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 Post subject: Tramadol, Ugh
PostPosted: Sun Dec 18, 2016 10:52 am 
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Some of you might recall that I went on 100 mg Tramadol/day as sort of a maintenance/antidepressant treatment almost 20 months ago after stopping a trial of 1mg Suboxone/day for depression.

(For those who don't know me, I was on Suboxone maintenance- up to 16 mg/day- for 3 years after an 8 year opioid addiction. I went off in 2013).

I should also throw in that during my active addiction Tramadol was a drug I abused. But anyway, I was put on 100mg extended release ultram and was given a small script (10 50mg Tramadol/ month) for my PMDD. I used it as prescribed. At some point I switched from the 100mg ER to 2 50mg/day because I'm paying out of pocket and the ultram was over $90 a month while the Tramadol was under $5. So I had a script for 60 a month and a script for 10 a month.

At the beginning of Nov. the doc said she couldn't give me 2 scripts anymore because Tramadol is now CIII and they're cracking down, etc. so she gave me a script for 90/month. At the same time the clinic I was working at literally fell apart (all the management from regional director down to office manager quit in about a two month period). I had to find another job, I was stressed and depressed and not taking care of myself at all. (Had 75 clients and virtually no supervision.) - No excuses, but you guys know how relapses happen.

Anyway, I immediately started taking 3/day and sometimes 4 even though I didn't need them - just wanted to change the way I was feeling. So after 19 months of stability I ran out of my script early for the first time. I got by with someone giving me some of their extras until I got my Dec script (90 again) and decided I should taper off. My doc disagrees & thinks I should just go back on 100mg/day because I have been doing so well. My one support person I have left from NA (who is on Sub) agrees with the doc.

Problem is, I'm going to run out of my Dec. script early. I had to "pay back" the pills I borrowed in Nov., plus I took extra the first week of Dec. Over the last 2 weeks I went back to 2/ day, then 1.5/day for a week, and I just started 1/day.

I know I just wrote a book but here are my questions. One, I don't know where to turn for support. I've been to NA/AA 2-3 times since I started working at the methadone clinic, and quite honestly I just don't want to go through the white key tag/ 1 day clean ritual again. I may be rationalizing, but if I had actually full out relapsed I would have taken 90 Tramadols in a week and then went running for anything else I could get.

Second, do you think it's possible to go back to 100mg/day which was working well for me, or should I just continue tapering off? I started Trintillex about a month ago, but I haven't noticed much difference. For anyone who actually read all this, thanks for listening. Just writing it all out helps.


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 Post subject: Re: Tramadol, Ugh
PostPosted: Sun Dec 18, 2016 11:51 am 
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Gosh Lilly, I just really wanted to offer u my support in whatever u do. Ur very smart and you'll know what decision to make. I've never battled depression other than the depression u get from being clean off everything.. kinda PAWS I guess. So I couldn't imagine how difficult it could be to deal with that plus addiction and recovery. It's got to be very hard to say the least. If u found something that works and is helping ur depression, that's huge, but the downfall being that u could possibly be tempted to take extra and then run out early....that's a whole other situation. If it were me.....if I thought I could control not taking extra (which I probably couldn't control it honestly) then I'd try to stay on it. If I knew that I was most likely to over take it then I guess I'd stop and go bk to the drawing board, and I know that would really suck though. So see, I'm not much help. I don't know much at all about tramadol. I know there was a few times during my active addiction where I took Ultram to keep from being sick. I don't remember what milligram it was because someone would just randomly give me some to try to kick my withdrawal. I just don't know much at all about them. Heck until recently I didn't realize ultram and tramadol were the same lol so I'm no help.

I can totally understand how stress can make u reach for extra, it happens. What really sucks though is running out early, that becomes a whole new set of problems that u have to add to an already stressful situation. But someone will be along that can help u much better than me, I just wanted to offer my support and tell ya how strong and smart u are, u will figure it out and be ok ♡♡♡♡♡

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 Post subject: Re: Tramadol, Ugh
PostPosted: Sun Dec 18, 2016 1:41 pm 
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Quote:
I may be rationalizing, but if I had actually full out relapsed I would have taken 90 Tramadols in a week and then went running for anything else I could get.


Hi Lilly,

In my humble opinion taking extra pills...two months in a row now if I read correctly... does represent a relapse, and like all relapses can lead all the way back to where you were and then some. Believe me, I'm not judging. i've battled various addictions all my life. They don't call it a disease for nothing. The only model that works for me are Twelve Step meetings. Also Suboxone which is really it seems to me a kind of miracle medication. But it sounds like you don't want to go back to that. Was your life so bad on the subs?

I'm far from an expert, but it does seem that your life has become unmanageable again...and perhaps in your heart of hearts you knew you were taking a big chance by starting in on the TRamadol again. Some would say that your relapse started the minute you accepted that script.

I'm curious why the subs didn't work? Well, actually it looks like it was working for those three years.

Again, Lilly I"m not judging. I just want to be of help if possible. Just like everyone else around here


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 Post subject: Re: Tramadol, Ugh
PostPosted: Sun Dec 18, 2016 2:01 pm 
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Hi Lilly, you know I'd throw my 2¢ in worth here. You've been with us as long as me or even longer. You know as well as I about the addict brain and how once you let that little vampire out of it's cage it starts to whisper the "I can handle it" quotes.

I too had an addiction to the Tramadol along with Norco, Soma, & Xanax, during my active addiction years. Yes, the drug makes you feel quite good for those of us who it does that for. Some people don't feel a thing on it. And I do remember the doctors swearing it was not addictive back in the late 90's and early 2000,s. Yet, here you are again, looking addiction in the eye. IMO, if you are intent on still taking it, bite the bullet and pay extra for the time release formula ones. Stay away from the 50 mg generic pills as they are the ones we abuse. Unless of course you decide to chew the time release ones. And if you do do that, then I say go back onto Suboxone and admit defeat. You can always taper and quit again once you're stable.

Godfrey said it about the same way, I just got more specific. I/we KNOW the little vampire on your shoulder and what he's whispering in your ear. It's subtle, insane, and like AA/NA says "cunning, baffling, and powerful".

You know deep down what to do. We won't tell you what you want to hear. The only decision you need to make is look deep inside yourself and find out if you can still take the time release version as prescribed. That's all I got. The rest is up to you.

rule

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 Post subject: Re: Tramadol, Ugh
PostPosted: Sun Dec 18, 2016 2:12 pm 
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Quote:
Yes, the drug makes you feel quite good for those of us who it does that for.



YOu've got that right brother. The opium...the major component being morphine...was a revelation. As I wrote somewhere else recently;. "At the age of 53 I was a rusting old wreck that even in my best days had never run right. Now it was as if I'd suddenly found a way to trade myself in for a better model. I was happier, calmer, more empathetic, and more productive."

By every objective measure I was a better person. Too bad it couldn't last. In six short months it was all over, although it took me nearly 12 more years to finally find a way out. Too bad I can never get them back.


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 Post subject: Re: Tramadol, Ugh
PostPosted: Sun Dec 18, 2016 2:22 pm 
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Thanks both of you for your kind words. I think the whole 12 step thing is part of what's bothering me. Right before I started working at the methadone clinic there was an issue in my home group where the chairperson got "fired" when someone found out he was on Suboxone. Add to that the many stories I've heard from my clients being told in NA/AA that they're not really "clean" on MAT.

Godfrey said that some would say that my relapse began as soon as I accepted that script. I'm certain my NA group would be the ones to agree with that. I disagree because it was my Sub doc that gave me the script knowing my full history, and my difficulties with Suboxone. I do agree that I have now relapsed, however.

So there are maybe 2 people (plus my Sub doc) who have remained supportive of me throughout my multiple failures with virtually every AD on the market and my decision to take Tramadol. But just like when I was on Sub I don't feel accepted in NA. It's funny because I always suggest to my clients not to share their medication status in the rooms, except for one on one with someone open minded who they trust. But I think there is a part of me that has bought in to that "not clean" belief. I was an active member of NA for many years and I've really internalized the belief systems.

The last 2 posts were posted while I was writing my reply. I think you're absolutely right, Rule, it's the one time release tab a day - just like a standard AD - or nothing. I'm not even sure I want to do that. I'm seriously considering just tapering all the way off. I do however highly respect the opinion of my Sub doc (who is a psychiatrist) and has worked with me for 5 years. She feels that I've been more stable over the last 18+ months than since she's known me. And, yes, she knows I relapsed.


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 Post subject: Re: Tramadol, Ugh
PostPosted: Sun Dec 18, 2016 3:33 pm 
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Quote:
I disagree because it was my Sub doc that gave me the script knowing my full history, and my difficulties with Suboxone.



Hi Lilly....

First off, I think it's amazingly ignorant that both of your 12 step groups consider suboxone therapy for someone addicted to opiates "using." I'm an old man now, and I don't care so much what people think of me.
Were I to go back ....it's been many years....I'd like to think I'd not only be upfront about my suboxone, I'd talk about it every decent chance I got, including from the podium, in an attempt to change minds. Of course some of the confusion is that non-addicts do use it to get high. So there's that. And I well understand the kind of peer pressure those groups can apply. Every hard to stand up to.

As for the above quote, I wasn't going to quibble. But in thinking about it it seems importan. I've been in that situation myself...and accepted the scripts...with that little nervous anticipation feeling that's so familiar to me....the feeling that for me anyway means...."I get to get high and it's all legit because it's my shrink doing the writing, and he went to med school and he's an expert, so he knows better than I."

But if that's so, why underneath it all did I feel so guilty..

I'm talking about me now Lilly, not you. Only you know what was in your addicts heart and mind.

The really important thing is that you're conceding you had a relapse. That's key as we all know...


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 Post subject: Re: Tramadol, Ugh
PostPosted: Mon Dec 19, 2016 1:44 pm 
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Lilly, I have been attending SMART Recovery meetings and they are very helpful to me. I suggest you give them a try. People in SMART sometimes have lapses too, but there is no emphasis on clean time there, just examining what has happened and why. I have a feeling you would like their meetings. :)

Amy

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 Post subject: Re: Tramadol, Ugh
PostPosted: Mon Dec 19, 2016 5:39 pm 
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I've been to SMART and I like it, but the nearest meeting to me is so far away it's not realistic to get there. I did go to an MAT support group meeting today, however, which I really enjoyed. The prison/treatment program where I did my internship has asked me to start an MAT support group there. I'm going to be starting that next month.

In other news, now that I'm down to 50mg of Tramadol a day I'm feeling even better than I did at 100 (or more).


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 Post subject: Re: Tramadol, Ugh
PostPosted: Mon Dec 19, 2016 11:31 pm 
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Hello Lilly,
As a veteran member here your story has seen it all.
I don't really speak these days on my 12 step/NA experience ,however it is to bad that they are not in favor of Anyone being on this medication no matter how loug you ve been there or how well you worked there program. I say this from 4 years experience. I can only say i COMPLETELY understand how you feel. The program gets in your head. The principle s are good, but you can never convince them that MAT is a good treatment. Ive tried. I gave up. I quit. Funny thing,all thoses friends I had while there vanished. All the talking in the world will never turn there heads,not as a group or program. Very sad. 4 members of the local fellowship went back out,consided sub treatment and were told not to do it,not clean. Now not alive. Gone.
Start that MAT meeting Lilly, do it! With my clinic and hospitals help im luckly to now chair and run two a week there. Thoses new to treatment (ddu),plus many from the clinic have a place to come,and shair our type of recovery. Our hopes of a new clean life.
You ve done it all Lilly, you no dought would be a chair person. I was angery for a loug time at thoses old NA ers ,but this year ive come to know that our groups,4 1/2 yrs now, are no different, we just have a safer stronger way to recover, imo.
I incourage any of you out there if it all possible to start a support group in your area. Always great to give back and to help others. If you have questions pm me anytime whoever you maybe.We use the forum and Talkzone for discussion topics.
We also have two Smart meetings at clinic too. There good and have just gotten started. It is always good to be around others in the same boat as you .
I just wanted to say it can be done. We are all "Clean Enough" today and moving forward with pride.

Razor58..


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 Post subject: Re: Tramadol, Ugh
PostPosted: Wed Dec 21, 2016 1:49 pm 
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Razor, I'm very flattered that you are using the blog and forum out there-- thanks!

Lilly, I don't know if I have much to add. There was an article in the wall street journal recently-- a very long, thorough article-- entitled 'Tramadol, the opioid crisis for the rest of the world.' We in the US tend to see Tramadol as a 'minor' drug, but apparently it is causing big addiction problems throughout the world, especially countries in Africa. The article was an 'eye-opener' for me, as it made me think twice about my attitude toward safety with that drug.

I've been around opioid dependence for 25 years, first on one side and then the other, and hopefully staying on my current side. You all know my attitudes- but after a while it all just seems so obvious-- that the misery, health problems, and risks associated with opioid dependence are worthy of medical treatment (!). The idea that in 2016, after the death of 30,000 people every year for 10 years, that we would still avoid using medication simply boggles my mind.

Treating opioid dependence with a low dose of Tramadol is illegal. I note that you wrote that he was treating 'depression'; that as you likely know is another huge 'can of worms.' For most people who have been addicted to opioids, attempts to use opioids in a controlled manner end in failure. Even in cases where the person maintains control, the work required to avoid over-use becomes depressing at some point. For those reasons my recommendation would be to avoid Tramadol.. but I realize that for ANY illness, one-size never fits all. That's a mixed metaphor, I know....


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 Post subject: Re: Tramadol, Ugh
PostPosted: Wed Dec 21, 2016 6:50 pm 
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Thank you for replying, Dr. J. I too read that recent article, and I remember reading one similar a few years back that didn't get much attention at the time. Right now I'm down to one 50mg tablet a day, and planning to taper off completely. It's not worth the risk of overuse for me, and I know from experience Tramadol WD is horrible. Also, it doesn't seem to be helping the depression as much now that I've been on it for over 1.5 years.

I did, however, want to add that a few studies have been done using Tramadol for opioid withdrawal/maintenance, so the idea didn't come out of left field. I cite one study below. My pdoc is aware of the legal ramifications, and therefore my pcp is collaboratively prescribing it. I believe the bottle says, take 2-3 tablets daily as needed for pain.

Citation: Pahwa M, Sidhu BS, Raj R, Kumar E (2015) Tramadol vs. Buprenorphine for the Treatment of Opioid Dependence: A Comparative Study. J Addict Res Ther 6:239. doi:10.4172/2155-6105.100023

Conclusion
• Tramadol appears to have comparable clinical efficacy as buprenorphine for treatment of patients with low levels of opioid dependence [5,13]
• Patients with moderate level of dependence; tramadol has more efficacy in detoxification and relapse prevention with minimum abuse potential.
• Patients with severe and persistent form of addiction are more likely to have co occurring psychiatric morbidity and typically require long term comprehensive treatment and in such patient’s induction and maintenance on buprenorphine may be more effective than detoxification for engaging and retaining patients in Comprehensive Outpatient addiction treatment.
• Detoxification with flexible dose schedule and tailoring the treatment according to individual has better outcomes as compared to fixed dose rapid or ultra-rapid detoxification [14].


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 Post subject: Re: Tramadol, Ugh
PostPosted: Thu Dec 22, 2016 10:45 am 
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Hello All, As most of you know, my drug of choice became tramadol. I knew what I was doing when I asked my primary doc for a script to help with pain in my knees from osteoarthritis. I was also experiencing some depression as a result of menopause so the trams helped with all of it....until I was out of control with them. I was taking 40 to 50 50mg tabs a day! Every time I decided to cut down, it never worked! When I would run out, the withdrawl was awful! The depression and darkness of mood was too much for me to deal with so I would always go back. Then August of 2014 they changed the classification of tramadol and boom! I could not find it anywhere. Unless I wanted to order it from overseas and it was expensive! That is when I made the decision to find a suboxone doctor. I was so very lucky in finding an amazing woman who was an internal medicine doctor for many years before retirement. She then decided to start a suboxone practice and I am so very happy she did! Each of our journeys are so personal! And, as someone has already mentioned, people can take trams the with no issue. I just know for me, they are a big problem! Have a wonderful day!


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 Post subject: Re: Tramadol, Ugh
PostPosted: Fri Dec 23, 2016 2:17 am 
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I enjoyed reading your story Michele. MIne's similar in that I drank my first cup of poppy tea
to relieve my pain, both physical and psychic. It worked splendidly for a long time...some years...but then
it was just a huge pain in the butt. It got harder and harder to find, and more and more expensive at the same time. I get sick when I think of how much my habit cost me over the years. But I thought I had no choice. I tried tapering down so many times! I'd reduce my daily dose by 10 or 20 percent then be unable to resist the urge to take more because I knew I could get a better high. That worked for a few days then I'd be right back to the same thing.

We find ourselves so desperately trapped. Over and over we wonder how we can possibly escape. But there is a way, just a few hours of pain and then an easily taken....very safe medication. And we don't have to be on it forever. Many taper off and go on to lead entirely drug free lives. Many choose to stay on. It's a choice, something we never really had when we were using!


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