Author: honeywhite

Posted: Mon Feb 27, 2012 1:11 am

Since the age of 13, I have been taking opiates IN MODERATION for chronic pain. I started with morphine (and the occasional hydromorphone), and since an MVA approximately three years ago (I am now 19), this was briefly supplemented with oxycodone. Once again, it must be emphasised that my opiate use was and is firmly in the responsible zone.

As someone who has been on every opiate available, I have formed preferences as to which is best, and I flatly refuse to take others. The classic opiates are the best; these include (dia)morphine, hydromorphone, oxycodone, and fentanyl, although I will not take fentanyl patches due to the O/D risk. I will not take pethidine (demerol) or anileridine (leritine) for their neurotoxicity or tramadol or tapentadol for their thymoleptic (SSRI) activity. I have taken methadone for cough that would not go away and later suffered my first and last episode of drug withdrawal; I liked methadone but hated the very long withdrawal period. I have experience with ketobemidone (ketogan), dextromoramide (palfium), and dipipanone (diconal), but none beats the classic opiates.

I was referred to a doctor who treats primarily addiction cases, but this fellow (who I shall call Dr Smith, because that’s his name ) agreed to treat my pain even though no addiction existed, then or now. He is a certified neurologist BTW. His favourite opioids, in order of preference, are buprenorphine and hydromorphone. Score! I originally insisted on hydromorphone, my favourite opioid. However, Dr Smith refused to supply it unless buprenorphine was first trialled, and I was quickly started on 14-16 mg of Suboxone.

Now, let it here be said that, in the UK, Suboxone (or a version thereof) is used to treat pain, not just the patches. For marketing reasons, the pain version is called TEMGESIC and is priced lower than SUBOXONE. Temgesic is available in 200 µg, 400 µg, and 2 mg versions; Suboxone is available in 400 µg, 2 mg, and 8 mg versions. Both contain the same ingredients in the same ratios: 4:1 buprenorphine/naloxone. The naloxone is included, not as common myth has us believe, so as to discourage abuse by the intravenous route, but to discourage the primary side-effect of opioids (included in morphine and in oxycodone for the same reasons), namely, difficulties in the lower digestive tract. This is due to buprenorphine binding almost irreversibly to receptors; naloxone will not dislodge it in any way approaching reliable (more on this later). For pain, Temgesic is taken four times a day; it is favoured especially in cases of laryngeal malignancy. Canadian doctors have not yet learned of this excellent use of buprenorphine and provide it for that most insidious killer, addiction, only.

Except Dr Smith, apparently. He put me on buprenorphine for my pain, and it has quickly become my opiate OF CHOICE. Sure, it might not offer instant relief, but I’d much rather relief that lasts. Dr Smith, however, was ignorant of the appropriate manner to dose Suboxone in chronic pain; he prescribed it to be used in the time-honoured protocol for addiction management: once per day, supervised. I had issue with this and will now be permitted to dose it in the British fashion, four times per day, self-supervised. This allows for dose variation, which Dr Smith dislikes intensely, but I favour (narcotics are addictive, after all, and it is nice to take a holiday once in a while). My prescribed dose is 14-16 mg, but I don’t take this much as a rule.

There’s a bit of a problem, though. Buprenorphine is an excellent anti-depressant and anxiolytic. It is better than morphine and oxycodone in this respect, and it rivals hydromorphone, my formerly favourite opiate, in its characteristic euphoria. One part of me likes, nay, LOVES this. No aggression, no anxiety, sleep better, driving skills improved. I haven’t ever felt better. However, a part of me hates feeling better. Somehow I feel like it’s a sin to feel this happiness, although it differs in no way from the happiness of the common man. I wake up feeling fine, too. Then I read the horror stories of withdrawal and on a recent trip to Finland saw the sadness of being a slave to the familiar white hexagons… heroin has been displaced by buprenorphine, and now I know why.

I am on pain blockers (injectable Marcaine) and on toradol, an oral NSAID. What do I do to handle my pain and depression? Should I listen to my instincts and take buprenorphine, the fix for my troubles? Or do I clench my teeth and live through this shit? Toradol is known to RAPE the kidneys, and I’m not too sure the Marcaine is a perfectly healthy solution either.

There is obviously abuse liability with Suboxone but I have not caved in at all. Buprenorphine is an irreversible agonist/antagonist; I know for a fact that injection of the Suboxone formula is possible and has recreational value. I have been tempted to try it, but I have a brain and know how to use it.