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PostPosted: Mon Mar 30, 2009 1:30 am 
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Trouble is I manage my 85 y/o Alzheimer's mother's meds (Medicare Part D, ordering at pharmacy, waiting 24 hr for the Oxycontin, filling her pill box, making sure she swallows everything--typical caregiver madness.) This is a rather shaky situation to be in for me right now

When my hip started my limping in Nov 06, they put me on some fairly useless NSAID, but with PT it ended up helping a lot. In the meantime I started self-medicating with nalbuphine, a Stadol-like agonist/antagonist for the pain--it worked well. A year later I had RNY gastric bypass (for which NSAIDs are contraindicated), and within a month I could barely climb stairs w/o the nalbuphine. Finally saw an orthopedist who referred me to a surgeon, and Rxed skimpy 4 5mg Percocet a day--not a lot for a bum totally-shot hip, but I could up the Percs from 4 a day to 6-8, and then use the nalbuphine (30mg SC 3/day) the rest of the month. Hey, I though that might also prevent tolerance / dose-increases of the oxycodone as well as stave off physical addiction due to nalbuphine's mu antagonist actions. Until my recovery from surgery, I was on this regimen for about 7 months. Stopped the Percs no problem, had a runny nose for a couple of weeks from stopping the nalbuphine, but I ended up continuing the nalbuphine; I really loved the stuff. (Still do!)

Now, I've been added to the unemployed (economy, not drug related), so no more $$$ for nalbuphine mail order, so I've been taking a few of dear-ol-mom's Oxycontin on weekends, say 40mg on Sat and Sun evenings. (Don't worry, she's prescribed a flexible dose schedule of 2 or 3 10mg tabs once in the AM and once in the PM. 3 10mg tabs twice a day really leaves her a zombie, so I've been sticking to 2 10mg tabs twice a day, which allows her to get the pain relief she needs without coming up short at the end of the month. I'm probably repeating myself from other posts here on here which haven't been answered.)

Assuming I will ever find a doc willing to prescribe bupe for my unusual drug combination as well as the fact that I'm not (or no longer) physically dependent on either drug, but have problems with residual cravings for which I think a regimen of bupe would definitely help me with, am I just kidding myself? Do I really have to make myself hooked on Oxycontin in order to qualify for a treatment which would help me free myself of the desires for both drugs to which I still have convenient access?

One question after whether a decision for bupe treatment of my situation qualifies under any interpretation of DATA2000/DSM-whatever is Suboxone strength. Back in the Halcyon days of Asia-based Internet pharmacies (2000/2001), you could order 100 0.3mg (300 mcg) Buprenex SL tablets for next to nothing, and there was no mistaking that you were getting the real thing, given the drug's potency. But 0.3 mg (if I recall) was REALLY REALLY strong at the time. I could have zoned out at work if I wasn't fully caffeinated. Now, granted, I now have a year or more of mixed agonist and agonist/antagonist use, and 40mg of chewed Oxycontin doesn't phase me at all, but I wonder if the lowest dose of Suboxone with 2mg 2000mcg could be too strong. I guess I won't know until I try if I ever manage to find a doctor willing.

I hate the idea of "doctor shopping" (I'm so thoroughly middle-class), but I could easily see that treatment here is a legit judgment call. My new shrink who I started with a few weeks ago (who is SAMHSA-licensed for bupe treatment) is addressing a sudden and uncharacteristic onset of depression about 9 weeks old, and I have no issue with his trying to get this under control first; he has a pretty good poker face though and I'm unsure if he'll ever be willing to consider Suboxone therapy for short, medium or long term use. It must be awkward for a MD to be the first in a field outside of a clinical study--I haven't seen anything on the use of bupe to treat agonist/antagonist dependence.

Meanwhile, I'm counting out Oxycontin for my mother's pill box trying not to put a few aside and trying my best to hold off on placing a credit card order for the nalbuphine using some of the unemployment ins which just kicked in! There's got to be a better and more rational way (thru chemistry) which avoids compromising my remaining morals and pissing away $$$ that I need for more important things than over-priced nalbuphine sold OTC over the Internet.

FooBear


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PostPosted: Wed Apr 15, 2009 7:42 pm 
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I've already gone into a fair amount of detail regarding my use of alternating regiments of oxycodone (and around the surgery, Dilaudid) and nalbuphine (an agonist/antagonist) during last year before and after I had a hip replacement (I figured that switching every 2 weeks would minimize tolerance and physical addiction--who knows if that worked, though it was OK for the pain). Trouble is, after my surgical recovery though my hip pain was gone, I really missed the psychological effects of this class of drug. I still do. Plus, I am in the unfortunate situation of caring for my mother, who is 85 years old, has Alzheimer's, and spinal stenosis which causes neuropathic "burning" pain in her lower legs and feet. She's on 3x10mg Oxycontin every 12 hours, although we (her MD, my sister and me) have lowered that to just 2x10mg every 12 hours because she's just too withdrawn and sedated from the higher dose (but the lower dose still has her complaining about pain often--however, she's less of a zombie.)

Anyway, the Rx is still for the higher regimen, since her doc wants flexibility in case she needs more meds. This is really difficult for me; I was able to stop everything once I was fully recovered, and the withdrawal was minimal: 2 weeks resembling hay fever from hell: sneezing and a non-stop running nose, but since then as I dole out and dose my mother, I find it difficult--no, IMPOSSIBLE--to not occasionally take advantage of the unused excess. This is infrequent enough (and there just aren't enough extra Oxycontin 10mg tabs) to ensure that I can't become addicted (without using up what she needs, which I would never do). But after reading (perhaps too naively) the manufacturer's promotional website and the naabt.org advocacy patient matching site, I contacted a shrink, explained my situation, and I thought that something like Suboxone would be perfect for dealing with still-strong cravings, helping me manage my mother's pills without relapsing into becoming a regular "user: if not (yet) an addict, and I dunno: maybe I explained myself unclearly, maybe buprenorphine is really only for "hard core" types, but he essentially accused me of wanting him to Rx Suboxone so I could get high from that instead of the Oxycontin, which was the furthest thing from my mind. (Granted, this happened after I told him I took 40mg to test my tolerance--which was fully intact, just in case even a low dose of Suboxone was going to knock me on my ass--I was still imagining that he was considering this as a treatment option.) But, this is clearly not going to come from him--he's on OK psychopharmacologist who is also treating me for a sudden uncharacteristic bound of depression, and that's working well, so I will stay with him at least for that. I've started "SMART Recovery" and it's too early to see how well this will work; I think finding the right group as well as the right group facilitator will take a while (just had my first mtg last need, next one is tomorrow.)

Anyway, I would appreciate a reality check from any of you guys who think I've just been unduly swayed by the "wonderfulness stories" you find on suboxone.com, naabt.org, and, yes, even here, though it seems that everyone here has really been dealing with a much heavier habit than I had. Am I out of line to approach an MD who can offer Suboxone therapy for the kind of situation I'm in? Or was my shrink just too conservative or judgemental? Am I just being stupid or naive? It really galled me to be accused to being a "drug seeker" via his practice--it seems to me that if I wanted opiates there are easier ways to get them prescribed than going to someone offering Suboxone treatment; hell, I've got my own source right now, and I'm trying to FIGHT that temptation.

Am I just not in the right league of opiate users/abusers to be considered seriously (as a part of legitimate medical accepted practice) for Suboxone? Comments invited; finding oneself on a "write-only" board gets a bit depressing after a while since there are so few places to discuss this.

/FooBear


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PostPosted: Mon Apr 20, 2009 10:40 pm 
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Find another doctor. You obviously need a opiat on your recepter sights or you will keep useing and being tempted by your moms drugs.


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PostPosted: Mon Apr 20, 2009 11:26 pm 
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I think that Suboxone will be used more and more for pain-- or more accurately, buprenorphine. Suboxone may keep a reputation as an 'addiction medication'. But there are tests in progress for different formulations of buprenorphine, to be used for pain. In the UK there is already a patch called 'Butrans' that releases microgram doses of buprenorphine over a three day period of time.

I would prescribe Suboxone for you, and you are welcome to e-mail me at drj@fdlpsychiatry.com. But be aware that when you go on Suboxone you are setting your tolerance at a certain point-- equal to about 30 mg of methadone. The ceiling effect makes it impossible to take 'small doses'; even a quarter of a tablet puts you 'on the ceiling' and so you will have the high tolerance. But it IS a good choice for people with chronic pain and addiction; it allows putting an opiate at your receptors, as said in the prior post, without driving you crazy.


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PostPosted: Tue Apr 21, 2009 11:05 am 
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I appreciate everyone's comments.

One important point which was implied in my earlier messages in this thread, but not explicitly stated, was that even before my hip dysplasia was diagnosed, then having had a hip replacement 4 months later, followed by a rapid complication-free recovery in 6 weeks or so, I could accurately be described as having been in chronic pain. But after I recovered from hip surgery, the pain was largely gone. I didn't have any sort of withdrawal from stopping the Percs, but I continued ordering and taking the nalbuphine; initially to treat the still-mild-moderate discomfort which comes from healing, but I continued well past the time that I was pain-free into January 2009, at which time I ran out of spare cash. Trouble is, I was left with cravings not only for the nalbuphine, but in its absence, my mother's excess Oxycontin. (This surprised me, since when I was on the nalbuphine, I would never have touched her Oxy; first because the nalbuphine was enough, PLUS the nalbuphine would have acted much like bupe in blocking the oxycodone's effects, and finally, what kind of person imagines himself capable of taking his mother's pain meds? That sudden and unexpected craving was a real wake-up call for me! I'd passed a boundary that I never imagined I'd hit.)

I will take this this up in private email with the moderator, Suboxdoc, to discuss this in more detail and discuss with him what my options are in my local area.

/FooBear


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PostPosted: Thu Apr 23, 2009 12:12 am 
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foobear, don't be so hard on yourself about taking some of moms painmeds. It wasn't you doing it but the addict in you. I'v done alot worse (Oh my God have I) and I'm sure so have alot of other addicts. Talk with the sub doctor here and you'll be fine.


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PostPosted: Tue Aug 04, 2009 1:04 pm 
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Agreed. Subutex works so well for me that I am not the slightest bit tempted by my mothers meds which I am in charge of which include Duragesic (fentanyl) patches, Roxynol (liquid morphine), and Oxycontins. What's worse is that my mother usually refuses to use any of her pain meds as she is an "old school" "I don't need that crap" type of person. God Bless her and how I wish that trait had been passed down to me.


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PostPosted: Tue Aug 04, 2009 11:26 pm 
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Daydreamer wrote:
Agreed. Subutex works so well for me that I am not the slightest bit tempted by my mothers meds which I am in charge of which include Duragesic (fentanyl) patches, Roxynol (liquid morphine), and Oxycontins. What's worse is that my mother usually refuses to use any of her pain meds as she is an "old school" "I don't need that crap" type of person. God Bless her and how I wish that trait had been passed down to me.


Daydreamer your a better person then me. I'm a weak mother fuc#$%. If I had that shit in the house I'm stopping the suboxone at enjoy. Especially if she doesn't really take them. Your a better man then I am. Good for you.


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