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  • Kicking Morphine Dependancy

    Hi Everyone. I started experiencing terrible nerve pain about 6 months post SCI in 2006. My Doctor and I settled on a treatment of long acting morphine sulphate and short acting break-through similar to what I was given in rehab after release from ICU. It worked pretty well but as the years wore on the dose needed to be increased (I topped out at about 700mg/day) to the point where I was having to take other meds to treat the side effects of the morphine. Eventually I toured multiple pain clinics in the Greater Toronto Area, seeing many pain specialists. I came to the conclusion that I should get off the opiates as they may be causing more pain than they are treating. The idea of seeing where my baseline pain is without drugs in my system, all these years later, also appeals. Unfortunately the Province of Ontario does not have any inpatient detox clinics for people who are dependent on opiates, only beds for addicts. So after slowly decreasing the dosage myself over the last 3 years I'm down to 10 mg every other day of long acting and am about to switch over to just taking taking a few mg of short acting every four hours or so. After a week of this I plan to go cold turkey.

    Does anyone have any experience with morphine withdrawal and mitigating the discomfort? I've got a small clonazepam script for sleep but thats it. I'm worried about my bowel routine and wondering if I should have a diet plan to get through the first few days. Any help is appreciated.

  • #2
    I don't have much advice to give, but just want to say how awed I am at your demonstrable desire to love yourself. Very Great!!
    As a sober alcoholic/addict I would counsel you that if it gets difficult, do like many did, remember that you only have to do it one day at a time, not forever!
    And always remember that once you've stopped, you must stay stopped; one drink/one hit/one tab will take you right back whence you came.
    Like they say in AA, if you don't take the first drink, you'll never get drunk! Keep it simple stupid
    Good luck and keep in touch! (that helps too)
    69yo male T12 complete since 1995
    NW NJ

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    • #3
      I recommend talking to your doctor. There are medications that can help alleviate the symptoms of opioid withdrawal (clonidine in particular), but this needs to be evaluated by someone who is familiar with your physical health conditions and someone who can monitor your vital signs, especially your blood pressure which sometimes runs low in SCIs and heart rate.

      The other issue that I imagine would be one of the biggest issues for our population is the diarrhea/loose stools that come along with opioid withdrawal. You can treat this with loperamide (immodium), which is available over the counter (at least in the US), but again I would advise asking your doctor about this, if you don't end up having diarrhea and you overdo the loperamide you could end up with a bowel obstruction.

      In the future, if you have some kind of acute issue like a broken bone or kidney stones or something, I wouldn't say there's any reason to think you should avoid opioids in the future, unless you feel for some reason that you misused your morphine or were chasing a euphoric high or your prescriptions caused you other concerning behavior (which your original post does not suggest at all).

      Your experience seems to reinforce what the evidence shows.
      1. Opioids work for chronic pain only when doses are continuously increased. Your body becomes tolerant of any particular dose and if you stay at that level, your pain will increase back to your former baseline with spikes higher than your former baseline if you ever go without the med or miss a dose.
      2. Opioids are kinda trash at treating neurologic pain (other meds aren't much better, but come with much fewer side effects and withdrawal symptoms)

      If you get back on short acting morphine, your withdrawal symptoms shouldn't last much more than a week or so, but obviously that could be a very shitty (in every sense of the word) week. However when you come off of them, THAT IS NOT YOUR BASELINE PAIN LEVEL. When you were on opioids your brain didn't know what to do with the excessive amount of endogenous and exogenous opioids and created more receptors to absorb all of them. It can take months (rarely years) for your brain to downregulate them and return to normal when it realizes the morphine party has left the building and is not coming back. This is called Post Acute Withdrawal Syndrome (PAWS). Watch out for things like depression, lack of motivation, sleep disturbance, etc. These things will get steadily better, but may take a while. Hopefully since you've been slowly coming down on the morphine over the last few years it will be relatively mild (hell, hopefully nonexistant) for you.

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      • #4
        Originally posted by pfcs49 View Post
        And always remember that once you've stopped, you must stay stopped; one drink/one hit/one tab will take you right back whence you came.
        Like they say in AA, if you don't take the first drink, you'll never get drunk! Keep it simple stupid
        Good luck and keep in touch! (that helps too)
        I too applaud the hard work and dedication Pucker has shown, but I don't think there's any reason to assume he is an addict and should strictly avoid any opioid medications no matter what. There is nothing in his story to suggest that he misused or overused his opioids or that he was somehow chasing a high or numbing some emotional pain with the medications. The reason he was unable to find detox centers is because they are generally only available for patients with addiction (or Substance Use Disorders as professionals might say). No one pays to house nonaddicts while they come off of opioids because they're perfectly capable of tapering down and doing it on their own as outpatients, there is nothing lethal about opioid withdrawal. Addicts on the other hand, are generally incapable of controlling their use and therefore need to be hospitalized or otherwise institutionalized or the urge to use to alleviate their physical discomfort in addition to the underlying addiction is likely to overwhelm their desire to get clean. By his description, Pucker is voluntarily coming off of his morphine and has been decreasing them purposefully for a sustained amount of time, this would be practically unheard of for someone with an addiction to opioids.

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        • #5
          I can well appreciate funk lab's comments, but the facts are that if you use an addictive chemical in enough quantity over enough time, you become addicted!
          That's fact. That also explains how we got into the current opiate addiction crisis.
          Someone who is habituated to opioids is perhaps, justifiably, addicted, but not an addict. An addict is one that takes steps to feed his addiction such as prescription fraud, secondary sources, etc.
          69yo male T12 complete since 1995
          NW NJ

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          • #6
            Originally posted by pfcs49 View Post
            I can well appreciate funk lab's comments, but the facts are that if you use an addictive chemical in enough quantity over enough time, you become addicted!
            I absolutely disagree and I think the vast majority of reputable addiction specialists and advocacy groups and persons in recovery would disagree as well.

            But perhaps it's just a matter of semantics.

            What you describe as "addiction" and "becoming addicted" is actually technically called "physical dependence". It means you will have physical symptoms if you stop taking it. For example, stop taking the clonidine I mentioned above and your blood pressure will spike, that's physical changes your body has made because of a substance you are taking... that is NOT addiction... if you were sucking dick in an alley to get someone else's clonidine, THAT would be addiction, but clonidine isn't addictive so I've never heard of that. Anyone on a baclofen pump is physically dependent on it and could have withdrawal which could cause death if they were to stop it suddenly, but that doesn't mean they're addicted to it.

            You rightly describe many of the behaviors of an addict (none of which Pucker has endorsed).

            I think we are saying the same thing, just using different words. I think you'll find in both the recovery literature and the medical world that it is generally accepted that an addict is one with an addiction (your prescription fraud, doctor shopping, buying from the street example above), and one does not have an addiction if there is no use despite painful consequences or drug seeking behaviors from use.

            It cheapens the meaning of addiction to lump everyone who's ever used a substance into that category. I was once given 7 days of tramadol after surgery and took it for 4 days, then left the remaining six pills in my medicine cabinet until they disintegrated from the humidity. Does this mean I am an addict as well, or rather, to use your terminology that I have an addiction?

            I have linked below a few brief websites that summarize the difference between addiction and dependence and have purposefully avoided listing those links by anyone who might provide opioid maintenance treatment or might have financial interests in the over prescription of controlled substances, so as to be as unbiased/biased towards strict sobriety as possible.
            https://www.therecoveryvillage.com/r...ddiction/#gref
            https://www.drugabuse.gov/publicatio...cal-dependence
            https://www.asam.org/docs/default-so...nsus-2-011.pdf\

            Even Miriam Webster disagree's with your assertion that any chronic use = addiction https://www.merriam-webster.com/dict..._source=jsonld


            The opioid crisis is a relevant issue, especially given Pucker's experience in the medical system. I am with you that there should be absolutely zero prescriptions for opioids for chronic pain with the exception of cancer pain due to incurable, fatal cancers.

            Opioids are amazingly good at what they do, though. And what they do is provide relief from immediate pain: Major surgery, broken bones, whole body burns, etc. Any use of opioids beyond 4 or 5 days is probably going to make the patient worse off and cause more pain overall, even if you ignore the obvious possibility that the person may become addicted or their drugs may be diverted towards those who have addictions.

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            • #7
              Thanks for the feedback. The transition to short acting has been fine. I actually only took 2.5 mg yesterday and was ok. Wouldn't you know it my hemorrhoids flared up viciously though! Always something with this bummer...

              As for weighing in on the addiction/dependence issues I feel that 'one day at a time' is great advice. I also feel I am not 'addicted' to morphine. I have followed the Doctors prescription to the letter. Addiction, as I understand it, is the result of the person being unable to stop using a chemical or behaviour on their own. There are negative physical, familial, social and/or economic consequences as a result of the usage, always. But the defining traits of an addiction, for me, are an inability to stop using even though you may want to. I also think that sensitivity to SCI sufferers pain management strategies, including the use of illegal substances like pot, means we should refrain from judging others. The terms addict and addicted are so charged. As the 1st step in AA says 'we came to believe' it is all about self diagnosis not someone else telling us we are an addict or we are addicted to such and such.

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              • #8
                I have heard that Kratom assist's with withdrawls. Good luck great choice props to you for making that choice. I have also been in chronic pain 24 plus years t-10 sci. In the last 6 months I have also lowered my count of pills of percocets. I have cut them down from 120 a month of 10-325 percocets down 60. I am hoping to be pill free before the end of the year.

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                • #9
                  Withdrawal sucks, but you've done it the right way. Good news is you're taking a relatively short acting opioid with a considerably smaller half life than that of other narcotics. Keep in mind once you stop taking your last dose it will take around 5 half lives which could be up to 20 hours.

                  I've been on high dose methadone which has an extremely long half life. I was approved for a pain pump and will be going into surgery next week. The docs have aggressively weaned me off of this because the best outcomes happen when exogenous opioiods are not present. I was off of the methadone within 5 days and I am not feeling well at all right now.

                  Just take it slow. I also cold turkeyed off of 8mg buprenorphine which is another long acting opioid and that withdrawal lasted almost a month before all the symptoms disappeared. Yours will be shorter. The restless legs (even though I don't have any), inability to sleep, and the nausea are the worst.

                  Good luck

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                  • #10
                    Well, I think we can all agree that opioids are bad news long term!?
                    69yo male T12 complete since 1995
                    NW NJ

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                    • #11
                      I have to disagree, opioids are safer on the body than alternatives that are hard on liver. to many patients drink alcohol when they are also taking opioids and this causes the deaths. Alcohol use with 24/7 opioid , especially the long half life meds like methadone really increase the chance of respiratory distress. Alcohol use with meds that have Acetaminophen in them is also hard on the liver.
                      cigarettes smoking has been banned in many public indoor and outdoor areas, it has been removed from many movies and TV shows so kids do grow up with it as a normal activity as my generation did . Smokers have been marginalized and not promoted as the cool kids on the stoop, we need this for alcohol consumption too,,excess drinking is still a huge college tradition, and this is when their brain is still developing. USA prisons are filled with people who now realize that if they hadn't been drinking they would not be in prison . Alcohol use needs to be exposed for the harm it causes
                      cauda equina

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                      • #12
                        Originally posted by metronycguy View Post
                        I have to disagree, opioids are safer on the body than alternatives that are hard on liver. to many patients drink alcohol when they are also taking opioids and this causes the deaths. Alcohol use with 24/7 opioid , especially the long half life meds like methadone really increase the chance of respiratory distress. Alcohol use with meds that have Acetaminophen in them is also hard on the liver.
                        cigarettes smoking has been banned in many public indoor and outdoor areas, it has been removed from many movies and TV shows so kids do grow up with it as a normal activity as my generation did . Smokers have been marginalized and not promoted as the cool kids on the stoop, we need this for alcohol consumption too,,excess drinking is still a huge college tradition, and this is when their brain is still developing. USA prisons are filled with people who now realize that if they hadn't been drinking they would not be in prison . Alcohol use needs to be exposed for the harm it causes
                        Not sure what point you are trying to make here other than alcohol=bad, but opioids are DEFINITELY capable of killing you without any alcohol involved. Take enough and you stop breathing. That’s just what the mu opioid receptor does.

                        im not sure what you consider “alternatives” that are hard on the liver. Most non opioid pain medications do not cause any liver issues. Opioids kill as many people as car wrecks do in the United States (and this is only counting acute overdoses, not chronic complications), it would take a hell of an unsafe alternative to approach that level of destruction and decimation of young lives.

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                        • #13
                          Originally posted by funklab View Post
                          Not sure what point you are trying to make here other than alcohol=bad, but opioids are DEFINITELY capable of killing you without any alcohol involved. Take enough and you stop breathing. That’s just what the mu opioid receptor does.

                          im not sure what you consider “alternatives” that are hard on the liver. Most non opioid pain medications do not cause any liver issues. Opioids kill as many people as car wrecks do in the United States (and this is only counting acute overdoses, not chronic complications), it would take a hell of an unsafe alternative to approach that level of destruction and decimation of young lives.
                          I don't have anything in from of me to confirm it, but I'm pretty certain that alcohol kills more than opioids in this country. Plus, many (a preponderance?) of alcohol deaths are not directly reported. How many suicides, MV accidents, organ failures have a root cause of chronic alcohol abuse but are not attributed?

                          And, no argument! Opioids ARE bad!
                          69yo male T12 complete since 1995
                          NW NJ

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                          • #14
                            Originally posted by pfcs49 View Post
                            I don't have anything in from of me to confirm it, but I'm pretty certain that alcohol kills more than opioids in this country. Plus, many (a preponderance?) of alcohol deaths are not directly reported. How many suicides, MV accidents, organ failures have a root cause of chronic alcohol abuse but are not attributed?

                            And, no argument! Opioids ARE bad!
                            Agree on all points. I just disagree pretty strongly with metro's assertion that opioids are "safer than alternatives"...

                            But if we're looking at the whole picture, there's a whole lot more people that drink, and that's why alcohol causes more deaths. I bet if 100,000,000 people in this country regularly used opioids, they would be more destructive than alcohol.

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                            • #15
                              I am speaking only of the people who are prescribed their meds and take them with out abusing them. and that includes without drinking alcohol . There are plenty of pain patients that have gone 15-20 plus years without any incidents.
                              Opioids have no upper daily limit, as long as the body is adjusted to the dose, which means if a opiate naive person took my dose of fentora or other narcotic pain med,they would suffer respiratory depression.

                              . Tramadol and acetaminophen both have a daily limit and attack the liver. I wouldn't want to be taking high doses of Tramadol for 15 - 20 years, I am sure the people that now have to take Tramadol since the hospital or doctor no longer will write RX for opiates due to fear of loss of license are taking well over the 400mg daily limit, they have no choice if they are in pain.
                              cauda equina

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