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Re: Holding up only for my family, and failing

Posted by musil on February 24, 2005, at 19:49:19

In reply to Re: Holding up only for my family, and failing musil, posted by Phillipa on February 24, 2005, at 19:12:16

With my pristine references and experience, I could land a job similar to your spouse's opportunity anywhere but here, easily around $90k if not more. But I've never survived long in the rat race -- I get sick and get squeezed out. My references on paper and my performance reviews are outstanding, but secretly my health record is permeating the HR offices of the places I might work.


Due to my congenital deformity with my rib and scoliosis, pain was a chronic problem. Therefore, I decided to try opiates, starting with oxycodone (short half-life, around 4-6 hours), with a high probability of steadily increasing tolerance as the number of opiate receptors naturally decrease in proportion to the increased opiate agonists present in the brain. Hence OxyContin, which is a specially formed time-release pill that releases oxycodone gradually over a period of 12 hours via a plastic matrix that the pill is made of. After reaching a maximum of 180mg of OxyContin/day, my doc cut me off at that level and I was left with pain due to opiate tolerance and a heavy amount of withdrawal ahead of me to knock down my opiate tolerance.

Enter suboxone, which was approved last year (though it's been in use in Europe for many years, of course, Damn USA medicine). Essentially buprenorphine (opiate, strong) and naloxone (opiate agonist, like Anabuse), it is a sublingual tablet and the naloxone is included in the tablet to avoid diversion of the pill to the street users (shooting up suboxone with the naloxone will make you very sick, as naloxone is an opiate antagonist, filling up the opiate receptors so that there's no room for the opiate agonists).

But Naloxone can't pass through the gut or sublingual barrier, so if taken correctly under the tongue, the tablet permits the buprenorphine to pass into the bloodstream while the naloxone passes through the intestines and is hardly metabolized in the body. There is a version of the sublingual tablet called Subutex, which is bupe without the naloxone, but the FDA is very afraid of this med being diverted for abuse on the street, so unlike Europe where bupe alone is often prescribed, suboxone with naloxone is the standard here in the USA.

In order to transfer from OxyContin to Suboxone, you have to at least get down to 80-90mg OxyContin , which is extremely difficult to taper and is just about the worst experience since the pain isn't being treated any more and the withdrawal is a horrible experience. Then you can switch over to suboxone from OC (or other compatible opiate dosage, like heroin, morphine, methadone, etc) and the swap eliminates the withdrawal symptoms while also taking away much of the pleasure or euphoria associated with opiates.

The good news is that suboxone is actually great for treating depression, IMHO, and it has an extremely long half life of around 30-40 hours so dosage can even occur every other day.

An MD must participate in an 8 hour seminar and pass a simple test to Rx Suboxone, and the MD is then put on a National Registration List (at
http://buprenorphine.samhsa.gov/bwns_locator/index.html)
and the MD cannot accept more than 30 suboxone patients.

I myself have tapered down to 2mg per day, but I'm back up to 12mg to maintain pain control. Fortunately, it's much easier to taper from suboxone than from oxycontin, even though it does suck and will usually bring on an underlying depression. As it does always in my case.

So my pdoc loves suboxone (I wonder if he likes it himself?) and if this diatribe helps anybody then great, cause it'll still be here when I'm good and gone. The question is when I'll be gone for good. I can't leave my kids with an self-offed-Dad, and so it must be that my perception of my worthlessness is not based in reality even though it feels so strong to me.


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poster:musil thread:461152
URL: http://www.dr-bob.org/babble/20050222/msgs/462916.html