Just dropping by…….

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Hello, it has been awhile since my last post here on this blog, but here I go. First partly to blame is my laptop gave me the blue death screen so I have been a way for a bit until I got me a new one. I guess it is good to take a break even from blogging.

So here I am back been out for about a month now and just yesterday I found out from a friend that I grew up with chatting with him catching up in time, that two more people who I grew up with have overdose on pills and heroin.

When I heard this I went numb, and this really bothers me how many more must die for the government and people to understand how serious this epidemic really is. People need to understand that this is just one of the many phase of Agenda 21! Now if you don’t know what this is just Google it.

The truth is that many have and continue to parish because of what probably stated out something that felt cool? But once you on it, try to live without it is like hell, this is why I say stay away from it!

But on the front I do also have good news for I have learned that some others have turned their lives around and I am glad that they have. So if you are an addict and on the fence about recovery, I will say get surrounded by people who will encourage your recovery, not people who wants you on the drug.

You are only as good as the people who you keep around you when you are in a vulnerable state of addiction! That is it for now, wishing nothing but the best for all, peace and Gods speed :-)

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Posted in Awareness, Recovery

Beating Heroin, Crack Cocaine and Other Addictions

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I often come across great information about addiction. I like to share it with others and if you have any you want to share please do so in the comments above. This article I came across was from one of my friends on Facebook, I found it to be quite good and informative.

by Tony Isaacs

(The Best Years in Life) Recently, I fielded two questions from members of my Yahoo group about helping with drug addiction.  The first was about heroin addiction and the second was about crack cocaine addiction, both of which are two of the more difficult addictions to overcome, though I know from my two years as a volunteer at a drug and alcohol recovery program for young men and my own research that both can definitely be overcome.

Drug addiction is a pervasive problem that cuts across all areas of society and I a sure that many who read this have a family member or friend who is affected by this scourge. In the hopes that I might provide some help, I am sharing what I wrote in reply to the questions based on what I have learned and experienced.

Heroin:

First of all, I agree wholeheartedly with the young man’s plan to avoid the standard drugs used for addiction.  It is my belief and experience that often you are merely trading your drug dealer from a street vendor to vendors of mainstream pharmaceuticals – and ultimately those pharmaceuticals will not provide what you need to help your mind and body recover properly.

It may be that some kind of prescription drugs are needed for a very short term to prevent what is often an agonizing and sometimes precarious withdrawal process when one attempts to go “cold turkey”, but the emphasis here should be on “short term” instead of prolonged prescription drug use.  Even then, withdrawal will not be pleasant but it IS absolutely achievable and the rewards of having one’s life, family and cash back in order are beyond measure.

Besides a good support group, desire, and the tried and tested axiom of avoiding old friends, places and things that are, or were, connected to drugs, and learning how to enjoy life without drugs, a proper detox, diet and supplementation program is essential I believe.

Cleanses and detoxes on a regular basis, as well as periodic fasting, are important to get not only the heroin, but ultimately the prescription drugs too, out of the system.  Otherwise, minute amounts may remain and trigger continued cravings for quite some time.  A weekly fasting day where nothing but one of the following items is consumed (as much as you want, but nothing else) will help:  watermelon, dark grapes (seeds and all), juiced vegetables, water.  That is also a good idea for people looking to reach and maintain their optimum weight.

Frequent baths will help wash off the night sweats one may experience and give a better sense of cleanliness and well being.

Sugar must absolutely be avoided to the greatest degree possible, as should bleached white flour, processed foods and junk foods – all of which feed addiction and retard recovery.

A high protein, nutrient rich diet that emphasizes raw foods is best.  Make sure there are plenty of omega 3’s and essential fatty acids.  Dark green leafy vegetables, such as baby spinach, are great.  I would also add some good supergreen food protein drinks containing such items as spirulina, chlorella, wheatgrass, barley grass and more. Remember, the brain is an organ like any other and for it to develop properly as well as maintain healthy function requires good nutrition.

Most people are aware that drug overdoses can kill you, but many are not aware of the other ways those poisons can kill or damage your body.  All drugs weaken the immune system.  Heroin, like cocaine, can also cause life threatening damage to the heart muscle.  For that reason, CoQ10 and Magnesium are both good supplements and I would say some Dr, Christopher’s Hawthorne Berry Syrup would be a good idea too.

Some other essential nutrients to consider are:

Vitamin B complex (100 mg of each major B vitamin) plus extra pantothenic acid (Vitamin B5 500 mg three times daily) and Vitamin B3 in the form of Niacinamide (500 mg 3 times daily and do not substitute niacin for the niacinamide).  Those will help reduce stress and help with proper brain function (and the way drugs work is primarily through tricking the brain and neurotransmitter interference).

Essential fatty acids, as directed on the label, are good for reversing the effects of malnourishment, which is common in heroin addiction as well as other substance abuse victims.

Calcium and magnesium (use 15oo mg along with 1000 mg of magnesium at bedtime).  These two essentials nourish the central nervous system and help calm the body to control tremors that often accompany heroin addiction.

L-glutamine (500 mg 3 times daily) passes the blood-brain barrier to promote healthy mental function and increases the level of gamma-aminobutryic acid (GABA), which has a calming effect.

GABA, as directed on label.

Glutathione, as directed on label.  Aids in detoxing and reduces cravings for drugs and alcohol.

L-phenylalanine (1500 mg daily upon awakening).  Necessary as a brain food and helps with withdrawal symptoms.  Caution: Not to be taken when someone is pregnant (unlikely in his case – lol), nursing (ditto), or suffer from panic attack, diabetes or high blood pressure.

S-Adenosylmethionine (SAMe), as directed on label.  Aids in stress relief and depression, eases pain, and has an antioxidant effect that can improve liver health.  Caution: Do not use if there is a manic-depressive disorder OR if taking prescription antidepressants.

Vitamin C with bioflavonoids (up to 2000 mg every 3 hours).  Detoxes the system and lessens drug cravings.  Use a buffered form such as sodium ascorbate and cut back on the dosage if diarrhea occurs.

Zinc, as directed on label but not to exceed 100 mg daily from all supplement sources.  Promotes a healthy immune system and protects the liver.

Iodine (up to 100 mg daily).  Helps restore thyroid function, which is often affected by heroin users.  Take with selenium (as directed on label) for maximum effectiveness.

I would also personally recommend an all around natural food derived nutritional supplement such as the outstandingIntraMAX  product, which contains 415 essential nutrients (and adjust the other supplements accordingly).  This will insure that no vital vitamin, mineral, trace mineral of other nutrient is missing and help speed recovery.

I hope this information proves helpful to your family member and he has my heartfelt best wishes and sympathy.  Believe me, I KNOW how painful drug addiction can be for young men (and women) and their families.

 

Crack Cocaine

Most of the above information about heroin addiction is applicable to cocaine as well.  One of the things cocaine does is fry the body’s dopamine receptors, which are the “feel good” receptors that utilize natural dopamine.  As time goes by, it takes more and more cocaine to just get back close to a normal level of feeling good, and crack cocaine is even faster active and much more addictive than regular cocaine.

A good diet and lifestyle that gets rid of junk food, processed food, sugar and caffeine to the greatest extent possible will help the body heal faster and help reduce cravings, as will the other suggestions in my post to the group. In particular, exercise can be extremely helpful.  Exercise not only helps eliminate drugs from your system and increases your energy and overall health, it also releases endorphins – which are feel good chemicals that will decrease stress and give one a higher sense of being happy and satisfied.

Now, here is an absolute must:  he must take every step he can to avoid all of the people, places and things that have been associated with his past crack cocaine use, because any one of them can and will trigger cravings that often lead to relapses.  If you go around people who use, you will end up using.  If you go to places where people use, or where you used to go when you used, you will end up using again.  If you listen to the same kind of music you listened to when you used (more often than not, that kind of music is Rap and/or Hip Hop for crack cocaine users), you will use again.  The old saying is oh so true:  If a person hangs around a barber shop long enough, one of these days they are going to get another hair cut.

Here is another absolute must:  Your son must avoid all alcohol, marijuana or any other substance that gets you high and/or alters your mood.  Most addicts make the mistake of thinking that they can have just one or two drinks, or perhaps smoke a little pot, without going back to their drug of choice.  It doesn’t work that way.  Not ever.  All it does is lower inhibitions and lead ultimately back to the drug of choice again and again and again. The user always thinks that they are the exception, but they are always wrong.  There is no exception!  You have a drink or two or smoke a little pot, pop a Xanax, or whatever and you think “Hey, that feels pretty good . . . but I know what REALLY makes me feel good” and back they run to the drug of choice.  Now, maybe after a full year or more of sobriety and recovered health, perhaps a person can once again enjoy a drink or two without it leading to a drink or ten and a relapse back to the drug of choice.  Until then, don’t even think about it.

He and his family are going to have to realize a few important things about crack cocaine addiction: there is no magic supplement or formula that will take it away and restore normal health and sanity overnight.  It can be done, but it will take time as it will also take patience, support and understanding on the part of his family and loved ones.  As Thomas “Hollywood” Henderson of years-ago Dallas Cowboy fame said, “The first time a person uses, shame on them – but from then on, pity on them” because of the way that drugs can take over your willpower and self control.

Most medications and the more potent herbs I know about often lead to either dependence on those substances or else to impaired cognitive thinking and physical well being. I am of the very strong opinion that mainstream medicine usually just trades a dependency on the illegal drug for a dependency on prescribed drugs, replacing the street vendor with the pharmaceutical companies – and I think that in great part that is by design.  My advice is to stay away from mainstream drugs and also avoid the more powerful herbs.  One example is the herb Kratom.  It has been used by many to overcome addiction to some drugs, but it also often becomes addictive itself.

To give you an idea of what lies ahead:  it takes a complete year for dopamine receptors which have been damaged by prolonged cocaine abuse to fully recover.  Now, as daunting as that may sound, also realize that the receptors can recover significantly in as little as two months and they continue to recover, and the road becomes easier, with each added month.  Take it one day at a time and realize that the road may be rocky at times, with some pitfalls along the way.

Never excuse a slip, but also do not condemn it because they are the rule and not the exception – which is not in any way giving an excuse to your son to have a slip.  And believe me, addicts are looking for excuses to use again. In most instances, they have even mentally planned out and justified what is going to cause a relapse in advance.  That thinking must be eliminated and he must be determined not to use again, period!  BUT, if he does slip after weeks or more of avoiding crack cocaine, that does not mean that all of his hard work and recovery time has gone down the tubes IF he immediately realizes his error and gets back on track.  It’s kind of like riding a bicycle – if you ride for miles and take a spill, it does not take away the miles you have traveled if you get back on that bike and keep riding.

Another thing a drug addict must do is learn how to have fun and enjoy life without using drugs.  To do this, one must remember the things they enjoyed before they began using. Maybe it was fishing, hiking or camping.  Maybe biking, working out, practicing martial arts.  Or perhaps reading, writing, coin or stamp collecting or some other hobby.  Or playing with your dog.  And then there is a whole world of new things to try that might be enjoyable besides the things that were once enjoyable.  I dare say that every addict out there once had things they enjoyed doing before they began using, and no telling how many things they never tried that they might have enjoyed.  The more you use, the more the things you used to do are discarded and the more things you do that are associated with drug use – just like the more you use, the more you discard the people who once were close to you who do not use – or else get discarded by them due to your drug use.

Now, this may come as a surprise to many people: but I am not very favorable towards recovery groups, rehab centers or halfway houses.  As someone who has worked as a volunteer in an alcohol and drug rehab program for young men, I know that the greatest downfall of those groups is that they inevitably bring you into contact with people who use drugs and often still want to use drugs.  There is an old joke that is really not a joke about it being easier to find and score drugs at NA meetings than practically anywhere.

Instead of being in regular contact with present and past users who will tell war stories that actually trigger you to use again or else will talk you into another episode of using, find people and groups that are not about drug use.

I have also researched the history of the AA, NA and other 12-step programs and found out that the true success rate is only about 5%.  That is as bad, if not worse, than chemotherapy for cancer!  Of course, half the people who attend one of those meetings drop out immediately.  That still leaves a huge majority who attend the groups and fail to recover.  Fact: more people successfully recover by far who never attend those groups than do the ones who attend them.  Of course, what the groups say is that those who work the program like they are supposed to are usually successful.  Keep working the program, they say, because it works if you do.  But most do not keep working the program and most do not recover due to the program.  So why are the 12-step programs so widely excepted?  Because, just like mainstream cancer treatments, those who formed those programs have lobbied long and hard to become the dominant form of accepted treatment, including convincing judges, probation officers and various other agencies and programs that their way is the only way.

Another reason I am not in favor of such groups is their philosophy that once a person has been an addict they will always be an addict for the rest of their life.  It is a form of brainwashing that says only by continuing their program and regularly getting up and prefacing every statement you make by “My name is Joe and I am an addict” will you be able to cope for the rest of your life.  I say bullcrap!  While it may be true that many alcoholics can never drink again without losing control and the same can be true of drug addicts, especially crack cocaine addicts, if you stop using and do not use again you are no longer an addict.  You are an ex-addict, a person who once had a problem with substance abuse and has put that problem behind you – and you should not label yourself as some kind of inferior person, but instead hold your head high and look the world squarely in the eyes and be proud of who you are and what you have accomplished!

Instead of the traditional 12-step programs, I favor the approach of the Jude Thaddeus recovery program – and there is an excellent book that can be used for a home recovery program by both the addict and his family that I highly recommend:  The Jude Thaddeus Home Recovery Program, which is widely available at bookstores such as Barnes and Noble and online at Amazon.

The road to recovery is not easy, and the first few days and weeks may be difficult ones – but it can be done and millions of people have done it.  Consider that you were not placed on this earth to live a miserable and likely short life of drugs and misery.  Life is meant to be enjoyed.  But you must choose life and reject misery.  It should be an easy choice, no matter how hard it may be in the beginning to achieve it.  And it gets easier and more enjoyable as time goes by.

Finally, here is a tool that I developed to make sure successful recovery is “in the cards” for those who have a substance abuse problem:

Get a notepad and pen. On one page, write down all of the positive things you can think of about being drug free — such as getting and holding a job, better self image, keeping the love and respect of family members and friends, being healthier, longer life, more active lifestyle, etc. Try to come up with the top ten reasons. On another page, write down all of the negative things you can think of about using drugs, including your own worst experiences: Losing friends and families, losing jobs, losing your home, auto and other possessions, having no money, feeling miserable, low self esteem, poor health, association with criminals and prostitutes, run-ins with the law, stealing to support your habit, etc.

Next, get yourself a few wallet sized index cards, or even make some up on your computer. On the front of each card write the negative things about using drugs and on the back write the positive things about not using drugs.  Put one in your wallet and one wherever else you may keep money and perhaps also tape one to the back of items like TVs, computers and stereos that you may have hocked, sold or traded to get drugs in the past.  And PROMISE yourself that anytime you are thinking about using drugs again, you first pull out that card and read it carefully and completely.  It may just be the “hole card” you need to win your game!

All the best, and I sincerely hope that I have been able to help.

Tony

Sources included personal experience, research and “Prescription for Nutritional Healing” by Phyllis A. Balch

See also:

OxyContin – One Young Man’s Story

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Posted in Awareness, Education, Recovery

No Goodbyes……

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Today I have mix feelings, yesterday I got a voice mail from Granny out at the Pike! She wanted me to call her claiming it was important. So I called as soon as I got out of the movies, she told me that Angel Face was out there and that she just walked out and that she would call me when ever she got back in.

Well this was a surprise again and so I waited, then after awhile went by the phone did ring and Granny was on the phone and said to me here, then I heard a sweet voice that I have not heard for awhile, it was Angel Face. Grant it was about a month ago when I did run into her out at the Pike but this time it was a little different. She was alone and was able to talk more freely with me.

She was inside of Granny’s room and it was a full house, I really could not hear her to well and I also got she could not hear me to well either. It was short but sweet, what I did hear her say was, “I’m sorry for what happen when I saw you last!” I replied, “you did nothing wrong to me!”

This must have been on her mind and been bother-en her! I wanted to let her know that she did not own me nothing and it was O.K. At this time the nose was so loud she told me, “I’ll call back later and talk!” This made my day, I welcome the time for this and need to get some things clearly understand about are friendship! Time will bring out the truth, I do believe this and will never say goodbye to her. She can go on her own way but I will always feel connected to her, and this you don’t find everyday in this journey that we are all on.

I know she is going through some tough trails, and there are many things I over look. This is because I know the side of her that many do not. I later after dinner went out to the Pike to see if I can sit down with her but things change so quickly. I saw her and Granny in the back of the hotel top floor. I stop and honked my horn and Angel Face just waved me on, so I did just that. I called Granny, she said, “ that the trucker that she has been with is on his way back! So that call was short, I called back later and Granny was all upset with her and told me that she did not want anything else to do with her.

She told me, “ Robert, she is gone, and I thought I would never say this about her!” I let Granny vent a little then she told me, “Robert I have my own problems!” I understand this and I told her, “thank you for everything you have done for her and me also, I feel a great debt to you!” And that was pretty much the end of are call then.

These girls are all addicts and are on different levels of their journey. I won’t give up on Angel Face, I am quit sure Granny wont either, I believe she has done all she can for her now and needs to work on herself. This is what I also told her at the end of my call with her. Either way my prayers go out to both of them and my love also. I just hope that Angel Face did not get upset because I been keeping in contact with Granny to know what little I can about my friend?

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Posted in Love

Successful Pain Management…..

 

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After hearing from my friend Long Hair, and her desire to try some kind of  pain management with her bad back while going through her journey towards a recovery and sober lifestyle, I did some research on line and came across this article. I wanted to share this with others who need to know that there is help out there if, you seek it. If you have more information please share with us in the comments above here, thank you and peace :-)

 

Successful Pain Management for the Recovering Addicted Patient

Christopher D. Prater, M.D., Robert G. Zylstra, Ed.D., L.C.S.W., and Karl E. Miller, M.D.

Author information ► Article notes ► 

This article has been cited by other articles in PMC.

 

Abstract

Successful pain management in the recovering addict provides primary care physicians with unique challenges. Pain control can be achieved in these individuals if physicians follow basic guidelines such as those put forward by the Joint Commission on Accreditation of Healthcare Organizations in their standards for pain management as well as by the World Health Organization in their stepladder approach to pain treatment. Legal concerns with using pain medications in addicted patients can be dealt with by clear documentation of indication for the medication, dose, dosing interval, and amount provided. Terms physicians need to be familiar with include physical dependence, tolerance, substance abuse, and active versus recovering addiction. Treatment is unique for 3 different types of pain: acute, chronic, and end of life. Acute pain is treated in a similar fashion for all patients regardless of addiction history. However, follow-up is important to prevent relapse. The goal of chronic pain treatment in addicted patients is the same as individuals without addictive disorders—to maximize functional level while providing pain relief. However, to minimize abuse potential, it is important to have 1 physician provide all pain medication prescriptions as well as reduce the opioid dose to a minimum effective dose, be aware of tolerance potential, wean periodically to reassess pain control, and use nonpsychotropic pain medications when possible. Patients who are at the end of their life need to receive aggressive management of pain regardless of addiction history. This management includes developing a therapeutic relationship with patients and their families so that pain medications can be used without abuse concerns. By following these strategies, physicians can successfully provide adequate pain control for individuals with histories of addiction.

Providing pain control for the 5% to 17% of the U.S. population with a substance abuse disorder of some type1presents primary care physicians with unique challenges. When these individuals experience pain, they are less likely to receive adequate pain management than individuals in the general population.2 While relapse in a recovering individual may occur in spite of appropriate use of opioids and psychotropic medications required for effective pain management, inadequate pain relief is also a significant risk factor for relapse.3 Some of the challenges that physicians face include distinguishing between seeking pain relief and seeking drugs for the euphoric effects and identifying predictable neuroadaptations such as tolerance and physiologic dependence that can be misinterpreted as drug seeking or relapse behavior.4 In addition, comorbid psychiatric and medical illnesses may complicate effective pain management.5

This article will address 5 areas related to successful pain management in the recovering addict: (1) basic principles, (2) legal concerns, (3) substance abuse terminology, (4) active addiction versus recovery, and (5) management strategies for acute, chronic, and end-of-life pain. This information will provide physicians with a better understanding of the unique challenges of providing pain control in these individuals.

 

CASE VIGNETTES

The following vignettes describing 2 actual patients* highlight some of the issues that can confront primary care physicians in their daily practice:

John is dead. He committed suicide last week. Until a year ago, he was a successful physician enjoying 5 years of recovery from addiction to hydrocodone and alcohol. He was doing well until he fell and fractured his distal ulnar (styloid process) and experienced associated mild-to-moderate pain. Like his primary care physician, the orthopedic physician who evaluated John knew that he was in recovery from “drugs” and prescribed the nonscheduled pain reliever tramadol. Significant pain was resolved after 1 week. John had his cast removed 4 weeks later and was released to the care of his primary care physician. Although John subsequently did follow up with his primary care physician regarding his fracture and had several office evaluations for different medical problems, the issue of his addiction was never readdressed. Drug testing at the time of his death revealed the presence of hydrocodone.

Ben enjoyed 22 years in recovery from addiction to alcohol, was gainfully employed, and had an active and stable family life with his wife and 2 children before suffering a back injury in an auto accident 3 years ago that resulted in a moderately severe pain syndrome. At the time of his accident, the emergency room physician successfully managed his initial pain with a combination of bed rest, cyclobenzaprine, and oxycodone. A week later as instructed, Ben followed up with his primary care physician, who continued his bed rest and scheduled him for magnetic resonance imaging (MRI) of his lumbosacral spine. Due to concerns related to Ben’s addiction history, his primary care physician changed his pain medication at that time to tramadol, a nonscheduled pain medication. Ben called back 2 days later to report a marked increase in pain, so his physician changed his medication to hydrocodone. When Ben called again in another 2 days, he asked to be given oxycodone, saying that the hydrocodone was not providing the pain relief he needed. He also reported not being able to get his MRI because of the incapacitating pain he was experiencing. Ben’s noncompliance related to obtaining the MRI and his request for a specific, stronger narcotic suggested to his physician that Ben was seeking drugs rather than pain relief. His physician became worried about relapse for Ben and the possible legal consequences for himself of “inappropriate” prescribing of narcotics and refused to change the prescription. Ben subsequently began self-medicating his pain with his drug of choice, alcohol. His alcohol use continued to escalate, causing significant consequences including the loss of his job and family.

 

BASIC PRINCIPLES

Regardless of substance abuse history, there are several basic principles in pain management.6 The first principle is to provide effective pain management, and this requires certain strategies. First, medications should be chosen on the basis of their ability to afford adequate pain relief. There are multiple medications and delivery routes that supply health care providers with a variety of pain relief strategies. An important principle is to use the level of pain the patient is experiencing in determining the strength of pain medication that may be warranted and as a guide for effectiveness of pain management. As discussed in the preceding vignettes, while John’s physician appropriately prescribed tramadol for his mild-to-moderate pain, Ben’s physician failed to adequately address his more severe level of pain. Considerable inconsistency has been found when assessments of pain intensity are compared between primary care physicians and their patients, with primary care physicians tending to rate patients’ pain much lower than the patients.7 The Joint Commission on Accreditation of Healthcare Organizations recommends a numerical scale for adults8 because of the ease of implementing the scale, the ease of understanding it, and its reproducibility. An example would be a scale of 1 to 10 where 10 represents severe pain. Perhaps the use of a simple tool such as this would have allowed Ben’s physician to deal more effectively with Ben’s pain.

A second strategy is to provide pain relief around the clock. Pain medications that are used strictly on an as-needed basis allow pain to escalate and require more medication for pain control. The use of around-the-clock dosing suppresses the pain and will provide better comfort for patients. This schedule is frequently best accomplished by continuous use of long-acting opioids with the p.r.n. addition of short-acting opioids for breakthrough pain. Opioids should be titrated to a level that provides adequate pain control (Table 1). Most opioids have no dose ceiling, and large doses have not been shown to suppress respirations or decrease life expectancy if patients are in pain.10

Table 1.

Table 1.

Pain Management Strategies Based on the World Health Organization Stepladder Approacha

When choosing pain medication, the emphasis should be on using medications that provide adequate pain relief. Attempting to use “less addicting” narcotics may result in inadequate pain relief, which may actually precipitate relapse by forcing recovering individuals to self-medicate their pain. This appears to have been the case in Ben’s situation, with his former drug of choice—alcohol—being used to help manage unresolved pain.

The choice of pain medication is based on the World Health Organization’s stepladder approach for mild, moderate, and severe pain.9 Step 1, mild pain, can be treated with acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and cyclooxygenase-2 (COX-2) inhibitors. Step 2, moderate pain, can be treated with the same agents with the addition of a weak opioid such as codeine or hydrocodone. Step 3, severe pain, should be treated with strong opioids such as morphine, oxycodone, hydromorphone, or methadone. Meperidine should be avoided because of its short length of effectiveness and its tendency to induce euphoria. Propoxyphene and its combinations should also be avoided because they provide minimal analgesia with a high abuse potential. Agonist-antagonist drugs such as pentazocine, nalbuphine, and butorphanol should be avoided in treating addicts who are actively abusing narcotics and those on opioid maintenance programs (i.e., methadone maintenance) because the agonist-antagonist drugs can precipitate an opioid withdrawal syndrome.

The second principle is that acute pain is a medical emergency and should be treated as such. If not treated aggressively, the pain can escalate, making it increasingly difficult to control. Finally, addiction concerns for those without an addictive disorder, although real, are frequently overrated, given that only approximately 3% to 5% of individuals with pain treated with opioids experience subsequent problems with addiction.6

 

LEGAL ISSUES

Many physicians have a fear of using opioids in adequate amounts to relieve pain (“opiophobia”).11 This is in part due to fear of legal repercussions for overprescribing narcotics. Even if Ben’s physician had correctly assessed his level of pain, the fear of “possible legal consequences” may still have resulted in the prescription of inadequate pain medication.

Through the Uniform Controlled Substances Act of 1970, federal law regulates the use of narcotics only when used for purposes of opioid detoxification and/or maintenance; it does not regulate the use of narcotics for pain relief. The Psychotropic Substances Act, a 1978 amendment to the Controlled Substances Act, specifically prohibits restrictions on opioid prescription for pain relief. Individual state regulations usually follow the federal guidelines. It is, therefore, the responsibility of individual practitioners to treat patients for legitimate medical purposes in accordance with generally accepted medical standards,12 such as those outlined by the Joint Commission on Accreditation of Healthcare Organizations in their standards of pain management8 and the World Health Organization stepladder approach to determining the medication to be used.9 Of utmost importance is clear documentation in the medical record of the need for narcotic analgesia, for both clinical and potential legal purposes. This documentation includes the indication for narcotic use, medication provided with the dosage, dosing interval, and amount provided. It is also important to document the timing for the next medication refill that is agreed on by the patient and the physician.

SUBSTANCE ABUSE TERMINOLOGY

To understand treatment strategies for recovering addicted patients, physicians need to understand substance abuse terminology (Table 2). The terms physical dependence and tolerance have been inappropriately used in the past to define the term addictionPhysical dependence is defined as development of a physical withdrawal syndrome following abrupt dose reduction. Its presence does not indicate the presence of addiction, but rather is a normal physiologic consequence of chronic use of many psychotropic medications. Tolerance likewise is not indicative of addiction and can be defined as a normal physiologic response at the cellular level to chronic use of many psychotropic medications that results in requiring more drug to elicit the same physiologic response. Physical dependence and tolerance to opioids are normal and predictable physiologic events that are natural consequences of chronic opioid use. Their development can be expected after extended use of these drugs (several days to 2 weeks) and does not imply the presence of substance abuse or an addictive disorder.13

Table 2.

Table 2.

Substance Abuse Terminology

Substance abuse is defined as use of any illegal drug (marijuana, cocaine, heroin) or inappropriate use of a controlled substance. In addition to the procuring of medications through nonmedical sources (e.g., buying drugs “on the streets”), another example of substance abuse would be the use of an opioid left over from a previous prescription for relief of a subsequently developed emotional pain.

In this article, the term addiction refers to the condition of both someone who is currently active in their addiction (“active addiction”) and someone who is in recovery from their addiction (“recovery”). The presence of active addiction may be difficult for the physician to determine. Active addiction is frequently characterized by the presence of potentially maladaptive, drug-seeking behaviors (Table 3).14 Physicians should familiarize themselves with these behaviors, because the presence of these behaviors can be instrumental in differentiating between drug-seeking individuals and pain relief–seeking individuals. Most important is the presence of a pattern of behaviors rather than the isolated presence of a behavior.14

Table 3.

Table 3.

Maladaptive Behaviors Suggestive of Active Addictiona

However, adding to the already difficult task of determining the presence of active addiction is a phenomenon called “pseudoaddiction,” which may mimic active addiction. Out of fear of not receiving adequate pain medication, individuals may hoard medication or ask for amounts that seem out of proportion to their pain.15 This behavior may be particularly evident in individuals who have previously experienced the prescribing of inadequate amounts of pain medication by physicians who fear using opioids in patients with substance abuse disorders.13

 

ACTIVE ADDICTION VERSUS RECOVERY

Active addiction can pose clinical problems distinct from those encountered with patients in drug-free recovery and those in methadone maintenance programs. Attempts to provide compassionate treatment to these challenging individuals may be skillfully subverted by patients seeking to obtain narcotics for purposes other than pain relief.16Addicts, especially opioid addicts, often require larger opioid doses and more frequent dosing intervals than nonaddicted patients to adequately control their pain. Ben’s need for what seemed to his physician to be excessive pain medication may have been due to a similar increased opioid requirement to relieve his pain.

Narcotic withdrawal symptoms can interfere with attempts to control pain. The time for detoxification is not when pain management is needed but rather when opioids are no longer medically indicated. For acute pain situations, opioids should be administered in doses adequate to prevent withdrawal and afford effective pain relief. The best analgesia is achieved when withdrawal states and anxiety related to inadequate pain relief are prevented. One way of controlling opioid withdrawal symptoms while maintaining effective pain control is the use of methadone, 15–20 mg/day, to control withdrawal symptoms, while additional opioids can be given for control of pain at their usual therapeutic doses.3

Methadone maintenance patients should be given their usual daily dose of methadone in addition to the opioids required for effective pain management. Methadone may also be used in increased doses (10–20 mg every 3–4 hours) for pain management in these individuals; however, the dosing intervals are adjusted for effective pain control because the pain-relieving effect of methadone may last only 4 to 6 hours. Because of the potential to precipitate an acute withdrawal syndrome, a mixed antagonist-agonist opioid such as pentazocine, nalbuphine, or butorphanol should never be given to anyone on a methadone maintenance program or to individuals in active opioid addiction.17

 

MANAGEMENT STRATEGIES

In a recovering individual, the fear of experiencing withdrawal symptoms can be a substantial block to successful discontinuation of narcotic medication when no longer needed for pain control. While continued use of opioids is warranted in patients experiencing tolerance, continued pain syndrome, or pseudoaddiction, patients who are physically dependent on opioids may continue their use despite resolution of pain solely to avoid withdrawal. Such use does not necessarily reflect addiction. Successful management of these concerns may be accomplished by slowly tapering medications over several days under close supervision. In certain cases, short-term admission to a detoxification unit may be necessary.

Colloquial definitions of addiction and dependence used by individuals with substance abuse disorders can be helpful in making this determination. Dependence is frequently defined as “I can’t quit” because the individual is unwilling to experience withdrawal symptoms. Active addiction is defined as “I can’t stay quit,” which is the result of reinstituting opioid use for reasons other than pain control after their appropriate use has been successfully discontinued. Such was the case for John. While tramadol is a pain reliever with a relatively low addiction potential for the general public, it has greater potential harm for the recovering addict because the mild “high” it produces can trigger the need for an even stronger “high” and subsequent relapse. Reserving the term addict for this second group of individuals can help limit the inappropriate labeling of every individual seeking pain medication as an addict and improve the diagnostic value of the term by putting the emphasis on the need for long-term rather than short-term monitoring for relapse when managing pain in individuals with addictive disorders.

Pain management with opioids for recovering addicts should include a pretreatment agreement for random, witnessed drug screens 1 month, 3 months, and 6 months after pain management has been discontinued. Any failure to follow through with the drug screen when a drug screen is called for is considered a positive screen. Once relapse is suspected, management includes offering medical intervention. Perhaps if John’s physician had established a screening schedule at the beginning of treatment, this extra level of accountability could have encouraged John to remain abstinent or detected his substance abuse in time to reinitiate treatment.

Acute Pain

The goal of acute pain management is effective pain relief, with elimination of pain as a reasonable endpoint.6Maintaining functional levels of physical, social, and cerebral activity is generally a secondary concern. Nonopioid and nonpsychotropic pain relief treatment options should be utilized whenever possible to provide effective pain relief. However, when effective pain management cannot be achieved by these measures alone, use of opioids and other psychotropic medications is warranted (Table 4).19 Physicians may need to overcome their fear that prescribing narcotics and other psychotropic medications for an addict will necessarily result in relapse.11

Table 4.

Table 4.

Guidelines for Directing Effective Acute Pain Managementa

If tolerance to opioids develops, more frequent analgesic dosing may be needed.17 A change should be made to nonopioid, nonpsychotropic medications such as acetaminophen, NSAIDs, and COX-2 inhibitors only when it does not sacrifice adequate pain relief. Because the “high” that addicts achieve from psychotropic drugs is directly proportional to the rate at which the concentration of the drug rises in the blood, long-acting opioids are used when possible.14 Use of opioid agonist-antagonists in known or suspected active opioid addicts is absolutely contraindicated because they can precipitate an acute withdrawal syndrome.14

The presence of a psychiatric disorder such as depression can significantly hinder treatment initiation and limit treatment effectiveness if not adequately addressed. John’s suicide could have reflected the presence of a clinical depression that may have contributed to his relapse.

Structured control of medication access can decrease the chance for relapse.18 Such control may be achieved by giving the medication at fixed intervals and by arranging distribution of the medication by someone other than the patient. Giving medication at fixed intervals may also help minimize conflict between patients and caregivers. As previously noted, inadequate pain relief may encourage addicts to seek pain relief through self-medicating, thereby increasing the chance for relapse.3

Risk of relapse is also related to the quality of a patient’s substance abuse recovery and support program.20 Active involvement in a recovery support program should be initiated or intensified during a period of pain management.21Additional suggestions for enhancing recovery are listed in Table 5.

Table 5.

Table 5.

Measures That Enhance the Recovery Program

Chronic Pain

The goal of chronic pain management is to obtain reasonable pain relief while maintaining a maximum level of function.13 When possible, opioid treatment should improve occupational and social functioning while minimizing any decrease in cerebral function. Physical rehabilitation is appropriate to help restore patients as much as possible to their premorbid levels of physical and social functioning.

Addiction and chronic pain may reinforce each other.3 However, while requests for increased amounts of opioids may initially appear to be drug-seeking behavior, such requests may also reflect the presence of pseudoaddiction or suggest the development of physiologic tolerance. In addition, an increased need for pain medication may be indicative of an exacerbation of the underlying disease process causing the pain or heralding the presence of an undiagnosed or ineffectively treated comorbid medical or psychiatric disorder. Prior to any increase in pain medication, patients should be evaluated for the possible development of new disorders or exacerbation of existing disorders. Physicians should be alert for lowered pain thresholds and subsequent increase in pain perception resulting from emotional pain, sleep deprivation, and fear of inadequate pain relief.22

When possible, pain should be specified as being inflammatory, neurogenic, muscular, etc., and medication directed at those specific sources should be used.23 Nonpsychotropic drugs should be used when they do not sacrifice adequate pain control or level of physical functioning. Comorbid emotional discomfort can be managed with nonpsychotropic medications, disorder-specific psychotropic medications, and counseling.5

Factors that contribute to effective chronic pain management include the following: (1) having only 1 physician prescribe all pain medications, (2) encouraging maintenance of stability at home and at the workplace, (3) periodically weaning the patient from the pain medication to assess the pain syndrome and level of function, (4) reducing opioid use to the minimum dose necessary to effectively relieve pain while maintaining an effective level of function, (5) using nonpsychotropic pain management options when possible without sacrificing effective pain relief or level of function, and (6) being aware that increased doses may be required to maintain effective pain relief and/or level of function due of the development of drug tolerance or the progression of the underlying disease.

End-of-Life Pain

One of the common concerns patients have at the end of life is control of symptoms, with pain identified as their biggest fear.24 Despite advances in pain management and increased awareness of the need for pain control during the terminal phase of life, patients still suffer from undertreated or untreated pain.25–27 This failure to adequately treat pain causes a significant amount of stress.27

As stated earlier, good pain control can be achieved for most patients, and acute pain should be considered a medical emergency. Escalation of pain could represent a progression of patients’ terminal disease or an increased pain perception secondary to nonphysical causes such as psychosocial or spiritual issues.

When providing pain management, opioids are not the only option for providing pain relief. In fact, in certain cases such as bone pain, opioids are usually unable to provide adequate analgesia. In situations where musculoskeletal or bone pain is present, first-line therapy consists of nonsteroidal anti-inflammatory agents or corticosteroids. There are 2 distinct types of neuropathic pain. The first is continuous dysesthesias, which are characterized by continuous burning, electrical, or other abnormal sensations. The second is chronic lancinating or paroxysmal pain, described as sharp, stabbing, shooting, knifelike pain that often has a sudden onset. The current first-line treatment recommendation for the continuous dysesthesia type of pain is tricyclic antidepressants such as amitriptyline. For lancinating or paroxysmal neuropathic pain, first-line treatment options are the anticonvulsants, with gabapentin representing the best choice in this class.

In pain management at the end of life, addiction should not be an issue. The philosophy of providing comfort during this time period is the same regardless of any current or past history of addiction. The mechanism for pain management, however, does differ. The recovering or active addict may require more opioids to control pain because of increased opioid tolerance than those who do not have a history of addiction. Another concern is whether escalation of opioid requirements for pain control is related to disease progression or a sign of substance abuse. This escalation can be controlled to some extent by providing only a specific amount and number of pain medications with strict dosage instructions and establishing a contract with the patient and family concerning these issues. If substance abuse or diversion of controlled substances does occur, a frank discussion concerning these issues needs to be performed with the understanding that these behaviors are not acceptable. Pain control is obtainable in patients with addictions, but it needs to be a collaborative effort between physicians and patients.

 

SUMMARY

Successful pain management, while complicated by substance abuse activity or history, can generally be accomplished in primary care settings. Recognition and attention to withdrawal concerns, relapse triggers, and comorbid conditions are essential, as is proactive support for long-term recovery.

Drug names: amitriptyline (Elavil, Endep, and others), butorphanol (Stadol and others), cyclobenzaprine (Flexeril and others), gabapentin (Neurontin), hydrocodone (Lortab and others), hydromorphone (Dilaudid and others), meperidine (Demerol and others), nalbuphine (Nubain and others), oxycodone (Percocet and others), pentazocine (Talwin and others), propoxyphene (Darvon and others), tramadol (Ultram).

 

Footnotes

The authors report no financial affiliations or other relationships relevant to the subject matter of this article.

*Patients’ names are fictitious, to protect the anonymity of the individuals.

REFERENCES

  • Warner LA, Kessler RC, Hughes M, et al. Prevalence and correlates of drug use and dependence in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52:219–229.[PubMed]

  • Portenoy RK. Pain management and chemical dependency. JAMA. 1997;278:592–593. [PubMed]

  • Savage S. Principles of pain treatment in the addicted patient. In: Graham AW, Schultz TK, eds. Principles of Addiction Medicine. 2nd ed. Chevy Chase, Md: American Society of Addiction Medicine. 1998.  919–946.

  • Newman RG. The need to redefine “addiction” N Engl J Med. 1983;308:1096–1098. [PubMed]

  • Koenig TW, Clark MR. Advances in comprehensive pain management. Psychiatr Clin North Am.1996;19:589–611. [PubMed]

  • McCaffery M, Pasero C. Overview of three groups of analgesics. In: McCaffery M, Pasero C. Pain: Clinical Manual. 2nd ed. St. Louis, Mo: Mosby. 1999.  103–128.

  • Mantyselka P, Kumpusalo E, Ahonen R, et al. Patients’ versus general practitioners’ assessments of pain intensity in primary care patients with non-cancer pain. Br J Gen Pract. 2001;51:995–997.[PMC free article] [PubMed]

  • Joint Commission on Accreditation of Healthcare Organizations Pain Standards for 2001. Available at:http://www.jcaho.org/accredited+organizations/long+term+care/standards/revisions/2001/pain+standards.htm. Accessed July 16. 2002 .

  • World Health Organization. Cancer Pain Relief. 2nd ed. Geneva, Switzerland: World Health Organization. 1996.

  • Bercovitch M, Waller A, Adunsky A. High dose morphine in the hospice setting: a database survey of patient characteristics and effects on life expectancy. Cancer. 1999;86:871–877. [PubMed]

  • Morgan JP. American opiophobia: customary underutilization of opioid analgesics. Adv Alcohol Subst Abuse. 1985;5:163–168. [PubMed]

  • Stimmel B. Prescribing issues and the relief of pain. In: Graham AW, Schultz TK, eds. Principles of Addiction Medicine. 2nd ed. Chevy Chase, Md: American Society of Addiction Medicine. 1998.  961–965.

  • Sees KL, Clark HW. Opioid use in the treatment of chronic pain: assessment of addiction. J Pain Symptom Manage. 1993;8:257–264. [PubMed]

  • Passik SD, Portenoy RK, Ricketts PL. Substance abuse in cancer patients, pt 1: prevalence and diagnosis. Oncology. 1998;12:517–521. [PubMed]

  • Weissman DE, Haddox JD. Opioid pseudoaddiction: an iatrogenic syndrome. Pain. 1989;36:363–366.[PubMed]

  • American Society of Addiction Medicine. Public policy statement on definitions related to the use of opioids in pain treatment. J Addict Dis. 1998;17:129–133. [PubMed]

  • Scimeca MM, Savage SR, Portenoy R, et al. Treatment of pain in methadone-maintained patients. Mt Sinai J Med. 2000;67:412–422. [PubMed]

  • Clinical Practice Guideline Number 9. Management of Cancer Pain: Substance Abusers. Rockville, Md: US Dept Health Human Services, Agency for Health Care Policy and Research. 1994.  AHCPR publication 94-0592. 134–138.

  • Portenoy RK. Opioid therapy for chronic nonmalignant pain: clinician’s perspective. J Law Ethics.1996;24:296–309. [PubMed]

  • Dunbar SA, Katz NP. Chronic opioid therapy for nonmalignant pain in patients with a history of substance abuse: report of 20 cases. J Pain Symptom Manage. 1996;11:163–171. [PubMed]

  • Thomason TE, McCune JS, Bernard SA, et al. Cancer pain survey: patient-centered issues in control. J Pain Symptom Manage. 1998;15:275–284. [PubMed]

  • Paice JA, Toy C, Shott S. Barriers to cancer pain relief: fear of tolerance and addiction. J Pain Symptom Manage. 1998;16:1–9. [PubMed]

  • Brucera E, Lawlor P. Cancer pain management. Acta Anaesthesiol Scand. 1997;41:146–153.[PubMed]

  • Singer PA, Martin DK, Kelner M. Quality end-of-life care: patients’ perspectives. JAMA.1999;281:163–168. [PubMed]

  • Ingram JM, Foley KM. Pain and barriers to its relief at the end of life: a lesson for improving end of life health care. Hosp J. 1998;13:89–100. [PubMed]

  • Wang XS, Cleeland CS, Mendoza TR, et al. The effects of pain severity on health-related quality of life.Cancer. 1999;86:1848–1855. [PubMed]

  • Addington-Hall J, McCarthy M. Dying from cancer: results of a national population-based investigation.Palliat Med. 1995;9:295–305. [PubMed]

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Posted in Recovery

A call to a friend….

Touch screen mobile phone

Well as the summer goes so does this heat go up here in South Florida, The other night I thought I would call one of my friends from out at the Pike. She just went through open heart surgery. She is out-of-state now and in a hospital recovering.

You might have heard me bring her up before I call her Long Hair! She is also a friend of Angel Face, and also an addict. Her story is one of what many is with her addiction. You see, she has bad back problems and was per-scripted the very same pills that she got addicted too!

She was thrown off of them so the doctor would not be liable for anything and had to turn towards the street for her medication. One thing as with many young ladies under this curse is that she found herself homeless sleeping in a tent with her then boyfriend and turned towards prostitution to pay for her medication that she needed for her pain.

This is what she always told me anyway, after knowing her for a while I personally witness some of the pain and trails that she went and still goes through. Her journey has not been easy at all and she does have my prayers and support when ever I can give it.

So she did answer the phone for I have been waiting for her to heal a little to talk to her, her voice was soft and weak but she still wanted to talk to me and clue me in on want was going on. She shared with me that she went through detox and does not want any more to do with them damn pills anymore!

This made me very happy and I told her that I was happy and proud that she was thinking like this and that there is always a reason for the season. She also shared with me, “Robert I need to do something about managing my pain and need to find a way to get off the Opioid s!” Will I brought up about seeing Angel Face again and I should have stayed on her instead because before you know it she had to go because a nurse came in the room and she was also very tiered.

So there is a time for change with this addiction and it is a lie and as anyone finds the courage, and do something about it, you will stay stuck in that cycle! So what is it my friend? Are you to stay stuck with all the lies and pain, or are you to be set free as my friend Long Hair?

You can put your comments up above and what ever you decide, peace and happiness in your journey :-)

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Posted in healing, Love, Recovery

Transcending addiction and redefining recovery: Jacki Hillios at TEDxBoulder

 

Why are some able to transcend their addiction while others are not? What do people really need to escape the shame of their addiction and achieve sustained recovery? Jacki’s talk focuses on answering these questions and demonstrates how resilience of the human spirit intersects with social contextual factors to set the stage for those struggling with addiction to choose a pathway to health.

 

We here at Angel Face Foundation also believe that addiction doe’s not necessary define the addict. It is a treatable disease in which anyone if they truly desire can break the chains. We have meet and also from personal experiences know this to be factual. 

 

 

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Posted in Recovery

Heroin at Home: Rise of Opiate Use

Published on Jul 30, 2013

A resurgence of heroin use, complicated by prescription pain-killer abuse, has dramatically risen in the last few years. The consequences, including a number of overdose deaths, have devastated a range of communities across Minnesota. This half-hour documentary explores some of the history, science, and social factors of opiate addiction. The voices of those in treatment and recovery are woven into analysis from some of Minnesota’s leading thinkers on the deadly rise of heroin and opiate use in the state. Co-produced by the Minnesota Department of Human Services and Twin Cities Public Television.

In the end some of the addicts vent and share that they hope family members and friends would understand and get educated about this epidemic and disease, we here at Angel Face Foundation share their wish also, this would help everyone through the journey towards recovery.

Please leave a comment above if you wish, peace and Gods speed :-)

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Posted in Awareness, Education
Today is the present.
September 2014
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Angelface-foundation.com, 2013, Unauthorized use and/or duplication of this blog’s material, both images and words, without the author’s consent is prohibited. Copies-provided-credit-is-given may be acceptable on an individual basis please contact author. Linking, ping back and re blogging through WordPress is permitted. Thank you for respecting me and my work. I will respect you and yours.

Robert Christopher Mergupis

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Robert Christopher Mergupis

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