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 Post subject: I'm confused!
PostPosted: Sat Feb 20, 2010 11:29 pm 
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Okay, maybe because I’m kind of new to all this, there are things I just don’t get.

I went to my second sub doctor appointment this past week. I expressed to him that if it were my choice, I would not want to stay on subs overly long, but that I was in counseling with a chemical dependency therapist, intended to stay in therapy (heck, I’ll be going for at least 30 visits, plus NA, as opposed to the medical group's requirement of one individual and six group sessions) and I also knew that I couldn’t simply go back to the way things used to be.

Predictably, he pretty much leapt on that one and was kind of terse: “We can’t know whether it will be three months, or six months, or a year, or more…it takes however long it takes. You’re no different from any other addict.”

Well, (she thought to herself) I never said I was. We all have traits in common, ergo, Addictionology. DUH. But I object to the one-size-fits-all approach, too.

Then he said, “It took you a long time to upend your life, and it’ll take a long time to put it back together again.”

“Uh, Dr. X, what is your understanding of how long I’ve been actively misusing?”

“Let’s see…um…in my notes it says something about 20 or 30 years ago…”

“Actually, no…there were a few months in the summer when I used on a limited basis, but the crap didn’t really hit the fan and I didn’t fully “cross over” until this past November. Actually, I was quite functional during that time, and our lives weren’t upended at all.” (I actually asked Hubby about this later and he confirmed it.)

“Oh, well, but didn’t you say something about twenty years ago?” At my first appointment he’d asked when my first experience was with opiates, and I said I’d had a Tylenol #3 20 or 30 years ago after getting wisdom teeth pulled. He asked if I liked the experience, and I said yes, I thought it was pleasant and it made a painful procedure much easier, but I didn’t feel compelled to go out and get more.

“Well, then, you see!? That’s when you became an addict, because you liked how it made you feel. So you’ve been on this path for years and years. You can’t tell me you haven’t misused before recently. Normal people don’t find opiates pleasant.”

Oh, COME ON. Really? Do I look THAT dumb? Why do I feel as though I’m part of a script, instead of a person, and that I’m being subtly encouraged to play a part in that script? Or am I just being paranoid? (I should add that this group is cash or credit card only, and it’s not cheap.)

I mean, if someone has had an especially nice glassful of Pinot Noir and found it a pleasant experience, does that mean they’re hell-bent for alcoholism at some later date? I have difficulty believing that most people don’t enjoy euphoria-inducing substances, unless they make them throw up (and even when they do make them throw up!) or they’re allergic. And most of us enjoy sex; are we all sex addicts in the making?

I do acknowledge that there are differences between people who eventually develop an addiction and people who don’t. I just think there are multiple factors—situational, emotional, probably genetic, and so forth—that come into play during the making of an addiction.

And it’s not like I can’t see where he’s coming from; it does take however long it takes, and I’m willing to do the work. I’m grateful suboxone is available to me. If not for the migraine stuff, I’d have no hesitation staying on it for however long, because I think it works wonderfully well.

However, I’m also faced with a Hobson’s choice in terms of health issues. Stay on sub long-term and risk another heart attack; get off sub too fast and risk relapse. To be fair, I haven’t had the emotional strength to bring that up to him; I’m burned out from arguing with medical people. I will tell him next time I see him, but I suspect it will be for nought. Still, I’ll try.

And just to add to the stress, as I was leaving the appointment, I overheard another patient say that her Imitrex (a triptan for migraine) had stopped working since she’d been on suboxone. Triptans are the only thing besides pain meds that will keep me from going through a full blown attack.

Anyway, just wondering if I’m missing something about addiction here, as someone who is not especially wise to its ways, or even to how her own brain operates at times. I’d certainly appreciate any of your thoughts. Thanks!


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PostPosted: Sun Feb 21, 2010 12:12 am 
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Interesting. I can see your point about being treated like a one size fits all. On the other hand, I think the doc might be trying to help you by preventing denial. He may have seen your eagerness to get off the suboxone and counseling plan as part of your addict mind trying to tell you that you are different and that you can direct your own treatment or that if you work EXTRA hard and are EXTRA zealous that you will be free from this addiction. I am not saying I think that way but I can see where the doc might. After all, they see addict after addict and I am sure they have become more the wiser to our ways of thinking.

I walked in saying the same thing and mine told me he thought I should be on them for at least 60 days and then he upped it to 6 months and I ended up being on it 2 1/2 years. I don't think it was necessarily a money thing and I did NOT like my doc so I wouldn't defend him unless I had to. I just think he knows how dangerous the disease is and the statistics on relapse.

Either way....nothing prevents you from tapering on your own. You can always do it your own way. Every time I do things my own way I get into trouble :-) That is just me.

Cherie


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PostPosted: Sun Feb 21, 2010 12:22 am 
Hey morningglory,

I'm glad you posted, and no, you aren't missing anything. It's very wise to question things along the way in your recovery. There are probably severaly factors working here. One, you are going to have to decide if you and this doctor are a good "fit." Personally, I'm not so suspicious of doctors that want to treat long-term, because I think it's better to err on that end of the scale. Rather, I'm suspicious of doctors that want to bill unneccesarily for tons of "therapy" appointments when you are already going to treatment of your choice and/or AA/NA. IMO, the medical doctor should be concerned with the prescription, and leave the counseling component to the patient. You might want to shop around for a better doc.

Also, ultimately you control how long you take the Sub. If the doc tries to keep you on it longer than you are comfortable, it is absolutely your perogative to stand up to him/her and make your wishes known. Or, you could begin to taper on your own, even while the doctor believes you are still taking the full dose. That is a way to have "insurance" in case the taper doesn't work out and you want to return to your full dose.

In the end, you control your recovery, and you absolutely have the right to ask questions and get answers about your health care and treatment! No one else has the right to say "you need to take Sub for x amount of time." Everyone is different, there is no one-size-fits-all treatment. It's of great credit to you that you realize this already! Continue with what you're doing, and good luck.

j


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PostPosted: Sun Feb 21, 2010 10:45 am 
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Welcome to th forum.....
JD has given you some good advice and yes if your not comfortable with your doctor it is your right to change doctors. As you will find out on this forum many doctors are different in thier approach. Some are very knowledgable about suboxone some are not and yes some may just see money. I have found it is not uncommon for many doctors to take cash only. I called over 10 doctors before deciding on mine and it was amazing to find out that the prices ranged from $450 for th first visit to $100 each time. My doctor charges $100 per visit and $50 for a drug test monthly..all cash. I have heard that some peopl have insurance that covers it and others that can get thier doctor to refer to it as pain management. Unfortunately my insurance is great but will not cover my visits...but does cover the medicine which I believe is the real expense. You have to own your recovery. I am a little confused about your post and maybe you can post your history a little more in detail if your comfortable. Do you beleive your an addict?....or do you feel you are physically dependent on opiates. I know you said you have migranes....what brought you to seek out suboxone? I hope someone here can help you figure out what is best to help you make the best decision on your recovery. Good Luck.


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 Post subject: Migrane - Imitrix
PostPosted: Sun Feb 21, 2010 2:21 pm 
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Hi MorningGlory!

I seem to recall that one of your main issues was migraine headaches - before suboxone - I hope that is right. Then you wound up on opiates as part of treating the migraines, but wound up on our wonderful opiate disease merry-go-round.

One thread said you had a heart issue/attack from triptans (imitrix type medications) - is that right?

Anyway - to your thread and feedback on your overhearing at the doctors on Imitrix.

I have migraines too. I don't know if these headaches started in my early days as typical migraines, but nearly always - a sinus headache would wind up behind one eye, and nausea would follow.

Like you, after doing the rounds through the MD's, I was prescribed Imitrix. When I took a pill - it really did not help, and made the nausea worse. Then i was given this 'injector pen' type of device where I had to put it on my muscle (leg usually) and inject it. Honestly, I wasn't too scared of needles like that - but for whatever reason - I hated giving myself shots, and ended up enduring more migraines than getting help (sillly I know).

Then I found Imitrix nasal spray. Besides a nasty taste in the back of my mouth after the spray - it worked. I feel bad that you had a heart incident with similar medication, but I can tell you that I have had a few migraines since starting suboxone (maybe more than a few) - and the Imitrix works just as well as it ever did.

What is different, and I'm being 100% honest here - is that my typical migraine routine was:

At the same Time:

1- Imitrix Spray
2- Take pain pill(s) - whatever I could get.
3- Lay in a quiet/cool/dark room and rest - careful breathing.

So, now I just remove #2 - and it still works. I just don't get any 'other feelings' for treating my migraine. Does that make sense? I probably really never needed #2 - but it worked in the old days - and when you are almost blinded by a headache - working is attractive. Bad habit, though, for an opiate addict.

Imitrix still works with suboxone for me - no change. Hope that helps some, and good luck with the doctor.

Sorry for the blather. If you can get on triptan's again for your migraine (something I thought you said you might be able to do) - I can tell you my own experience that they still work the same as before suboxone.

Keep us posted!


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 Post subject:
PostPosted: Sun Feb 21, 2010 3:49 pm 
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Thanks, everybody! My post was pretty much all over the place and I was in a kind of snarky mood last night, so I appreciate your wading through it.

Cherie, that's a good point--he probably deals with a fair number of patients who are on the fence or outright want to get back to using, or who are in denial. Most likely he's just being cautious, and after all, I can't expect him to know me or how I think after two visits. Plus he's operating on limited knowledge of my situation, and that's my doing. I should cut the poor guy some slack. : D

JD, thanks for the support and advice. In its favor, the place I'm with does reduce your fees if you choose to seek counseling outside the group, and they even suggested it first, since I live a fair distance away, so that's a plus. It's good to hear someone affirm that I control my recovery; those are words I need to hear and to remember. Guess I feel beaten down, and I'm so distrustful of docs at the moment, even though I'm in the medical field myself.

ReRaise, as with JD, thanks for reinforcing the concept of owning my recovery. My post was pretty rambling, sorry to confuse you! I have had a lot of serious pain issues crop up over the years, and I finally caved and crossed the line late last year into both physical and psychological dependence. I was basically forced to go on suboxone before I felt quite ready, due to the uncaring and judgmental attitude of my former family physician's office (they more or less abandoned me), although sub was an option I was seriously considering and wondered if I would need in future. I posted a lot of my "stuff" in the My Addiction Story and Suboxone Induction sections, but they are long posts, so if you're interested in reading them, be forewarned! : )

Whew, Lathedude, no blather at all, and I was hoping you'd chime in with some good news about triptans! Thanks--I can breathe a bit better now, knowing that they'll still work. I was wondering whether you used Imitrex or some other in its class. I did have a mild heart attack from using triptans every day for over a week straight. No serious damage done, but I have some unstable angina now, and my body likes to outwit any preventive meds I use, and since serial migraines are part of my pattern, most likely I'll be facing more weeklong attacks in the future. What happened to me is a good example of why docs are supposed to have migraine patients alternate pain meds with triptans (or whatever other type of mig meds work for them, e.g. ergots) if they're prone to serial episodes. Hopefully you don't have that sort of pattern with your migraines. It's interesting, lots of people think they're having bad sinus headaches when they really have migraine. I'm just glad you and your doctor were able to identify what was really wrong and treat it successfully. I haven't tried the spray, but since I have to start experimenting with triptans that have a shorter half-life than my old one (Imitrex's half life is fairly short) I think I'll look into it. Does the spray come in generic now, or just the tablet? I know Amerge is horrendously expensive; even with my co-pay, it's $100 for a script of 9 tabs. Oh, and I'm curious--do you take any preventives, or are your headaches relatively sparse?


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