DrugBuyers.Com: Oxy holiday - similar to Hydro holiday? Thoughts?

Redhill,

At the dosage and duration youve implied, and in the absence of a proper medical evaluation, you have most probably become physically dependent. If you feel badly, dont. There is nothing inherently wrong or evil about having developed either a tolerance or physical dependence; it is simply an inherent characteristic of long-term opiate/opioid treatment.

Physical dependence is entirely different than addiction. Dependant individuals experience withdrawal when the body does not detect expected levels of a substance. Symptoms, severity, and duration depend upon dosage, duration, physiology, and other individual factors. Onset typically occurs within 12 to 24 hours of a missed expected dose. Prescribers who treat patients using long-term opioid therapies should be just as willing to taper dosages to mitigate withdrawal and have an ethical obligation to do so. It is also extremely difficult for even the strongest individual to self-taper without the informed support of his or her healthcare provider and at least one close friend or family member who can hold, dole out, and refuse access to more medication as the tapering continues.

Addiction is an entirely different animal that includes psychological and emotional dependence and becomes most apparent when a patient begins taking the drug for the drugs sake and demonstrates behavior consistent with seeking out a substance or prioritizing the drug above the condition. Addicts almost invariably develop physical dependence, but being dependent does not, in any way, ensure addiction. Numerous pain studies, including those by SAMHSA and AMA have determined that only a very small percentage of physically-dependent legitimate pain patients become addicted despite long-term high-dose opioid use. Recreational use is an entirely different circumstance for another discussion.

To gain some perspective, your current dosage is a daily Oxycodone dose of 60mg which, from your post, may be supplemented to as much as 100mg. OxyContin delivers a 12-hour sustained dose of Oxycodone, and its common dosage forms are 10, 20, 40, and 80mg prescribed either BID or TID. It was once available in a single 160mg tablet, but was discontinued due to its high diversion and theft rate. With common daily doses that range from 20mg to 240mg, you are nowhere near the common extreme. Enlightened pain managers avoid imposing dosage ceilings and focus on sufficient dosing, provided it isnt otherwise dangerous.

At a certain point, most prescribers will typically reevaluate the current therapy to consider alternate treatment methods or lower and less frequent doses of stronger medication. Oxycodone is pretty far up the strength scale, and the real alternatives are Morphine, Hydromorphone, Methadone, or Fentanyl-based products. Even with stronger medications, effective pain managers focus on pain control over dosage limits, which can theoretically expand infinitely with tolerance. This may be a good option for you, as it has the additional benefit of being proactive about your care, and subjecting yourself to less of the anxiety that comes with knowing you will eventually be in pain or withdrawal. In and of itself, that piece of mind can be priceless.

If you do choose to self-withdraw with the goal of lowering your tolerance, you should do so with open eyes. First, it isnt pleasant, and you are likely to feel miserable, like you have a terrible case of the flu, but worse. You also wont have the euphoric opiate effect to offset your discomfort. Leg cramps and involuntary kicking, spasms, insomnia, diarrhea, cold sweats, chills, fever, and nausea are de rigueur. Even worse, a period of notable depression is very common and doing so alone, without the help of a medical professional or, at the very least, a trusted friend to offer support encouragement, and objective insight can make it infinitely more difficult. Second, a single day, or even a week may not be enough to lower your tolerance level. If your pain is valid, and treatment is appropriate, there should be no reason to do so, as you are already likely physically dependent; but addiction is an issue to address when you no longer have a valid need for pain medication. You havent indicated that this is the case.

Nevertheless, whether withdrawing intentionally or in a pinch, you are virtually powerless except to treat the symptoms as they occur. OTC pain relievers and Imodium can relieve some of the fever, aches, and diarrhea. (Do not use Lomotil (Lonox) as its active ingredient is actually narcotic) A prescribed sedative like Valium or Xanax, carefully taken to ensure that it does not become dangerously potent with the residual opiates, can take some of the edge off the anxiety and help you sleep. Low, titrated doses of a blood pressure medication, Catapres (Clonidine) can provide tremendous help by lowering your then-elevated blood pressure and easing the severity of many of the unpleasant side-effects. It can be a Godsend, but you must take it carefully as the ad hoc combination of medications can be dangerous to a body in distress and the resulting physiological roller coaster can be dangerous. Benadryl (Diphenhydramine) is a wonderfully benign antihistamine and the active ingredient in most OTC sleep aids. It interacts with very little, but caution is still wise. Vitamins, clear fluids, Gatorade or Pedialyte, and any sort of comfort food, distracting movies, or ANYTHING that has ever made you feel better at one time or another sure couldnt hoyt!

Each persons DNA is different and although most would share similar withdrawal experiences, its manifestation and severity will vary. For some its unbearable; for others, its not so bad. All the time, bear in mind that if you are solely coping with physical dependence, you have done nothing wrong, and are no different than a cigarette smoker or coffee drinker changing their routine. Unless your doctor would intentionally cut you off from your necessary pain medications, I would absolutely try to enlist his or her support. As they help chemotherapy patients cope with the pain of their treatment, so should they help you; and many, many will. If one refuses, ask another. I would work my way through the phone book, not discounting any relevant specialist, including GPs. You may be surprised at who is ready to help you without making an immediate addiction assumption and immediately guiding you toward a treatment facility. If you find resistance, thank them for their time and move on. Take a positive role in your own health care.

My point is that the incorrect assumption that dependence means addiction is terrible, and there should be no need for you to experience painful or potentially dangerous abrupt withdrawal. For your own sake, find a doctor who will work with you to find an effective therapy that is right for you. Even if you dont have the resources, being open and honest is likely to yield more positive responses from those willing to help than you may have ever imagined. If withdrawal ultimately proves to be the answer, doing so with a doctors support can make all the difference in the world and even enable you to function during the process. It is NOT generally appropriate for doctors to treat addiction by continuing to prescribe for the sake of supporting a habit. However, it is equally inappropriate for them to withhold treatment for physical dependence which is as different from addiction as a mole is to melanoma.

Please forgive the length of my response, one and all, and for everything you may have already known. I hope it has provided you with at least one new option to consider that may be safer, more effective, or less painful. I also hope it might help others facing similar decisions or circumstances, regardless of reason, make a better informed choice.

Best of luck and health.