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PostPosted: Sat Aug 05, 2017 12:29 pm 
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Greetings all! First of all, I want to thank you all on here. My story is a little bit different but I'm hoping someone can help me. I was put on Butrans for lower back pain, it worked great for about a year. I went from 5mcg to 10mcg to 15mcg and then 20mcg. About exactly a year after I started using this patch, one day I had a massive anxiety/panic attack at work. I thought I was having a heart attack. Off to the ER and got a few tests done but nothing. Everything was normal. The next day after this, severe deep dark depression set it, almost suicidal depth. It's like my brain turned on my body and I lost the will to live almost entirely. I'm 40 years old and i've never had either anxiety or depression. I've never been on full time pain meds (other than these patches) or any drugs. Since I am on no other meds, I knew immediately that the patch had to be the cause. Repeated visits to the doctor - they did not think it was the bupe patch but agreed to help me get off of it. I tapered down over the next 5 months to 5mcg and then i cut the patches down into tiny little squares, stepping down tiny little bits every week or two depending on how i felt. I stopped putting the patch on January 11 2017. It wasn't too bad for the next week or two, I didn't miss work or anything but lack of energy was there, depression and anxiety were terrible in the evenings and every morning I woke up early sweating and absolutely terrified. Every morning for the first month or so was horrible. I did get some Xanax at about month 3 to help with the persistant anxiety, just a few pills that I use very sparingly. The depression has subsided in depth and is very minor for the most part now. Here is where I need help: Every 2 weeks, I go through extreme withdrawals for a few days. The runs, stomach cramps, gas, anxiety, depression, sinus issues, rls and the morning extreme scared feeling. It isn't quite as extreme as it was in the beginning and I really feel good in the 2 weeks between the WD's coming back. About a month ago i started working out in the mornings before work to try to get rid of this but I think it made it worse! I'm just not sure how long I can keep the strength up to get through this! I also developed an extreme fear of dying thru this whole thing which is very new as well. Help, please!


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PostPosted: Sat Aug 05, 2017 4:00 pm 
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Welcome Portlandguy!

So sorry! The PITs this is going on for you. Of course, IDK and am not a medical Dr. but it sure reminds me of my friend w the exact same story except no bup use, same awful cyclic symptoms. She stopped a long term acne antibiotic thinking that was it.

Turns out her cyclic severe anxiety attacks, sweating, diarrhea, RLS, feelings of impending doom were from an unusual functioning tumor. Functioning, meaning it produced powerful hormones Adrenalin causing the severe anxiety / impending doom and Vasoactive Intestinal Peptide which sends more water into the colon which causes diarrhea, cramping, real GI distress. Her diagnosis path went from a pheocromocytoma, to a paraganglioma to the final diagnosis a VIPoma. All VERY unusual. Very small tumor, benign and scooped out of her pancreas. She sorta self diagnosed and learned hormones could only be caught during a spell so during one she went to ER, insisted they test, results were slightly high. Her Dr had her carry lab orders w same/more blood/urine tests so when the spell came, she went to labcorp and caught it. Imaging, biopsy and small surgery followed. This is a very unusual story but I share it to illustrate her med was not the cause.

Imo, yours is not coming from bup use 7 mos ago. My bias is to always first look for a non bup medical reason. We have folks here that suffer like you have for too long, finally get a good medical workup and find there really was something wrong that can be treated. If nothing is found or simultaneously, a psyche investigation needs to be pursued. Sorry this is all so hard. Best always, Pelican

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PostPosted: Sat Aug 05, 2017 6:08 pm 
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Thanks so much for the reply! I was in dire straights about a year ago, anxiety and depression every day after never having either ever before in my life. It was really odd. It came on suddenly in waves and I was almost paralyzed with impending doom as well. Brutal stuff. I made the decision to jump off right then and there but when I removed the 20mcg patch, I couldn't even walk or talk it was so bad. I lasted for about 5 days and I put a 15mcg patch on and all the above symptoms were gone, I was totally fine. I slowly tapered my patches with about 2 or 3 weeks between drops and sometimes had to go back up to my last dose to cope, then slowly drop back down. I am just so sensitive to bupe I guess that even miniscule amounts that I dropped would hurl me into depression/anxiety within a few days. But, slowly and steadily I dropped down to tiny, tiny little patches. Every step down resulted in some WD symptoms, almost exclusively stomach and depression/anxiety along with leg pain/rls. THe final jump wasn't all that bad for the first month but then it came roaring back and although the time between the bad times has increased, the intensity can still be hard to deal with.

I go to my GP quite often - he has been really good to talk to. He ordered a ton of tests, bloodwork and stomach/back MRI, tissue samples, stool samples and urine samples. Everything was normal. He wanted to see me when I was feeling the worst and he redid all the lab work, still nothing. I have another appointment next week but I'm feeling so crummy that I might just head for the ER.

I am in no way slighting bupe or butrans in any way. I loved the fact that my back pain was gone and I felt no "high". It is an awesome tool to fight pain and addiction. It may be that my body just rejected it for some reason or it could be like you said, an underlying medical cause has set this off. Thanks again for the reply!


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PostPosted: Sat Aug 05, 2017 7:24 pm 
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One quick note I wanted to add to this. About exactly 6 weeks ago my back was hurting really bad. I called my back doctor and he sent me a script for oxycodone, 15 of them. I took one and it didn't work, no feeling, no effects, nothing. I took another. Still didn't work, felt nothing. About an hour later the depression rolled in like a thick fog. I waited a few days and tried it again. This time I felt a little bit of pain relief but it only lasted about 15 minutes - an hour later the depression fog came rolling in again. I threw the remaining oxy away.

I am still kind of convinced the Butrans is affecting me. I'm almost tempted to fly out to try the rapid detox method to clear my receptors even though it's been 7 months - I think the bupe is stuck to my receptors and every time it drops off I go through WD's again. I'm just not sure what else it could possibly be! I am scared to just try naloxone to test my theory in case I am right, it would be full blown WD's again.

However, that is just a theory based on zero evidence. It just feels like WD's that keep coming back.


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PostPosted: Sat Aug 05, 2017 10:55 pm 
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So painful to read and so sorry man.

Save your rapid detox $$$$. My rapid detox was a sham as are most. It only cuts off a couple days off of opiate detox. $25K. Shit my brains out for days. Left fully stoned on phenobarbital. Awful awful experience. I had such high hopes. 2 folks came back for a 2nd and 1 for a 3rd rapid detox. SAD. Altho they did get yelled at for relapsing, it was not a big enough problem to turn down a repeat $25K patient. Parents emptied their own retirement accounts to pay. SAD.

Does nothing nothing nothing when you've been off so long. Worthless. They prey on your desperation. Sadly, they'd prolly still take your $$. Sad, really sad. Don't do it!

You're too fixated that its bup. Its not bup. Put your gift of desperation and passion toward UN investigated options.

If you end up in ER and think my example still applies, mention you think you have a neuroendocrine tumor and are trying to catch it producing hormones, Adrenalin/noradrenalin aka epinephrine/norepinephrine and VIP. Plus a bunch of others. Metanephrines too but these are best w a 24 hr urine test.

I had severe anxiety w marked depression after stopping my doc. Crippling. No one knows how crippling and devastating anxiety is until they experience it. Seroquel and a SSRI worked well.

IDK psyche at all - are you rapid cycling w anxiety/depression? Could be... You have not had a psyche eval.

I know you're not bashing bup. no worries there. And bup does have side effects and we full on know all of them here and straight up will say - ya that side effect sucks.

But you had no prior opiate history, were on micro doses for 1 yr for back pain, and now been stopping or off for a year, one year. a whole yr. from a 15 mcg micro dose tapered for 5 mos and now off 7 mos = 12 mos, 1 entire yr. Ya that's not bup. If it were, we'd all be telling you its bup -- and how to handle it . But sorry man, imo, you've got to look elsewhere bc its not from bup.

Put the gift of desperation and passion toward what hasn't been investigated. Best always, P

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PostPosted: Sat Aug 05, 2017 11:24 pm 
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I am very very thankful for your replies. The anxiety/depression thing is absolutely crippling, I had probably even joked about something giving me "anxiety" which to me meant a little stressed out. That word will be removed from my joke vocabulary from now on, it's no joke! I will talk to my doctor about the neuroendocrine thing this week, I did a quick google search and the symptoms sure match up. I will post with results, thanks a ton!


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PostPosted: Sun Aug 13, 2017 7:16 pm 
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Hey PG!

I really hope you can get this figured out! Your symptoms sound debilitating! You wouldn't be the first person who has come here with odd symptoms thinking that buprenorphine was to blame. I think one person ended up finding out that they actually had a problem with their liver!

Amy

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PostPosted: Tue Aug 15, 2017 3:50 pm 
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It's odd. All tests came back negative. I met with my pain doctor yesterday and he said he has had a few cases like this from Butrans. He speculated that my first panic attack was a form of withdrawal and even now it's not uncommon to get these symptoms. So I'm just going to wait it out and keep doing what I'm doing I guess. He said one of his patients had to wait over a year! I'm not that far off and it's not an option for me to take it again. I have Xanax to take for the panic attacks that happen every couple of weeks. Thanks for your help!


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PostPosted: Fri Aug 18, 2017 9:55 pm 
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I wouldn't go and waste money on a rapid detox for PAWS. Also understand that anxiety / depression can happen to anyone, even in their 40's. It doesn't need a drug like Butrans to be a trigger. It's rare, but some people get late onset mental illness. It's not even unheard of for people to get their first manic episode in their 40's. Addiction can also be late onset.

What you're going through sounds a bit like what I experienced when I came off methadone. Methadone is a nasty drug to come off, worse than buprenorphine, largely because methadone is so lipid soluble that it gets in all your fatty tissues, leaving a relatively lengthy period of both acute withdrawal and post-acute withdrawal. I remember I would experience a number of hours of noticeable withdrawals every few days for many months.

I'm TOTALLY speculating here, so don't run off thinking this is the answer to anything. But given Butrans is taken as a patch on your skin, it is possible that traces of the buprenorphine may linger longer in the tissues where the patches were placed than for those of us who take buprenorphine sublingually. In the same way methadone withdrawal would hit me in waves for many months after I stopped taking it, it's possible that the tiny traces of buprenorphine that linger could be slowing down your recovery a tiny bit. Note the emphasis on the word "possible" and "speculating". There's never been any studies into anything like this.

If this is the case, all you can really do is keep pushing on, and exercise. Exercise helps the body grow new tissue, and sweat things out. It's interesting that exercise actually makes you feel worse.

Whether my speculating is right or way off the mark, it might be useful to view these periods of PAWS-like symptoms as necessary for your recovery, and for your brain to heal. I personally view withdrawal as a period of healing, as your brain further adjusts to the lack of external opioids. With each wave of PAWS, you're actually getting closer to being recovered.

I don't personally think going on an antagonist like naltrexone, even temporarily, will provide much benefit. If there was more evidence that it helped in your situation I'd say go for it, but given the lack of evidence, it's entirely possible it would either be (a) a waste of money or (b) might actually have a negative effect.


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