Opioid Dependence and Mental Illness

Pile of pills

I’m not an addict. I’m not! I’m mentally ill. I have Bipolar Disorder. I also suffer from chronic pain in my lower back.

My primary care doctor (PC… PCD? Uhh… let’s go with MD) had been prescribing me oxycodone for the server and persistent (chronic) pain that I’ve had for years. After being active and doing something super strenuous like gardening for 15 minutes I think I’m dying. I’m exaggerating of course, but when I work as hard as Atlas does while holding up the world my eyes leak, I whimper and sit down. Sometimes I end up laying on the floor. The floor is such a very bad idea. If I straighten my legs my whimpering becomes desperate and I realize I’m crying. If I forget myself and straighten my legs I’m done. I can’t move. The pain paralyzes me.

I’m NOT an addict.

When I can think again, I try to find my phone. If I can’t find it right away I feel the panic rising and it triggers thoughts and emotions I thought I’d had under control.

This last time I thought I was managing my mania and depression (mixed state, rapid cycling) pretty well. I haven’t bought piles and piles of books on ducks or Oprah or how to be an astronaut. Honestly, I really haven’t. But please, don’t ask me what I’m thinking about. Also, I’ve been able to get out of bed AND wake-up in the morning and even go for walks. My depression skips through the dandelions with the mania comingling into a mixed state, which is always confusing.

I’m not an addict.

After many months of giving me a legal way to get my the Oxycodone I take for pain legally, and for free. The label on the bottle says I’m to take the little unassuming pills three times a day. They are 20 mg. Currently, I’ve convinced the assistant fellow at the pain clinic to reduce my Oxycodone to 20 mg twice a day.

I’m not an addict.

I’m mentally ill. I have Bipolar Disorder, ADHD, chronic pain, and other stuff.

I was referred to a pain chronic clinic… ah… chronic pain clinic, where my Oxycodone prescription was reissued. A five-minute verbal probe, that’s what it took for the doctor to determine whether or not I needed the narcotic. We didn’t talk about Bipolar Disorder or any potential interactions the Oxycodone might have with drugs that are meant to manage my wild emotions or tame my fantastic panic attacks. I’m not certain she has any record of my current medications. She asked questions, and I quickly tailored my answers to fit what I thought she was waiting to hear. She made a few notes on a paper as small as her palm. I wondered if she was actually making notes that she could refer to later. She thought for a few seconds and then wrote the prescription. I sighed in relief.

I’m not an addict.

A while later, like over a year or maybe two, I’m still taking the narcotic. The clinic has new owners and staff. They no longer asked me questions. Sometimes they required a urine test. Then, they stopped asking me anything at all. We spent my appointment chatting. I started asking if we could please try to figure out what was causing the pain and try to deal with it by correcting the problem. I wanted the pain to stop.

They didn’t listen. They wrote the prescription without hesitation.

I’m telling you, I’m not an addict.

My mental health drug dispenser began paying attention after I updated her about my drugs and included Oxycodone in the list. She stopped talking about whether or not my meds were working to stabilize my moods and started talking about “Black box” warnings.

She had my attention. I started to panic.

At the time I had over five medical people prescribing medications. They didn’t know what the other office prescribed me. They relied on me to tell them the truth. I didn’t have to tell anyone I was taking Oxycodone. That got me thinking.

I’m not an addict.

Later…

I’m still asking the medical folks to figure out the cause of my chronic lower back pain. I’m still not getting results. I’m getting way too much Oxycodone every bloody month.

Because I can, I’ve been researching my of collages of illnesses, disorders, and psychological malfunctions.

Ah ha! Black box warning. Do NOT take anti-anxiety medication (benzine’s) – death may result.

Oxycodone 20 mg

I recently saw Dr. T, my very superior knee surgeon. He saw the condition of my spine when he was looking at the x-rays of my hips. He was making certain that my persistent knee pain, post second replacement, wasn’t being caused by anything running amock in my hips. He was eliminating any possible cause of my knee pain before he even considering using surgery to further correct the inept effort Dr. B made the initial knee replacement. Dr. B successfully replaced my knee, but that’s where the project ended.

It sucked. My leg from the knee down, well, it kind of turned the wrong way.

Dr. T corrected the first replacement. He tried to minimize the damage his surgery could do while trying not to blow up my entire joint… okay, the joint that was already gone.

Dr. T showed me the x-rays he’d just had taken and explained where and why he left Dr. B’s “efforts,” while replacing the replacement. A month ago we tried a shot to relieve the pain and keep from having to have surgery again.

Nope. I’ve had no relief from the pain. In fact, my brain was overjoyed and thought that my knee was doing awesome. Holy cow! I should NOT have knelt down like that! Looks like surgery is probably what our next conversation will be about. I’ll need to be on pain medication again…. I intend to be off Oxycodine ASAP. I would really like to have some kind of painkiller to take after surgery – assuming I have it. Always be prepared! Sigh…

I’m not an addict.

After my constant complaining about my back pain that happens every time, I do regular human type activities involving the lower back. I’ve finally had x-rays of my back taken. Holy heck. Next stop is at a spine doctor.

The online personal information provided by my medical organization includes this: Opioid Dependence.

My chronic pain clinic instructs me to continue taking the Oxycodone. I haven’t been able to identify any specific relief from the pain in a long time. I have never felt any “fun” results from taking it. It has never made me feel sleepy.

I have found that taking Oxycodone at bedtime with the medication I take for Restless Legs Syndrome (RLS) helps me to get to sleep and not wake up in agony caused by the RLS.

Am I an addict?

“Taking opioids over a long period of time produces dependence, such that when people stop taking the drug, they have physical and psychological symptoms of withdrawal (such as muscle cramping, diarrhea, and anxiety). Dependence is not the same thing as addiction; although everyone who takes opioids for an extended period will become dependent, only a small percentage also experience the compulsive, continuing need for the drug that characterizes addiction.”*

I’m mentally ill. In my opinion taking any medication, especially one that alters my brain chemistry (opioids do this), should be thought about and discussed with other medical personnel who are also responsible for my continued living – and to live my best life.

Am I an addict?

No.

I have Opioid Dependence.

Dependence. I can live with that, but look, let’s get rid of that too. Okay?

{I have Bipolar Disorder. I’m a little manic now. I’m using it to write and post while I can. So, for now, I will post often because tomorrow, I may be depressed and unable to say what’s on my mind. I may not have anything on my mind.}

* https://ghr.nlm.nih.gov/condition/opioid-addiction

Bipolar – Med Provider Day

I’m unstoppable.

I’ve been trying to sleep, but it eludes me like a chicken running for its life.

I’m going to see my med provider at 10 in the morning today. I hope she listens this time. If she doesn’t I’ll be requesting someone else and informing them of why I’m choosing to under go all the stress that comes with a decision like that. I’ve had enough.

I’m going to confront her with the facts. I’ve been keeping a list of my symptoms since I saw her 30 days ago. It has grown quite long. It looks even worse than before I was being medicated.

I’m unstoppable.

My pain management guy and I had to ween me off one of the long acting pain killers I’ve been taking for a couple of years because of supply issues. I went from 100 mg twice a day to 50 mg over night because there wasn’t anymore to be found anywhere. No one knew it was going to happen so there was no helping it. It didn’t feel so great. Then we kind of gradually weened me off the rest. Now my pain level is constantly higher. Also, the torn fascia in my foot still isn’t healed. It’s painful. I got special shoes for it today. But as the compassionate woman said while I walked around and around testing shoes, my foot was going to feel soar and tired. It still is. It wasn’t fun.

All this has added to my overall stress level, as you can imagine. Withdrawal is never a good time, nor is added pain.

I’m unstoppable.

I will be thankful if my counselor, Arthur, can make it to my appointment. He said he’d try. He feels it is important for her to understand my mental state from his side of the equation. He’s been with me two previous visits.

It hasn’t helped.

I’m still choosing to be unstoppable.

I may stumble, and I may fall over and over, but this damn illness is not going to continue to run my life. I’m very ill. I’m too exhausted not to fight anymore. I feel like my life has been a waste.

I’ve had enough.

I’m unstoppable.

Help me. Or, stay out of my way.

I refuse to stop!

Bipolar and Adaptation

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From today through about August 18th I need to be able to be my best self. That means I will have to be super vigilant and sensitive towards my Bipolar Disorder symptoms. Theoretically, that’s how I’m supposed to be all the time, but right now it’s really evident that I have to pay attention. The stress of looking for a house has rolled over to moving and that will roll over into flying out to Florida to meet my daughter and driving across the country with her two cats to bring her home.

I must prepare myself physically, mentally for what’s next. I tend to react to situations and my moods swing without my even being aware of what’s happening, that is, until I’m done reacting.

This is going to be a good experience for me to practice adapting myself quickly to changing situations and emergencies without losing my temper like I’ve done in the past. My usual reactions are an abrupt swinging of mood, or panic and then the mood swing.

This skill, the skill of flexibility and adaptability, is an important skill to have while coping with our mental illness. Each new skill I learn builds upon the base of my positive mental attitude, my chief definite aim, or my passion in life. (I tend to think of the three things as different ways of saying the same thing.)

Having a flexible disposition means I must be able to quickly adapt to my environment. When I say “environment” I mean not only the physical situation, but also dealing with the people involved in the situation. It means that I can harmonize with my environment in a flexible way.

I’m not suggesting that I ignore my principles or altering my goals. I’m simply suggesting that I recognize my mental attitude towards the situation and determine if the situation is a disaster or a windfall. If it is a disaster I have the opportunity to change things and make them better. Because I use positive mental attitude, I have an even better opportunity to change the disaster into a boon.

I think that part of being adaptable means that in every situation with every person I try to understand their needs and demands. An example would be my Mother calling me a couple times a day and telling me something else I need to do to prepare to move. Yesterday it was that I should go to the Loews and Home Depot on Meridian to purchase boxes, start packing, have the kids (my son, 21 and youngest daughter, 19) come over and help me go through things, and to get rid of the piano. Being sensitive to her and to protective of myself I suggested that she make a list. We’ll see if she can do it. I eventually did go to those stores and bought boxes, but not the ones on Meridian. I hate driving on that street. It’s too busy and too long and too slow.

My plan includes to getting up at the same time every day, feed the animals and take my meds, eat healthy foods, exercise (I walk down the highway with Bailey), give my brain a break by reading or watching TV or listening to an audio book while walking, planning and making lists, keeping appointments or doing errands, spending time learning about how to be successful, spend time doing reactional activities, and so on. I need to keep things fairly structured. When I just watch TV all day it usually takes me another day or more to get back on track.

I’m going choosing to daily be flexible, adaptable, and let me just add: I’m going to be kind to others. (Ellen DeGeneres)

Bipolar Struggling

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I’m struggling. I want to be successful, but I have this illness that makes it harder to succeed for me to do so than if I didn’t have it. I just get going, and then I get depressed and circle downwards further away from my goals. I feel sad and unfulfilled. Tired. And then I blame my lack of success on the fact that I have Bipolar Disorder. The blame game. But there is truth to it.

I know intellectually what I need to do to be successful, but I feel like haven’t the strength right now.

Have you ever felt like this? Sounds like a broken record to me I’ve said it so many times. I know the feelings so well it’s like embracing a lover comfortable, warm, and familiar.

I tried to walk Bailey (the dog) around 5 this evening. My right knee felt like a vice grip was clamped on to it so I did one lap up and down the road and had to stop. I’ve had this knee replaced twice. (I had it done at a much younger age than most. Thought I’d do it a second time just to see if we could get my foot to point the right direction.)

It is 9:41 p.m. and I just realized why I feel like I should have gone to bed an hour ago. I forgot my afternoon meds. My son was over mowing my lawn around lunch time and I guess I got off schedule.

You know what? I have goals that I’m passionate about and I want to succeed in achieving them. However, I’m somewhat depressed right now and I’m not believing in myself the way I need to if I’m going to be successful. And I’m being scattered. Forgot the Ritalin. I’m blaming the illness. Now that I’ve figured out why I got more depressed today I can fix it tomorrow by taking all my meds.

It would have helped if I’d taken my meds. I’ve taken my p.m. meds already. I talk about how important it is to take your meds. This is why. My just missing one afternoon’s meds cost me my afternoon and evening and I feel more depressed.

Tomorrow is a new day. I’ll stick to my morning routine. I’ve got a morning routine. If I deviate from my routine, the rituals, I usually forget something. The rituals make me feel comfortable and steady.

I forgot to feed the cats this morning so Maks, the younger of the two, went into the kitchen and opened the cabinet doors and let them slam shut. I’m sure he knows I hate it when he does that. My dog Bailey chased him downstairs. That’s what happens when you have a cattle dog without cattle. She reverts to herding the cats.

I’ll take all my meds tomorrow. I’ll have to take my afternoon ones just before I leave to go to our family BBQ for Mother’s Day at my brother’s mid-century (I watch HGTV) home overlooking Puget Sound. It has a beautiful view. We’ll eat and play cards. I’m sick of playing cards but at least we have something to do. It can be fun. Depends on my attitude.

Time to take Bailey out. Then I think I’m going to journal for a little while.

My youngest daughter got hired Thursday to work at a car wash that her brother works at ($15 an hour plus tips!) and she worked today. That was fast. I’m so proud of her. I’m so proud of all my kids.

Yep, time to put this to bed.