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PostPosted: Wed Dec 16, 2015 6:56 am 
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Hi,
I am a 51 year old man, who has had the usual mix of ups (no puns intended) and downs over 5 decades of life...and a few minutes of actual death. I have been a casual drug user for most of those years, switching from daily, well controlled, smoking of hashish whilst excelling in a high pressured job, and over consumption of E and stimulants during times of less prosperous employment and boredom. I started abusing tramadol in 2009 after discovering the serotogenic high, and during a period of bronchial illness, accidentally overdosed and was resuscitated only to contract multi drug resistant pneumonia, which led to complications, 4 weeks in ICU and lasting physical damage. After a few clean years, and one successful taper off codeine, I stupidly,stupidly, tried tramadol again, got hooked, began a slide into complete self destruction. I was saved by my quite incredible wife taking me to a psychiatrist who gate me suboxone, which surely saved my life.
I am just starting my 2nd year of Suboxone, and am in the (fairly common, it seems :cry: ) position of knowing that it saved my life, but also hating, resenting and cursing the need to continue taking it. And wanting to stop, have tried and failed to stop, and seeking reassurance that it `is` possible to stop. Because I've been feeling that it isn't, and that I am doomed to a lifelong dependency on a medication that, in truth, I cannot afford. The cost is crippling my life, the deadening of emotions is crippling my life, the side effects have robbed me of much already.
I want to say thanks to those who have managed to use it properly, and eventually remove the "necessary evil (?)" from their lives, and who have returned here to post positive action plans and encouragement. They offer the prospect of some hope, where now I see little, and fear very much.
I have read a lot of posts, whilst trying not to get too freaked out at the immensity of the task of getting off what had originally hoped was a short term detox cure. The spirit is willing, but last year when I got to 1mg and tried to quit...well, so many of you here knows what happens. I currently manage on 4mg daily, and struggle to maintain at that dose without craving...craving any "high" just craving a feeling of "wellness" and normality.
I'll be visiting here often, while I learn how I might best handle this unwanted, but yet definitely life saving, medication.
Thanks for reading.
G.


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PostPosted: Wed Dec 16, 2015 2:11 pm 
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Hi G, Welcome! First, let me say this, tramadol is a very evil drug! Doctors prescribe it with no idea of how addicting it is! I have had clients prescribed tramadol as an alternative to opiates due to their addiction issues! Obviously, tramadol was my drug of choice. I was dealing with osteoarthritis and depression associated with menopause. I just started taking more and more trams to feel normal. I was really never looking for a high. I just did not want to feel depressed. I do not feel that suboxone is evil nor do I dread being on it. It has normalized my life. I started at 24 mgs and have tapered to 6mgs. I dont know if I will ever be off of suboxone but if it happens, ok. My only worry being on it is if I should be in an accident or need surgery. I don't have any side effects other than an impact on my sex drive. But, that also is related to menopause. I think tapering, without a timeframe is the best way to go if you are able to do it. Please keep posting so we know how you are doing!


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PostPosted: Wed Dec 16, 2015 9:39 pm 
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You hopefully know by now that there is no such thing as a 'short-term detox cure.' I hear the DA, the police chief, and other community 'leaders' in my area talk about the addiction epidemic, clearly believing that there is such a thing. At a heroin summit that I attended, the DA told people that the opioid problem is all because of the difficulty of withdrawal, and if we can get people through THAT, they can get on with life.

That thought is silly, as anyone knows who has been there. In late addiction, people commonly hate opioids enough to tolerate the weeks necessary to detox... but they all return to using just at the point where they think they have things on the right track. That's the maddening thing about being addicted to opioids!

I've worked in residential treatment programs for a number of years, watching people get 'clean' only to die weeks or months later. The big lie of residential treatment is not just a rip-off. It is evil. Family members drain bank accounts and have high hopes... and then when relapse inevitably occurs, they are encouraged to believe that their loved one 'didn't get it'-- as if he/she SHOULD have got better, but somehow didn't have the 'stuff' necessary to get there. In reality, almost EVERYONE relapses! What is more evil than THAT?!

settle down, junig...

change takes time. I wouldn't get too worked up about whether or not you take buprenorphine over the next few years. I would just recommend that you get on with life... and unless you are a rare person who has side effects to buprenorphine, just take it and stop worrying about it. After a few years, you'll be ready to take a couple weeks off and detox, hopefully under the care of a doc who will give you some comfort meds to ease the process.

But until then-- don't count the days. Just get on with life, and by all means stop kicking yourself about the things that happened in the past. You are alive, where many people are dead. Celebrate life, and ignore the people who tell you that you should be struggling with a horrible disease. You've had all the misery you deserve, and then some-- so just let it go.


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PostPosted: Thu Dec 17, 2015 2:42 am 
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I would like to give a very heartfelt thank you to Michelle and Dr. Junig for replying to my introductory post. I have read quite widely across the 'net about this medication, and prefer the helpful, positive tone of discourse at this forum, for reasons so well exemplified by the replies that I received.
I'll split my reply into 2 halves, for simplicity.
When I looked back over my post, I found the complacency of my stated drug use to be slightly disturbing, so I would like to qualify that. I lived my teenage years in Holland, where I first tried hashish, and until about the age of 30 I smoked it regularly but not obsessively, using it as an end of day relaxation in the same way that others use alcohol - I didn't drink - and just stopped using it, without issue, when I felt the hazards of smoking outweighed the benefits. However, my use of other substances was slightly out of control because a major career change in late 30's gave me excess free time and the desire to experience what friends were using, and I suppose that would be classed as an addictive personality, without adequate self control, so everything tends to excess. I am not proud of that, make no mistake.
Into my 40's I was diagnosed with depression, which seems to be a family issue - my parents are both prescribed antidepressants, and my younger brother committed suicide whilst in a state of depression - although how much is actual gene level depression versus self inflicted mental trauma due to self medication it would take someone more educated than me to decide.
I thought about lying, to you and to myself, about my reasons for taking tramadol. I have used the excuse of pain before, but if I am honest it was a desire for a "high", the only caveat being that I could not be sure if it was a purely self indulgent high, or if it was a "necessary" high to try and lift myself out of unnaturally depressive thinking. Either way it spiralled way out of control, and the thing that I hate the most was that I went through absolute hell in ICU, withdrawing from both tramadol and a huge dependency on clonazepam only to repeat offend a couple years later. I am a reasonably well educated, generally considered intelligent person, but the travesty of falling into the same trap again is one of the greatest acts of stupidity in my entire life...without question.
So, full and honest disclosure. Whether that affects anyone's opinion of me is moot, I can only offer honesty if I am to be able to face what I have done to myself, and to my family, because trying to hide behind rationalisations is just lying. I choose not to do that here. Judge me on that basis as you will.


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PostPosted: Thu Dec 17, 2015 2:44 am 
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I'd like to say a little about my treatment, with specific regard to psychiatry in Malaysia.
I am an ex-pat Brit, living in Malaysia.
I have been treated by my GP for about 8 years, for his diagnosis of depression. I am still on diazepam, and at one stage was on doses up to 8mg of clonazepam! See later... I was also given various SSRI medications, none of which, frankly, gave much relief from symptoms. Although generally a good doctor, he was far too liberal in giving benzodiazepines, resulting in extreme tolerance.
When I suffered my near fatal collapse due to overdose, I was taken to hospital where I contracted MDR pneumonia. As Dr Junig will certainly aware, this is by no means uncommon following OD cases and ventilator resuscitation. At the time of collapse I was on 40-50 tablets of tramadol and 8mg clonazepam daily. I underwent the most extreme and disturbing withdrawal, for the first 9 days I was not "conscious", by which I mean to say that although awake I was completely unaware of where I was, who I was, what had happened. I attacked nurses, had to be restrained and was labeled the worst patient in the hospital. After 9 days I woke up with self knowledge, aware of my surroundings for the first time. Fortunately for me, a new antibiotic was being trialled in Malaysia, and this saved my life as I was dying due to the standard antibiotics failing to work. One of the disturbing aspects of the experience was when the hospital psychiatrist visited me, and asked why I wanted to kill myself. I reacted with horror, as I have never been truly suicidal - especially having seen my brother kill himself, I am very anti-suicide. I discovered that in Malaysia any overdose is considered an act of suicide, and reportable to the police, who will arrest you as soon as you are well enough! Fortunately my wife had prevailed upon the doctors not to treat it as a suicide attempt, and I avoided being charged. It would have been the ultimate disaster to lose my liberty after almost losing my life! The attitude of most of the doctors and nurses was extremely good, and supportive with top class care. There were however 2 doctors who considered that my self-inflicted illness made me less worthy of treatment than others, and made it obvious and apparent at every opportunity they had. It was quite distressing, as deep down I agreed with them.
When I finally made my recovery, slowly and painfully, I was discharged, on 2mg clonazepam and one of the weaker SSRI medications. I had to go back for monthly outpatient psychiatric consultation. This proved to be very concerning. I do not wish to malign the hospital as my current psychiatrist has assured me that it is not the norm, but the doctor that I saw added Thorazine to my meds, with little background investigation, and offered to give me a catalogue of meds to try until "I" found some combination that worked. After experiencing what Thorazine is like, I didn't go back! And then, 2 years or so later, I tried tramadol again. Oh, FFS...the stupidity! Still angers me now. One problem is that it is extremely easy to buy, I had a choice of pharmacies that were willing to sell me up to 10 boxes at one time (I feel physically sick typing this) and I would alternate pharmacies as I bulk bought my way into addiction. I was so unwell that lost my job, my reputation, almost everything. Until my wife gave me the ultimatum..treatment or leave.
So we found a psychiatrist who specialised in drug abuse. Although Malaysian Indian, she was educated, and a fellow, at Johns Hopkins, which to me seems about as good as it gets in terms of qualifications. Certainly she proved to be very different from my hospital experience. She discussed my situation...I had taken 30 tablets of tramadol just in order to be "straight" enough to make it to see her, and she pulled no punches - " sir, you are in deep shit!" Then she told me about suboxone. Prescribed it, with the caveat that my wife would control access (sadly very necessary..then, not now.) and I went through induction into maintenance. I levelled out at 8mg daily, and gradually reduced to 2mg, at which time I was having personal training and lots exercise, which I am sure helped hugely in controlling the dosage. However the cost here in Malaysia is huge, there are no generics, and it currently takes nearly 40% of my monthly income. I was running low, so I rushed to taper down to 1mg (starting to feel barely functional) and then stopped.
I lasted a week, I have never felt so awfully in my entire life. So I went to the pharmacy, bought a box tramadol to stop the hurting, and...well, as if that isn't an old story. After one month, with my tail firmly between my legs, I went back to my psychiatrist and asked for help again. I told her what had happened, and she asked, "what happened about going from 2 to 1.5 to 1 to 0.75 Etc?" And that is when I learned how tough this is. And then, recently, with the cost becoming almost unsustainable (the Malaysian currency has devalued significantly against the US dollar, pushing medication costs sky high) I started to investigate further how to "kick" and found this site.
So, in summation, I need to do as suggested and live with this medication being a necessity, same as my 10mg diazepam. I suppose all I can do, practically, is try together back to 2mg as a daily dose. That is affordable. Currently 4mg daily is too much. So that's my goal - forget quitting for now, but never give in on the prospect of one day being medication free, because I still cherish that goal. I don't drink, smoke, or take anything unprescribed anymore, I don't feel any need to get "high" just want to be straight. And one day will be. Hopefully while I'm still standing!
A last note: have read Dr Junig's notes, but unless I am being totally blind, I cant seem to see - how long you needed suboxone, and how you quit..if indeed you did?
And I read your method for best sublingual dosing. That is the only point at which you are at variance with my own doctor. She recommends a very wet mouth, so as to mimic dosing by solution for best BA. Ive tried both, and am yet to be convinced either way. Maybe the dose that I take doesn't show enough differences. Anyway, she is a very experienced sub doc, so?I mention it only as a point of interest.
Thank you, most sincerely, for the work that you have done, and are doing, and I hope to be able to contribute in whatever way that I can to this site and forum.
G.


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PostPosted: Thu Dec 17, 2015 10:56 am 
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Hey G, First, you must STOP beating yourself up for relapsing. As Dr. J said, it happens to just about everyone. You must use it as a learning experience and continue to grow and heal! I too was taking 40 to 50 tabs of tramadol a day. I know I have already said this but, it is an evil drug! I must also say that you will never be judged by me. I am no different from you, human! And, it would surprise me if anyone else here judged you. That is not what this forum is about. It's support and encouragement to keep up the battle against addiction! Have a wonderful day!


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PostPosted: Thu Dec 17, 2015 11:23 am 
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Thank you Michelle. Sorry for labouring the point, I just wanted the opportunity to vent my entire story.
I've got your point, loud and clear. And I'm going to start acting on it..starting now!
Thanks for your very direct and positive reply.
You have a good one too!
Cheers!


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PostPosted: Fri Dec 18, 2015 4:46 pm 
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Hey G, just checking in to see how you are doing? I hope you are having a wonderful day!


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PostPosted: Fri Dec 18, 2015 7:23 pm 
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Michelle is right. Please stop beating yourself up for what are ultimately just symptoms of addiction. You are an opiate addict, which is a chronic condition characterized by relapse. I'm sure you can taper to 2 mg and stay stable there.

I'm glad you're here, because I think you need some positive support. We are here for you!

Amy

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PostPosted: Sat Dec 19, 2015 2:26 am 
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Thanks Amy and Michelle. :)
Yup, still trying to"face the fact" of what I am, and I am sure that one of the reasons that I am here is that I need a bit of positive attitude - which you are certainly helping me with.
I am going to concentrate on being and doing, instead of fretting. I'll give myself the simple aim of trying to get stable at 2mg (did it before, can't see why I shouldn't be able to do it again) but won't stress about it. Just one day at a time, and be happy that I have that chance. :)
Have a great weekend, I'll be doing good :)


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PostPosted: Sun Dec 20, 2015 12:13 am 
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Welcome to the forum. I'm glad you are still on the proper side of the dirt. From my experience, the guilt and shame of this disease process always kept me Ill. I sense a great deal of it from reading your posts. I know it is much easier said than done but try your best to kick it to the curb. I suffered endlessly through my addiction and now that I am clean my mind still tries to tell me I'm not due to the fact I am on a replacement therapy regiment. The truth is, most of the time, my mind is not my friend.

Like you and most others on this forum, we are fairly intelligent people. The danger of being enlightened is that, try as we will, we can't think our way out of this disease. Believe me, I've spent thousands of hours trying to do exactly that and what is always the result for me? Relapse with a capital R. Give yourself a break and try not to be so critical of what you did and have done through your active addiction. That's what always kept me stuck in that dreaded downward spiral. Like you, I was recently in a coma for 6 days due to my consumption of opiates.. Not a good time at all. Not one thing I read in your posts was even remotely shocking to me, we are all addicts and that's what addicts do? Glad to have you here, your story helped me and that's what it's all about. Keep fighting the good fight!


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PostPosted: Sun Dec 20, 2015 10:57 pm 
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Thanks O'Brien.
You and I seem to have similar thoughts on the situation, both with respect to the addiction and the treatment.
I hope we can all fight the shame, consider the treatment for what it is - lifesaving in so many literal ways - and pass beyond it into full health and happiness without artificial aids.
It ain't easy!
Best...and thanks.
G.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

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