RAPE the kidneys, and I'm not too sure the Marcaine is a perfectly healthy solution either.

There is obviously abuse liability with Suboxone but I have not caved in at all. Buprenorphine is an irreversible agonist/antagonist; I know for a fact that injection of the Suboxone formula is possible and has recreational value. I have been tempted to try it, but I have a brain and know how to use it.


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PostPosted: Mon Feb 27, 2012 3:18 pm 
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I must say you sure seem to know more about opiates than most doctors in pain management. The only concern I have is your last statement about shooting Bup. You say you have a brain and from what I read it's a well educated one. I hope you stick to your common sense and continue to use the opiates for pain management appropriately.

Bup is a partial agonist but it does feel like a full agonist if you take more than you should. Your method of dosing is spot on and I'd suggest you continue that way of treatment.

Don't be afraid of the withdrawals from Sub. People make so much more of it than they should. The ones who suffer from bad w/d's are those who stop taking it while on a large dose. If you read the stories here you will see there is much success if it's done correctly. I tapered down from 24mgs to 1mg without any ill effects whatsoever and would have quit at .25 or less but a health issue came up and like you I need it for pain for awhile.

I think it's great you found something that works better than the other narcotics. I firmly believe Bup is by far the best one to take with the least side effects or damage to any organs. It's doubtful it would take any years off someones life if they used it forever. That's only my opinion and it has no science behind it.

Your plan sounds good to me, good luck sticking with it.

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PostPosted: Mon Feb 27, 2012 9:54 pm 
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In that case, I take much more than I should, and love it. The full agonist properties are what keeps me on my feet and smiling. Yet I only take a few milligrammes four times a day.

None of the classical opiates (and I now include buprenorphine in this list) have any toxic effects with the exception of addiction. You can not take years off your life by (ab)using dilaudid, supeudol, morphine, hydrocodone, or even buprenorphine. All are safe, with the only possible side effects being thirst (that's not a bad one), intestinal motility reduction, and habituation.

I cold-turkeyed from 16mg/day with no problems apparent except a drastic increase in pain. Does this indicate withdrawal? In that case, why are people making such a big deal over it?


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PostPosted: Tue Feb 28, 2012 4:37 am 
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Maybe I'm out of line but, you say your opiate use is in " the responsible zone" but some of the things you are saying are textbook addict mentality. You write as if romanticizing about each opiate and how it made you "feel". My mom got norco when she broke her wrist and she is definitly not an addict. I can't see her entertaining "shooting" her pain meds. Your young like me and it seems like you are very smart, and sometimes that can work against us young addicts. I think we tend to overanalyze things and thus, rationalize just about anything. I wasn't going to post anything, but your post really resonated with me for some reason. I guess your last sentence basically threw me for a loop after your explanation of how you were handling all these meds. If bupe really does the trick for you then concider yourself lucky. I can think of a lot worse ways to manage pain and emotional issues. Just...take it the right way, there are tons of risks when using steel.

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PostPosted: Tue Feb 28, 2012 6:07 pm 
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honeywhite said, "You can not take years off your life by (ab)using dilaudid, supeudol, morphine, hydrocodone"

What about all the people who died from overdose? Those numbers are in the THOUSANDS!! It sure took some years off their lives.

I know I took your quote out of context, but this is still a valid point I'm bringing up. BTW, your list of possible side effects is not comprehensive.

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PostPosted: Wed Feb 29, 2012 3:47 am 
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I meant organ toxicity... overdose is due to respiratory depression (stopping breathing), which is temporary. But of all those that don't overdose, they don't get any lasting side effects from their choice of poison. Toradol kills the kidneys. Tylenol kills the liver. Aspirin causes hearing loss. Between those four, I'd rather the opiates any day.


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PostPosted: Wed Feb 29, 2012 10:17 pm 
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I'm sorry, but I must agree with StillProdigy. You stressed that you're on bupe/sub for pain only and your opiate use is "responsible"; however, you've also said more than once that you love the euphoria and the feeling these drugs give you. I don't mean to be rude or offensive, but those are the words of an addict - or at the very least, an addict-to-be.

I agree with the others that you're obviously very smart and well educated, too. That will serve you well, but when it comes to opiate addiction, smart people don't get a free ride from addiction. I'm not saying you think that, but many people (maybe even some of us have thought that).

I, too, am on sub for pain (as well as for addiction). I take between 16-24mg, depending on my daily level of pain, but I usually dose 2-3X per day. Splitting your dose is the right way for using sub for pain, as it's pain properties last on average only 4-6 hours, as opposed to the mean half life it has when being used for addiction purposes (37 hours).

It almost sounds like you're aware that you're walking a slippery slope with regard to how you're feeling about your med. Please just be careful. Because I feel it IS a slippery slope you're on. Please take care.

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PostPosted: Thu Mar 15, 2012 3:26 pm 
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I have to agree with some of the other responses..
A single word was in my mind the entire time I read this post.... Addict.
I don't mean that disrespectfully, just being honest.


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PostPosted: Thu Mar 15, 2012 4:22 pm 
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Anyone that seriously contemplates shooting their pain meds most likely has a problem- whether they admit it or not. You've got a very bright mind and I truly fear for your well being. The passion you feel for these opiates is evident in the way you speak- its also a little creepy and VERY concerning. I wish you the best. I know you feel you have this totally under control (you pointed that out several times) but there's red flags popping up everywhere.


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PostPosted: Thu Mar 15, 2012 4:52 pm 
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honeywhite, are you still around? I know we have been blunt with you, myself included. I just wanted to see if you're OK and to find out if you wanted to talk about any of this. We're here for you if you want to. Take care.

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PostPosted: Thu Mar 15, 2012 6:54 pm 
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honeywhite wrote:
Buprenorphine is an irreversible agonist/antagonist; I know for a fact that injection of the Suboxone formula is possible and has recreational value. I have been tempted to try it, but I have a brain and know how to use it.


It doesn't matter HOW smart a person is if their intelligence is hijacked by addiction. You may have the quickest car on the road, but it's being driven by something that's dead set on driving it into brick walls. Addiction lives in a part of the brain that's a lot deeper and more primeval than our frontal lobe. There is no way for a person to think their way out of addiction. If anything, they have to UNTHINK their way out of addiction.

You say opioids don't cause brain damage aside from addiction. I'd argue that addiction IS brain damage, a result of opioids neurotoxicity on our natural opioid system. Opioids cause huge long-term changes to our endogenous opioid receptors, and even years after a person is abstinent those changes never completely revert - hence cravings can return decades after using. I believe the damage to our natural opioid system is no different to amphetamines frazzling of our serotonin / dopamine neurons. Both result in an intense need to continue drug use to make up for the damage caused.

Also there IS a belief in the medical world that opioids do cause their own kind of brain damage. The main symptom of that damage is hyperalgesia - or increased sensitivity to pain. When a person quits opioids long term, they often find that they are more sensitive to pain stimulii than before they ever used. This is an indefinite change in their pain perception.

I'm interested to know how your travels in Finland went. Why is it the heroin addicts over there prefer buprenorphine? I'm assuming they're injecting it.


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PostPosted: Fri Mar 16, 2012 8:43 am 
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You say opioids don't cause brain damage aside from addiction. I'd argue that addiction IS brain damage, a result of opioids neurotoxicity on our natural opioid system. Opioids cause huge long-term changes to our endogenous opioid receptors, and even years after a person is abstinent those changes never completely revert - hence cravings can return decades after using. I believe the damage to our natural opioid system is no different to amphetamines frazzling of our serotonin / dopamine neurons. Both result in an intense need to continue drug use to make up for the damage caused.


Devil's advocate: Did the opiate use cause the changes in the brain or were we born with the differences in the brain and that's WHY we became addicts in the first place (or something to that effect)?

Kind of a "what came first, the chicken or the egg" argument. Did addiction make us this way or did being this way make us become addicts? I think it's a toss up myself. At least at this point because there isn't enough that we know about addiction. We know there can be a genetic predisposition and that an addict's brain is different. But the question is - was it different BEFORE the addict BECOME a using addict?

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-I'm only responsible for what I say, not for what you understand.


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