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Medically-assisted opiate cessation


cobd

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I am an opiate addict.  I have been for the past two years, to varying degrees, ever since a particularly bad breakup.

I only use to get high or to feel "normal", as is the unfortunate truth with opiates and opioids.  They call out to you.  They make you feel like something is missing in your life, like you just need a little bit to make it through the day.  To be normal.

I don't want these in my life anymore.  I want to break free.  I've been able to quit on my own from time to time...only to relapse within a month.  I've been working with my psychiatrist to determine the best course of action in order to make sure I don't relapse again. I'm three days sober, and my psychiatrist had prescribed naltrexone.  For the uninitiated, naltrexone is an opiate blocker.  It is non-narcotic, and will prevent any opiates from having an effect on me.  The downside is I have to be clean for at least seven days, lest I be thrown into the worst withdrawals of my life.

She offered suboxone as a secondary choice...which I'm hesitant about, seeing as how it's a partial opiate.  Methadone is a third, distant option.

I wanted to reach out to this forum, and See if anybody has any personal experience with any of these medications.  I have the drive.  I have the desire to quit.  I just want to give myself the best shot possible.

Thank you in advance.

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Congrats on 3 days sober!  While I have no experience with those medications I'd say you're attitude may be one of the keys to staying free.  You have the right attitude, desire and drive! So go for it :)  You've also reached out for help from a medical professional - that says something.  I'd say continue working with them taking it one day at a time and working on why opiates played an important role in your life -like what gap were they filling?  What can you do to replace them with something better for you that also makes you feel better about your self.  Only you can answer that. Also seek out others who are or have gone through the same thing. Get that kind of support to help you finally break free.  I look at it this way - if at first you don't succeed try and try again.  Just because you relapsed before doesn't mean this time you can't do it - the opposite maybe because you know what triggers made you relapse and can work on avoiding or minimizing them giving yourself a great chance. As they say people don't plan to fail they fail to plan so work on a plan that will give you the life you want for yourself!

Good luck - you can do it!

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Hi codb and welcome. I echo everything xia said especially seeking out others who have gone through the same thing. Like you, I could quit for short periods of time but it was only when I put myself in a "clean" environment for 30 days could I quit for good. I realize not everyone can or even needs to go away but for me, it worked.  Have someone you can call when a craving hits. Or come here and post. Just have a plan so you will know what to do vs picking up when your will power gets low. Good luck. Three days is great and can be the beginning of three weeks, months, years.  I am 3 yrs clean today from a nasty Benzo habit and I know if I can do it then you can also.  

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there's something called "the thomas method" that seems to help many people detox at home.  a google search should yield results should you decide to go that route. 

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Of the three you mention Naltrexone is the way to go and Methadone is the worst.   If you google Methadone you will find forums where you will see nightmare posts of people trying to get off of it and it is very hard.  I've had experience with Suboxone and it totally helped me get off opiates but then I took it for too long and getting of the Subs was very hard.... much harder than getting off opiates which is withdrawals for 4-7 days and withdrawal from subs can last months if taken for a long time.  Congrats on the three days and it sounds like you are doing everything perfectly and are on your way to success.

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headbanger

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Support groups like AA/NA can help if you think you want to give them a try.

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cobd, it sounds like you have more of a relapse that a usage issue. You and your therapist should talk more about that if you can.

I went to a few and when we realized that depression was a big issue I started with Zoloft and along with the shrink was able to stay clean.

Kudos Roger. A benzo addiction is the worst in my opinion. I've been there brother and it sucks!

 

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I'd like to thank everyone for their input here...it's certainly heartwarming to see such a show of support from individuals that I only know from browsing these forums!

I have to apologize in advance for the length of the following post.  I tend to be extremely verbose when describing situations and emotions.

At this point I've been nearly 7 full days sober.  Though, in truth, I've been using a low dose of Kratom in the mornings to help me get through the day at work.  I work in construction; HVAC/R controls, startup, and service in particular.  It's a high stress, highly team-centric, high demand job.  Union work, too, and I am an apprentice.  Wonderful pay and benefits...excellent retirement prospects.  I've proven myself to be competent, driven, meticulous, agreeable, and dependable for the most part...something that is rare to find in my trade.  Thus, I've worked up to something of a leadership position.  Unfortunately...I hate my job.  It's entirely unsuited to my personality.  I have difficulty dealing with the stress involved, and the drama that inevitably forms in a team-based environment.  Plus...apprentices are often subjected to outright harassment and bullying by their superiors.  Not a good thing. 

So, that right there is one of my triggers.  I've identified that much.  Another one of my triggers is my close proximity to the drugs in question.  I'm currently living with my parents, saving as much money as possible...which originally was supposed to go towards a down payment on a house.  My mother has been an enabling force for my condition, as she's an addict as well.  I've seen what it does to her though...and I don't want that kind of life for myself.

So...I've spent some time trying to determine how to nullify my triggers.  First off I need to deal with my proximity to the drugs.  I can do this one of two ways; by moving out and separating myself from my mother whom I love dearly despite her condition, or by medically nullifying any affect the opioids have on me.  This is where the naltrexone comes in...if I move on from the pills to the once-monthly shot I can ensure that no matter how close I am to the opioids, that even if I take them they will have no effect on me.

As for keeping that once-daily routine for the pill form of naltrexone...I already do have a routine in place at night.  It was previously stated that I may have a relapse problem more than a use problem...and the truth is that is exactly the case.  I've been dealing with depression for the majority of my life.  This was the first issue I brought up with my psychiatrist, and I take venlafaxine XR 150mg nightly.  The naltrexone will fit right in with that.

Now...my second trigger is inextricably linked to the first.  My job.  I've already decided: construction is not the life for me.  It will pay the bills.  It will provide financial security, as long as I don't slip up.  Which...well...I have recently.  I had an emotional outburst on the job that got me sent home.  Even if I maintain a calm demeanor, keep my head down, and work hard though...I just don't see myself ever being happy.  The stress from work will seep into my personal life.  I'll have money.  I won't feel fulfilled.  I'll always be looking over my shoulder, waiting for the other shoe to drop.

I'm willing to suffer for a little bit to ensure a happier future.  I'm willing to tough out this job for a little longer to learn some new mechanical skills that could come in handy later on in life, and to continue saving money.  Except now, my job wouldn't be a "career", and that money would not be for a down payment on a house.  If I bought a house I'd have to ensure that I had a solid and steady cash flow, which would limit my employment options.  So instead, that money would now be used to finance my higher education.  I've always dreamed of getting my masters or PHD in psychology, and having my own practice as a MFT, counselor, psychologist...etc.  Or maybe even going into physical therapy.  I believe I'd be much happier in a job that fulfills my values: I like to help people.

The question is...how much longer?  I have about 22K saved up so far.  I could complete the apprenticeship, but that would take another three years.  Knowing my current stress levels...and the stress levels of the job...I don't know if I could fully ensure that I don't relapse in that time frame.  Unfortunately, it's also the source of my health insurance.  So I'll have to look into an alternative means of health insurance.  I suppose that's a question for an accountant though.

The last concern...my kratom usage.  I've done research on kratom and naltrexone, and what I've found is disheartening.  The last time I used kratom was yesterday: about 4 grams.  I'll have to do some more research on just how bad the withdrawal interaction between the two is.  I'm taking a week off work, though...so even if I have to suffer, it wont affect my job.

Thank you again for the support.  I want this time to be the last time, and to never look back.

 

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headbanger

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Wow congrats on your sober time cobd. You seem to have a really positive attitude which is great. Once the drugs, whatever they are, leave our system the brain starts function properly again. Better decisions, being aware of consequences, remembering yesterday...

Well good luck cobd. They kinds of stories can really help other people who may be struggling.

Thanks

HB

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cobd, I hope with all my heart that you will be able to leave your job and go back to school and fulfill your dream.  It's great that you already know what would make you happy as that is a big thing that many people wish they knew.  The one single thing that helped me the most with triggers was to think of addiction as a separate (evil)  entity who whispered lies into my ear.  This gave me the strength to fight back.  When I felt strong urges pulling on me I would say to the troll "no, you are lying you mofo" and as silly as that may sound the urges started leaving me alone and in a surprisingly short time they went away... but....the minute I let myself think, even for a second, that I might indulge it came back whispering lies in my ear again.  When pushed by someone people tend to push back and I think for that reason thinking of it as an enemy pushing on me gave me the strength to want to push back.  Good luck to you my friend.

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Suzie...it's interesting that you bring that up!  It's something I've been struggling with a bit.  I recognize the truth in what you're saying.  I'm an easygoing individual though...anger isn't something I can hold onto for very long.  I was using anger before to push away those lies that whisper in my ears...but that faded.  That subsided.  Maybe the truth is that I shouldn't use my anger, my rage against substance abuse.  Maybe I should approach it from a more logical angle: that this is a voice that cannot be trusted.

That leads me to one of my greatest inspirations for getting clean...and one of my favorite musicians.  Maynard James Keenan.  He's been through the prescription drug thing...and he writes about it a lot.  The entire "Thirteenth Step" album from A Perfect Circle is about this.  He uses the metaphor of "the devil" whispering in his ear quite a bit.

If I can indulge in the lyrics of one of their hits a while back, "Weak and Powerless":

*Little angel go away/Come again some other day/The Devil has my ear today/I'll never hear a word you say

He promised I would find a little solace and some peace of mind/Whatever, just as long as I don't feel so...

Desperate and ravenous/I'm so weak and powerless/Desperate and ravenous/I'm so weak and powerless over you*

Yeah...Its nice to find an artist I can identify with so much on an intellectual and visceral level.  That entire album is a concept about one person's progression from addiction, to recovery, to relapse, to finally putting his foot down and choosing to embrace the vulnerability that comes with kicking the habit for good.  All the emotional ups and downs...the numbness, the fiending, the hopelessness, the heartbreak, the anger, the fear.  Somebody who's been through what I'm going through, and came out the other end stronger for it.  I'm a hobbyist musician/songwriter/producer myself, and for a long time I convinced myself that it was the drugs that were allowing me to create.  But the truth is...I'd just get too whacked out of my mind and lose all interest in making anything.  

And the truth is...I've cried many times over the last week.  Kicking this stuff...it can be like losing a lover.  It can be like breaking up with somebody.  Sometimes in a relationship, you have to recognize that even though you love somebody, they're making you miserable.  You have to take yourself away from them.  For your own sake.

Except...well...fuck opiates.  They have no feelings.  It's like leaving a sociopathic lover.  They don't really care about you.  The Devil indeed.

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Also the crying may very well have to do with a chemical imbalance we all have at this point and that will get better in a little bit of time.  I can't hang on to anger either but just thinking  of addiction as a separate entity who does not have my best interest at heart really made a difference when it came to triggers and it kept me from beating myself up which only leads to relapse I believe.  Just know that it will get easier and easier and you will get stronger and stronger.  It helps to talk about it so please keep writing and getting support here.

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Guest blissopifree 2

Well done cobd,I myself have a opiate problem going back over 20yrs now so my advise would definitely be the naltrexone route now that you have basically beat the opiates bar the kratom which wds are not too bad if not overdone.I have been on the m/done many times and done over two years on suboxone  which I struggled to step off,basically meaning I'm back on the m/done and I hate the fact I am (handcuffed) once again.

This has to be my final attempt at recovery as I'm so tired of being sick and tired,over time opiates rob you of everything family, job prospects (I have always been employed btw) or better job prospects due to lack of self belief or drug testing as part of the job criteria.Cobd you are relatively new to addiction and you have seen your mother struggle no doubt so I think you are strong enough to stop and keep away from opiates.One thing I will say if possible go for the naltrexone implant as I had been clean a  few years back after a rapid detox , after a few weeks struggling with m/done wds (basically NO sleep)stopped taking my naltrexone orally and used H.Big mistake I should,v been stronger and relapsed of course.You sound like an intelligent young man and please don't waste any more time with this most cruel of maidens  as one day like me you look around and think where have the last 20 years gone.I wish you all the best and be strong,I myself HAVE to do it this time as I REALLY am sick of it and I'm doing for myself not for a partner or family but for ME.Until you wanna get clean for yourself you'll never do it and it sounds like you do so stick in there bro...

Peace 

Bliss. ...

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^No, there is no boredom here.  I understand the ambivalent nature of my condition...though I didn't have words for it until you stated it.  The truth is that a part of me is in love with using opiates and opioids.  I love the rush, the euphoria, the numbness, the feeling like that of a warm blanket wrapped around my head on a cool day.  The contentedness.  The loss of worry or cares in this world.

But I also see the other side.  I see the side where I do not, and will not ever have access to enough of these to continually be in this state, and that even if I did it would A: morph into something darker and B: probably eventually kill me .  I also know that once I leave this state...I just want it again.  Soon.  Quickly.  As soon as possible, really.  And I know that once I exit this state...my body is useless.  I'm useless.  I'm miserable and unhappy and depressed.  I can only think about using again.

This has simultaneously been one of life's greatest joys and one of life's deepest sorrows for me.  The thing is...the balance tips heavily towards sorrow, and the joy is short-lived.  Temporary.  Fleeting.  And then I'm left with what I've done with my life: not a whole damn lot.  It's a hedonistic pleasure, one that doesn't translate into the longevity of happiness.

Here's the way I look at it: Do I want to take the short path to pleasure, which leads to unhappiness and discord throughout this one life that I have?  Or do I want to discard that which would poison my other life, pursue my dreams, and hopefully...down a long path...attain happiness?

I choose the latter.  I started Naltrexone last night.  25mg for four days, a full 50mg after that.  No ill effects.  Actually...I think I feel a little better.  Like I have more energy.  Could be a placebo effect, but who knows?  Eight days since last opiate use (40 mg 0xy, 15 mg hydr0).  Three days since my last Kratom usage: 4 grams.

I feel like I have control over my destiny.  I hope this feeling lasts.  I know I've had it before.  But now...now I have a bit of help.  Thank you all.  I'll continue to keep you posted on my journey.

I'll end this post with another lyrical passage from Maynard James Keenan:

"High and surrendering to gravity and the unknown/Catch me, heal me, lift me back up to the sun/I choose to live"

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Well, the four days of the initial dose are up.  Now it's time to switch to 50 mg tonight.  

Truthfully: I've done my research on this topic.  My own ability for research is what scares me a little bit when it comes to this sort of thing.  I've found myself wondering...why haven't I heard more about this drug?  Well...the truth is that it's longevity as a treatment plan in oral formulation is heavily contested.  

Here's the thing: Naltrexone does help to quell the physical symptoms of opiate withdrawal.  I've experienced this first hand.  I've got more energy.  My body doesn't hate me anymore.  It's...kind of a minor miracle.  It does not, however, quell psychological symptoms of opiate craving.  I still think about them, and I still want them.  I just have to remind myself: even if I take them, they won't do a damned thing.  They'll probably just make me sick.

So here's what naltrexone, oral formulation does: It removes the moment-to-moment struggle.  This is huge.  All it takes is one moment to pop a pill and get back on the road to addiction.  It does not, however, remove the day-to-day struggle.  If I'm weak enough for long enough...I can plan ahead, skip a dose, and take something that I shouldn't.  But all it takes is one moment within that 24 hour period for me to say "NO!" and take my naltrexone.  That's why many doctors push their patients towards the once-monthly injection.  Though...in truth, I think with my busy schedule I'm more likely to skip one of those than I am to take the pills they send me in the mail.

The other potential problem is...well...naltrexone doesn't defeat addiction long-term.  Only constant vigilance can.  So...I'm already set that I need to be on this stuff for a year.  At least.  Maybe the rest of my life?  I don't know.  Certainly as long as I'm in close proximity to the stuff.  I just hope that, with time, these voices in my head begin to quiet.

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