I often hear from people on pain medication about how difficult their lives are, but who go on to say that they are not ready to make changes. As we move into 2013, I encourage anyone taking narcotic pain pills to give the options serious thought.

Most people have heard about the epidemic of overdose deaths in the heartland of the country.  One question I pose to new patients is whether they have lost anyone from overdose, and it has become rare for people to answer ‘no.’  No person expects to die from overdose, and yet death from overdose has surpassed motor vehicle accidents as a leading cause of death for America’s young people.  Overdose usually occurs  when a person combines potent opioid pain medications with sedatives like Xanax or Klonopin, although heroin has become a larger and larger factor as well.

Every person who takes opioid pain medications faces some risk of respiratory depression and overdose.  Changes in absorption from the intestine can occur becaue of changes in food intake, and the breakdown of opioids can be affected by interactions with other medications, both with the potential to cause dangerously-high narcotic blood levels.  But even patients not personally involved with overdose are affected, because controls over narcotic medications have increased, and fewer doctors are willing to prescribe opioid pain medications.

When a physician stops prescribing opioid pain medications, his/her patients enter a period of intense suffering due to withdrawal from the medications.  Some patients so cut off end up purchasing pills from friends or relatives.  And some people, as withdrawal becomes severe, begin using Heroin, which has actions very similar to oxycodone.

As much as I feel for such patients, I am pleased to recognize that many have entered a period of opportunity, and a chance to be free from the shackles of opioid pain medications.  On pain pills, people live according to a 4-hr cycle, becoming deathly ill if medications are not available at regular intervals.  That schedule demoralizes a person over time, as humans long to be free– and being on pain pills is anything but being free.

A new approach to treating pain has appeared over the past few years;  an approach that many patients find more compatible with freedom and happiness.  Buprenorphine is a potent pain reliever that has a ‘ceiling effect’ to its actions in the brain, causing the medication to have unique properties.   For example, tolerance to buprenorphine is limited to a certain level, and doesn’t reach to the sky as with other pain pills. More important, when patients are prescribed an amount of buprenorphine  in excess of that ceiling level, the brain does not experience variation in opioid effect over time.  In layperson’s terms— there is no wearing off, and no withdrawal.  Plus the long half-life of the medication allows people to take just one dose per day— escaping the misery of the 4-hour roller coaster ride.

Changing from one pain medication to another can be difficult, as most patients know.  To most people on pain pills, the medications become a trusted friend, even as they exert greater and greater control over a person’s life.  But with careful consideration, a change to buprenorphine does not have to be difficult or uncomfortable.  Special considerations are taken for every person’s clinical situation, and care is taken to avoid discomfort.  Within 2-3 days, a person who has been stuck on frequent pain pills can gain control over his/her life.  The misery of counting the hours or waking up sick can stop– and does stop.

If you are tired of being sick and have questions about getting your life back, consider sending an email, with specifics about your case, to drj@fdlpsych.com .

As a recovering opioid addict, I know too well the misery of withdrawal from potent opioids.  As a physician and scientist, I use my knowledge to help others avoid the misery that often– even usually– comes with use of opioid pain medications like oxycodone, Oxycontin, Vicodin, and methadone.

In the past, great efforts have been put forward to ‘dispel myths’ about opioid pain medications.  Doctors, nurses, and patients were told that the risk of addiction is low for people with actual pain, and that more pain medication should be prescribed.  We now know that much of that encouragement came from policy centers with significant connections to the very pharmaceutical companies that manufacture such medications, and that tens of millions of dollars were paid to these centers to do ‘research’ that would support the recommendation to prescribe more, more, and more pain pills.

Pain Stinks

I have great sympathy for those people who live with chronic pain.  I recognize that pain has a cumulative effect on a person’s mood, energy level, and quality of life.  I am NOT saying that people in pain do not need or deserve treatment.  But as I will describe, current treatment approaches do little to reduce pain and improve quality of life.  And worse, the use of opioids comes at very great costs.  People taking pain pills become greatly focused on the number of pills remaining each month, knowing that running short will mean significant misery, to put it mildly.  And even the people who stay on schedule must be careful to avoid theft or loss of medication.  All people taking pain medications are familiar with the attitudes from health care practitioners and pharmacists, who treat patients on opioids as if they are guilty of some unstated crime, or as if they are drug addicts.

But the main problem wtih current methods for treating pain is the basic limitation on the use of opioids:  tolerance.  The body becomes ‘used to’ the person’s dose of pain medication over several weeks, so that any given dose soon becomes ineffective.  The ONLY way to continue to get the same amount of pain relief is to escalate the dose.  And dose escalation is not an option for most people.  Yes, doctors do participate in dose escalation– but when they do, the outcome is ALWAYS a disaster.  I rountinely see patients who have had their pain medication dose increased over time to ridiculous levels– 300, 400, 500, and more mg of oxycodone per day.  The important fact is that no matter the dose, TOLERANCE will eventually remove the beneficial effects of the medication.  So patients end up taking and paying for hundreds of milligrams of oxycodone per day, but getting the EXACT SAME PAIN RELIEF as they did at far lower doses.

My Expertise

Everything about my background– good and bad– has contributed to my ability to help people in this horrible situation.  I initially earned a PhD in neurochemistry, learning and studying about actions of neurotransmitters, including opioids, at receptors in the brain and spinal cord.  I then became a medical doctor, and completed a residency in anesthesiology.  I worked for ten years in operating rooms and in pain treatment programs.  Most pain treatment programs are run by anesthesiologists;  I was once one of those people, and I understand the abilities and limitations of the medications and procedures used by these types of practices.

I became addicted to opioids after an initial period of legitimate use, and I went through treatment about ten years ago, in 2001.  The treatment was successful and I’ve done well, but my addiction cost me my anesthesia career, since I cannot allow myself to work in an environment filled with potent opioids going forward.  So I returned to residencey, in psychiatry.  I completed residency in 2006, and I am Board Certified in Psychiatry as well as Anesthesiology.  I also became certified to prescribe buprenorphine or Suboxone, a new approach to the treatment of opioid dependence.

My Approach

There are new medications that use buprenorphine to treat pain.  Buprenorphine is a unique medication with unique effects at the opioid receptor. There is a ceiling to the effects of the medication, for example.  This property and others allows buprenorphine to activate the same receptors as oxycodone, but with different effects.  The margin of safety is much higher with buprenorphine.  And buprenorphine causes much less ‘craving’ for opioids.  In fact, the medication is used to TREAT opioid dependence by eliminating cravings for opioids.  So patients on buprenorphine typically report no desire to push the dose, or to take more than is prescribed.

Unfortunately, buprenorphine is subject to tolerance in the same way as other opioids.  But through treating hundreds of patients with buprenorphine for the past five years, I have learned that buprenorhine can be used to treat pain in ways that avoid the ‘tolerance problem.’  My approach, in my opinion, will eventually be a standard method for treating chronic pain.  But because my approach utilizes generic medications, there is limited motivation for pharmaceutical companies to invest in the research to develop the techniques used in my practice.  But in the meantime, I am able to offer the approach for my patients.

Are You Getting Better?

For many conditions, pain medications make things worse.  We now know about a phenomena called ‘opioid-induced hyperalgesia’ where taking potent opioids will cause the perception of pain to increase, rather than decrease.  Of course, few patients will go through the horror of opioid withdrawal out of trust that things will get better.  I can assure you, though– sometimes the pain DOES go away or improve when the pain pills are taken away– after the misery of withdrawal.  There is no way of knowing if you are one of those people, though– so I understand your reluctance to sign on to stopping pain meds.

There are also people treated with narcotics who truly do not need them– people with lumbar strain for example, who would heal much more quickly through use of a heating pad, ibuprofen, and rest.  Some people have been conditioned– by their DOCTORS– to take pain pills for every little problem.  For those people, I can only strongly recommend that you consider finding new doctors, who will treat you without simply throwing pain pills at the problem.  Or better yet, avoid the doctor entirely for minor aches and pains, or minor bumps and bruises.  Your grandparents probably got through a tough life without those pills– you can too!!

But IF you are one of the many people who have true chronic pain– you have had a lumbar fusion, or you are getting steroid injections in the knee just to tolerate each day, for example- consider making an appointment.  The goal would not be to eliminate the pain pills, but rather to use them in a way that is safer, that reduces or avoids dose escalation, and that allows the pain medications to work ‘chronically’ without the development of ever-increasing tolerance.

Criteria for Treatment

Consider making an appointment if you are:

- Currently taking potent opioid pain medications like oxycodone, hydrocodone, methadone, or dilaudid.

- Experiencing chronic pain from a serious condition that is not likely to improve.

- Struggling to avoid increasing the dose, or running short on pain medications some months and experiencing withdrawal.

- Always or often focused on the pain or on pain pills;  counting pills often to make sure they will last the month, for example.

- No longer getting adequate pain relief from your pain medications.

- Sick and tired of the affects that taking pain pills has on relationships with people close to you.

- NOT drug seeking.

What do I mean by that?   I do not provide pain medications when pain is not an issue, and when the person is instead seeking a ‘high.’   Suboxone and buprenorphine are potent pain medications, and like all opioids should only be used for significant pain.  If you are unsure whether your pain disorder is ‘significant’, e-mail me and have that discussion, to avoid spending money on an appointment without benefitting in return.

If some or all of these conditions apply, consider making an appointment.  I will not ‘shame you’, and I will not force you to go through detox.  I will help you take the pain medication that you need, without the destructive impact that pain medications often have on a person’s life.

Details about my practice can be found at fdlpsych.com; it is a comfortable, private office where you will be treated with respect.  More information about Suboxone can be found at Suboxone Talk Zone.

When you are done learning, make the call.  I promise you, with all the nonsense claims out there about fixing pain, this is something that can truly make a difference in your life.