I had a response from codeine cough syrup. It felt like a warm hug. But then I realized it and got scared to death I was getting addicted, causing severe panic. I’ve not taken the stuff since.
I’ve since been told it was likely my imagination and/or coincidence, as the dose was too small to cause that effect. But I’ve not taken the chance. Though, granted, I’ve also not had coughing so bad that I needed anything like that, either, nor pain bad enough to need opioids.
I will also say I’ve since had the warm hug feeling without any drugs, too.
Dextromethorphan is an opioid, but one that’s not real good at bonding to the opioid receptors. But in higher doses it has quite a dissociative/hallucinagenic effect, not unlike PCP. It’s become a popular drug of abuse in some circles, so much that most pharmacies in the US now keep it behind the counter. Its isomer, levomethorphan is a schedule II drug, just like morphine. Opioid chemistry is weird.
One strong hypothesis is that people with a strong tendency for opioid addiction are often deficient in an enzyme that converts folic acid to L methyl folate. This metabolite is used to produce dopamine. Without adequate methyl folate, their production of dopamine is reduced, and hence there’s a baseline dysthymia/depressive state that predominates for their entire life. Exogenous opioids (i.e. morphine, oxycodone etc.) are a real powerful and quick fix for this type of dysthymic mood. A single dose can be a “Eureka!” moment.
Opioid addicts who have the genes for impaired production and who take the L methylfolate supplements are less prone to relapse. I’ve had my genes tested and I have the two most common gene types which reduce such production. Though I stayed clean for 25 years without the supplement, I started taking it over 5 years ago now, and I must say my mood is more stable.
Other opioid addicts have been found to have opioid receptors that do NOT respond to their own naturally produced endorphins (the body’s own version of an opioid drug) so they go through life with no natural metabolic relief from injuries, stresses and other states. These people do however respond, and quite powerfully, if/when given a dose of codeine or morphine etc. These folks too tend to proclaim they’ve found the thing they didn’t know was missing all their lives.
Those are just two of the more prominent molecular pharmacology hypotheses being investigated at this time; there are others.
That is fascinating; I’d love to hear more about the other hypotheses.
I’m feeling a little disconcerted at the realization that I’ve taken lots of prescription painkillers over the years and never once felt any kind of high from them, nor any ill effects after stopping. They work spectacularly to alleviate my pain and rarely cause any issues–only Percocet made me puke. Is that weird?
Were you on opioids when you went through medical school and training? Did that help?
Would you happen to know the equivalent information for alcohol abuse, like the defective biochemistry and the alternatives/supplements? My father, grandfather and likely further ancestors were alcoholics and I haven’t fallen into that trap but it might be relevant to me (with the usual you’re-not-my-doctor, this-isn’t-medical-advice caveats).
My sister and my daughter, both of whom suffer from anxiety and depression, had a similar “this is what I’m missing” reaction to a single dose of Valium.
They both take prescription antidepressants, which help them function. But I’m sure there’s some chemical malfunction involved there, too.
@MichaelEmouse During med school it was a little alcohol or pot here and there (like most of the rest of the student/resident/faculty), with infrequent opioids. Once I was an intern and had access to drug samples (yes, drug companies would hand out narcotics to us back then), I was off to the races. Initially it worked well for me, killed the pain of fatigue, anxiety, etc. and I was known as an amazingly effective intern. But it made me sick, I got treatment and completed the rest of my 2 and 1/3 years of training substance free. Further relapses occurred in private practice, but resulted in treatment fairly quickly too.
Opioid dependency is a subcategory of overall chemical dependency, which also includes alcohol, stimulant, other depressant addiction drugs too. Classic alcoholics often started out with opioids after surgery, but when they were cut off from supplies of that drug, turned to alcohol. Or some to benzodiazepines, or cocaine, etc. Whatever can be gotten that relieves the symptoms best in the moment. Other folks seem to only desire to abuse a certain drug, and don’t cross addict. It’s still a complex puzzle. But the picture is less muddy than it used to be.
More addictionists these days are advocating for medication assisted therapy (MAT), using meds that are appropriate for the situation. L Methylfolate for those who can’t produce enough on their own, methadone or buprenorphine for those whose native opioid receptors don’t recognize their native opioids, and even nicotine patches for those whose nicotine receptors are under-responsive to the body’s native version of nicotine (these folks underproduce dopamine too). Many alcoholics seem to benefit from opioid antagonists, as do certain opioid addicts.
Lots of info can be found from genetic analysis as to just what may be deficient. But that complex puzzle is far from completely solved.
Same here: I’ve used opioid painkillers a few times in my life, most notably when I had kidney stones. It reduced the pain, thank goodness, but it didn’t give me any kind of high. The biggest effect I felt is that it made me dizzy and sleepy.
I remember having some dental work in the late 1980s, and the dentist gave me a card with 4 capsules on it. I don’t remember what they were, except that they were C-III (and I did know what that meant). IIRC, I ended up taking one, and didn’t take another because it really didn’t do anything for me.
Later, when I was in pharmacy school and volunteered at a free clinic, a drug rep dropped off some samples of Phenergan with Codeine, and we did not dispense those because we didn’t give out controlled substances from the pharmacy (although the doctors occasionally wrote prescriptions for them; they were part of a $25 voucher that could be used at several local pharmacies) and we certainly didn’t want word getting out on the street that you could get codeine at the free clinic.
I guess I’m on the other side of the bell curve. I’ve been taking opiods for over 15 years now due to Failed Back Surgery Syndrome. I’ve been prescribed everything from Vicodin, Morphine, Oxycodine and Fentynal over the years. Currently I take 30mg morphine xr twice a day with 10mg oxycodone every six hours for breakthrough pain as needed. Down considerably from much much bigger doses years ago.
The only time I ever experienced any type of high was when I was first injured and they gave me demerol in the ER, it sent me to the moon. Other than that, not even once. No peaceful feeling, nothing except pain relief and even that isn’t too good any more because of tolerance.
Anyways, prior to the opioid crisis my primary care doctor handled my pain management (and quite frankly did a better job than any pain management specialist I’ve seen since). When the government changed the rules and he could no longer prescribe to me I had a very difficult time trying to get an appointment with a pain management Doctor. My prescriptions ran out and I had about a week period where I went cold turkey. It was HELL, but not for the reasons you would think. I had almost zero withdrawal, except for a little bit of “weakness” for a few days. What I did have was unbelievable pain. I truly thought that death might be a better option it hurt so bad.
Once I got to pain management I told the doctor that other than pain I had very minimal withdrawls and he looked at me and said “You Sir, don’t know how lucky you are”. And he’s probably right. At that time I was 12 years in, opiods every single day and nothing.
If the doctors could find some way to stop the pain I’d gladly dispose of every Damn one of these pills I have and never swallow another. I feel terrible for those who are grasped by their pull, but I can honestly say I don’t get it.
I get so scared sometimes by the crackdowns on prescription painkillers. I’ve never endured anything like what you describe, yet (fingers crossed). But I have been in pain so intense I would’ve done anything to make it stop, and the thought of not being able to get relief when I need it haunts me. I hope you find some more permanent relief, but if you don’t, I hope they never take away your pills.
I was in the hospital a few years ago and they gave me pain meds (Dilaudid IIRC) I told the nurse I was worried about addiction issues. She told me that since it was only happening over a few days not to worry but she also said that when given to mitigate legit pain (as opposed to taking it recreationally) addiction was much less of an issue.
I have NO idea if she was right or not but being on it for a few days posed zero problems for me later. No problem whatsoever going off of it. That said, I definitely remember looking forward to my next dose while I was on it.
We should all be scared my friend. Pain Management is turning into"We don’t care if you’re in pain, we’ve got to reverse the opiods crisis at all costs" management.
Every single month my pain management Doctor keeps lowering my dosage and every single month they work less effectively and I’m in more and more pain. I’ve tried nerve burns, cortisone shots and even thought of sacrificing a live chicken. Yet none of it worked. The Dr. said to me a few months ago “Nothing we try is working” in a tone suggesting it’s somehow my fault.
Now she’s trying to force me into having a pain pump installed and I’ve said no. It isn’t worth the risk to me. Since I’ve did that she’s been trying to force me out of the practice.
And good fucking luck finding a new pain management Doctor. I’ve tried, I’m told based on my opiods history that they won’t take me. Never mind I’m in agonizing pain. Bunch of assholes.
I think I’m going to try and get an attorney and see if what my current succor is doing is considered malpractice. I can’t believe I just typed that, but I really don’t know what else to do. I’m afraid they’re just going to cut me loose.
And unfortunately medical marijuana isn’t an option for me. My career will not allow it under any circumstance.
They won’t ‘cut you loose’ without another physician in place to treat you. That would be abandoning a patient and that would be malpractice and actionable. She is offering treatment- a pain pump-which you are declining. Sounds like she is taking your pain seriously.
IANAD-am a nurse and have also used pain management physicians myself