Patients on those doses of drugs for no diagnosable physical disorder need to be evaluated for a possible detox. And opiates can be stopped ‘cold turkey’. That’s one thing about opiate withdrawal, it won’t kill a person, even if they feel like killing themselves. “Weaning” an addict off an opiate is like hanging a man slowly, not really a kindness.
Benzodiazepines like Xanax and Valium are more tricky.
And no real psychiatric diagnosis can be tendered with any real accuracy until the person is off drugs for at least two months. Active drug addiction mimics a lot of psychiatric diagnoses.
What can you do about this? Frankly, other than join Al-Anon or Nar-Anon, not much. Detach with love, it is not your problem. You didn’t cause it, you can’t control it, and you can’t cure it. And don’t enable her! Don’t pick up her meds for her, don’t help her doctor-shop for more drugs, but let her suffer the consequences of her behavior herself.
It sounds very much like the woman needs a competent addictionist to get the drugs out of her system.
jarbabyj, I hear ya. I’m thinking the level of addiction must be awfully high to go through that sort of pain (not everyone does go through it, of course, but it’s never comfortable). These patients, the addicted ones, they start asking for demerol the moment they hit the door. So there’s another incentive for coming here.
A concrete example of the number of medications some patients are taking (directly from the patient’s packet): Dalmane (a sleeping pill, addictive, in the benzodiazepine family); Percodan (Mmm, good stuff); Dilaudid (pain medication which can apparently cause addiction after only a few doses); Soma (a nifty muscle pain pill, seems to be non-addictive); Oxycontin (which we all know and love); Xanax (which is, in fact, addictive); Valium (Yay!); Lortab (which is just Vicodin under a new name).*
This doctor clearly needs to stop with the prescription writing, yes? It’s not as though these patients take the pills as necessary, but instead they are told to take them three or four times a day. That it’s legal for them to drive is a wonder.
I can only assume the withdrawl symptoms are more painful than the injections.
[sub]*All info about these medications, except for the snide remarks, are from pdr.net. [/sub]
My docs, despite my YEARS of chronic back pain from my spinal fusion, have adamently advised me not to take narcotics for chronic pain. I’ve been doing pain management as best I can using other drugs and such, but they’ve each said basically “Look, I’ll write it if you want it- I dont’ blame you for wanting to do whatever it takes for relief, but please- don’t do this.”
I’ve had one prescription for Vicoden in the 12 years since the surgery, and I’ve taken maybe 6 total. I’m with Jar- it just feels WAY too fucking good, and given the choice between living in chronic pain and living doped up on Vic, I’d probably choose the Vic if I got used to taking it.
Jeanie: While it does indeed sound like this is a psychosomatic problem your friend’s got, as others have pointed out, there’s a chance that it’s some real, undiagnosed disorder.
Has your friend (or her doctor) heard of RSD? Reflex Sympathetic Dystrophy is a chronic neurological pain disorder, the physical signs of which can often go unnoticed, or misdiagnosed. The pain from an advanced case can indeed get you hooked on painkillers in a big way.
Might be worth looking into. YMMV.
[sub]I’m with Hello Again on Vicodin. Stuff frequently makes me wanna puke about 10 minutes after I take it.[/sub]
Qadgop, although you are the doc and I am not, I will say that quitting opiates cold-turkey can kill you if you don’t watch it. The vomiting and diahhrea can dehydrate a person very quickly and other symptoms can be lethal in some cases to a person in an already weakened state.
I grew up with a pill popper and so I try not to take anything unless I really, really have to.
Down side is I’m a migraine sufferer and with the frequency they have me on a nightly med. Needless to say on a year script I maybe get them filled three times in the year and I’m in the ER once or twice a year when the pain gets away from me.
Vicaprophen and such make me ill and when I have had to take them after surgeries I have had to cut them in half. After my gallbladder the nurse gave me two pills before I was discharged for the “bumpy ride home”. I made it a block or two away before I was laying on the floor of our van praying to pass out.
My moms answer to everything is take a pill. And yes, she has a lovely doctor who hands them out like candy.
About a month ago hubby and I got in an argument and the heathens and I went to stay with her for a few days until the air cleared, and that was the first thing she did was offer me something to “help”.
Later in my script bottle for my migraines I found some xanax she had slipped in there, but also realised she helped her self to my Amytriptiline.
Because of my mother I also had a hard time medicating my son for ADHD. That is a whole nother story and debate, but I didn’t want for my son to have to live his life dependent on little pills. He is on a the lowest dose and it looks like soon we will be able to back him down even lower. Yay!
Jeanie, good luck with your friend. Here’s hoping she isn’t putting children through a nightmare.
Is there a group for people like me? Like they have adult children of alcoholics?
Kricket is the Amytriptiline working for your migraines? I’ve been on zoloft, trazadone and depakote before and the amitriptiline seems to work best for me.
I’ll have to ask for a cite for that one, red. Addictionists and other detox specialists agree that opiate withdrawal does not pose a threat to otherwise healthy individuals.
QtM
I’m no expert like the good doc Qadgop, but if that if I am recalling my “drug chemistry” class correctly ( with good 'ole Sasha Shulgin - now there was an eccentric gent ), I’d have to agree with him on the opiate withdrawal. Supposedly if you knocked someone unconscious for the entire period of withdrawal, the physical symptoms would at worst resemble that of a nasty cold. It’s the psychological addiction on top of that, that makes you want to die,
By contrast, my understanding is that stopping a barbituate addiction cold turkey, will kill you dead. In fact an old med school demonstration to that effect using a cat was rather vividly described to me.
Personally, I seem weirdly resistant to opiates. I shocked my doctor after an endoscopy, by being completely clear-headed seconds after the procedure was complete and vicodin ( I have a few now after an agonizing episode a week or two ago with a kidney stone ) gives me not even a trace of euphoria. It does however make me feel like shit for several hours ( lethargic and heavy-limbed ). Even when I was hospitalized, I couldn’t even feel the lowest dosages of morphine they gave me for pain relief, I had to have it upped ( that gave me a brief surge of pleasant euphoria ).
As a recovering addict, I’ve met literally thousands of heroin addicts. Most kicked without a detox center or medical supervision. I have never heard of anyone who died while kicking.
I’m not saying it isn’t possible. I’m saying I’ve never heard even a story of it.
As a recovering addict, I’ve met literally thousands of heroin addicts. Most kicked without a detox center or medical supervision. I have never heard of anyone who died while kicking.
I’m not saying it isn’t possible. I’m saying I’ve never heard even a story of it.
Is there a danger of suicide if you are going through withdrawal?
My psychiatrist is very well known in his field. For many years I have been taking three xanax at bedtime along with dalmane and two anti-depressants. A fourth xanax is available if I need it during the day. I’ve never considered increasing the amount on my own. People can take these medications without ruining their lives and it is what it takes to keep me from endangering my own life. I don’t think that is true of your friend.
My doctor has said many times that I am not to cut back cold turkey. When I did try to cut back with his supervision, I tried doing it half a xanax at a time. Even that was nerve-wracking for two or three days. Eventually, I would return to the same dosage anyway.
Sorry if this is a hijack to this point.
I would want a friend like you, OP, if I were taking more medications than I am supposed to. But there may come a point where you have to protect your own self emotionally by disengaging. If that time comes, please, please don’t feel guilty.
Meanwhile, even though a doctor can’t discuss another patient with you, I don’t think there is anything to keep you from notifying her physicians and pharmacies of what she is doing. Put it in writing! Only you can decide if you want to take that step. It may result in her going nto the street to get drugs.
I have been told that vallium (as well as alcohol and pot) are depressants and that may work against her anti-depressant.
However, I am not a doctor and don’t even want to play one on SD.
Thanks for the heads-up on the dangers of Vicodin. I take maybe thirty in a years time but I do want to continue to act responsibly.
I wouldn’t be surprised if there is an increased suicide risk during opiate withdrawal, but I doubt it’s all that significant.
Xanax and Valium are benzodiazepines, and as QtheM pointed out, they’re a different story. Withdrawal from those puppies can kill you. Opiate withdrawal just makes you wish you were dead.
I have had friends and family members of patients write me letters telling me about my patient’s drug seeking or addictive habits. Most of the time, it doesn’t come as much of a surprise. I’m not sure how much it would help in this situation, especially if the doctor is enabling her as much as it seems.
Oh, and regarding Vicodin: if someone were taking large amounts of Vicodin, I would worry less about the opiate and more about that much Tylenol.
Something you have to remember is that opiate addicts aren’t always the healthiest of individuals. I have written a paper on opiate addiction and withdrawl; however, the bibliography and paper are on another computer. I do remember reading that there are some cases of death due to withdrawl of heroin.
Ah, the “Waismann” method! That’s fallen a bit out of favor. Going under general anesthesia and then getting flooded with opiate antagonists to force an acute withdrawal is certainly an extreme measure.
And keep in mind, their site is primarily commercial, to attract business for their brand of detox. I’m sorry, but I cannot consider them a reputable source of data for detox morbidity and mortality.
So I stand by my original assertion: For an otherwise healthy individual who is addicted to opiates, the opiate withdrawal process is neither life or health-threatening. I have overseen the detox of at least 40 different individuals in my career, with 4 of them being in the last 3 months. And I’ve managed thousands of people with cardiac, pulmonary, renal, and circulatory dysfunction, so I am well aware that opiate addicts aren’t always healthy.
BBJ - You might try suggesting that she talk with someone in the pain management dept. from one of the larger hospitals in her area. I would imagine at least one of them would have a chronic pain rehabilitation program. These programs work specifically with individuals who are experiencing chronic pain. They look at all aspects of the person’s life and use many different pain reducing strategies not just drugs.
I will concede the debate to you Qadgop, as I too recognized that site as commercial and I haven’t seen detoxes like you have. I agree that it is safe for healthy opiate addicts; my only question would be about heroin addicts who may have been infected with dirty needles or other biohazards and may have diseases that make it particularly dangerous to go through withdrawl symptoms.
Frankly, GKW, going by the OP’s description, it sounds like this patient is the kind that drives chronic pain professionals mad. I do not deprecate their efforts at all, and they have excellent strategies to deal with true chronic pain. But so many people take their emotional pain and somatize it (convert it into physical symptoms) severely. Many cannot distinguish between emotional and physical pain.
I know at least a dozen former patients of mine who spoke of their severe, incapacitating back pain, requiring high doses of narcotics daily to even get out of bed. After appropriate detox and pain management became essentially fully functional with minimal pain. But detox generally must come first in these types of individuals.