Wowâ?¦the (mis)information posted here has angered me enough to register to try to correct some of this before someone winds up dead.
First of all, combining opiates with other opiates or certain medications can kill you. Oxycodone and Xanax both cause respiratory distress and is a great way to kill even a young and healthy person. Anytime you use any sort of opiate you need to be aware of the other medication (AND supplements) you are using and disclose this to your pharmacist (doctorâ??s know less about drug interactions). Alcohol and opiate use is also particularly dangerous.
Doctors suck managing chronic pain, especially with younger persons. Like most people, doctors are biased and discriminate who they give drugs to and who they donâ??t. While they hand drugs out like M&Ms to cancer patients, younger chronic pain patients are not as (un)fortunate. Younger persons are stereotyped to be the ones who use drugs the most, but recent empirical evidence shows addiction is evenly spread.
Empirical evidence also shows that strong opiates are relatively poor choices for managing chronic pain and should be used as a last resort. This is amplified when the pain patient is a younger person. Despite what people say, opiates almost always cause the user some level of impairment and often, the user does not believe they are impaired which is particularly dangerous; I am talking about legal therapeutic doses. Obviously, illegal doses will cause even more impairment. As others have said, it causes brain changes, which are, at best, poorly understood. Opiates have absolutely no relation with the pain condition as they change the brainâ??s chemistry to not register pain and this all occurs inside of your brain. This can mask the underlying cause. All of the effects of opiate based drugs are not well understood, especially long-term use as until about 50 years ago, most people died early and opiates were not well studied. It is known that long-term opiate use requires a progressive increase in the amount of the medication due to opiate-tolerance, it DECREASES the pain threshold of the user considerably, often masks other problems and underlying causes, and that the brain can actually stimulate pain to convince the user to take more of a certain drug. Young people needing long-term pain control should avoid opiates simply based on the fact that if you continue to increase the dose as needed, you are eventually going to be taking so much that you are virtually incapable of even basic tasks. A person who is 80 years old does not have this issue as they are statistically going to die in the near future and that functionality may be less of a concern due to retirement and lesser social interaction standard of aging.
A lot about opiate addiction is not well understood. When opiates are used for longer periods of time, physical dependence occurs, which, like addition, abrupt discontinuation will result in withdrawal. Donâ??t panic, dependence is different from addicted and you are not going to wind up â??sucking dick for drug moneyâ?? after taking 30 Percocet or Vicodin pills you got when you injured yourself as both dependence and (physical) addiction take time to occur. With that said, psychological addiction can occur quicker but when used for real pain, this is not usually the case. Opiates are both safe and effective medications for controlling acute (short-term) pain. If strong opiates are used to manage chronic pain, recent evidence has shown that hydromorphone (Dilaudid) is the best choice due to a variety of reasons, one being lower observed rates of misuse. The use of an infusion pump (which does not let the patient take more than programmed) can be useful to patients with prior opiate addiction issues.
Now as far as the OP, he has shown almost all of the characteristics of drug seeking behavior. This can occur in chronic pain patients so it is a gray area. The information the OP has provided concerns me that this patient may go home and take the entire bottle of narcotics and OD, and so he would be ideal for an infusion pump and frequent drug testing to ensure he is not using other medications. With that said, many chronic pain patients research online how to best approach doctors because doctors are often overly cautious of prescribing and many people in serious need for opiates are denied (and stereotyped by most of society). This however is an institutional problem as one wrong move and a doctor could legally lose everything they have ever known. Consequently, this is tough, as our society has not adapted to suit the need of chronic disease patients and most especially, younger males in chronic pain. Obviously, any chronic pain patient needs a holistic treatment and management plan to try to decrease the pain long term, as stronger opiates are not usually sustainable. The basis of this holistic plan is eating well, exercising, and keeping a healthy BMI; this in most chronic pain patients reduces the pain substantially. Western ideals tell us to take a pill and we are ok, which is not the case at all for chronic pain conditions as they take a tremendous level of long-term effort on behalf of the patient himself.
I am so pissed from reading this because I am a chronic pain patient myself. I had severe pain that shot down my leg, was in my right testicle, near the got, and up my spine. It was so bad I went to the ER about ten times in 3 years. I saw numerous doctors, some who even directly told me I was just trying to get â??highâ?? and that the pain was: â??in my headâ?? and â??not as bad as you are making itâ??. One even said verbatim: â??go back to the street you fucking junkieâ??. After about 20 different doctors, a neurologist made a diagnosis of multiple sclerosis. With my GI problems I was also diagnosed with Crohnâ??s disease, which often accompanies autoimmune disorders like MS. I am 25 years old and male (a walking liability for doctors). Words cannot express the amount I have suffered. There have been many, many days where I have come very close to killing myself and only did not because I was in too much pain to get up and end it. To the person which suggested suicide, you are either very ignorant or just an outright asshole. Chronic pain patients have very high depression and suicide rates. I was in a MS support group and one of the people their who I made friends with blew the entire back of her skull open with a .357 Magnum.
As far as pain management medication, the primary strong narcotics I used were Percocet and Oxy Contin, both oxycodone drugs. Chemically speaking, these drugs are very close (composition wise) to heroin and when heroin is not available, heroin users prefer oxycodone to most other strong opioids. Even at the prescribed dose, my personality changed. I lost much short-term memory and had to resign my position within the government and withdraw from school. I became lazy, fat, stupid, and started to grow tits due to decreased testosterone (normal for use of narcotics long term). I was mentally impaired and I lost all ability to have emotion. I never had the â??rob for drug moneyâ?? but I still hurt a lot of people through forgetfulness and insensitivity. The dose went up with time and after about two years, I was taking a more than prescribed as the medication was no longer effective. Before I knew it, I had to take it just to feel normal and I realized that the dependence I had for some time was crossing over to a hard drug addiction. All opiates need to be increased for the same level of pain relief with time as the body builds an opiate tolerance. I hated myself so much and I could not live that way any more and so I changed my treatment plan. I did the opiate withdrawal cold-turkey and it is very intense but oxycodone withdrawal is about 4-7 days so it is not exceptionally long. Specialized PT and avoiding inflammatory foods helps, but I am still in a lot of daily pain and so I battle the psychological ramifications of addiction daily as my mind pushes me to take more medication for relief. I changed from Oxy Contin to a combination of tramadol (Ultram) and ketorolac (Toradol), which are actually less safe than most opiates but they do not have the mind altering affects of strong narcotics (tramadol is an opiate but not a narcotic and its addiction potential is small; ketorolac is a cox 1 NSAID and has many risks; anyone who might use it needs to consider the risk vs. benefit). I have spent the last year and a half picking up all of the pieces from the time I was on strong opiates and it has been hard, but I am mentally able to do it, which is more than I can say when I was on oxycodone.
Overall, the choice to use narcotics for acute pain is usually a good idea as they are safer than most NSAIDs when used as prescribed. Using them for long term control of chronic pain requires careful consideration of the risk versus benefit. Personally, I wish I never used any oxycodone for the purpose of long-term pain control but someone else may say the opposite thing. I had legitimate pain from two rather severe conditions and over time I became addicted to narcotics; this happens to the best of us. Even though the OP shows virtually every drug-seeking sign and shows the desire for impairment, you cannot initially discredit his level of pain without detailed analysis. If the OP is in legitimate pain and wants to decrease his level of pain, he needs a wider spectrum treatment and needs to be open to trying drugs other than strong narcotics, as other options exist, including antidepressants, pain-shifters, cox 1 NSAIDs, cox 2 NSAIDs, Tramadol, anticoagulants, and certain anxiety medications. He also needs to realize that without a solid plan of life changes, there is no medication that will make pain disappear completely. Beyond all, the OP needs to consider a LONG-TERM and SUSTAINABLE management plan that maximizes the quality of life, and that strong opiates, when used on a long-term basis, are a double-edged sword, as with the benefit of pain relief comes a variety of risks. The rest of us need to consider that the OP is in legitimate pain even though he shows a history of addiction issues and that denying him the medication necessary to decrease his pain to a manageable level is just as wrong as writing him any and every prescription he requests.
With his current attitude however, I do not feel positive about the OP’s ultimate health outcome.