Azrayne's drug geek thread

Aychamo BanBan

Aychamo BanBan

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McQueen said:
Prescribing a medication with no issues for several years, then abruptly forcing a contract on your patients or cutting them off if they refuse is totally not retarded though. It's not like forcing a contract under duress that violates the constitutional rights of your patients is a great way to show that you're a caring and compassionate doctor or anything. You people shouldn't be surprised when the patients you treat like criminals from the jump don't trust you enough to be honest about their troubles.

Your new system is practically designed to make criminals out of previously honest, law-abiding patients.
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You mean, prescribing medication while the pt is adhering to the contract they signed, and then stopping when the patient breaks the contract is bad? And almost zero patients in a suboxone/methadone clinic were "previously honest, law-abiding patients."

I've never worked in a methadone clinic, but I did in a suboxone clinic for 2 years. Look at this way. You're a doctor who has been in school since they were a fetus, has an extremely valuable medical license and DEA #, and you're seeing patients, every single one of which has previously been illegally purchasing and diverting narcotics and any of a number of other drugs, and every patient is a self admitted addict, and you're going to be prescribing them potentially lethal doses of these medications (suboxone patients got a month supply), and when they get drug screened it shows that they are STILL using other drugs on top of what you're prescribing. Fuck no a doctor isn't going to want to keep writing you medications, so that when you overdose you can sit there and blame the doctor ("he saw I was using, and continued to feed my habit, now I overdosed, am brain dead, and my family want $3,000,000.") Furthermore, the state boards will count it against you if you prescribe large quantities of opiates and people overdose

Let's make one thing clear: no doctor is obligated to prescribe you a controlled substance. You are not entitled to this, and the victim card doesn't work.

But the system is changing. The DEA regularly sends out pamphlets now on "proper opiate prescription techniques" (which are ridiculous), and the professional societies (ACEP, ABFM, etc) all send out things saying it is now considered unprofessional to prescribe chronic opiates (without meeting all sorts of guidelines), so the opiate trend is starting to come to an end. All the ERs in our area have adopted strict pain policies, and almost all patients are simply discharged with Tylenol and/or Motrin, and to follow up with their regular doctor for any further meds.
 
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Vanderhoof

Vanderhoof

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Every clinic that provides Suboxone/methadone has you sign a controlled substance agreement when you begin treatment, so of course they fired you for using a medication that is absolutely contraindicated for use while taking methadone.
 
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MrHolland420

MrHolland420

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The current clinic doesn't completely cut you off, they drop you to 80mg and if you have a legitimate prescription you can dose up to 120mg. All contracts are different.
 
jayrebb

jayrebb

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wonderguy101 said:
I've never worked in a methadone clinic, but I did in a suboxone clinic for 2 years.
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So you're like...scum of the Earth. Assuming this is in a suburban or rural setting where its mostly just pills and white privileged people bellyaching over withdrawals.

You're slightly less scum if its in the city where suboxone clinics deal with a lot of traumatic addictions and therefore actually save people from killing themselves.
 
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Vanderhoof

Vanderhoof

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Opioids are a problem in every community, be it fentanyl, Oxy or heroin. They all do the same thing to your brain. Every patient I've known who uses heroin started by using pills. People are dying in hillbilly county southwest Missouri and people are dying of the same thing in St. Louis.
 
Azrayne

Azrayne

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#junkielivesmatter

Speaking of suboxone, down to 0.75mg. Barely stabilising with these tiny dose drops now I'm so low, so if all goes to plan I'm just gonna drop another 1/4 in a fortnight then spend a week dropping 1/8th every second day, then jump.
 
pharmakos

pharmakos

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been on morphine for a few months as i went through chemotherapy... my pain is gone now after my last chemo, tho, so i'm tapering off. i was set to drop it after doing 30mg a day for a bit, but my doctor wanted me to do 15mg for a week, then 15mg every other day for two weeks. i think it will go fine... got some good Blue Cheese medical bud to help out if its rough.
 
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jayrebb

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pharmakos said:
been on morphine for a few months as i went through chemotherapy... my pain is gone now after my last chemo, tho, so i'm tapering off. i was set to drop it after doing 30mg a day for a bit, but my doctor wanted me to do 15mg for a week, then 15mg every other day for two weeks. i think it will go fine... got some good Blue Cheese medical bud to help out if its rough.
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oral sulfate instant release? 30mg once a day? If sulfate oral + just 1x day should be a breeze.

When jumping from low doses during the acute I always recommend neurontin 300mg for nights as needed where you feel that mawing void and need a barrel roll out of it. Its been discovered that it has sophisticated action on spinal endorphin function which is one of the systems responsible for creating withdrawal. Its not just a "sedative" or anti-epileptic like people think. Its really quite special. A true ancillary, sorely underutilized and mostly ignored by the medical community at large.
 
pharmakos

pharmakos

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jayrebb said:
oral sulfate instant release? 30mg once a day? If sulfate oral + just 1x day should be a breeze.

When jumping from low doses during the acute I always recommend neurontin 300mg for nights as needed where you feel that mawing void and need a barrel roll out of it. Its been discovered that it has sophisticated action on spinal endorphin function, so its not just a "sedative" like people think. Its really quite special. A true ancillary, sorely underutilized and mostly ignored by the medical community at large.
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extended release. i don't expect to have any problems, but its my first time ever being habituated to the point of needing to taper, so part of me is still a bit nervous.

i have a big stash of neurontin... but i already take lyrica 3x a day and i believe there's cross tolerance between the two. the doctor also prescribed me ativan in case i need it for withdrawals. herb should do just fine tho.
 
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Woefully Inept

Woefully Inept

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pharmakos said:
been on morphine for a few months as i went through chemotherapy... my pain is gone now after my last chemo, tho, so i'm tapering off. i was set to drop it after doing 30mg a day for a bit, but my doctor wanted me to do 15mg for a week, then 15mg every other day for two weeks. i think it will go fine... got some good Blue Cheese medical bud to help out if its rough.
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I became addicted to vicodin after needing it legit for nearly 3 years. I wish I had some medibud to help at the time. Before I stopped I was up to 8 pills a day. I'd take them like clockwork and have a near panic attack if I didn't. Getting off that shit was rough.
 
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Azrayne

Azrayne

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Been experimenting with weed and it does wonders for the nausea and cramps, and that's just shitty AU weed, not the insane shit you guys grow in the States. Might be shitty for a couple days, but as long as you haven't been on that dose for years I think you should be good man. Luck.
 
Woefully Inept

Woefully Inept

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If that was a reply to me I'm long off the stuff. That was back in 2003ish. It's all good now.
The best part of fully detoxing? Being able to take a regular dump. Oh man the first one was heaven!
 
Azrayne

Azrayne

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Nah I was talking to Pharmakos, should have clarified.

But yeah, I've finally stopped having to use laxatives and fibre supplements for the first time in years since dropping under 1mg - being able to effortlessly crap every morning is a gift from the universe which you never appreciate until you lose it. Never taking that for granted again.
 
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Woefully Inept

Woefully Inept

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I've had at over a dozen surgeries. Taking a dump asap after surgery is the most important thing in my life in that moment. Not being able to go after surgery is incredibly painful and taking more pain meds really doesn't help because they just block you up worse. And then worst case scenario is you can't go for long enough and then there's a host of more serious issues that it could be. It's absolute misery just to have that in the back of your mind and then you're still dealing with the pain.
Now I usually have them hit me with a laxative or something as soon as I'm moving around. I'd rather shit all over myself than deal with that pain. What generally happens is I end up shitting every 10-15 minutes for about 8-10 hours straight. Extended hershey squirts are misery too but not on the scale of severe constipation and gas pains. I've been in so much pain that it took 80mg of morphine to allow me to breathe comfortably. I've had gas pain far worst than that. It's obviously a different pain but man the severity isn't on the same level. I've had gas pain that I'd easily say is the worst pain I've ever had. Feeling like you're literally going to explode is insane. See above about pain meds for it.
And yes I'm high. lulz Hope that was informative.
 
Azrayne

Azrayne

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Since there's no point in having a thread with your name on it if you can't do the occasional attention whoring - I'm just about to do my final jump off suboxone, after 6 years on the program. Decided enough was enough back in September, but I had to wait until I could afford to blow off the real world for a few weeks.

Tried jumping straight from 5/8th mg a week ago and lasted 30 hours before I wanted to amputate my legs to stop the cramps and RLS, so I decided to rapid taper the last little bit. Down to 1/8th mg now after a moderately uncomfortable week (never thought I'd say this but thank fuck for weed - and of course valium), and there's really not much lower to go without getting silly, and I want to get on with my shit, so I'm going to take 48 hours to settle on this tiny dose then take the leap and just eat whatever discomfort comes my way. Even if it takes a few attempts, I have enough stashed away to last me for months, so either way I'm done with the program.

Wish me luck boys.
 
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Vanderhoof

Vanderhoof

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Good luck. 6 years is a long time to be on Suboxone; are you involved in any kind of treatment program aside from replacement therapy?
 
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Azrayne

Azrayne

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Cheers - yeah 6 years is ridiculous, and I don't want to drag it out any longer. It's really only once I started to drop below 1 - 2mg that I realised how much it was dulling life down all this time, aside from the assorted physical side effects. There was a definite narrowing of the emotional range, which is weird to be coming out of.

Definitely needed the first 4 years or so to get my head in order and let the cravings die down, but I wish I'd started tapering earlier, and faster, and not stayed on such a huge dose for long. The guidelines for the program are ridiculous and obviously not designed by anyone who has real experience.

As far as other treatment, I started therapy about a year before I started the subs, when the meth smoking was starting to fuck with my head and a bit before I stepped up to shooting oxys. My shrink doubles as my prescribing doctor, which is convenient. I've also done a shitload of mindfulness/meditation training over the last 5 years, which has helped at least as much as the therapy, and made all the usual lifestyle changes (sleep, exercise, diet, cut sketchy fuckers out of my life).
 
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