Skip to content
My WebMD Sign In, Sign Up
Includes Expert Content
Very high tolerance to all Narcotic medication..Why?
avatar
rjbeck77 posted:
I've been hospitilized 28-times since 2005. First for a Pneumothorax that required a Thoracotomy/rib resection and decordication due to an empyema.Before this only had mild asthma. Then in 2008 another empyema but in the other lung with a pneumothorax but I was treated @UNC Chapel Hill instead of South Florida. I came down with avascular necrosis in 6 joints knee's,hips,shoulders due to prednisone use. Replaced left hip and right shoulder. During this time I was being seen by a Pain Management doctor since 2007 And I've tried every pain med. In the hospital I was put on fentanyl thru a central line and was on a dose of 225mcg's I don't know the frequency but the surgeon told me he could only do this for 24hr's because it was a super high dose that is used for anesthesia so they put me on dilaudid thru my pump. I am on fentanyl patches 200mcg's every 48hr's and my doctor told me there is no where else to go. Then they suggested subutex with a dosing of 3times daily I don't know the dose..Does this sound correct..could this medication help? Any advice is appreciated..Thanks Randy
Reply
 
avatar
77grace responded:
Hi and I wish you lots of luck!!!Subutexis similar to suboxone but has no angtaganist,Iknow it helps some people with pain it did not elp me and I took it 34 times a day!Maybe nopt ther same dose,give it a try????Good luck! 77grace
 
avatar
Peter Abaci, MD responded:
Subutex contains the active ingredient buprenorphine. Bupenorphine is considered to be a partial agonist and antagonist on opioid receptors. What that means is that it binds to the same opioid receptors as does the fentanyl and has some activity on them but there is a ceiling where the effects level off. The antagonist part means that it binds very strongly to these receptors and it would essentially block other opioids like fentanyl from binding thereby negating their effect.

Subutex could be an alternative medication for you to consider. We have been using medications like Subutex for several years and have found it to be a good alternative to high dose opioid therapy for most who have tried making the change. There are a number of reasons for this. Many patients report feeling more clear-headed and like their old selves after making this type of change. When the body develops a tolerance and continues to feel like it needs higher dosages, the buprenorphine seems to help diminish that craving.

You may have heard or read about something called opioid-induced hyperalgesia which is a theory that prolonged opioid use can make the body more sensitive to pain. In cases like that, buprenorphine may also be a good alternative.

Despite some of the potential benefits that it may have, it is important to also remember that pain management can be a very comprehensive specialty that encompasses much more than just medication therapy. It would be reasonable to talk to your doctors about other approaches to help you with your pain. It is also understandable to be anxious about making any medication change and you should be able to receive the appropriate education and counseling to help you work through that in a supported manner.
 
avatar
dfromspencer replied to Peter Abaci, MD's response:
Thank you, Dr. Abaci

I was going to post a simular question, but you have already answered it for me.

Thanks!!!

Dennis
 
avatar
Onehurtguy replied to dfromspencer's response:
When I got "up there" with respect to my prescribed opiate medication, I remember my PM telling me "I don't know that I feel comfortable going up on your medications again". I knew at that point that my prolonged usage had left me extremely tolerant, and I needed to do something about it immediately.

I did not want to continue, as even my PM was getting worried about how much I was taking daily. When I look back at my first opiate, that single 5 mg Vicodin used to provide relief and 7 years later I was taking 300 MG's daily. I decided that I would completely detox my body and get back to a manageable dose, which is I guess what I'm suggesting to you...

Fortunately, I'm not an addict, I'm dependent on opiates, so quitting was purely physical. Withdrawals, while hellish was nothing compared to the pain I had to bear while letting this stuff get out of my system completely. I made it two weeks before I just couldn't take it anymore, but it worked, and I was able to go back to 40-60 MG's per day vs 3-4 hundred. Two weeks may not sound like a long time, but for someone with my issues, trust me, it was an eternity. I had left over medication that I could have taken anytime to stop my ride on the roller coaster of pain. At first I refused, after a week, I knew that I would overdose if I took those pills.

Maybe it's time for you to clean this stuff out of your system, and "reboot" your system. It's worth it, as every doctor has his limits as to how much they feel comfortable giving you, and I'd much rather have this be my decision than to be forced to detox. For me, it was quite liberating, knowing that I could quit anytime I wanted to instead of fearing running low on my prescriptions.

Either way, good luck, and know that you can do anything you need to, just steel your mind!

I don't know that there is a dose of Subutex high enough to keep you going. Stay close to your MD.

R
 
avatar
ctbeth replied to Onehurtguy's response:
Hello Mr R,

I've written this a few times, and I so loathe to repeat myself, so just skip to the next paragraph if I've told you about my dead SCS battery, ok.

I am not going to increase my MSC or add back the OxyIR PRN, which was the first med that I dc'd. After that, I significantly down my MSC.

The abrupt discontinue and ninety-day "holiday" are being postponed until I get my battery surgically changed.

I am still grateful that you've offered to assist me, and I do have some questions that even mt PM MD cannot answer, since he has not been in our situation. Mostly, about receptor healing and what sort of "re-set" I can realistically expect.

I'm hoping that when I'm through with holiday, that I'll be able to use Butrans for my LA and Tramadol fro BT.

I have Tramadol for BT now and I find it helpful as oxy IR, for me. Many do not like it, but I've had a wonderful success with it.

Mostly, I'm hopeful that I can not increase my opiate during this time between now and battery change,

My pain right now, without the SCS, is insane. Hence, 3 AM and I'm clacking away on mt Ipad after watching a 1966 British movie.

Have you ever seen "Alfie"? Michael Caine is brilliant~ was then: is now.

Thank you for your support regarding the acute pain vs chronic pain.

CTB
 
avatar
Onehurtguy replied to ctbeth's response:
Hey Beth, sorry to hear about your battery, that must be terrible.

Is there a way to send a personal message to one another on these forums?

Let me know, I'll send you my emails address.

I can imagine your pain level is out of control right now and I sincerely feel for you. Constant pain will make you crazy by itself, not sleeping on top of that is a really bad combination.

R
 
avatar
Onehurtguy replied to Onehurtguy's response:
You know, I was thinking last night about how much medication I was taking before my detox, and after coming up with the grand total per day, I'm stunned...

I won't go into detail, but it was all prescription opiates given to me by my PM, totaling 760 MG's every 24 hours for over 12 months straight before my re-boot.

WOW! I honestly was taken back when I sat and figured this out...

I guess what I'm saying RJ, is that if I could go absolutely cold turkey from nearly 800 MG's of Oxy-everything to zero for two weeks, including 4 days of withdrawal, while suffering mind blowing pain levels with almost no sleep and not lose it, anyone can, you just have to want to do it, and know that you'll be in a much better situation when you're finished.

Testing your mental and physical limits is something that I was used to before my accident. Whether is was Triathlons, or surfing, running a massive company, or just raising four kids and cherishing my marriage. Anything worth while is going to cause you some work and pain.

As I hinted to in my earlier post to you, once you do it, you'll never fear a prescription bottle again, or anything else for that matter.

People have ZERO concept of what we go through everyday, and like CTB said, "our physicians don't even know, as they've never been in our shoes". I would say the certainty that people in our shoes are some of the strongest ever made.

Stay strong, hope this helps!

R
 
avatar
rjbeck77 replied to Peter Abaci, MD's response:
Dr.Abaci,
Thank you for taking the time to answer my question. Before this I was told by many other pt's that it was going to be the worst mistake to change to that medication but you and my PM doc both agree that this might be the best thing for me at this time.. Also besides the medication therapy I am seeing a psycologist who specializes in chronic illnesses and has put me on an antidepressent plus every 3 month's I speak with another Phd about my situation. This seems to keep me sort of grounded and helps me vent my frustrations of one minute being a very healthy 37 yr old to being a 45y/old unable to work.Thank You very much R.B.
 
avatar
ctbeth replied to Onehurtguy's response:
Hello again, Mr R,

My email address is bethhuntington@live.com

Yes, my pain level is way up there. I'm horizontal right now and have only been up once for tea.

I slept a few hours and hope to be able to have a nap later.

We have six seasons of Doc Martin, two of Wallander, and about twenty of Poirot downloaded. These are my favourite BBC shows. I'm hoping that they can be a distraction.

The meteorologists are warning about the storm that's to begin within a few hours. That's good as the atmospheric pressure starts to rise soon as the precipitation begins.

Any relief is significant right now. I hope you're feeling relatively well today.

CTB


Featuring Experts

Peter Abaci, MD , is certified in anesthesia and pain management by the American Board of Anesthesiology. Dr. Abaci received his undergraduate educat...More

Helpful Tips

Every Chronic Pain Patient Needs to READ THIS!!!
There is a group of thirty seven Doctors, Companies. and Researchers that are petitioning the FDA to change the labels on Opiates so that ... More
Was this Helpful?
44 of 49 found this helpful

Related News

There was an error with this newsfeed

Report Problems With Your Medications to the FDA

FDAYou are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.