Expert: Peter L. - 6/21/2011

Question
First of all thank you for taking the time to read this. I am in a situation that I am not sure where to go or what to do. I will brief you on my history first.(I'm not so good at brief,but I will try ;)
  I am 29 yrs old and have 2 herniated discs and bone spurs in my neck. About 5 years ago I was given oxycodone for the severe pain I was in and was put on a "pain treatment" kind of plan where they gave me trigger point injections, epiderals, and more pain killers. I eventually became very addicted to the medication and was almost in more pain than when I had started.
I felt out of control and went to my doctor about it. He set me up with a doctor who dealt with suboxone and I was able to get off of the oxycodone. However about a year later and still on the suboxone I became pregnant. I consulted the doctor and he told me not to get off of it and to cut back as much as I could without withdrawing in fear it would harm the baby. I was able to cut back enough to where I was literally taking a crumb when my little guy was born. I felt fine. The baby was fine and I thought I had over come everything. Well I remembered the doctors telling me that if I ever had another craving to take a suboxone instead of pain medicine obviously and when my son was about 3 months old I did just that. My husband and I had just moved 400 miles away for an amazing job opportunity.We arrived only 2 weeks before the baby was born and didn't have very much suboxone but thought it was ok because I only took a tiny bit every so often. well eventually I was taking it more frequently and ran out. I had no family physician and obviously couldn't get anymore. I had no idea how bad I would withdraw and having just moved, had no one to help me with my baby as my husband was at work and I knew no one. I tried but physically could not continue to care for my baby as the withdraws were debilitating. I was so upset no one had ever told me how bad they would be. If they had, I would have been more careful. I also had some tramadol I had been given in the past and took some to see if it would help. It definitely did and I felt I had taken another step to getting off this stuff completely. In the beginning I was taking up to 12 of them a day. When I had decreased that amount down to 6 of them I tried to quit taking them. I thought that there was no way the withdraws from Tramadol could be as bad as suboxone and I was wrong. After 1 week of this and the withdraws seeming to to get worse I couldn't do it to my son any longer. I literally have no one to help me take care of him while my husband is at work. I started taking them again and while decreasing the dose continued to keep trying to get off of them, but each time having the same result. I since just continued to decrease my dose by 25mg a week. I am now down to 3 a day and only have enough of them to get me through a couple of days. Every morning I feel like I'm withdrawing again until I take my 1.5 pills.
I still don't have a physician. I did get one since I've been here,but he moved away and now I'm back to square one. I should have taken care of this sooner but feel very judged anytime I talk to doctors about it.
I would really like to be able to continue cutting back until I am down to taking only a quarter or so of one to make the withdraws easier. I may also be able to arrange going home while I do this and having my mom help this way. She doesn't know, but I would be willing to tell her. She knew everything up until the baby.
 I just got busy with things and have always planned on calling a doctor or getting a little more somehow but talk myself out of it because I'm afraid they won't help me.
Now for the question... I'm just wondering if you think a doctor would be willing to help me if I talk to them honestly or if I should just try and get off of them again? If I didn't have my son I would just deal with the withdraws and get it over with. I am so sick of relying on this stuff, but refuse to make my son pay for it. Your thoughts or ideas would be greatly appreciated. I honestly do not know what to do. I really am, and have been, just trying to do the right thing.

Answer
Hi Melanie,

I can see you're trying to do the right thing, and I commend you for that.  A lot of my time spend as a substance abuse counselor is spend playing detective as some of my clients try to get over.

As a result, I really appreciate honesty, and when it comes to this issue, it is definitely the best policy.  Most docs are used to people who try to manipulate them.  As opiate dependence, either through pills or heroin, continues to proliferate, more doctors are facing tough decisions about how to deal with opioid dependence, and when, or why to prescribe an opiate replacement drug such as Suboxone.  

Withdrawal from medications, or even Suboxone, can be stressful.  I would advise you to contact a new doctor and explain your situation in detail.  You might also contact a substance abuse program and maybe have an evaluation.  There are physicians in these programs usually.  I've found docs very helpful when someone is honest.  The key here is for a doctor to get a sense you are not going to be abusing any medication, and that you want abstinence from substances.  They will listen to that, as they are usually dealing with someone who is trying to con them for more drugs or Suboxone, much of the time so they can sell the latter on the street.

I'm not sure what is the proper protocol to deal with the withdrawal you speak of; that's the territory of the medical professionals, which I am not.  But I think you'll have good luck with an honest approach.

Best wishes to you as you tackle this.

Peter