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Suboxone For Chronic Pain? Reasons My Dr’s Have Given Me Against Suboxone.

So, if you have read my previous posts, you know that I was on Suboxone for chronic intractable back pain caused by herniated discs from L3 to S2, along with retrolisthesis at L5/S1, S1/S2. I was discharged from my pain management group because I continued to take my Klonopin, which was prescribed by my psychiatrist here in town for panic disorder. In short, I do not respond to Zoloft, or Paxil when it comes to anxiety. I have been on as much as 200mg of Zoloft, daily, with no real progress. My klonopin is something I was told I would have to stay on because I’m prehypertensive, and can’t afford to worry incessantly. When I do worry, it’s bad. Really bad. I’ve punched holes in my wall, kicked a brick, barefooted, into another wall. So, I had no intention of getting off of my klonopin. Had I known then that the next 2 and a half years would be this bad in regards to my pain treatment, maybe I would have discontinued the drug. However, that was then, this is now. And now, I am getting the most asinine excuses from my Drs as to why they do not prescribe Suboxone for pain.

My latest clusterfuck of a problem happened about 3 months ago. My pain Dr, who has me on Norco 7.5/325 TID told me point blank, “we do not prescribe Suboxone for pain because the street value of the drug is too high.” Really? So, because a bunch of heroin addicts want to keep Suboxone close to them in case they can’t score, I have to suffer? There are so many easy ways to make sure I, as a patient, am not diverting my meds. Namely, have me retain all of the film wrappers, and present them to you at my next appointment. Hell, have me come to the office to get my 3 strips per day.  In the past few years, I have tried not to be judgmental about others situations, but when someone makes the conscious decision to begin heroin, and essentially, give themselves the disease of addiction, those of us who can benefit from a certain drug that just happens to be your pharmaceutical of choice solely due to it’s ability to halt a person’s withdraw, we have to suffer? Bullshit.

I want to admit something here, right now, to help people understand why I liked being on Suboxone so much for my pain. There was no high with it. There was no side effects from it. It killed the pain, and not one damn time did I start having withdrawal symptoms between doses. I am on Norco now, and have been for the past 2 and a half years, and I hate it. I hate it with a passion. If any chronic pain sufferer, whose treatment consists of immediate release medications only to treat their pain, will tell you the truth, they will admit that in between doses, we experience mini-withdrawal symptoms. Are we addicts? No.We are simply not receiving the proper treatment. I am not saying that Suboxone, or any buprenorphine products for that matter, will work for anyone else. I only know what I experienced. For almost 4 and a half years, I experienced no mini-withdrawals while on Suboxone. I felt normal. My pain was the lowest it ever was, for the entire time I was on Suboxone. Yet, I can not get it prescribed because of the street value? Honestly, had a doctor not told me that the street value is so high, I probably never would have even thought about it’s street value. I do not care about it’s street value. I only know what worked for me, and that was Suboxone.

Another reason I was given, from a different doctor, to not prescribe Suboxone for pain was “because of the naloxone in it, I would not receive adequate pain relief.” That statement was one of the dumbest things I had ever heard in regards to Suboxone, and as a result, I left that practice to be taken care of somewhere else. Yes, it is true, Suboxone does indeed contain naloxone. What the doctor failed to realize was that even though Suboxone contains naloxone, the naloxone remains inert (inactive) so long as the medication is taken the appropriate way. I understand that since the films were released, junkies have found a way to shoot up the strips. However, that should be expected. Junkies will fine a way to abuse anything. It’s the nature of their disease. When a doctor fails to take that into consideration, I can’t help but question the doctors ability and knowledge of pain medications, and specifically, Suboxone.

I am not going to deny that there is an opioid problem. However, doctors need to realize that some of us actually do take a vested interest in our treatment, and be honest with us.  If you do not fully understand Suboxone, that’s fine. Admit it. Do not give me a cookie cutter response as to why Suboxone will not work. The opioid problem is not being driven by pharmaceuticals, or pain patients. The FDA, DEA, and CDC seem to make sweeping generalizations about persons on opioids for pain based on the heroin addicts and drug abusers. They (the government agencies listed two rows above this) need to realize that we simply want pain relief, and to not be treated as though we are drug abusers. Yes, we are dependant on narcotics in order to live a somewhat normal life. However, the only drugs you have OK’d to treat pain are full opioid agonists. You took what Reckett-Benckiser told you about the drug as truth, and limited it’s availability. In a way, you are sort of fueling the epidemic. By limiting Suboxone, which by itself, is not as much of an overdose risk as every other opioid on the market, you are forcing us to become slaves to our medicine, which you know we will become tolerant to, requiring an increase in dosage, or frequency, and continuing this ridiculous cycle.

If, by chance, any doctor happens to stumble upon this, please post a response to this question: wouldn’t you rather your patient be dependent on a drug that really can’t be abused by opiate tolerant patients versus having them go through withdrawals all damn day?

Of course, I am extremely biased. I have had adequate pain relief, and want it back. However, thanks to the CDC, FDA, and DEA, I can not get relief anymore. I am being forced to choose between “some” pain relief in exchange for full-fledged panic disorder not being treated, or I can have my panic disorder treated, but not my pain. Why do we have to choose? Especially those of us who are both opiate and benzodiazepine tolerant. I feel like has gotten so much worse since doctors became so worried about prescribing anything.

ADD, Panic Disorder, and a Diabetic Sister.

Well, like most things in life, you start with a good intention, and end up falling short. What I said in my earliest posts about having an update every day ended up being more of a wish than a reality, and I’m okay with that. I haven’t purposely not posted here. Life happened.

In order to possibly regain the trust from the few of you who read this page, I will offer an explanation as to where I’ve been, and why no posts have been made. To start with, my sister is a diabetic who can’t seem to get her sugar under control. She lives with her boyfriend, and my nephew, but I found out my nephew has had to take care of her. He is 12, and that just isn’t right. Anyway, my nephew called me at 9:45pm on a school night, and told me he couldn’t wake his mom up after he went in to check on her. I was across town by 9:55pm, and met the firetruck (our mayor, being the complete moron he is, closed one of the fire/rescue stations that was equipped with ambulances, as well as firetrucks) in the apartment complex. I walked with the paramedics, and when we knocked on the door, my sister answered. The first thing out of the paramedics mouth was, “she must be doing better then”, but I knew better. Her mouth, when she talked, resembled that of a stroke victim.  The paramedics checked her blood sugar, and it was 41. 41, after two big spoons of peanut butter and a glass of OJ. I looked through their medicine cabinet, hoping to find a glucagon shot. Well, I sure as hell did find them… 3 of them. The date they were filled was 2-8-17. This happened on 2-15-17. All 3 of the glucagon shots were gone. Those glucagon shots, for a diabetic, is basically the last defense against low blood sugar. If you want to, think of glucagon for diabetics in the same vein as naloxone shots for heroin addicts. They are both last resorts, and meant to be given to save a persons life. After this last episode, and upon finding out they had gone through 3 glucagon shots in under a week, I began helping to watch after her.

To make matters worse, I was sent to a new psychiatrist, who reviewed my medical records, and restarted my Vyvanse for ADD, after 3 years of being off of it. I don’t know if it’s me, or the medicine, but I don’t remember having side effects to Vyvanse when I was on it from 2011 to 2015, but I am having side effects now. Usually, the main side effect with Vyvanse, or any amphetamine, is jitteriness and insomnia. However, I get tired as hell about an hour and a half after taking it. It does help, drastically, with my ADD, but if I am not actively doing something, this med will put me to sleep. I asked my pharmacist if this is a common side effect, and he told me that I was experiencing a paradoxical, diagnostic confirmation side effect in that it slows everything down. Well, it does slow everything down. I have to put forth a lot of effort to fight through that 3rd and 4th hour, and then I’m fine. Furthermore, I was put back on Vyvanse, and taken off of Klonopin. Anybody who knows me, knows this isn’t an optimal trade off. The reason my psychiatrist told me she could not prescribe my klonopin is because of “the new FDA and CDC warnings against the use of benzodiazepines in patients who are taking narcotics.” Again, I am dealing with half-truths. Yes, there was an order given by the CDC and FDA in regards to patients requiring opioid therapy who are also on benzodiazepines. However, that order did not state that it was forbidden to prescribe benzodiazepines to persons on narcotics. What it did say, was “each patient who requires opioid therapy, who are also on benzodiazepine medications, should be re-evaluated on a patient by patient basis, and continue both treatments only when the risks have been evaluated and the doctor determines that the risk is sufficiently mitigated by the reward.”

What do you do when you know you are being fed half-truths? Before anyone says, “call them out on their BS”, you have to remember that, while doctors appreciate those who take the time to read up on their medications, they sure as hell do not like being second guessed by their patient. I learned that the hard way when I called out my previous pain doctor, who was circulating an inconclusive report regarding dementia, and benzodiazepine use. In short, the papers’ authors conducted research on patients who were in a hospital setting who have been diagnosed with dementia, and are receiving benzodiazepines. However, my Dr. was handing out one page of the paper that contained nothing more than a theory, yet he was giving it to all of us (his patients) while simultaneously telling us we had to quit taking our klonopin, or whatever benzodiazepine you may be on, because if we didn’t, we risked dementia. Well, the paper he gave us was printed from a computer on the business’s network. This doesn’t sound like much, but when you print from a network, especially one that contains the prescription paper that prescriptions are printed on, you leave a pretty significant footprint. One of these pieces of the footprint is the Dr’s name in the lower left hand corner (or whoever printed the page), as well as the URL that you are printing off. My Dr. either thought all of us were idiots, or maybe he just had the “God complex” that so many pain Dr’s see to get, and he got sloppy. Due to his sloppiness, I was able to go to the URL (website) that this report was on. Once I accessed the entire report, I knew that something was not right. In the very first page of the report, the authors acknowledged that this report would  be inconclusive at best. The official conclusion of this study was that more research is needed. They acknowledged that they do not know if the benzodiazepine was to treat a symptom of dementia, or a cause of dementia. Furthermore, the scope of the study was horrible. The “in-patient” treatment center that this study was being conducted in was a transition house where patients would begin trying to learn enough to be home bound. So, again, I was dealing with half truths.

I’m going to wrap this stinker of an article up with a sum of what my problem is now. In short, when I start researching something, I tend to over-research it. I attribute this to my Vyanse. Also, I have a sister that is unstable at best with her diabetes. I worry non-stop now that I am without my klonopin. In my worry state, nothing else matters except what the current perceived crisis is, and I begin overthinking things that are really quite cut and dry. Yet, after 12 years being on Klonopin, suddenly coming off of it has been a real bitch. Some nights, I am up all night only to sleep the day away. I wasn’t tapered, I was discontinued because of the fact I am on a narcotic for pain. Being pulled off of klonopin abruptly has made me kind of not really give a damn about anything. I get upset, and I stay upset, over the dumbest shit, and begin cyclical thinking that revolves around whatever is going on at the time. I am trying, very hard, to resist my old ways, where I would punch the wall, or some other stupid shit, just because I couldn’t cope with whatever my current anxiety attack was over. If I revert to my old ways, this damn house might fall down.

So, I apologize for being gone, but it was for a good reason. Yes, from here on out, I will simply post about the good that comes from buprenorphine, and the hurdles we face getting on buprenorphine+naloxone for our pain. Matter of fact, this post will probably go up at the same time another post is uploaded regarding Suboxone, and pain.

Thank you for understanding, and lets get back on track:)

 

Been Researching- plenty to come starting Monday.

Since I plan on uploading a full blog post tomorrow, I will just explain briefly what I have been doing, and why I haven’t posted in a couple of days.

To start with, I was sent by my family doctor to a psychiatrist for “medication management”, which is just another way of my primary physician saying, “you need to be on this medicine, but I want someone else to prescribe it.” The medicine in question, is my Klonopin. Without Klonopin, I can be a real dickhead to people if I feel I am being cornered, or the center of attention. For that reason, I have been on the medicine for over 12 years. I know, SSRI’s and SNRI’s are what many will say treats panic disorder better than a benzodiazepine. Well, to them I say, “You are correct, it does work better, for some people.” At my psychiatrist appointment, the psychiatrist was nothing but extremely generous, and thoughtful, and compassionate. She actually did 2 years of training under my former psychiatrist, who I absolutely adored, until she moved away to California to take care of her mother. The new psychiatrist saw that, in my new patient forms (forms that had to be filled out online, and had some of the most ridiculous and repetitious questions I have ever answered) I had checked ADD/ADHD as a condition that I had been diagnosed with, treated for, and then abruptly had to discontinue therapy when my doc left town. This new psychiatrist asked me how I functioned prior to being diagnosed, as well as while being treated for ADD, and what changed when I was no longer treated for ADD. To get to the point, I told her my life went from focus driven events day by day, to momentary interests that last a few hours at most, followed up with never finishing projects I start. Also, I explained to her that since being off ADD meds for 4 or 5 years, I have wrecked 3 cars- totalled- and every single accident was my fault due to either flat out not paying attention (thinking about things other than driving, NOT texting and driving), or I was traveling way too fast for the weather conditions. The first two wrecks, even though I caused them, were not really something I dwelled on or thought about much. I didn’t even link ADD to a possible cause. However; the third wreck was a complete and total disaster that I still haven’t lived down to this very day. I know many of you may have done some dumb shit in a car. Maybe you’ve backed into a street light. Maybe you hit a car pulling into a parking spot. Well, my friends, I wish that is what my third wreck involved. What I managed to do was actually hit a parked damn boat at the end of our court, in the middle of the summer. Let me make this clear: we do not live near a lake, or any body of water for that matter. So seeing a boat is something that really should stand out. However, I went to take my diet coke out of the coke holder, and the whole damn holder came up, and I ended up hitting the parked boat (it was on it’s little stand they pull boats with to and from the lake). This was the wreck that made me question if I maybe, perhaps, I really did have ADD. I know that I was diagnosed as a young adult, and it was one of the rare cases that genetics did not play a role with my development of the disease. My ADD was brought on by a traumatic brain injury from the wreck that I did not cause, and have mentioned on this blog before. Most things I can look back on and laugh. However, this is not one of them. I feel horrible for wrecking my dad’s Stealth, and they can not find parts to repair it.

So, while I did get my ADD treated again, I ended up without my Klonopin, again. The problem I have with her reasoning for not prescribing klonopin  is that she was not honest with me. She gave me a partial truth, explaining the black label warnings for patients on benzodiazepines and opioids. What she told me was “there’s a black label warning against prescribing klonopin for you since I see you are also on Norco. The government won’t let us prescribe a CNS depressant to patients who are on narcotics.” What the black label warning actually states is that there has been a trend of narcotic overdoses that included benzodiazepines, and that “each doctor should consider whether keeping a patient on opioids while on benzodiazepines on a case-by-case basis.” Once again, I am getting half truths about medication, and medication policies. Unfortunately, I had not done thorough research on the black label warnings regarding opioids and benzodiazepines prior to that appointment, so I could not call her out for her bullshit. Now, however, I do know the facts after reading a mind-numbing full version of the FDA and CDC’s joint letter to physicians and pharmacists regarding opioids and benzodiazepine coadministration. I plan on finishing the article regarding this letter by tomorrow morning, and should have the blog post up no later than 9pm.

I am also reading a study out of the University of New England Medical and Pharmacology school regarding Suboxone and it’s role it has in anesthesia (pain management). I will say that the New England paper has been a lot more interesting than these stupid regulations, and guidelines that I keep reading about.

So, I will end this blog post now, since I really don’t have a topic formulated, as is probably apparent by this somewhat rambling post. I thank those of you who took the time to read this in it’s entirety, and promise a better blog tomorrow. I also want to thank those of you who have been visiting my page everyday. I do not know who you are, but my statistics page shows that I have had close to 2K views over the past week, which is roughly as long as this page has been active. While I hate to ask for others to help spread the word about my page, this is one rare time where I feel I truly need to ask for those of you who read my blog (thank you, again) to share the link with any forums or online friends you have, even real life friends. My intent is not to garner attention for myself, which is why I choose to keep my ID a secret to everyone, except for one visitor who I have known over a decade from a medically based medication identification site that he and I both moderate on. He does far more moderating on that board than I do, and he does a hell of a job at it as well. To that friend, I say “thank you”, again, and please feel free to share this with any of your forums that you are also active on that I am not a part of. My goal of this site IS to create a lot of traffic, for informational purposes only. I make nothing from this site. Hell, it costs me $2.49 per month to run this site. I will continue to pay for this blog until more people are aware of Suboxone’s potential for being a life-saver to those who need pain management, but have an aversion to taking regular pain pills.

Please, help me get the word out about this site, even if you hate it, or hate how I write. I sincerely appreciate absolutely every single one of you who visit my site, and it keeps me motivated to bringing you the best news (fact based news) that I can find.

Common Sense With Benzodiazepines and Opioids

Before I even begin, I want to link any of you who may be reading this to an article I found on the FDA’s website concerning widespread change as to how opioids and benzodiazepines are to be prescribed. The Official FDA Link Can Be Found Here. To be fair, I am all for, even encourage, the responsible use of medications. That being said, perhaps I suffer from a case of naivete when I assume that most people are like myself, and actually take the time to read about the drug they have been prescribed. Either way, I am apparently wrong, as the FDA states:

” the FDA is requiring boxed warnings and patient-focused Medication Guides for prescription opioid analgesics, opioid-containing cough products, and benzodiazepines – nearly 400 products in total – with information about the serious risks associated with using these medications at the same time.”

  Maybe I am wrong, but I am pretty sure that doctors have known, long before the FDA took it upon themselves to issue this warning, that certain medications, when combined with other medications, can potentially cause death. From my vantage point as a health blogger, and as one who has never worked a day in the medical field, this appears to be damage control on behalf of the FDA. What this article fails to mention, or differentiate between, are opioid-tolerant vs. opiate naive individuals who are also either benzodiazepine tolerant or naive. For me, personally, I have been on Klonopin for panic disorder for over 12 years. I have been on pain medicine for almost as long. At no time have I ever suffered any type of adverse effect from taking the two drugs, though I never take them at the same time.

  I can not help but think back to a time not too long ago when the gold standard for muscle pain, and muscle relaxant medication was Valium. This drug was frequently given to chronic-pain patients who are also opioid tolerant patients, and there was never the fanfare like there is today. The main reason is simple: the opiate that people are overdosing on, in combination with benzodiazepines, are illegal drugs like heroin. I will contend, until the day I die, that a doctor who treats a patient will always know the best way to treat that patient, as opposed to an organization like the FDA. Don’t get me wrong, I do believe that the FDA does do some good, but this opioid epidemic that we are in now is in direct correlation with the crackdown on doctors who have become afraid to prescribe opioids to patients who genuinely need them, forcing these patients to take to the streets and hope that the heroin they receive is not going to kill them.

  In short, I can sum up this entire short blog post with just a few statements. There will always be drug-drug deaths, regardless of the type of drug or the individual using or abusing it. Instead of taking an entire group of patients who are on benzodiazepines, and opioids, and telling them “either one or the other”, is simply irresponsible.

Less Buprenorphine for Pain? Bullshit.

I do quite an extensive amount of research, and advocacy, for pain patients who wish to transition onto Suboxone. I also advocate for those who are in pain, and tolerate their medications very well. I try not to push my views onto others. However; sometimes you run across something while researching that just makes you say, “That has to be bullshit.”

I had that “bullshit” moment quite a few times recently when reading about Suboxone dosages of buprenorphine being too high for chronic pain patients. For those who are unaware, Suboxone is sold in milligram strengths of buprenorphine. However; since Suboxone is not FDA approved for the treatment of pain, and must be used “off-label” to treat pain, we chronic pain patients frequently receive the ugly step-child of buprenorphine products.

Ugly step-child number 1? Butrans. Butrans is a patch that is sold in microgram form (1/1000th of 1mg), that takes 3 days to reach a steady state in the blood, and releases it’s contents (usually 5, 7.5, 10, or 20mcg) over the course of seven days. 3 days to achieve miniscule amounts of buprenorphine in the bloodstream, I can tell you from experience, is complete, and utter bullshit. Perhaps it performed so poorly for me due to the fact that I was on Suboxone previously. When you expect the gradual onset of relief to occur in 1 to 3 hours- not getting relief for at least 3 days is a real kick in the balls. I normally try to keep my opinion out of these blogs, but Butrans is one medication that I feel so strongly about that I can not silence myself as to it’s ineffectiveness, and downright horseshit delivery.

Let me ask you this: if you were maimed in an accident, and had to be sedated in order to be worked on, would you want the 5mg, or 20mg of morphine? Surely, going by the logic associated with buprenorphine, and it’s “less is more” attitude, the 5mg has to be every bit as strong as the 20mg of morphine, right? No? Well no shit, Einsteins.

I gather that most of the doctors who have taken the time to even consider prescribing Suboxone for pain get their information solely from scholarly articles, and structural molecular patterns, and whatever academic horseshit they spoon feed these poor doctors, but why in the hell has there been so few doctors to ask the question: Why? Or even “How can that be possible?”

From personal experience, anyone who not opiate naive, should never be given Butrans. It is a shitty medication for chronic pain. Everything from it’s delivery system, to it’s onset of action, even it’s absorption rate, is completely shit. Suboxone, on the other hand, provides a very well balanced pain relief profile, without the feelings of euphoria that so many of the other opioids are known for. And yes, nerds, you can get into the who “well, buprenorphine primarily binds to the mu receptor, with affinity to blah, blah, blah”, but you are just regurgitating something you have read.

Please, do yourself a service, as well as your patients a possible service, and try them on Suboxone, as long as their are no contraindications. You will find that, not only are these patients less likely to ever need an early refill, these patients most likely will become your best, most rule-abiding patients in your practice.

 

Open Question for All Doctors Regarding Suboxone, and Pain.

Allow me to post the following link from http://www.naabt.org, and some of the answers it gives regarding usage of Suboxone. Here is the link to the full article. What I want you to pay careful attention to is the second sentence:

“The way the law is written, any doctor can prescribe Suboxone for treating pain, however the FDA has not granted approval for Suboxone to be used for pain, so it would be an off-label prescription.”

  I mention this passage because I truly want to hear from any medical personnel that may access this page. Why, aside from chronic pain patients with past struggles with addiction, is this drug not being used more frequently as a pain medication? Is it because of the fact that using this drug to treat pain would constitute an “off-label” usage? For Heaven’s sake, if that’s the case, think how very little progress would have ever been made in numerous other medical fields. One of the first drugs that comes to mind is Viagra. Viagra was not intended as an erectile dysfunction pill, it was developed as a pulmonary hypertension medication. I know this from first hand information because my Grandmother was lucky enough to have a cardiologist who was willing to think outside of the box, and remembered Viagra’s initial purpose. The funny thing with Viagra, and the treatment of pulmonary hypertension, is that Pfizer double dipped into the same product: sildenafil citrate. One was labeled as Viagra, the other labeled as Revatio. I mention this to simply prove that there are many medications that have been used off-label, often to great success, but far too many doctors seem willing to use “off-label” prescribing habits. To you, the medical professional, I ask: “Why?” Is it the possibility of a lawsuit due to the off-label nature of the drug? Do you, yourself, not fully understand the way Suboxone works? Help me understand what it is that you, the medical professionals, do not comprehend.

  Up until now, I have kept my personal life off of this blog solely because I thought simple anecdotal tales that can be found on the web about patients being treated with Suboxone for pain would suffice. However, I will share my story of how Suboxone changed absolutely everything about my pain situation, for the better.

  To start with, I began seeing a pain management group in Indiana. Central Indiana to be more precise, and I absolutely adored that place. My first year with them, 2006, I was allowed to get by using only Norco 10/325 tablets 3 times per day. I remember actually telling the doctor, “I don’t want a long acting pain medicine, I want to control the pain.” Looking back, that is one of the stupidest things that could have come out of my mouth. Fast forward to around 2008, and roughly 15-18 steroid epidurals given from L3 all the way to S2. During a follow up visit with my “interventionist” (the guy that does the shots), he recommended starting me on Avinza (one daily morphine ER capsules), along with Norco 10/325 three times per day. I gave the Avinza a chance to work, but I could not stomach the feeling of nausea, compounded with the confusion and lack of ambition. In a word, I felt “sick”, but more precisely, “sick from the drugs”.

  After about a week, I called my nurse practitioner, and explained to her that I was not tolerating the Avinza well at all, and told her that if I absolutely had to be on a long-acting pain medication, could I please try Suboxone? After all, this was still when they were pushing Duragesic, and Methadone for most forms of chronic pain. Needless to say, my P.A. was absolutely ecstatic that I volunteered to try Suboxone because, as she put it, most of the patients fight tooth and nail to keep their old narcotics. The difference with me was that, unlike most of the patients who take narcotics, I disliked mine. I disliked the unnatural feeling of well-being that I knew was being caused by the drug. I disliked feeling the drug enter my system after half an hour, and I especially disliked feeling the drug dissipating roughly 3-4 hours later. In short, I was sick of the roller coaster ride with Norco.

  So, I was given a taper schedule for my Norco, since I had already admitted that I wasn’t taking the Avinza (I actually returned a paper script to their office- something they said had never happened before). In short, I was supposed to be in withdrawal on “induction day” for Suboxone. Fortunately for me, I don’t really have withdrawal symptoms from Norco, so I basically just quit taking the medicine until my induction date. On my induction date, I picked up my prescription from the pharmacy, took them to the doctor’s office for their nurse to dole out the medicine until I reached what felt like a comfortable, pain-free stage. At the time, this was with the 2mg/0.5mg buprenorphine/naloxone tablets.  At 6mg of buprenorphine, I felt much better, but not in an abatement of withdrawal symptoms sense. I felt true, honest, pain relief. I will remember until the day I die, the thought that went through my mind: “I will never, ever take a traditional painkiller again.” Seriously, the pain relief was long lasting, from just 6mg (I was told that 6mg was my initial dose, and could take 2mg twice more during that first night if I needed to). For the first few months, I was able to get by on about 8mg of Suboxone (in 2mg/0.5mg tablets). However; I did indeed need to increase my dose. Substantially.

  Before I was discharged from this pain clinic, for being on the same medication (klonopin) that I had been on for the previous 8 years with them, I had been titrated up to 24mg; 8/2mg strips 3 times per day, for pain. Was the milligram dosage that I ended up on at the higher level? Yes. Did I ever, even once, have the slightest hint of withdrawal from this drug if, say, my prescription came due on a Sunday, and my pharmacy is not open on a Sunday? Absolutely not.

  I am still upset with the way things ended with my pain group, and eventually, will name them when I know that it is safe, legally, to do so. However; to name them now would only ensure me a spot on a blacklist because nobody wants to treat a patient who bitches about the treatment they received. Hell, to be honest, the first 8 years were great. Only the last 4 visits, spanning 4 months, were pure, and total, hell.

First, a look at commonly prescribed opioids for pain treatment.

While I acknowledge that the intent of this site/blog is to inform, educate, and hopefully pursuade others to consider speaking with their doctors regarding switching their pain medication to buprenorphine/naloxone, I would be remiss if I did not at least acknowledge the other pain medications on the market.

While Suboxone is still relatively new, and only used for pain “off-label”, there are many other prescription opioid pain medications available, most of which are control pain extremely well. What follows is a list of commonly prescribed pain medications, the time for their onset of action, their peak level, and their duration. Following the posting of all of this information, I will include the source where all of this information was gathered.

Hydrocodone/APAP immediate release products:
Onset: 10-30 min  Peak: 30-60 min  Duration: 4-6 hours

Hydrocodone Extended Release: Currently, I am finding conflicting information and refuse to post until I can find verifiable information.

 Oxycodone/APAP immediate release products:
Onset: 10-15 min  Peak: 60-90  Duration: 3-6 hours

Oxycodone ER products:
Onset: 10-15 min  Peak: 3 hours  Duration: 8-12 hours

Hydromorphone (Dilaudid):
Onset: 30 min  Peak: 30-90 min  Duration: 4-5 hours

Fentanyl; Duragesic & Actiq
Duragesic Transdermal Patches:
Onset: 6 hours Peak: 72-96 hours Duration: Supposed to be 3 days per patch
Actiq (fentanyl lollipops):
Onset: as little as 3-5 min  Peak: 45 min  Duration: 2-3 hours

Methadone:
Onset (of analgesia): 30-60 min  Peak: Info not immediately verifiable  Duration: 6-8 hours when used for pain.

NOTE: All information was verified through FA Davis Company, online.

Be sure to remember this list of medications, and their onset and duration length. The next blog post I am writing will include all of the same information, but for buprenorphine/naloxone, when it is used as a pain medication.

Until tomorrow, I hope you are all safe, happy, and enjoying life.

Take care, my friends.