First let me congratulate you and give you all applause. I am fortunate to have a Doctor like Dr. Junig who is very caring and compassionate and who's gone to battle in full armor in many cases for me. I can't thank him enough.

My story starts in my early 20's. Iam almost 40 now. Several years after a bad car accident at age 16 I began to develop bad back issues. After refusing surgery I was left with no choice but to suffer through the pain or go into pain management. I chose management. The long and short of it is two fold. I refused to take drugs like OxyContin, but ended up at some point trying them all. I have always been compliant, never complaining and always thankful. After my first doctor tried pushing oxycontin on me and me refusing, he said the only other thing he could give me was methadone. I accepted. I have been on methadone for about 14 years for pain. The last 5 years or so I have been through three doctors for various reasons not my doing. From retirement, to "I'm getting out of the business" to my last doctor who I had been seeing for a year who apparently had issues with the DEA closed practice without warning. I had had it with these doctors at that point. My PC's nurse told me about Suboxone. I found a doctor and gave it a try. Short of it is, I love this stuff. It helps to control my pain, I feel normal....I feel like me again but with the added benefit of moderate pain relief.

After a year on this stuff, I can't afford it any longer between the dr. visits and paying out of pocket for my monthly meds. I would love to stay on it. Recently, (after all these years) I found I have a debilitating muscle issue in my back and throughout my body where the muscles herniate and push fat and nerves through the outer layer causing pain. I will have to have surgery every few years or so to repair them.

So now I find myself having to go back to pain management since 1. The suboxone is not affordable for me any longer and 2. It doesn't cut the pain like it used to.

My question to all of you who may have gone through this is how on earth can I transition back to a full opiod? Is there an opiod that is strong enough to get me through until the suboxone is gone from my body? I have struggled for the last 2 months back and forth as the full opiods just don't cut it. I got myself down to 1mg a day on suboxone before I switched. I have been on exalgo and opana. Both are extended release versions. Next step...unfortunately will be to try the new OxyContin.

What can I do? Will I ever win this battle? I work full time and am a single dad by IRS standards at least. And I work in an agency, high up on the food chain of the fed if you know what I mean.

Any pointers would be greatly appreciated.

Dr. Junig. If your reading could you chime in?

Hello and welcome to the forum. I am so sorry to hear about all of this pain you have to constantly be in. I understand abou tthe sub not working as well. I wish that I had some useful advice for you besides what you are already doing. It sounds as though you have tried just about everything. It doesn't sound like you ever had an addiction to these full agonist opiates. Am I reading that right? If so, then why the hesitancy to use them? I'm just curious so that we can better understand how to help you. Because you really sound against them...especially OxyContin.

I wish you the best and hope that you are able to find a doctor that will get you in the least amount of pain possible. Noone deserves to be in that much pain. It is so life altering. Anyone who hasn't been there just doesn't fully understand how it can impact ones life. We have quite a few members on here who should be able to give you some advice. Best of luck to you and please keep us updated as to how you are. And again, welcome.

_________________
"All great changes are preceded by chaos."
~Deepak Chopra

@Goingstrong. Yes you are correct. I have not had any real issues with addiction. In fact that's the first thing my Sub doc picked up on when I first started seeing him last year and was a bit hesitant to put me on sub. At that point in time I was willing to try just about anything as I was 1 week into methadone withdrawals coming from a very high dose of methadone for pain management. Honestly, suboxone has done wonders for me. I have lost 30+ pounds over the year. My eating habits have gotten 10 times better and I spend much more time with my son versus self indulging for various reason like work.

But no. I don't have an aversion to taking pills like OxyContin. I have just heard the horror stories over the years so I think my true aversion is with having to deal with the dependence or possible addiction. 5 years ago this probably would not have been a problem for me but now I know I really do need the treatment to manage my pain. As I mentioned, I first started on ER 10mg (hydromorphone) which did absolutely nothing for me after cutting suboxone down to 1mg before stopping. The doc switched me to Opana ER 20mg 2x/day. I get some relief but not enough. Opana should be doing the trick as I know it is stronger that the OxyContin. I think that's why he put me on the stronger forms due to the suboxone. I see him again this week and m thinking of giving the OxyContin a try. BTW. Opana is oxymorphone and ironically is only bio available by about 10% orally. I read that the OxyContin is bio available orally by about 80 to 100 % depending on the persons ability to metabolize the medicine which is why I think the OxyContin may just do the trick even though it is not as strong as oxymorphone (opana).

While I am on the opana, I still feel like I am in some sort of withdrawal which is very weird. About every third day or so I wil take .25mg to .5mgs of suboxone just to feel okay again. I am just wondering if the half life of suboxone has built up so much in my body that it will take much more time than I was originally led to believe. I was told I should start feeling okay with 72 hours after stopping the suboxone. This is crazy. What has suboxone done to my receptors?

In any case I just don't know what to do.

I tend to think of all the mu agonists as the same-- except for minor differences in side effects, such as histamine release from morphine, and differences in speed of onset caused by how well a drug dissolves in fats. Otherwise I doubt that one will work better than the other for this situation.

People going from buprenorphine back to an agonist have two things in their way-- 1. high tolerance, equal to about 60 mg of oxycodone per day, and 2. the blocking effects of buprenorphine. Buprenorphine has a long half-life; it takes a couple weeks to clear it from one's system. But even after a couple weeks, people tell me (usually people who stop it before surgery) that it still seems to be there; that even after a couple weeks, pain meds don't 'feel' like they did before buprenorphine. I've heard patients say that even after a long time-- several months-- that pain pills 'feel' different--- that the euphoric component is gone. I can't imagine how buprenorphine would have THAT long of an effect, though, and I assume, in those cases, that the person is just not taking a potent-enough medication, given the person's tolerance.

I would assume that taking 60 mg of oxycodone--- say Oxycontin 20 mg, three times per day-- would be the 'break even' amount-- and then 15 mg more, every 4 hours, would provide meaningful pain relief. The problem, of course, is that your tolerance will go higher very quickly, and take away whatever effect you get. That is why many people do better on buprenorphine; it does have the limitations on potency, but it prevents the crazy ride of dose escalation-- that always ends badly.

I've discussed my 'findings' that people who take an agonist AND buprenorphine seem to have their pain relief extended-- maybe indefinitely. The buprenorphine seems to anchor tolerance at the lower level. People taking the combination say that the pain is relieved, BUT it never feels like pain pills USED to feel; there is no feeling of warmth, and no euphoria. But the trade-off is getting a more stable course of treatment, over time. The hard thing though would be to find a doc willing to prescribe both together. I do that when a person has surgery, buit not in other cases--- as there is always that fear that the DEA won't understand what is going on, and suspect that it is allowing for diversion.

Thanks Dr. Junig. I think you hit the nail on the head with my thoughts and what I should explain to my PMD. I am wondering if I should ask him for a break through med to take just long enough for the bup to find its way out of my body. But I am going to ask him to switch me to OxyContin and see how that goes.

As an after thought, since bup does provide some relief for me, I am also wondering if I should just stay the corse but my only concern is when it comes surgery time. I have to go and see a hernia specialist for a low and mid back issue. How ironic. In any case, my former (which I could go back to as I have made sure all doctors are aware) suboxone doc but he charges me $250 every visit so I'll need to find someone else. Other than that, if it weren't for the fact I have to spend $420 /month it be a no brainier.

I will post again in a few weeks and let everyone know how it's going.

UPDATE:

So I paid a visit to my PMD on Wednesday and told him things were not going well with the transition. He did not want to put me on OxyContin just yet because he thinks my tolerance is too high due to the suboxone. Prior to suboxone, I was on Methadone and Dilaudid for BT. High doses I might add.

So, the regimen is to stay on the Opana but he added MSContin to take at night before bed. So far this has helped a great deal as it has seemed to stop my morning withdrawal symptoms.

But for those in a similar situation, this is what I did. Originally I stopped suboxone at about 2 to 4 mgs before switching over to the Opana. That was a big mistake. So over the last month I have tapered down to .5 to 1 mg per day while continuing to take my daily dose of Opana. Now in the second month I have cut suboxone back to .25 mgs per day. Over this last week while still taking my daily Opana dose, I have skipped to every other day of the .25 mgs. I have noticed a dramatic difference in the way I feel. It seems now to be much easier. My goal is to not increase my tolerance as much as I can until I get through my surgeries.

So the bottom line is to at least get your suboxone dose down as far as possible before making the switch. And ALWAYS, be honest and up front with your doctor so that he/she can help you the way you should be helped. I think it also helps to establish trust.

I am not walking away from suboxone for good. In fact, if I could take that with a low dose BT for pain that would be ideal for me. Suboxone enabled me to get my health back in check, form a closer bond with my family, loved ones and friends. I just felt like me again without that monkey on my back. Though I have never had an abuse problem, I can still see how hard it is even when it is for legitimate purposes.

Dr. Junig should get the Phsycologist/Doctor of the year award for all his efforts.

Keep up the good work Dr. Junig. I don't know you but I have read your stories, read your blog and have seen your videos. I hope you know how much those things alone has helped many.

In any case, I'll report back in a week or so for an update.

Hi GLJim and welcome to the forum. I'm glad Dr. J chimed in to explain how sub makes it difficult to go back to full agonists (because of the high tolerance and the blocking effect), so I don't think I need to add anything there, other than one thing. It appears that since you're still on a low dose of sub that you're already doing the combination approach that Dr. J mentioned (mixing full agonists with sub), which is probably why you're getting decent pain relief right now). Be prepared that once fully off sub and only on full agonists that your pain control might not be so good.

I assume since you're paying cash for your doc visits and meds that you are uninsured? Have you inquired with your sub doctor about the Patient Assistance Program (PAP)? It's through sub's manufacturer and is for uninsured patients with income eligibility. If approved, your meds would be fully paid for a full year. It's encouraged by the manufacturer that the doctor's visits be reduced as well, but that's up to the doctor. It's worth asking your sub doc about it. Each doctor is allowed three patients on the PAP.

I hope this helps. And I hope you get some stable pain relief. Keep us posted. And again, welcome.

_________________
-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

-I'm only responsible for what I say, not for what you understand.

Did methadone work well last time?

Would you consider using it again?