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Addiction & Recovery Message Board

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Whether you can get off Bupe or Subutox is dependent on your personality and whether you are addicted or physically dependent because of the pain treatment, as well as your physical nature. I can't tell based on what you wrote, and would not be compentent to judge you in any case.

Do some web searches of "Addiction" and compare them to "physically dependent", and see which describes you. Ask your loved ones for their opinion.

One question is, "Are you still in pain?" Despite the side effects, if you are in pain, the meds are likely still indicated.

If you need to be detoxed and you are not addicted, or you are well motivated, well, lots of people do that at home. I just did, four weeks ago, to do a narcotics holiday since I had developed tolerance for the meds I was on to the point where they simply stopped working at any dose (fentanyl, oxycodone). I made up a taper schedule for myself that took about three weeks and which was based on what I had on hand. One of my pain doctors says that a 30 day holiday will allow the mu receptor count to return to normal and I will get pain relief from doses that are a lot lower than my old doses. I am still noting cognitive changes and physical changes in week four. I feel almost as good as I did on the narcotics (since I had thoroughly adjusted to them) except for the pain. My reality is that off the narcotics I am in a ton of pain. (5(short bursts)-8 on the 10 scale, burning pain all over my body) plus cervical pain.

So, after seven years of increasing doses, I am putting up with seven weeks of discomfort and pain - to be able to take smaller doses and to have them effective and maybe to be able to get relief from breakthrough pain. I had seven years of fair comfort. Not a horrible trade. With better techniques I might have had 10 years.

But I would recommend that you talk to your doctor about a taper schedule. Try to get the doctor to make it a month to six weeks, it will be a lot more comfortable than a 1-2 week taper.

If you feel like you need psychological help, well, decide what sort of program you want or need - there are programs that do not treat pain patients who have taken meds according to instructions and who need a holiday or who want to investigate what life is like or alternate pain modalities without narcotics as addicts. I have a personal bias - I'm an atheist and don't feel like there is a higher power for me than my own will, so a 12 step program would not be for me. I called a lot of programs - and most simply did not differentiate between physical dependence and addiction, or they did not have the facilities to deal with someone who was in chronic pain, or they were simply not interested in treating me, since I was not an addict and I was not an appropriate candidate for their pseudo-medicine and intense psychological treatment/torture/12 stepping.

I called a number of programs before I decided to do it at home. I was never able to find a program that was not oriented to treating addicts. I found one on the web, in California, but I decided to just do it at home. One issue was the cost. I'm hoping that by the next time I do this it does not cost $5000 for a bupe prescription, and that they have dropped the requirement that the doctor referr you to "therapy" if they are not treating you for addiction.

Don't go into an addiction program unless you have decided that you are addicted. Pain programs are more appropriate.

But the reality for me, at least, is that I have already talked about my history to my pain doc, as well as the amount of pain I am in during my holiday, and the plan is that I will go back on narcotics once the 30 day holiday is over. Not, of course, at the same doses I was at, a milligram an hour of fentanyl would kill me.

I had thought that the narcotics had become completely ineffective on my base pain level, and I was completely wrong. They had become partially ineffective on my breakthrough pain, but they were effective on my base pain. A medication holiday allows you to look at your pain with a clear mind and to remember why you put up with the narcotics. There is also some likelihood that you will say, "heck, the pain is just as bad with narcotics as without them. Why take them?"

That is not my case, but it is something you have to consider. I have heard of this anecdotally.

As to whether you can get off Subutox, of course, the drug maker would like Subutox to be a lifetime thing, but there are many doctors doing six week decreasing dose detoxes on Subutox. People who get Subutox for lifetime use are the same sort of person who gets methadone for lifetime use.

If you really want to be on narcotics, you could always declare yourself an addict and go to a community methadone program. The people at a methadone program can use the drug to maintain your addiction, legally, just like a subutox doctor can use that drug to maintain your addiction. If you are married, Subutox has less effect on testosterone levels and therefore your libido. It is a big step, legally, for someone to declare themselves an addict if they have no felony convictions.

So, are you still in pain? If so, talk to your doctor about a month holiday to get off the percocet. Perhaps not to stay off of it, but to reduce your tolerance. Frankly, if you are taking percocet and not, say, oxycontin, your doses are simply not that high. Percocet has a tylenol component - which you have to keep under 4 grams a day. If you are taking 10/325s, the strongest I have seen, you would be limited 12 pills, or to 120 mg/day. If you are taking 10/750s, well, that means that more than 5 a day would be over the 4 gram limit. That would be 50 mg of oxycodone, max. When I last looked, a few years ago, the 10/325s were not available generically. 50 mg/day is not a small dose but not as much as a single oxy 80. Think about why Rush Limbaugh went deaf while he was abusing the mixed narcotic/NSAID/Acetominophen drugs. I was taking 240 mg/day of oxycodone (3 80 mg oxy) with the fentanyl.

So, are you still in pain? If so, talk to your doctor about your pain, not your depression or other side effects. In today's environment, no one is going off label for oxycodone unless all standard drugs fail and the need for the off label use is well documented. If you are not in pain, well, there may well be better drugs for depression and bipolar disorder, although they are probably just as addictive and just as likely to cause dependence, and in some cases even more sommnolesence than the narcotics...but they are non narcotic so they are better for you, right? (That was a joke.) One possibility is Cymbalta, which is an antidepressant with a pain indication. It works for many people but it does cause physical dependence and some people find that the smallest available pills are not small enough for a taper, and the detox effects, like irregular heartbeat require that they resume taking it -- but it is non-narcotic so it is better for you. If you find that you can't detox from a single 30 mg capsule, talk to your doctor about a prescription for a compounding pharmacist, who can make you smaller capsules. Also, some people find that Cymbalta works for a while and then they need to change drugs to another SSRI, essentially the same sort of thing that happens with the Percocet. Talk to your doctor, and, seriously, if you feel suicidal, call a crisis service or 911 right away.

But if you are in pain, your doctor might want to rotate you to hydromorphone, maybe 5 or 10 mg Opana. or he might want to shift you to something else. As one doctor told me, when you have an effective dose and it stops working. the first reaction should be rotation to an equipotent dose of some other drug, before dose escalation.

This is a tactic to try and beat tolerance. If you rotate drugs, they may go through different metabolic paths, or hit different variations of the brain receptors and that might allow you to use a less drug than you would need if you kept on the same drug.

The other reality is that with holidays and rotation, if you are in pain, you can stay on narcotics for a very long time. The big issue is dose escalation. A good doctor can help you with that.

I wish you luck. And I might consider getting a second opinion, although you have to be careful of "doctor shopping". In Florida, you are doctor shopping if more than one doctor is prescribing narcotics at the same time for the same indication. As far as I can tell, all your chronic pain is the same indication while acute conditions (kidney stones, for example) are different indications. So when you change doctors, you have to make sure that there is a handoff. But you can see another doctor so long as that doctor does not prescribe narcotics for you or coordinates the prescriptions with your regular narcotics prescribing doctor. Or, if you like the second doctor's proposed treatment plan better, you can make sure that both doctors know you are transferring your care. There may be similar rules in other states.

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