Dependance or Addiction???

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uniquelyme
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Date Joined Nov 2008
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   Posted 11/25/2008 3:44 PM (GMT -7)   
 
 
Hello all,
I'm sure this topic has been here before but it is important so I'll take the chance.
 
I have been taking opiates, in one form or another, since I was 12.  It started with Endal Hd for Chronic Bronchitis (I would get it at least 6xyear).  It got to the point where I could just call my doc, at 13, and they would call it in for me. This went on for years.  Then at 19 or 20 I had my first incident with my lower back, lorcets for everyone!!! turn   That went on for years as well.
 
When I was 24 my family Dr. (cough medicine man) decided that he needed to call my mom and tell her that he thought I had a problem with opiates.  So, here I am at 41, been taking pain meds for all of my adult life, and I am wondering.....How do you know the difference between being dependent and addicted?
 
I know that when I take too much and run out before it's time I feel like "Shooky".  I sweat,ache, all the withdrawl symptoms. 
 
Don't people without addiction problems go through the same thing?  After being on pain meds for years what is the difference?  Isn't it all the same?
 
Me

 
 
spinal stenosis,degenerative disc disease,bilateral neuropothy.
lamenectomy L3,L4..spinal fusion L4-S1
 


BionicWoman
Regular Member


Date Joined Jul 2008
Total Posts : 243
   Posted 11/25/2008 5:08 PM (GMT -7)   

The difference between dependence and addiction can be found in the outcome.

A chronic pain patient that takes their narcotic pain reliever(s) as prescribed will develop tolerance and physical dependence over time. Those are biological processes and are expected with many medications, not just narcotics. Physical dependence, in and of itself, does not have negative consequences. For a chronic pain patient, the overall result of their drug use is positive; they experience a reduction in pain, which leads to improved function.

Addiction, on the other hand, is a psychological process and is characterized by continuing use in spite of consistently negative consequences. People become addicted when the drug use is no longer appropriate or adaptive.  They continue to use the drug inappropriately, even though the direct result is a decrease in their ability to function and they experience increasingly negative consequences.

:-)  


PAlady
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Date Joined Nov 2007
Total Posts : 6795
   Posted 11/25/2008 5:57 PM (GMT -7)   
Bionic's description is pretty accurate, although addiction is both physical, psychological and social. I'll try to bump up an old thread (uh oh here I go!! LOL) that contains a link to an article which defines it in more detail. May take me awhile to find it.

PaLady

uniquelyme
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Date Joined Nov 2008
Total Posts : 1037
   Posted 11/25/2008 6:54 PM (GMT -7)   
I knew I would get some good responses....

Let's say we have 2 CP people that take the same kind of pain meds, and they have for years. For some reason they happen to run out...and they both go through withdrawls, both physically and mentally. Just because they have the same symptoms are they both addicts? or are they just physically dependent? To me it could be either or both....am I wrong? and what does it matter? The outcome is the same...

????Me????
 
 
spinal stenosis,degenerative disc disease,bilateral neuropothy.
lamenectomy L3,L4..spinal fusion L4-S1
 


BionicWoman
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Date Joined Jul 2008
Total Posts : 243
   Posted 11/26/2008 9:00 AM (GMT -7)   
To begin deciding if there is an addiction problem, I would want to know more about the "some reason" that they "just happen to run out." For me, there's always a red flag that tells me to investigate further when I see references to "when I take too much" such-and-such happens and/or when someone runs out early. When you're using medication as prescribed, then you don't "just happen to run out."

The second red flag for me comes with the notion of going through withdrawls mentally, which indicates psychological dependence on a drug. Psychological dependence on a drug is not an expected part of narcotic use for medical reasons.

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 11/26/2008 1:13 PM (GMT -7)   
A significant aspect of this is genetic, and may be no fault of the person him/herself. If there is a family history of addiction, then dependence and tolerance may occur more rapidly without there having been any addiction history with that particular individual. I think we have to be careful about blaming too quickly. I've got professional background dealing with addicitons, which I'm not here to specify no to give professional advice (as that's not permitted on the forum anyway), but as a chronic pain patient I now can see a lot of things from the inside out, so to speak, and that has added a new dimension. The concept of pseudo-addiction also needs to be understood, and I also think the total context of how difficult it is for many of us to get adequate pain treatment from doctors is also critical. Undertreated pain I think is far more common than addiction in relation to chronic pain patients; it's just not as sensationalized.

PaLady

uniquelyme
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Date Joined Nov 2008
Total Posts : 1037
   Posted 11/26/2008 7:24 PM (GMT -7)   
The only reason I said that they "ran out for some reason" is because there are many reasons that could happen. Maybe I didn't put what I wanted to say very clearly....it's hard sometimes when I hear it in my head and then try to put it on "paper"....But, I just wanted everyone's input. Sometimes it isn't so Black and White when talking about addiction and dependence. I have a really good friend that has issues with her lower back but she hasn't ever gone through all of the tests needed to find out exactly what is wrong. So, she just takes Percocet and methadone and thinks that's it. She often runs out because she takes way more then she should and then she has horrible withdrawls, both physically and mentally. She has anxiety and takes Xanax and runs out of that too. It has gotten to the point where I'm scared to have her in my house(she might steal mine)...At what point do you cut someone loose?

Me.
 
 
spinal stenosis,degenerative disc disease,bilateral neuropothy.
lamenectomy L3,L4..spinal fusion L4-S1
 


kttn251977
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Date Joined Jul 2007
Total Posts : 554
   Posted 11/26/2008 7:43 PM (GMT -7)   
from my understand opiods attach to the brain which in return causes the pain relief. there is no way, whether the drugs are abused or not, after 6 years of being on opiods she would not have withdrawls. its in her chemistry now. from my understanding withdrawls can take up to a week... and again it can be simply from all those years of using these meds. vh1 has a show called celebrity rehab- it touches on this subject a lot, there is a lady who has been on opiods for 35 years & embarrased when told she may have severe withdraws. its not her fault how long it takes, its in her system. have you voiced your concern about this to her? i'm by far no dr, but there are safe ways to come off these drugs that can come with counseling- which she will more than likely need. i know its probably a tough topic, but if she admits to you she runs out of meds- maybe she is asking for help? i know i had some severe stomach issues that caused me to withdraw from not being able to keep the meds down. i finally went to the dr & once they got my meds in me it was within the hour i felt so much better. combined with the stomach issues it was almost too much. if there ever comes a day when i stop needing my meds i would 100% go someplace safe to come off of them. it was an awful experience. check out that show, i watch it online- maybe it will offer some insight. maybe ask your dr for some info to present to your friend in a comfortable enviroment & a family intervention. i am sure you are not the only one concerned at this point. you are a really good friend, it may get tough- but hang in there & good luck! maybe put a rehab post up & see if you get any bites?
RX's: Oxycontin 60 MG 2x's daily; Oxycodone 30 MG 4x's daily; Soma 3x's daily; Lyrica 100 MG 3x's daily (all for pain & fibro.); Phenergan 25 MG (as needed); Amitriptyline 25 MG 1x at bedtime; Cymbalta 60mg 2x's daily (for pain & fibro); Restoril 15mg at bedtime; Zanaflex 4mg 3x's daily; Metoclopram (as needed) & Senokot (as needed).
"The most critical choice you'll ever make is the one you make about what you're going to do with this. The past is over. The future hasn't happened yet. The only time is now."
- Dr. Phil


PAlady
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Date Joined Nov 2007
Total Posts : 6795
   Posted 11/26/2008 9:33 PM (GMT -7)   
Uniquely,
Your friend is likely exhibiting signs of addiction although that's not 100% because it's always possible she has undertreated pain. Does her doctor know how she's taking her meds? If she hasn't discussed this with her doctor - for example, that her pain isn't being covered by her current dose - and she's just doing this on her own then that's medication abuse.

Our bodies do become physically dependent on a number of medications, as others have said. That's a normal part of the process. Taking your medication as prescribed, and being open with your doctor when it's not covering your pain is how someone who's not addicted would handle it. I'm tired tonight and so may not be clear on what I write, but I would suggest talking with your friend our of kindness that what she's doing is not ok. If she's not willing to go to her doctor, depending on how involved you are with her and her family, you could contact an addictions treatment facility and ask for help. Or see if she'll let you go with her to her doctor and tell him/her what you observe. If she's not willing to do any of this,, you do possibly risk her taking medicaitons from you.

I'll try to re-copy the link to the article I think it would be valuable for you to read. That would help you assess your friend's behavior.

PaLady

If you want, this statement is written by several groups of doctors and helps clarify the difference between dependence, tolerance and addiction.

http://www.ampainsoc.org/advocacy/opioids2.htm

Sorry you'l have to cut and paste the link!

Post Edited (PAlady) : 11/26/2008 9:37:03 PM (GMT-7)


BionicWoman
Regular Member


Date Joined Jul 2008
Total Posts : 243
   Posted 11/26/2008 10:17 PM (GMT -7)   
For me, the statement "she often runs out because she takes way more then she should and then she has horrible withdrawls, both physically and mentally" wraps up in nice tidy package there's a problem that needs to be addressed. Regardless of the reason, she is abusing her medications by not taking them as prescribed.

I "cut loose" anyone that crosses that line and abuses their medications. I will go to the ends of the earth and offer absolute support to my friends and family who are struggling and living with undertreated pain, within the limits of the law. But if they engage in the very behaviors that have created this system and that leave so many of us fighting to receive basic, adequate pain management, I have no place in my life for them. People have told me that I'm too harsh on that topic, but I refuse to support the people who support (by their behaviors) a system that treats me like a criminal because I live with chronic pain.

uniquelyme
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Date Joined Nov 2008
Total Posts : 1037
   Posted 11/27/2008 1:02 AM (GMT -7)   
Bionic Woman

You are NOT being too harsh...We have to be our own advocates because nobody else will. I have to do something, although I care a great deal about my friend, I can't worry about what she might do when she comes to my house or rides in my car. And NO, she doesn't tell her Dr. how she uses her meds. I'm really shocked by the number of people that take advantage of the Dr.'s that actually help us. And there aren't that many of them to begin with. In a perfect World....we would all be pain free. That will be my wish for the New Year.....Pain Free for Everyone!!!!!

Me.
 
 
spinal stenosis,degenerative disc disease,bilateral neuropothy.
lamenectomy L3,L4..spinal fusion L4-S1
 


Hound-Dog
Regular Member


Date Joined Oct 2005
Total Posts : 183
   Posted 11/27/2008 11:30 PM (GMT -7)   
In my case,I have required ever-increasing amounts of opiates just so that I can shuffle around with my elbow-length crutches after my last botched operation over nine years ago.I have letters from some of the best Dr's in the business (Provincially) that state any further surgury has too great a risk of me losing my ability to walk at all.If I was not on narcotics, I'd not be able to get out of bed even, as I can't sit without leaning forward and putting alot of weight on my elbows on the table for short periods of time.So, in other words,even if I could live through the withdrawl period,the excruciating pain would still be there afterwords.I doubt I'd live long being unable to get out of bed.I've never ran out my medications because I take my long lasting narcotics exactly as prescribed no mater how bad a day I have and only use my break-through meds on the very worst of days or "as needed" like my prescription says.This way I've been able to save a few extra pills for the really bad days and not run myself short.We all likely have some days that are better than others so if you can get by until your next dose of long lasting meds without a B/T med, do it.You will sure appreciate your efforts the next time you have a really rotten painfull day and need a little more painkiller.

straydog
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Date Joined Feb 2003
Total Posts : 13454
   Posted 11/29/2008 8:42 AM (GMT -7)   
I have often wondered how people decide to take extra medication that their dr has not prescribed. How do you know if that exta pill or two isn't going to wipe you out or cause serious health problems and perhaps even overdosing? How do you know its safe?

I guess I am too much of a chicken to ever consider doing something like that for fear of ODing and then what are you gonna do? What happens if you end up in ER and they call your pain dr, most likely he will dump you ASAP. Then its on your records and no decent dr will want to touch you.

I guess I have too much of a healthy respect for my medications. Oh there has been times I thought well, if I take one more, maybe that will do the trick. Of course I didn't, because who knows what can possibly happen. Susie


BionicWoman
Regular Member


Date Joined Jul 2008
Total Posts : 243
   Posted 11/29/2008 10:33 PM (GMT -7)   
I certainly believe in taking the least amount of medication possible to effectively manage pain, but I don't quite understand saving the so-called extra pill for a bad day perspective. I've never had a doctor prescribe pain medication "as needed" without the stipulation of a certain number of hours between doses and/or maximum doses per day, which leaves me wondering how one could take their medication exactly as prescribed, but appreciate/take an extra pill on a bad day.

Hound-Dog
Regular Member


Date Joined Oct 2005
Total Posts : 183
   Posted 11/29/2008 11:46 PM (GMT -7)   
My Dr. is well aware of how I take my medications and not only condones the practice but encourages pain patients not to take b/t's when they're not needed.That's the way to end up with an extra dose or three at the end of the month that can be used on really bad days.

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 11/30/2008 10:43 AM (GMT -7)   
Ray22,
Exercising 2-3 hours at a time for chronic pain patients? That could be dangerous. It also sounds like an addictive behavior. And I don't believe the forum rules allow for links to such websites.

PaLady

BionicWoman
Regular Member


Date Joined Jul 2008
Total Posts : 243
   Posted 11/30/2008 12:45 PM (GMT -7)   
I understand not taking the breakthrough medications when they're not needed. What I don't understand is using the extra pills on a bad day.

If your prescription reads take one pill every 6 hours as needed, then you may take a maximum of 4 pills in 24 hours. If you only take 3 pills in that 24 hour period, you have one extra pill; that does not, however, give you freedom to take 5 pills in the following 24 hours of a "bad day" because your prescription equals a maximum of 4 pills in 24 hours.

As I understand proper medicaiton use, if you don't take your full allotment of breakthrough pills per day, then your prescription will exceed the number of days before you require a refill, NOT allow you to take more pills per day when your pain levels are increased. If it were the latter, your prescription would read "take one pill every X hours, unless you have hoarded extras and are having a bad day, in which case you may ignore the limits and take as much as you feel you need."

Piercings
Regular Member


Date Joined Aug 2008
Total Posts : 326
   Posted 12/1/2008 9:13 PM (GMT -7)   
I do believe in the difference between dependence and addiction. To me, there is a HUGE difference. Recently I was reading something written by a drug counselor talking about his patient. This statement is to me a defining point in the debate of dependence over addiction.

Sorry if this derails any debate that you're having over how to follow dosing directions, but I thought it was an interesting statement on where use/dependence turns into addiction.

"He started taking the pills for pain — like most. He later became dependent. Then he crossed the line and started becoming addicted.

When you start having behaviors that you wouldn’t have when you are sober, there is a problem. When the chemical begins to be a primary relationship - like a spouse - and motivating factor in your life, then you know you have a huge problem. This is when addicts use with harmful circumstances."

Hound-Dog
Regular Member


Date Joined Oct 2005
Total Posts : 183
   Posted 12/2/2008 2:51 AM (GMT -7)   
I live in a small mountain town where snowfall or roadslides can cause drug delivery problems and a Dr. that believes that 10 or so days extra of ALL my meds is prudent and has made it so.He has given me permission to take extra b/t if needed and I always tell him how my b/t's are holding out every visit and he prescribes accordingly.I'm not some head-banger trying to get "high" and my Dr. knows that.My oxycodone bottle says "take one or two tablets every six hours AS NEEDED for pain.

Pamela Neckpain
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Date Joined May 2008
Total Posts : 1821
   Posted 12/2/2008 10:55 AM (GMT -7)   
My doctor knows I save a few pills out of my prescribed amount. He laughs and
says, "You just never know when your doctor will skip town."
He knows I wouldn't take a bunch and do myself in. I have his permission to
take extra if I have dental work done or have to go to my out-of-town doctor.
What if the factory burns down? (Could happen in CA) What if the manufacturer
goes bankrupt?
I take really good care of my prescriptions. I think most of the people who post
here take care also.
Pamela

kttn251977
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Date Joined Jul 2007
Total Posts : 554
   Posted 12/2/2008 12:30 PM (GMT -7)   
Hound Dog, my script says the same thing as yours.... 1 or 2 every 4-6 hours for pain. i try not to take 2 just cause it scares me. but, there are days where i have. as long as it is prescribed to you & your dr knows- then you are following orders. we all have days where the pain is worse. but have you considered maybe stepping it up a notch so you don't have to take 2? maybe they just aren't working as well- your tolerence level may be building up. just as long as your dr is aware, ultimatly its up to the both of you what is best for your treatment plan. i know it usually helps if i drink water with my pills & much better when i have an empty stomach. i don't like getting a buzz or that sleepy feeling- but i would take it anyday over the pain. i think maybe some people didn't get all the facts & didn't know it was ok by your dr to take the meds the way you do. my dr allows the same thing- except i get an extra 3 days worth of pills, i don't need that many i try not to take 2 unless i just can't get out of bed. thats one reason i am looking forward to getting the pump- no more pills! praise God, i am so sick of taking pills! i hope this cheers you up some & pray you have a pain free day.-Shan
RX's: Oxycontin 80 MG 2x's daily; Dilaudid 8 MG 4xs daily; Zanaflex 4mg 3x's daily; Restoril 15mg 1x; Soma 3x's daily; Lyrica 100 MG 3x's daily (pain & fibro.); Phenergan 25 MG (as needed); Amitriptyline 25 MG 1x (chronic pain); Cymbalta 60mg 2x's daily (pain from fibro); Metoclopram (as needed) & Senokot (as needed).
"The most critical choice you'll ever make is the one you make about what you're going to do with this. The past is over. The future hasn't happened yet. The only time is now."
- Dr. Phil


BionicWoman
Regular Member


Date Joined Jul 2008
Total Posts : 243
   Posted 12/2/2008 2:23 PM (GMT -7)   
Perhaps I'm a little thick, but I still don't understand how holding your unused medications equates to "You will sure appreciate your efforts the next time you have a really rotten painfull day and need a little more painkiller."

If your prescription reads take 1-2 pills every 4-6 hours as needed, then simple math says you may take a maximum of 8 pills per day. Where does the appreciation of your efforts come in on a really rotten painful day? A maximum of 8 pills is a maximum of 8 pills, regardless of how many days you only needed and took 6.

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 12/2/2008 2:40 PM (GMT -7)   
Bionic,
I think it can depend on exaclty what med you're taking and if there is a MDD. In the example you gave, you could take more than 8 pills a day if you consider taking 2 pills every 4 hours - which one would think would be on a "bad' day. But if there's a MDD then that puts a cap on it. I think it all depends on how the script is written, and insurance companies can weigh in, too. Sometimes I've had my doctor prescribe a certain amount, but the insurance company not give the full amount because of their limitations.

I do agree with you if there's an MDD there's usually a good reason (like too many can be lethal, or at least harmful to the liver, etc.), but that may not be true in all cases because it's so variable.

I'm actually more of a hard head when it comes to taking meds as prescribed, addiction issues, etc., than I sometimes appear on the forum because things may not be written clearly in some cases. Yet in others it's quite obvious there's abuse. I hope I'm making some sense! LOL

PaLady
BTW Pamela's comment about the fire burning the factory isn't so far off base. Years ago a factory that made one of my seizure meds. was destroyed in a hurricane, and they became very limited. It was quite scary for me as aburptly discontinuing these meds would likely cause a seizure. I'm actually more concerned about those meds than my pain meds!

Post Edited (PAlady) : 12/2/2008 2:46:05 PM (GMT-7)


BionicWoman
Regular Member


Date Joined Jul 2008
Total Posts : 243
   Posted 12/2/2008 10:21 PM (GMT -7)   
You know, I tried specifically not to do it and I did it anyway..  that 8 in my last post should have been a 12.   tongue
 
I guess simple math isn't always so simple when you've programmed yourself to understand that when the doctor writes 1-2 pills every 4-6 hours, he actually means 1 pill every 4 hours (6 a day) OR 2 pills every 6 hours (8 a day).  I recognize that some doctors write that and allow 2 pills every 4 hours, but I've never had one that does, so I come pre-programmed to read that as 8 pills a day.  redface
 
It doesn't really change why taking fewer on a good day would directly benefit a person on a bad day?  

Hound-Dog
Regular Member


Date Joined Oct 2005
Total Posts : 183
   Posted Yesterday 1:57 AM (GMT -7)   
The break-through medications of fast acting morphine or oxycodone are for exactly that...break-through pain.When it gets to the point that I'm using all my prescription of b/t's and then some just to be able to walk, then it's a sign the Dr.looks for to raise the prescription of long-lasting meds.The first thing a pain patient needs is a Dr. that's willing to control ones pain and trusts in the patient to use the drugs for pain control only. Because some of us get a cocktail of pain-killers,the b/t's aren't prescribed on the patient having to take the max amount for 30 days at a time but still a decent amount so on a good month you can have a few left over.
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