[Terry Allen Blackburn]

There is a huge difference between addiction and dependence. The brain contains many receptor sites that accept neurotransmitters that fit in to the receptor site like a key in to a lock. The mu opiate receptor site is where the opiate locks in to, thereby, blocking the pain messages to the brain. When a person is in pain, the opiate works to block the pain signals to the brain. Unfortunately, when a person is on the short acting opiates, tolerance is achieved quickly and, it requires more of the opiate to achieve the desired result. In chronic pain patients, it is very useful to utilize long-acting opiates, as tolerance is not increased so quickly and, the amount of time between dosages is longer than, the one or two pills every 4-6 hours as needed for pain orders. These medications are taken, on average, every 12 hours, with some immediate release medications utilized for break through pain. When a person is on the opiates for a period of time physical dependence occurs. This means the person will experience withdrawals when taken off of the medication too rapidly. It is then better for the patient to withdrawal gradually though, every person is different, depending on the amount they are taking and, the length of time they have been on the medication. It is always necessary to have your physician come up with a gradual withdrawal protocol, which will taper you off in the safest and least uncomfortable manner possible.

Addiction occurs, when the patient is no longer utilizing the medication for pain management but, to feel euphoria. Once the person is not experiencing pain, the effects of the opiates cause a pleasurable, euphoric condition. The person then experiences cravings to continue the use of the medication and, to find ways of obtaining it, no matter the cost or consequences. It is still unethical for a physician to cut the person off even if addiction sets in. The physician owes it to the patient to refer the patient to a detoxification program so they can be withdrawn in a humane, safe manner.

It is up to your physician to provide you with a taper protocol to gradually bring you off of the opiates in a safe, sane manner. Once you get down to an acceptable level, Buprenorphine may be used to make the withdrawal safer with less withdrawal symptoms. There is also a possibility of utilizing a Tramadol protocol which also gradually removes you from the primary opiates in a safe manner.

Please discuss this with your physician to have them help you in this important step. No one is more qualified than your personal physician to taper you off of the medications. If you want any further assistance you may PM me and I can make an appropriate referral for you.

Do not feel ashamed of this process as, this is a naturally occurring phenomenon, that can take place with the protracted use of long-term pain medications.

Terry Newton