Question on Opiate Addiction

[OhCasey]

Difference of opinions? My opinion is based on medical facts yours isnt so ya they differ.

even under pain management addiction is a real problem.

I agree its a problem (for some) but its not inevitable, which is what youve stated above.

[samuraigecko]

Originally Posted by OhCasey

Difference of opinions? My opinion is based on medical facts yours isnt so ya they differ. I agree its a problem (for some) but its not inevitable, which is what youve stated above.

Based on who's medical facts?

Here is the example intended but obviously overlooked.

1] person takes opii's at a fair dosage for a long period for a legitimate reason.
2] medication is abruptly stopped.
3] the result is obvious, ask any doctor.
4] this is why SWIM stated about "good" pain management.

You cannot expect everyone to believe that your OPINION is medical fact, either can I.

Everyone will be told something different by almost every doctor they seek, which is why the "second opinion" is often looked for.

The above example should also be looked at subjectivly with the rest of ones posts. A person whom is weened properly from opii useage for a legitimate reason may not even notice any WD or side effects from coming off the medication, however, if the medication is abruptly stopped during treatment then the person will almost certainly in 99.9% of the cases experience some kind of WD.

SWIM actually just got back from his pain management specialist and was told the exact same thing, this specific clinic is regarded as one of the best in his country, but that is still not to say that the quacks cannot be wrong.

Again I say the same to you as what was said to me by yourself:
Do not sling your opinion as medical fact.

The results of opii use for legitimate reasons are varied and subjective with quite a number of variables.

A person taking opii's for a legitimate reason for a short period of time may not feel any WD or side effects. The risk of them experiencing any WD or side effects is increased if they abuse the drug or have previously abused the drug in the past.

A person taking opii's for an extended period under pain management will feel WD and side effects from abruptly stopping the medication, this is for the most part controlled well by pain management specialists and people are successfully weened off opii use all the time without any complication at all.

Take the time to read ones posts in the future rather than just assuming one point of view from SWIM.

[Guardian]

lets say the patient stops his pain management and been on it for a while at a high dose they will fell the wd affects, i would think why not? so then they would be started back at the same level of meds they where on, so if they couldn't get meds for 2 days for some weird or lets say due to acts of nature, hurricane, tornado ect, now patient gets back to doc for meds would they be put back on the same level they where at previous? if yes they they will feel the rush from the meds due to wd i would think right. patient might enjoy and then that could change it. sry if dumb post..

[OhCasey]

Originally Posted by samuraigecko

Based on who's medical facts?

Here is the example intended but obviously overlooked.

1] person takes opii's at a fair dosage for a long period for a legitimate reason.
2] medication is abruptly stopped.
3] the result is obvious, ask any doctor.
4] this is why SWIM stated about "good" pain management.

You cannot expect everyone to believe that your OPINION is medical fact, either can I.

Everyone will be told something different by almost every doctor they seek, which is why the "second opinion" is often looked for.

The above example should also be looked at subjectivly with the rest of ones posts. A person whom is weened properly from opii useage for a legitimate reason may not even notice any WD or side effects from coming off the medication, however, if the medication is abruptly stopped during treatment then the person will almost certainly in 99.9% of the cases experience some kind of WD.

SWIM actually just got back from his pain management specialist and was told the exact same thing, this specific clinic is regarded as one of the best in his country, but that is still not to say that the quacks cannot be wrong.

Again I say the same to you as what was said to me by yourself:
Do not sling your opinion as medical fact.

The results of opii use for legitimate reasons are varied and subjective with quite a number of variables.

A person taking opii's for a legitimate reason for a short period of time may not feel any WD or side effects. The risk of them experiencing any WD or side effects is increased if they abuse the drug or have previously abused the drug in the past.

A person taking opii's for an extended period under pain management will feel WD and side effects from abruptly stopping the medication, this is for the most part controlled well by pain management specialists and people are successfully weened off opii use all the time without any complication at all.

Take the time to read ones posts in the future rather than just assuming one point of view from SWIM.

I cant believe that someone would think that when i said "my opinion is BASED on medical facts" that they would think they read "My opinion is medical fact". I'll make it simple Wthdrawal does not equal addiction. Physical Dependence does not equal addiction. If your doctor thinks this he should have his license pulled. Ive seen numerous pain specialists and can assure you the addiction is NOT inevitable in opiate management of pain could you imagine the shape of the country if every person who took opiates for prolonged pain mangement ecame addicted? Try to grasp the sheer magnitude of Americans who use Opiates daily for the management of pain the number is staggering. You throw around withdrawal like it makes someone addicted. You can be addicted to something and not experience withdrawals from it and vice versa.
I like how someone gave me a negative rating on one of my posts because they disagreed with what i was saying. I think its especially funny cause ive even backed it all up with sources. I wonder who it was.

[samuraigecko]

Originally Posted by OhCasey

I cant believe that someone would think that when i said "my opinion is BASED on medical facts" that they would think they read "My opinion is medical fact".

well it was you whom said "me and the GLOBAL medical community", you only have yourself to blame there because to some it may come accross as "big noting" yourself as though you speak for the global medical community rather than just basing your facts of a few GP's and PMS's you may have seen about any past / current pain problem you may have.

Originally Posted by OhCasey

I'll make it simple Wthdrawal does not equal addiction. Physical Dependence does not equal addiction.

We have had this discussion before.
How can someone go through withdrawals if their body was not addicted to the substance first?
One has shown how opii use effects endomorphin production, has provided the reasons why it causes Addiction and WD, even provided links etc . . .

Originally Posted by OhCasey

If your doctor thinks this he should have his license pulled.

Which of the hundreds of doctors should have their license pulled?

Originally Posted by OhCasey

Ive seen numerous pain specialists and can assure you the addiction is NOT inevitable in opiate management of pain could you imagine the shape of the country if every person who took opiates for prolonged pain mangement ecame addicted? Try to grasp the sheer magnitude of Americans who use Opiates daily for the management of pain the number is staggering. You throw around withdrawal like it makes someone addicted. You can be addicted to something and not experience withdrawals from it and vice versa.

One thinks that yet again you have failed to grasp the point of ones posts.

One never said that it was "inevitable" during pain management.

One did say opii addiction is inevitable for prolonged use patients and that the opii user would go into WD if the opii was taken away WITHOUT a weening program in place while the patient was still on larger dosages.

People with a good weening program in place may not even experience any opiate withdrawal, but they will have been addicted even if they didnt know it.
The only way they could have known it is if they had their pain medication taken from them abruptly during the pain management without weening.

This poor pain management actually happens all the time, people have also ended up "self medicating" with other illegal opiates as a result. Doctors can provide poor pain management at times which is why it is always advisable to go through a pain management specialist. Fortunately the country which SWIM is in now has law in place where a GP cannot provide pain management and one has to be referred to a PMS by a GP.

Originally Posted by OhCasey

I like how someone gave me a negative rating on one of my posts because they disagreed with what i was saying. I think its especially funny cause ive even backed it all up with sources. I wonder who it was.

How unfortunate . . . SWIM can sympathize though because he had the same problem a few posts back but can never be certain whom it was since feedback is anonymous.

have a nice day

[OhCasey]

Originally Posted by samuraigecko

well it was you whom said "me and the GLOBAL medical community", you only have yourself to blame there because to some it may come accross as "big noting" yourself as though you speak for the global medical community rather than just basing your facts of a few GP's and PMS's you may have seen about any past / current pain problem you may have.



We have had this discussion before.
How can someone go through withdrawals if their body was not addicted to the substance first?
One has shown how opii use effects endomorphin production, has provided the reasons why it causes Addiction and WD, even provided links etc . . .



Which of the hundreds of doctors should have their license pulled?



One thinks that yet again you have failed to grasp the point of ones posts.

One never said that it was "inevitable" during pain management.

One did say opii addiction is inevitable for prolonged use patients and that the opii user would go into WD if the opii was taken away WITHOUT a weening program in place while the patient was still on larger dosages.

People with a good weening program in place may not even experience any opiate withdrawal, but they will have been addicted even if they didnt know it.
The only way they could have known it is if they had their pain medication taken from them abruptly during the pain management without weening.

This poor pain management actually happens all the time, people have also ended up "self medicating" with other illegal opiates as a result. Doctors can provide poor pain management at times which is why it is always advisable to go through a pain management specialist. Fortunately the country which SWIM is in now has law in place where a GP cannot provide pain management and one has to be referred to a PMS by a GP.




How unfortunate . . . SWIM can sympathize though because he had the same problem a few posts back but can never be certain whom it was since feedback is anonymous.

have a nice day

You have repeatedly shown your ignorance on the subject of Addiction, Pain management and opiates in general. I have received countless PM's from members telling me not to even answer your posts with sources and knowledge just for the simple fact that you ignore knowledge, facts etc. You dont have to be addicted to experience withdrawals, period, its common medical fact. I hope that anyone reading these posts ignore all information provided by gecko, ignore my posts too and research the subject its not that hard google pain management addiction and opiates you will find all types of knowledge that backs up everything I've posted. If anyone needs help regarding pain management PM me, i cant sit here and post over and over definition of words which is something i cant make up since i didn't come up with these words. I know with some people it takes repetition to learn new things so ill leave Gecko with this Physical Dependence is NOT the same thing as Addiction. Everyone who takes opiates over a period of time will develop a physical dependence as you would develop a physical dependence to almost anything you put into your body. Not everyone who takes opiates over a period of time will develop an addiction.



Bloodred i think you're pretty dead on about addiction being genetic, environmental, etc.

[samuraigecko]

Originally Posted by OhCasey

I have received countless PM's from members telling me not to even answer your posts with sources and knowledge just for the simple fact that you ignore knowledge, facts etc.

It is funny you should say that because SWIM has experienced exactly the same thing. BTW, One has provided links and proof in many threads already and one asked you to back yourself up previously and you couldn't.

One will in no way ignore information, good information, if it is given.

[bloodred1889]

if one was to rotate her pain managment, say take a strong opioid for a couple of months and then take somthing else, like tramadol or a muscle relaxent for a couple of months and then go back to the opioid and so on and so forth would this help to stop addiction/dependance?
because my logic is you wouldnt be taking it long enough to get really addictive and then because you have a brake with somthing else tolarence and stuff would go away, so when you started again it would be like you had never taken opioids, at least to your body.
or is that the stupidest thing you have ever heard?

[0utrider]

no, well first off tramadol is also an opiate, it wouldnt matter, in SWIMs opinion it could even be worse, SWIY could develope a polytox drug adiction habit, which is even worse, and "a couple of months on strong opiates" would require "something" to ease of some w/d symptoms, which will sooner or later occur, no matter what, at one point the schedule won't work and swichting also doesnt.. and you can get addicted without being addicted, i mean psychologically without being physically addicted (which is still the worse, the psychological part), and thus not even realizing it at first. someone wrote something about self-medication earlier, i think it could lead to think, which doesnt have to be, but pretty likely will be, a bad idea

the idea is not so stupid, its just that it wont work, maybe not on the shortterm, but on the long-run its impossible. also it kinda, swim has to mention this, sounds like a good way of finding excuses and ending up in a real f'd up situation after some time.

theres also this theory (well its a theory) if one smokes one cigarette he can be called addicted to some extend. SWIM doesnt support this theory but still thinks it has some truth in it, there will never be a point again when SWIY's body is like it never tasted opioids before, at least if used for more than a few days, especially with the "strong" stuff (whatever exactly that is). maybe close to, but never "as if it didnt"
according to another theory (again just theory, but in SWIMs opinion also some truth in it) its similar to a disease, the body will develope a programm in order to get it out of your body, so it will never be the same as the first time. the body might not get a tolerance (well, noticeable tolerance it is to say) but still he will develope patterns of enzyme creation etc to face the substances in his body. and from the 2nd time on that's a learned pattern, just like a virus, the body has a plan. its not like he "never took it before".
no swim will not find any references to these theories since they are not true like that, its simple to find that out, but there is some truth in both, that many people who experienced addiction (certainly not all, since its always individual) would agree upon


and guys, i didnt read all of that, cuz its quite confusing, personally SWIM found truth and misunderstandings in both of your posts, as well as "not so well planned" writing. but just don't let it get to personal, this is just a sharing of knowledge, a discussion (also discussions have rules) no need to give negative reps and stuff like that!!

[0utrider]

no it was in swims opinion.
but its perfectly normal to not be spaced-out if on the same dosage, isnt it? thats why in europe in many countries opiate addicts that are under treatment (i.e. same dosage) get a "opiate ID" that allows them to drive and everything without problems, why, because they are not high. and its not only methadone, like SWIM said, also the pain treatment ppl, and SWIm knows some who are under "pain treatment", but actually just abuse it, so for him its quite obvious its not about killing pain or not, just about dosage and schedules and the bodys ability to adapt.
and he kinda doubts it, that SWIY has been for years on vicodin, without tolerance.. most pain management "specialists" are just stupid, if thats the case, but SWIM has experienced that most pain management doctors are actually just stupid, not only concerning that..

[OhCasey]

Originally Posted by outriderx

no it was in swims opinion.
but its perfectly normal to not be spaced-out if on the same dosage, isnt it? thats why in europe in many countries opiate addicts that are under treatment (i.e. same dosage) get a "opiate ID" that allows them to drive and everything without problems, why, because they are not high. and its not only methadone, like SWIM said, also the pain treatment ppl, and SWIm knows some who are under "pain treatment", but actually just abuse it, so for him its quite obvious its not about killing pain or not, just about dosage and schedules and the bodys ability to adapt.
and he kinda doubts it, that SWIY has been for years on vicodin, without tolerance.. most pain management "specialists" are just stupid, if thats the case, but SWIM has experienced that most pain management doctors are actually just stupid, not only concerning that..

Well i meant to say "No increase in tolerance". You dont get it its not about developing an ability to function on opiates, which does happen in long term use with both addicts and patients. It is the belief of most experts in the field of pain management that those in pain, acute or chronic, react differently to pain killers. Its been accepted by doctors that people in pain who take opiates as prescribed by a doctor even for long periods of time rarely become addicted to opiates. I know what youre saying about those pain specialist. Who are they to tell us about pain and addiction. What kind of person would they think they know more then us just because they studied the subject, received a degree and practice in said field. I dont think pain specialists know everything about pain and problems arise, imo, when they become jaded from dealing with "drug seekers" but ill refer to them for statistics on pain management and addiction.
Sam you lack fundemental knowledge of the word definition. You say youve backed your arguement with sources, well i challenge ANYONE to tell me im wrong when i say Physical Dependence is not Addiction. Anyone want to tell me im wrong when i say that you can have physical dependence present and not be addicted, bring your sources. Anyone else think that "With opiates / opioids one is sure that almost everyone will agree that if continued use over a significant period of time is involved then addiction is inevitable."? Addiction is a disease. Learn something sammie.

[moda00]

I agree it is important to shed some light on the differences between these two conditions of opioid use, and between the terms we use to describe them. To shed some light on this, perhaps it will help to look at the DSM IV, which is the reference used in the fields of psychology and psychiatric medicine to diagnose psychological abnormalities and disorders.

The DSM IV defines substance related disorders as "Substance Abuse" and "Substance Dependence." To be diagnosed with substance Dependence, these are the criteria used in psychology:

FIRST- Maladaptive patterns of substance use causing significant impairment and/or distress (this is a requirement for both Abuse and Dependence diagnosis- if someone qualified for Dependence they would not concurrently receive the diagnosis of Abuse)

PLUS- at least three out of seven must be present:
1) Presence of tolerance
2) Presence of withdrawal
3) The substance is taken in larger amounts than originally intended
4) There is a persistent desire or unsuccessful efforts to control use
5) Considerable time is spent obtaining, using, and/or recovering from substance in question
6) Substance use replaces significant activities
7) Substance use continues despite its causing or increasing problems that are psychological or physical in nature

I think the terminology can be confusing, but to me, the DSM requirement for significant negative effects (distress or impairment related to use) matches closely with my personal definition of addiction- that the use must be causing some sort of harm physically, psychologically, and/or functionally to be considered an addiction ("Substance Dependence"). I think those words often get mixed up, and note here that what I would define as "addiction" is labeled in the world of medicine as a Substance Dependency.

Both "Substance Abuse," which we might commonly know as problematic use without dependence, and "Substance Dependence" in the context of being a condition or disorder, what we might commonly call problematic use with psychological and physical dependence, or "addiction," have first and foremost the clear requirement that the use of the substance has caused either significant impairment in functioning and/or significant distress. So it seems the third category, and that which the hypothetical pain patient in the original post might fall, is a category of non-problematic medical use with physical dependence only? (And then there is also problematic use with psychological dependence only, which people on DF commonly refer to as "Psychological Addiction," but that is unrelated/unlikely to this particular situation with opioids)

In addition, to classify as Substance Dependence one must have at least three of the seven traits- so one could have tolerance and withdrawal present, but would still need one additional qualifier from the list alongside the requirement of clinically significant impairment or distress. It seems to me that while opioids are pharmacologically doing the same things by binding to the opioid receptors in the brain, and the physical dependence is the same, there are massive differences between the opiate addict and the pain patient. Since the opioids are actually being used in most cases for medical reasons, this is in direct opposition to what seems a clear criteria for "Substance Dependence" or addiction (again, what I am referring to as problematic use with psychological and physical dependence). It is being used to treat a medical condition, and is thus ideally minimizing distress and improving functioning.

To me, this is the main difference. Along with that comes of course the psychological factors, and the schema in which the substance use is perceived. If the substance is being provided by a doctor to treat pain, it is perceived as a medication. It is ideally used at a dose which effectively manages pain while minimizing any negative potential side effects.

The idea of introducing a substance to the brain repeatedly means that the brain will adapt, and we know how this works and how strongly this effect is present with opiates. So we know that the brain will make adjustments to the presence of this medication, but since the medication is taken regularly in set, effective doses, and provided by a physician and pharmacy, the idea of 'cravings' or 'withdrawals' are not even a part of the pain patient's reality- although they might feel pain and respond by taking the medication, this is not the same as feeling a psychological craving for the drug itself- it is not about the drug, it is about the medical condition and the relief of pain, which I think is the main distinction. With active opiate addiction, the drug is the center of the addict's world, and meanwhile things disintegrate. With pain management, the drug is, I would think, a balanced part of the patient's world, a tool enabling them to function better and participate more, not less, in their daily lives.

The idea of physical dependence in the medical context is not seen as a horrible obstacle, simply a trait of the drug that requires certain dosing structure and instructions, as when it is being used in that manner it is quite manageable. When one is taking stable measurable doses, one has a specific therapeutic outcome, and progress can be measured and weighed against that. Thus whether they are titrating upwards to find an effective dose, stabilizing and managing pain, or tapering off a medication, this is all looked at as part of the medication process, and is done steadily over time, not rapidly as in addiction. In addiction, one is not treating any specific condition except for the addiction itself, which is not really being "treated" in the medical sense; just fed. There is no progress in addiction because it continues on- one can never have enough and needs more and more while meeting no therapeutic objective, and on the converse, continuing to use despite its direct negative consequences.

I would argue that the psychological experience of the opioid drugs themselves differs greatly as well for many people- while for the addict, the primary purpose and anticipated effect is the "high" of the opioids themselves (and then eventually the relief of withdrawals, of course), for pain patients the opioid is simply a means to an end, the end being pain relief- so it brings relief, but for different reasons.

I would also argue that addiction does definitely have genetic factors and can "happen" to just about anyone, as a majority of people do try a substance such as tobacco, alcohol or other drugs at some point in their lives, and no one can predict or choose who will struggle with addiction. So while we can't predict it or see it, there are predispositions and I would argue that the addicted response to a drug is fundamentally different than a "normal" person's. For example, when most people describe their first time drinking or using a substance, they might not even remember it, or they might have gotten sick, or thought it was fine, or whatever. But an addict will remember that like no other.. swim read her journal entry about the first time she ever got drunk, and she can still remember that day, how amazing she felt, how she knew she would seek that rush, that instant gratification, that warmth, over and over, she knew she loved feeling intoxicated. And most people don't respond that way from my experience.

Swim has also discussed opioid pain meds with those who have been on them, and many say what others have said here- that they don't feel they "get high." Partially this is likely because they are not perceiving it in that way, they are not looking for that or expecting that, and the mental effects that are felt- "cloudiness," sedation, "spaciness," etc. are perceived simply as side effects or effects of the medication and not necessarily "good" or "bad." Some are even bothered by it. And sure, some pain patients certainly enjoy the feeling of taking the medication, but who could differentiate removal of pain from addition of pleasure, where is that line? And if one is conditioned to know that taking the medication will get rid of their pain, would they not have a classically conditioned positive association with it for the pain relief itself, on top of the "euphoric" effect of opioids? Plus, an individual taking opioids for pain management would not generally be taking doses higher than needed to manage their pain- so while a person who is at baseline and in good health would get "high" off most any reasonable amount of an opiate drug, a person who is in pain is simply relieved from the pain and brought somewhere near a baseline? (I saw a chart of that in rehab, and it is the same concept once withdrawals start in addiction- the person is no longer at normal brain chemistry getting high, but are at abnormal functioning and using often only restores one to baseline)

I certainly don't feel it is a moral issue, I just feel that they are two very different states while similar and comparable in the sole function of both involving the same substance taken repeatedly. One is a managed and controlled treatment for a condition, one is an uncontrolled and unmanageable condition needing treatment.

[OhCasey]

The only problem with that definition is, and you touched on this, it leaves out the pain patient who only experiences #1 & 2.

[OhCasey]

Originally Posted by betsym

Swim must be one of the "weird" ones then because she doesn't get high from her pain meds that are given for a chronic pain condition. All she gets is pain relief, a "space-head", and sometimes nausea, none of which she considers recreational but Swim is one of those rare individuals who experience natural highs that are much stronger than anything that can be gotten from artificial means and is often accused of "being on" something when she is not. Swim is ADHD, has a lot of energy, and an over-abundance of creativity. An artificail high probably doesn't register with swim because her natural ones are so much stronger. Swim may have a degree of bipolar as well, and this has been linked with high creativity. It could be that people with bipolar and ADHD have brain chemistries that respond differently to most drugs since hyper people are given stimulants to slow them down and these are known to "speed" others up who aren't ADHD. Swim keeps her pain meds to a minimum whenever possible because she is aware that tolerance can build and she does not want to stress her liver by taking too many for long periods of time. She has been on them for over 5 years now and still takes the same pill in the same strength. She may take 2 at once occasionally, when the pain gets worse, but she doesn't have withdrawals when she takes 2 week breaks every month or so. Does any other chronic pain patient on here have a simialr experience?Swim does not take for granted that could change at any time in the furutre. Chronic pain is just that, chronic. It comes and goes but never goes away completely.As for depression, Bipolar and ADHD does have a downside but swim has learned to think of that as rest and recovery time. Painmeds do not cause swim to be drowsy, even when not taken with ADHD meds but they don't jack swim up, either, like they do some people. Swim does not want to take pain meds indefinitely and will keep herself in check because she wants the painmeds to keep working at lower dosages and she doesn't want to be dependent on anything in order to get by or just live. Chronic pain is real though and undermedicating is a problem here in the USA because of govt regulations. Swim thinks that chronic pain patients should have representatives on EVERY medical board and in govt agenices so that somebody knows what it feels like to have to deal with that. Witholding painmeds from someone who needs it is like witholding food from a baby or anyone else who is starving. Swim does understand those who get addicted because for a long time she thought everyone had natural highs and she knows that depression could be bad if she viewed it in a different manner than as a "rest" but staying "up", natural or otherwise, can be exhausting. For those chronically depressed, opiates often seem to offer a lift. Ironically, chronic pain can cause chronic depression in the sufferer and this is often what has them reaching for their meds more often than usual. Hopefully most chronic pain sufferers can tell if it's the pain or the depression brought about by the pain that has them reaching for their meds more often but depression hurts just like physical pain so it may be hard to tell.

Youre not weird i have been on almost the same dose of hydrocodone for 4 years with no tolerance what so ever. Most pain management specialists agree with you that people in pain for the most part dont experience a high from pain meds especially that like most normal people would. outriderx you should re-read your post it wasnt really based on facts or well written, theory huh?