Pain Management Community

All the opiates have the potential for addiction and abuse. Fentanyl is no different than the oxycodone or the morphine or the lollypops would be. The lollypops are also fentanyl, so I doubt that would be a very good idea for you. I don't understand what the difference is between a drug patch on your arm or taking pills all the time?

It is important to remember that addiction is a side effect in up to 5% of the people who use opiates for pain management. This is an important thing to remember and it is important to catch this quickly and see an addiction specialist right away.

Your doctor is handling this correctly from the medical stand point. Switching to another opiate, Avinza, and gradually decreasing the fentanyl is the best bet for tapering off the fentanyl without withdrawal symptoms. But, what are the odds that you will switch your abusive behavior to the other opiate you take? They are pretty high.

Are you seeing anyone to treat the drug abuse? You need to add an addiction specialist to your treatment team. Addiction or drug abuse is a medical illness that needs to be treated, it does not magically go away.

What other meds are you using for your pain? What non-drug treatments have you tried?

Take care, Annette

Hello Paul. Sorry to hear about your trouble with Fentanyl. If you fear withdrawal from Fentanyl, ask your doctor about Suboxone. It's a well-tolerated opioid antagonist. Using Fentora or what you call the "lollypop" would be pointless. They both contain Fentanyl.

When one becomes tolerant to a narcotic pain medication, it is best to rotate to a different narcotic for a while. You can then return to the original narcotic and it will be more efficacious. But you should understand that Fentanyl is far more powerful than other long-acting narcotics. You might discover (as I did) that my pain was uncontrollable with the other medications. I returned to Fentanyl and used a larger amount. This allowed me to work 9 years longer than I had imagined possible. Used as directed by a physician, patients can take large amounts of narcotic pain medication and still function quite normally. Many of us also have an unusually high tolerance for CNS depressants. We require larger than normal dosages to achieve the same results.

Research reveals that less than 5% of all chronic pain patients using narcotic medications become addicted. That is a very small chance. I'm not suggesting that you are or are not addicted. But, please select your words carefully here. Addicted patients obtain multiple prescriptions from various physicians, purchase it illegally from dealers, burglarize pharmacies, steal medication from friends, run out far too early and use abnormally large amounts. If that's you, then I'll take your word for being addicted. But, it's very important that people here understand the difference between tolerance and addiction.

Tolerance is a PHYSICAL need to take larger amounts of medication in order to achieve the same effect. Addiction is a PSYCHOLOGICAL condition in which people take medication to achieve a "high." Addiction and tolerance are very different in nature.

The vast majority of people who use Fentanyl do not become addicted, experience significant respiratory depression or have abnormal problems with tolerance. It is the most powerful pain medication. I suspect that most people would rather use it and be tolerant than use something different and deal with higher pain levels.

Thank you so much for your response. I only see one doctor and I am very honest with him. When I first came to see him I was on 150mcg and I was very tolerant to it. He doesnt use Fentanyl much so he thought that was a crazy dose. He didnt want to go higher so we started to drop and I was going to be put on morphine. at first we dropped from 150 to 100. That drop was too much and I started to abuse the med rather than just call and tell him. I eventually had to tell him because I was going to run out. He was very symphathetic with me and agreed that we droped to fast. We then started with 12mcg per month drop. Now that I am down to 87 1/2 along with 30 Avinza and 30 oxycodone x4. I am just obeseed with the patch. I not only am in a lot of pain but my body and mind is just craving more.

I saw him today and told him that I really just want to get off of it infear that I will abuse it and run out. We agreed to drop to 50mcg and raise the avinza to 90 and take the oxy x4. Hopefully that will make me more comfortable and not so obsessed with the patch.

I am very dissapointed that all this happened because like I said for the first year -year and 1/2 it was the wonder drug for me. I have been on a lot of heavy duty meds before. 120 methadone with oxycontin and oxycodone, then I was on straight oxycontin 80 x2 then I was put on the patch and felt like I got my life back. I never felt the need to take extra of any of those pills. Even now I dont feel the need to take extra Avinza or oxycodone. I am just in fear that I will take the patch off and try to get it all into my system at once. I have done that in the past and its VERY dangerous.

Bottom line is that I know I have an issue with Fentanyl and know I need to get off. I think the decision that we made today will be helpfull.I really dont consider myself an addict at all. Especially after what you Posted, that made me feel much better. I dont do any of those things and I have nothing to hide from my Doctor.

I also havent had an epidural in a while. Those really help a lot. Thanks again for the reply it was very helpfull.

Paul

I also need to make it clear to anybody who has read my post that I dont want to get HIGH on my meds. Fentanyl never made me high even in large amounts what I am craving is what the med made me feel likein the begining and that was pretty much pain free and able to sleep, and function on a job without feeling drugged or having lots of breakthrough pain. Fentanyl was the only med that didnt make me feel medicated it just worked really well untill I became tolerant. Then I would get tired and have breakthrough pain and yawn a lot, it was starting to feel like what I read about withdrawel symptoms. I hope im explaining this properly. Sometimes I have a hard time putting into words how I feel.

I appreciate everyones feedback and opinion.

Suboxone is a combination drug, it contains buprenorphine, a narcotic which contains both opiate agonist and opiate antagonist properties and naltrexone. Naltrexone is a pure opiate antagonist, and is often given as an antidote for opiate overdoses.

According to my drug handbook Suboxone is indicated only for opioid dependence. Plain buprenorphine (without the naltrexone) is indicated for pain or for opioid dependence. Often once a drug is approved for one indication, it is often used for other off label uses.

Discuss this and other treatments with your doctor and see what he can come up with to help you.

Take care, Annette

I was on the fentanyl patch as well. My doctor gave me a "detox" patch and I was able to be completely off fentanyl in two weeks. It was suposed to be a 4 week treatment, but it worked very well. Hope this helps!

Hi Charles,

I have not been on this sight. I have fibromyalgia - very painful!

I just had a discussion with a friend of mine who is a pharmacist. He is very knowledgable. Although I have not had to come this route yet, a friend of mine has and from what I have heard here, I tend to agree with you.

It looks like to me the words you are using, such as tolerance, physical need, psychological addiction, achieving a high, are terms that people tend to use incorrectly.

It sounds like Paul is going through a lot, but running to an addiction center is not always the answer; it could be. What I am saying is it needs to be thought out thoroughly and talked over with doctors - DOCTORS. Many forget that holding down a job in this economy is difficult right now. I do not know what type of work you do, but if it was government related or somehow sensitive, which is the case for many, one could lose their security clearance.

So, many things need to be tossed around here. It is so straight cut, especially in talking on a message board. Paul may need the help, but he also "may not" be "addicted."

I think that your advice is good. This is my opinion. Ann

Thanks Annette. I have spoken to the DR. about Suboxene. He is liscened to prescribe it. So far the dose of Avinza that he has given me in combonation with the 50mcg patch is working well. I have no desire to abuse the patch at this point. Next month we will drop to 25mcg and go up on the Avinza. After that I iwll be off the patch and on Avinza with Oxycodone for breakthrough.

Since yesterday I have not needed the oxy. I am not having breakthrough pain. Since I have a low tolerance for pain and a high tolerance for opiods, will the suboxene control my pain?? Last summer I was on it for a week. I was in the hospital for severe depression and asked the drs if they could detox me?? I was taken off the fentanyl and after 3 days took suboxene. I didnt like it at all. I went right back on Fentanyl after about a week.

I think maybe because I went from 150fentanyl right to suboxene it was to quick. I thought the suboxene was making me stomach sick and I also felt very anxious on it. What do you think?? Can I be on suboxene and oxycodone for breakthrough?

I personally have not seen any medical literature that indicates Suboxone is safe and effective for chronic pain on a long term basis. Are there any studies of Suboxone that have been completed for chronic pain? I know I haven't seen any that indicate it is better than the older opiates that have been used for that purpose for many years. I have never seen any good studies that show any one opioid is better than another for chronic, non-malignant pain.

I don't wish to be anyone's guinea pig. I tend to use tried and true meds rather than new ones with lots of promises from the drug companies about how great they are. I won't use a drug until it has been widely used for the indication I need for at least five years. I have been a nurse for 39 years and have seen many drugs come, and many drugs go by the wayside after they proved not to be as great or as safe as their makers said they were.

It is hard to tell if the Suboxone was making your stomach sick and causing anxiety or if it was opioid withdrawal from the fentanyl detox.

I am not clear what you mean by your abuse of the patch, I simply take your word for it that you feel like abusing it. If you can use the Avinza and oxycodone combo, they control your pain, and you do not feel any urge to abuse them, then I would stick with them. I would also talk to an addictions specialist and get clear on abuse vs. just needing relief from pain. If you have any tendencies towards abusing these very powerful drugs, you need to deal with that. Drug abuse can be a terminal illness if left untreated. It is far easier to control if treated early on in the disease process. People with a history of drug abuse can still use opioids for chronic pain, they just need a little extra help to avoid relapsing.

Keep in touch.

Take care, Annette

Hey I was there. I was on the patch at one time. It is to bad that you do not want to use methadone . I went to a pain management Dr and he put me on methadone 10 mg five times a day for two weeks. Then after that i took some drug that hepled me not get sick.. forgot what that was.sorry but maybe your dr can get you off the patch with methadone until you are off the patch... then give you something else after.. Hope that you do well.. I know that my health problems are very depressing, and painful... allmost parlized at 32 my t-9 t-10 ruptured and had my spinal cord pinched off I was allmost parlized have surgery or be in a wheel chair... So keep smiling Life has to get better Cat

Paul said that he wanted to stop using Fentanyl. I recommended Suboxone because it is an opioid antagonist. I have never suggested that Suboxone would be effective as a pain medication. I've seen no solid (control group, double-blind) research that supports that conclusion.

Perhaps Paul has confused tolerance with addiction. Maybe Paul has mistakenly suggested that the pain relief he experienced with Fentanyl is associated with addiction. I've used Fentanyl (Transdermal) for many years and I know how powerful and effective it can be for reducing chronic pain. There is nothing wrong with desiring a stronger dose of a drug that removes pain. THAT DOES NOT IMPLY ADDICTION. And, the fact that Fentanyl was designed for the opioid-tolerant patient may further mask the real benefits versus the potential for abuse. After all, no one can blame a patient for enjoying the pain relief offered by Fentanyl, even if the patient might confuse relief with "addiction."

Addiction is a psychological disorder. It happens to LESS THAN 5% of patients using narcotics for chronic pain. When I use Fentanyl, it makes me feel better. I have less pain. I like it. I want more of it. THAT Doesn't MEAN I'm ADDICTED. I would much rather have a decent life with Fentanyl than live endlessly horizontal, with horrifying pain, without it. So, I choose not to abuse it. I have the discipline to use only that which is directed.

Let's put the addiction debate to rest. If you have chronic pain and you have a history of drug abuse or addiction disorder, then you might have reason to fear using Fentanyl. But, if you don't have a history of addiction disorder (more than 95% of the population), then you have nothing to fear from Fentanyl. In fact, Fentanyl could give you what it gave me - 9 additional years of work and a decent quality of life. Without Fentanyl, I would decide not to live. With it, life is more than tolerable. It's that potent.

In conclusion, I would much rather use Fentanyl, than to stop it and live in severe chronic pain. Unless Paul has a history of drug abuse or addiction, he should have no reason to stop using Fentanyl, which apparently helped to control his chronic pain. In reality, very few people have an addiction disorder. And, in reality, Fentanyl is a safe an effective drug for relieving chronic pain. I feel sorry for people who live with unrelenting severe pain, when they could have successfully treated it with Fentanyl, or another powerful narcotic.

Paul: You have said nothing(except in your first post, of course) that leads me to believe you are talking about "addiction" at ALL! It sounds to me that you merely, finally, got your pain under control, since you said you never achieved a "high" from the Fentanyl. To be addicted, you must be going for a high, not merely pain control. If I were you I'd talk to my doctor and ask him if he thinks you mistakenly thought you were addicted, when in reality you merely got your pain under control. That's a good thing in my book. You DO feel better, I guess it could be almost like a "high" if you are used to being in pain all the time and it is suddenly controlled completely. Most of us don't EVER get complete relief and maybe since you did, you just thought you were addicted, when you just felt like a million bucks because you were pain free?

Just a thought. But if you were NEVER going for a high? I would re-discuss this with your doctor because you could be making the biggest mistake of your life if your pain was controlled and now it won't be. As Charles said, most of us accommodate, meaning we don't "feel" the medication, especially after taking it for a while;, but it still helps with the pain. I personally haven't felt a narcotic pain med since the second or third prescription I went through, and I was actually glad when that happened. To get pain control without side effects is a blessing.

Now, maybe I am just not understanding your issue though. I'm happy to announce that after 16 months of working with my doctor, I finally am on the right meds at the right dose to take care of my pain the best it's ever going to get I think. Sometimes it just takes a long time working with different meds, but if Fentanyl was the one that helped you the most, I'd not give up on it quite yet, unless the doctor refuses it to you after what you've told him, now that he thinks, and evidently you do too, you're addicted instead of dependent with proper pain relief. Dependence is something most pain patients deal with. And since you are coming off it, make sure to take THAT as slow as possible so you have limited withdrawal effects. But you and your doc know this.

Good Luck, and please re-check your symptoms and make sure you were not just feeling well because your pain was controlled.

Rick

you can ask for soboxin but as soon as you take it you get withdraws right away but the next day your fine

Hey There Mrs. Bobble-Ty Boop, Cookety Cooker Bop lol, you ARE Funnies Funny bummy hehehe or lmFao ... In the 1st statement of MCL's (myself C.Lombardi yes the hip-hop "ICON") Anyways a drug abusing addiction?, is NOT NOT NOT NEVER EVER EVERLY a Medical Condition Ok?. I have been Hit, Hurt, Killed, & revived on multiple occasions & I don't got a "Drug" problem there skip diddly doo bop person. I have what most "un-abusing" pain people got. It's called Way High Tolerence & Excrutiating Pain!!!, I been on Fenty now Fo?, ... Oh God?, like 3years & at first the patch on my arm really did werk Fo Pain but w/ such a high Tolerence it exhausted itself very very very VERY quickly I Hate my opiate Tolerence which is something I cannot control. I was on the OxyContin 80's 3Times a Day, w/ side dillauted 8's Fo Pain med's. They upped me @ first to 100mcg's a Fent, DIDN'T WORK, soo "B06"B06"B06, 125,150,175,200 I'm addicted & Want OFF!!!!!, what can I do?, MCL