I’ve been taking doctor prescribed opioids (di-hydrocodeine and morphine) for pain relief since leaving University in the final year of a 3 year degree in Molecular Genetics on medical grounds (back pain, literally couldn’t sit the ~21 hours of exams) almost 20 years ago (1996)!
I updated this article 3 years after failing to completely wean myself off opiates in December 2010 (it’s April 2014 now) which either caused or coincidentally was when I developed pain in my coccyx: another pain that sucks, that’s been hurting over 3 years!
Currently (2014) I’m on a dose of 30mgs of time release di-hydrocodeine twice a day, roughly equivalent to 5mgs of morphine a day (morphine is around 12 times more potent than di-hydrocodeine) and it doesn’t do a great deal for pain relief.
As I was in opiate withdrawal when I first wrote this article (2010) it’s not exactly my best work :-) I’ve fixed some of it, but it does ramble a bit more than I normally would!
Morphine Drug Abuse
Interestingly not once in this period of needing pain killers have I abused opioids, beyond taking more than prescribed for pain relief: when I did an activity that took more than a couple of hours, I’d take extra, or did since I don’t anymore.
I’ve never used opiates recreationally, also before developing chronic pain steered clear of street drugs: once shared a joint with friends when I was in my late teens, but took so little had no impact. I was one of those teens hooked on exercise in the 90s, the no pain no gain crowd and only abused alcohol in a relatively limited way, didn’t like feeling drunk. I’ve been teetotal for over 20 years, never understood the allure of alcohol consumption.
Something that’s disappointed me in this period of my life is I’ve NEVER had an opiate high, you’d think with how much morphine I’ve taken at times I’d be somewhere in the clouds at least once, but the best ‘high’ I’ve had is one very short lucid daydream: it was about the Simpsons and it wasn’t that good!
Even in hospital when I was getting maximum dose morphine injections every two hours plus some awful tasting morphine solution, I had awful nausea, buy no high, though had some memorable (but not exciting) dreams for a couple of nights when I finally went on 200mgs time release morphine (normally don’t recall my dreams).
Very disappointing :-) but seriously why do people abuse opiates, I just don’t get the appeal.
How much morphine do you have to take to get high?
Before my back operation (had two disks fused) in February 2009 I was taking 360mg time release di-hydrocodeine a day (recommended maximum medical dose is supposed to be 240mgs a day) and it took the edge off the pain (it never removed the pain).
After the back operation I was at first in even more pain (a LOT more pain) and left hospital a week later on 200mgs time release morphine a day (technically equal to around 2,400 mg di-hydrocodeine, though I understand doses of di-hydrocodeine above 400mgs aren’t absorbed/effective: I’ve taken over 500mgs on bad days, didn’t work mind you).
Within a week of leaving hospital I’d reduced that down to 100mgs morphine a day – got used to the pain. Took a few months for the pain to start to reduce significantly: it was a slow recovery process from the back operation, the surgeon has to cut through large back muscles and remove bone, not to mention add metal pins (have quite a big bulge along my spine now, which is cool :-)).
We recorded a video of my wife removing the 20 staples from my back, but can’t find it. They were irritating me (were due to be removed) and couldn’t get a district nurse to remove them that day, so my wife did it while one of the kids recorded it for posterity.
We did a lot of research on YouTube how to remove surgery staples and still got it wrong :-0 Found that bit on video!
Post Operative Pain Relief
Over the next 20 months it was very hard going, a combination of pain due to the operation (could barely walk for pain for two weeks) and other health issues, but I worked through the pain and got stronger.
I spent over a year stuck in bed before the operation, so lost a lot of muscle mass/fitness: I used to weight train, used to be fit, quite well built, as my body healed/I got stronger/fitter I reduced the morphine intake to a level where it took the edge off the pain: my experience is opiates are rubbish at reducing back pain (at times I’ve wondered if they are doing anything at all!).
Morphine for Toothache
Interestingly opiates have had ZERO effect on toothache, had a couple of difficult root canals and a couple of paracetamols (Tylenol) worked 10X better than opiates!
Ever had a tooth drilled where the anesthetic didn’t work and the dentist tried injecting through the drilled (very sensitive) tooth directly into the exposed nerve, still didn’t work, but I swore at the dentist!
Weaning Off Morphine
I’ve asked for no help from my doctor for opioid withdrawal treatment (just seeing a GP now, they aren’t very good, but the benefit of that was they left me alone regarding taking opiates!) for help on reducing morphine intake and by December 2010 I’d got my dose down to around 6mg morphine a day.
You can’t get time release morphine tablets any smaller than 5mg tablets, so I’d switched back to di-hydrocodeine (I had a bottle of 120mg time release tablets left from before the operation) and starting at 120mg di-hydrocodeine a day (lots of fun cutting 120mg tablets in half :-)) I was down to 70mgs di-hydrocodeine a day (GP prescribed 30mg and 40mg tablets).
After a week or so on 70mgs realised I’d been prescribed instant release (numpty GP), which went along way to explain why despite such a small drop in dose my withdrawal symptoms was all over the place over the week or so!
It is really irritating you can not get small dose time release opiate tablets. Smallest for morphine is 5mgs, smallest for di-hydrocodeine is 60mgs. Dropping from that level cold turkey results in significant withdrawal symptoms! It does not make sense why there are not morphine in 1mg time release tablets, and di-hydrocodeine 10mg time release tablets.
Going Cold Turkey From Opiates
Since I coped with the withdrawal mess that week, decided to jump straight to zero: go cold turkey off opiates.
I occasionally make rash decisions, for example spent months slowly reducing my morphine intake, would drop 5mgs at night, wait a few days for the relatively minor withdrawal symptoms to settle (at first I was surprised dropping from say 60mgs morphine a day to 55mgs resulted in any withdrawal symptoms, but it did!) and drop 5mgs in the day wait to stabilise on that dose and try again: basically wait for my fitness to catch up with the lower dose, fitness has been by far the biggest issue I’ve had since the operation (less fit I am = more pain I feel generally and I was doing awful in 2009 when I had the operation).
At 40mgs morphine intake decided to drop to 20mgs over night (half my dose), that was a heck of a fun week, the worst part for me is my legs. I pulled/tore a muscle in my leg (groin strain type pull/tear) years ago (carrying a 25KG bag of cement upstairs) and I ignored it and worked through the pain for months, it’s not healed well and hurts almost all the time.
During withdrawal the pain flares, the only thing that helps is a hot water bottle. Also strained my other knee and that felt sore all the time as well, during withdrawal it flared (not as bad as the other leg though). Relatively speaking my back was doing great, ached a little bit more during the withdrawal phase, but felt the same a few days later. If it wasn’t for leg pain I’d have been off opiates 6 months before trying in December 2010.
After two day since I took the last tablet, I had a relatively good nights sleep the first night considering. My legs felt agitated in the late evening, so hot water bottle to the rescue: I don’t think I’d have got through it without them, they are very effective. At night two (when I started writing this article) and the nights are always the worse and this is the worst withdrawal pain I’ve had yet!
I woke drenched in sweat and so had to change everything, by the time I’d got settled my legs were freezing cold (another health issue, cold/painful knees, but nothing wrong with my circulation apparently!) and in combination with withdrawal pain it was HELL (except cold).
Was very tempted to take part of a di-hydrocodeine tablet (break a 30mg tablet in two) to take the edge off the withdrawal, but that would make the process take even longer, so struggled through it (hence this rant of a post at 6am in the morning :-))
How I thought going cold turkey from opiates would go:
Few more days of this pain and I should be off opiates for good assuming my body can cope with whatever real pain is left over (not related to withdrawal). In hindsight this was the worst time to make this decision, it’s harder to stay fit in Winter (a very cold mid December in the UK right now and we are looking at a another cold spell) which means I tend to feel more pain. I’ve been experiencing mild withdrawal like symptoms (sweats, painful legs, bowels not happy!) for over a year, my body never seems to fully adapt to the new lower level of pain medications, so I’m feeling crappy most of the time. I want to be completely off opiates to see what is ‘real’ pain/health concerns and what’s caused by taking opiates for so long.
BTW If I tear anyone a new one this week, you know why!
That was a bit of rant, but it did kill 30 minutes of a long night in pain :-)
How going cold turkey from opioids actually went:
I lasted around 6 days without taking any opiates, by day 6 the opiate withdrawal symptoms were getting worse, I was completely exhausted form a lack of sleep, had diarrhea and was living with hot water bottles pretty much strapped to my legs and lower back 24/7!!!
I was and still am surprised at how bad it got, it was bloody awful and I’m really good with acute pain: for example I have ingrowing toenails and regularly tear them off, really freaks my wife out :-0 it hurts, but it’s over in 5 seconds! It was only 70mgs di-hydrocodeine I went cold turkey from, expected some withdrawal, but not like what I experienced.
Can only imagine what it must be like for drug addicts coming down from really high doses of opiates!!!
Failed at Going Cold Turkey
I started taking di-hydrocodeine again and the withdrawal symptoms went away after a few days. But I was left with pain near my coccyx. I don’t know if it was simply coincidence or cause, but I’ve had that pain ever since and it’s really disruptive. Can’t sit or lay flat on my back, have to lay on my side most of the time, makes it really difficult to work!
Since then my upper back and shoulders have also started to hurt, feels like they are really tense and can’t get comfortable. So currently have no plans to try reducing my opiate intake in the near future.
Considering I’m in more pain today than ever before other than the year I was stuck in bed (could barely move due to pain) and the first year after the back operation I’m happy with how I’m coping with pain today.
I walk 5 miles a day, through dieting have dropped almost 4 stone in weight (now at my perfect weight just under 10 stone: BMI below 20) and do light weight training. Considering I’m 44 next month and feel like crap I look great, biceps are bulging, have a one pack developing and the medium clothes I bought after dropping the weight are getting tight around the shoulders :-)
Funny thing is my youngest son (late teens) has recently started going to a gym to weight train, he’s lifting heavy weights for hours a day, I do it for minutes a day with light weights and my arms are better defined. I do enjoy winding him up about his puny arms :-)