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 Post subject: Cast out
PostPosted: Thu Jan 02, 2014 7:24 pm 
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I've been wanting to ask is anyone here aware of the fact that there is as much a problem in this country understanding chronic pain as there is addiction?
I've been blessed with the care I have received from both my doctor and the pharmacy I go to that serves a lot of his patients (probably a testament to their knowledge and compassion) but I dealt with it more with hospital docs when I was still awaiting diagnosis. Growing up, i watched my mother go through it with her docs and she's dealing with it now as she is preparing for the fifth back surgery she has had in her lifetime in hopes of relieving her spinal pain and structural problems. I heard it from other strangers whose names I will never remember yet whose voices I will never forget when I accompanied her to her chronic pain support group at our local hospital when I was too young to stay home alone while my siblings were at my dad's house. It wasn't too bad for an 8 year old, I mean they had cookies.
Like I said I've been lucky, so my most recent hurdle was a couple months shy of 2 years ago when I sought treatment for pill addiction, simply opiates. I was at a point where I wanted out so badly I was willing to do anything. I'd been found out, and was willing to go to a rehab but my mother and psychiatrist at the time warned me how there would be no one at the particular place available to me financially to help manage pain or any sort of medical issue, and that worse they're used to people court ordered, many of which don't want help yet, so no one is going to give a fuck that I'm having a flare up. The whole militaristic method they described scared me into their recommendation which was to check in to a behavioral health center (really a mental hospital but with wards for higher functioning, low risk patients) where I would be under the care of my then-psychiatrist. (He worked there for patients in the high function ward in addition to having his own practice, thought he didn't care at first when I met him but after a while realized he's old and tired, very busy man). In the end this place was not the best place for someone for primary treatment of addiction, but definitely the right choice. Better than the alternative.)
The people were characters, but a lot were normal and I made a lot of friends in there but it's typically how I survive a situation like that, I can't ever just be the one who sits in the corner silent the whole time.
Anyway, I'm getting off topic. I had my same psych doc in there as promised, and to keep me out of withdrawal and try treating the pain (but barely) he kept me on a regimine of 5 mg oxycodone. Way less than I was prescribed but I was happy to be getting anything and shut up about it. The nurses there were kind, and they meant well, but I hated and wasn't the only one who hated how every time I'd go to the counter and ask for my meds no earlier than the allowed time frame I'd often get a lecture on the addictiveness of the med or some kind of statement to that effect. It made me feel nervous and was very humbling every time I needed to ask for the one lousy 5mg pill, and it's easy to internalize that and end up feeling humiliated every time it's time to humiliate yourself. They meant well, and I have positive feelings towards many of them but they didn't know why I was there exactly or my physical condition or how my doc decided to have me on a greatly GREATLY reduced dose of my medication until we decided what the plan would be to get me off of them. I know some of you reading this might be confused at this point as to why I went for help and was still on the Oxys, but for clarification it was to keep me stable in regards to both pain and dependency until he consulted with my pain management doctor and could have a better idea of what to do with me.
I made an error in judgement while I was in there too. Our docs came to see us and meet with patients for ten minutes or so individually every day, and one day my doc was unavailable so he sent another psychiatrist as a replacement. At the time I hadn't heard of suboxone, and this replacement guy started telling me through a thick accent of some sort that it's a good option for people with both opiate addiction and chronic pain and he gave me a brief explanation of what it was. As an active addict my first thought was this guys judging me. Even though I was there for help with this shit!!! I felt defensive like he was one of those doctors who just couldn't understand what it was like from my point of view and why opiates are necessary for some people who are in so much pain there's no quality of life without them. But I still wanted to recover, so I told him I'd be open to trying it but I want to wait until either I or my psychiatrist discusses it with my pain management doc.
It took another 5 weeks and another shorter stay at this facility to get on suboxone, as I had admitted I had a problem but at first didn't have a long lasting commitment to it. I hid my problem reaaally well from my pain doc, never asking for early refills or drugs by name or anything. So he felt that maybe I should be given another chance in case this whole thing got blown out of proportion or it was self medicating rather than addiction. Long story short I screwed up again, but the second time in the looney bin I met someone who is now the love of my life (the beginning of another long story but it's funny how things work out) and he told me more a out suboxone, and that I should in fact at least try it.
I was lucky enough that my pain doc is licensed to prescribe it, so he was willing to let me try it, found the right dose for me that'd be therapeutic enough for my pain management, continued therapy with the social worker in his practice, and got my life together. My pain is better on suboxone than it ever was chasing opiate highs. I was "with it" enough that I could do the physical therapy I needed to do.
Now I know that substitute psychiatrist was trying to push me towards something he's seen a lot of opiate addicts become content and functional and well on.
By the way, I hope you guys don't jump to conclusions about my pain doc, he really just didn't know and is the kind of doctor that doesn't hand out pills like candy but still is compassionate to the fact that a lot of stricter docs don't know how some of us with pain have to live. He's also seen addict behavior in patients who were just trying medicate their pain and became stable once they found a treatment that worked for them. He was very forgiving of me and the whole situation and kept me as a patient so i can have my physical problems analyzed and not deal with some of the bull shit others deal with with their sub docs AND pain docs.
I know this post was long as I got really off point here, but can anyone else back me up on this?
I heard of a pain management doc that took advantage of patients trading meds for sexual favors.
My mom has a hard time anytime she has to be hospitalized for something because the docs won't talk to the pain doc (same as mine) and assume she's milking it.
Nurses judge before they read your file.
I'm 22 and can't make anyone understand what my limitations are. I'm young therefore I'm supposed to be invincible, and for that we really get the short end of the stick. To be under 40 and have either sciatica, fibromyalgia, Lyme disease, auto immune diseases, rheumetoid arthritis, etc

And the biggest crap out of all...
The fact that there isn't even a place for people who have both addiction and chronic pain, at least when it comes to inpatient treatment or being honest with the fellowship at NA. Or outpatient treatment centers who drug test, I can't believe I don't hear it from others more often.


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 Post subject: Re: Cast out
PostPosted: Fri Jan 03, 2014 1:42 am 
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There are growing forces to make it even more difficult to treat chronic pain using opioids. Google PROP and Andrew Kolodny and check out the agenda. This year, most of the items on their agenda failed; they tried to block Zohydro, and tried to make chronic use of opioids 'off label', so that doctors would stop treating pain with opioids for fear of being sued. They took partial credit for the up-regulating of hydrocodone to schedule II, which will prevent people in rural areas from having hydrocodone called in by telephone (have a toothache? wait for the mail to arrive!).

I see PROP as a bit naive.... After working for years with patients who have suffered traumatic injuries, one realizes that even with tolerance, a schedule of opioids can mean the difference between life and despair--- for example in my patient whose arm was torn off in a snowmobiling accident. He has managed to fix small electronics using one hand, provided the phantom limb pain is at least reduced a bit with oxycodone. We've used the same dose for years... but if his suffering worsens, I'll do what I can to help him, including using one of nature's greatest gifts to humanity.

There will always be fanatics of every stripe. But unfortunately, right now, there are few people willing to stand up for patients in pain-- without the claim that 'I know better than you how you are feeling', which is the PROP stance. There are places to be heard and counted--- be part of the debate, or your side will go down in flames.


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 Post subject: Re: Cast out
PostPosted: Fri Jan 03, 2014 11:19 am 
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It wasn't just PROP that opposed Zohydro- A scientifc panel voted 11-2 against the drug but FDA approved it anyway. Do you really believe the US needs an extended release hydrocodone without any abuse deterrance?

The reason that overdose deaths in this country have skyrocketed is because we have an epidemic of peoople addicted to them (and not enough addicts are accessing addiction treatment with suboxone). The death rate is highest in middle-aged, opioid-addicted pain patients who are getting full agonist opioids prescribed to them by docs.

Suboxdoc- Since you seem to think that opioids work well for chronic pain, I think you need to pick up a few medical journals and review the evidence. Alternatively, try speaking with pain specialists who have lots of experience using opioids for chronic pain. You might want to start by watching this video:

http://www.youtube.com/watch?v=l4Y3TQUsH4k

If you review the evidence and keep an open mind, you may actually want to join PROP to help get the word out that aggresive opioid use for chronic pain is harming pain patients and has led to a public health crisis.


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 Post subject: Re: Cast out
PostPosted: Fri Jan 03, 2014 7:31 pm 
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I did take a look at some articles on PROP, and I'm not saying their intentions aren't pure, suboxdoc didn't exactly deem them nazis either in regards to motives. The overall idea here is to call into question whether the manner in which they execute their mission is really going to do anything about the problem of opiate addiction and recognize that when it comes to people who need treatment there's a lot of collateral damage from these regulations. I believe it's largely an issue of education, just like it is when it comes to reducing ignorance directed at suboxone. I can't say that I or any patient I talk to would really know what the proper balance is, but I can't see how simply creating more hoops to jump through is going to lower statistics of addiction. The nature of addiction means that if an addict can't get it from the physicians, they're not gonna throw up their hands and say oh well, I tried. It is likely some will resort to other methods that involve the black market and crime. I just want to see less collateral damage, the patients who can't get the doctors to take their problem seriously. This problem the doctor will hear about over the course of a consult, but that the patient will take home and have to live with.
In the articles I read about PROP, it seemed no matter how humble and well intended they described their efforts, perspectives were represented for every involved party - except the patients.
And yes I agree that some people need suboxone more than they need the painkillers, and I wish that they more widely available. What would help is if some of the stigma on suboxone was resolved as well, and I'm all for that.
By the way, on one of the articles at the bottom of the first page of my google search of PROP, they actually referenced suboxone talk zone. There was a link following a statement about how widespread opiate addiction is, I forget exactly what it said but it was something like "this epidemic of opioid addiction and it's fallout can be seen on the forum: (link)"
I'm still not sure whether that reference of the forum was in the context of recovery/addiction stories, or here ya go - addicts.

I'm not trying to stir shit here or anything I'm actually just flattered my thread received responses from not one but two doctors lol


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 Post subject: Re: Cast out
PostPosted: Sat Jan 04, 2014 5:44 pm 
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I think the problem is lack of comprehensive work ups on the front end and continuous follow up thereafter. I think that for some individuals, such as the gentleman Dr J mentioned, opioid use for chronic pain can mean the difference between a life of sheer agony and a bearable life and even possible productivity. I don't think ANYONE thinks that opioids are the best first option for all chronic pain cases, but they should be at least available.

I do not think that Zohydro will be the 'new Oxycontin,' simply because we've learned a bit from that mistake. There will be no Zohydro teddybears, it won't be pushed to narcotic prescribers as being 'safer than hydrocodone due to the lack of tylenol' with no mention of the rapid release of potentially fatal doses of hydrocodone if tampered with.

There's no people up in arms about MS Contin which existed years before OxyContin and is still has no abuse deterrent years after they were added to oxycodone. MS Contin was never marketed in the way Oxycodone was and isn't prescribed as , uh, liberally, or sought after by drug-seekers in the DR's office. Hence, it isn't seen on the street to the same degree, certainly sought after to the same degree. Ask ten random people what Oxycontin is, they will know, as the same ten people if they know what MS or CS Contin is and they likely won't.

All in all I think it's good to have another drug that can be in the arsenal. Perhaps people who are getting up to taking 12 lortabs daily, can exliminate the Tylenol while also avoiding multiple time daily dosing, and avoid having to go to a more potent narcotic without Tylenol, most-likely oxycodone of some version.

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 Post subject: Re: Cast out
PostPosted: Sun Jan 05, 2014 7:01 pm 
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True, I agree with what you've pointed out here. But also, regardless of how it should or shouldn't be advertised, Tylenol can be a very dangerous component of meds like Vicodin. Not in terms of addiction, but in terms of what it can do to the liver of someone with a 15 pill a day habit. Tylenol can be useful for pain so I understand why it might be better on a fundamental not-causing-gastric-bleeds level to make an opioid med available without it so someone, whether an addict or not, can control the amount of acetaminophen they put in their system on the side by taking the store bought tablets with the non Tylenol scrip med.


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