Wednesday, July 13, 2016

Overcoming Opioid Dependency is Tough

Physical dependence happens when the body adapts to a particular drug and gets used to receiving regular doses of that medication 

Opioids are a class of painkillers with high addictive potential, typically used for the short term for treating severe pain following surgery generally prescribed for durations of less than seven days. 1
Unfortunately, injured workers who suffer with chronic pain often have little recourse other than taking pain killers long-term. "When the medication is abruptly stopped or the dosage is reduced too quickly, the person will experience withdrawal symptoms."2

One patient, who was injured on the job nearly fourteen years ago, waited two years to get approval for spinal fusion surgery, while his pain continued to get worse. Most of his daily activities, walking, bending, carrying things, even sleeping became impossible without agonizing consequences. 
During this time, the Pain Management Specialists continually added stronger prescription narcotics while the injured party fought a battle with Worker's Comp to be approved for surgery.

After surgery, the hardest part of the journey began with the challenge of getting off extremely high doses of prescription drugs. This is the true story of how, "J" overcame his dependence on opioid type narcotics.
Although the patient tried to reduce his prescribed medications under the guidance of his Pain Management Specialist, it was nearly impossible due to the side effects of withdrawal. 
The most difficult medication to stop taking was the 75 MG Fentanyl patch which provided direct cutaneous absorption of the strong drug (directly into the skin). Stepping down to 50 MG patches every other day led to insomnia, extreme agitation and psychotic episodes of paranoia including the shakes. The next level of reduction to 25 MG proved too much to bear. J worked through the problem by cutting the remaining 75 MG patches in half to receive a dose of 37.5 MG to ramp down the medication with less duress.


Once he was able to step back to 25 MG of Fentanyl, he began cutting those patches in half.The process had its drawbacks and didn't happen overnight.

Only when J felt confident taking the next step, was he able to cut back further, eventually, quartering the patches and adhering the patch to his skin with paper tape.
Once off the Fentanyl patch, he started the rigorous attempt at reducing the daily doses of Oxycodone Acetaminophen 10-325 tablets. By this time, the drug had reversed its relaxation effect and had transformed into a powerful stimulant causing insomnia. Attempts to further reduce the number of daily tablets left him agitated, suffering involuntary leg twitching, sleeplessness and ongoing depression. At this point, it became clear that he would need help to get off the remaining narcotics.
An important note is that no method will work for everyone. A structured plan, discussed in detail with a Doctor is the only remedy suggested. Never, ever try to go off these medications without consulting a medical specialist or serious consequences are likely to occur.

The final piece of the puzzle came from a reputable rehabilitation program in Dallas named PRIDE, an acronym for Productive Rehabilitation Institute of Dallas for Ergonomics. After years of taking exceedingly strong doses of Class Two narcotics, J broke through and no longer needs the drugs his body once strongly craved. For this, he thanks the dedicated team at the institute who provided encouragement, guidance, physical and nutritional training and counselling during his rehabilitation.
“PRIDE’s novel approach to chronic pain, known as Functional Restoration is a medically directed, interdisciplinary treatment that emphasizes measurement, mobilization, and re-activation supported by education, counseling and stress management.”3
The program consisted of one hundred and sixty hours of guided exercise, treatment and counselling designed to “provide measurable improvement in function, medication management or in helping patients return to productivity.

The most amazing thing was the speed at which he was able to quit all the drugs completely. This followed a one-week dose of an effective medication (also opioid based) called buprenorphine.
Buprenorphine (Subutex) treats withdrawal from opiates, and it can shorten the length of detox. It may also be used for long-term maintenance, like methadone. Buprenorphine may be combined with Naloxone (Bunavail, Suboxone, Zubsolv), which helps prevent dependence and misuse.
Workers' Comp fought hard to deny this program. Approval was gained only by the persistence of PRIDE's knowledgeable medical staff whose experience in these cases proved to be the key factor.

Completing the PRIDE experience, provided a deep sense of relief for this long-time, chronic pain sufferer who feels it was well worth the incredible effort needed to endure the program.
The impetus that pressed J forward through the most difficult times was the hope of returning to a life where his long-neglected hobbies could be resumed. He pushed through those times when he would rather have slept in after a night of insomnia and episodes of extreme anxiety.
"PRIDE (Productive Rehabilitation Institute of Dallas for Ergonomics) was established in 1983 as an alternative to chronic pain management programs with a mission to empower and assist patients to return to work, improve their quality of life, decrease dependence on medication and health providers and avoid recurrent injuries by increasing physical capacity to the highest level possible through functional restoration." 4
Please remember to consult your doctor when undertaking any sort of changes to your medication especially those which may have addictive properties.
Only your physician can assess your health and wellness and prescribe the best plan for reducing an Opioid dependence.



Sources
  1. Harvard Health Publications, Harvard Medical School, Article, Avoiding Addiction, Nov 13, 2013 
  2. Drugs dot com, Fentanyl Side Effects
  3. Health Central, Remedy Health Media, Christina Lasich, MD, Health Pro. Sept. 24, 2012, 
  4. PRIDE, 5701 Maple Ave. Dallas, Texas 75235 http://www.pridedallas.com/

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