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 – I Think You Should Take Fewer Pills

I’m going to notify my counselor that I must be rid of my med provider as soon as it can be arranged. I’ve told Arthur, my counselor, that I don’t feel that Jamie (med provider) is working in my best interest. My next appointment with her she started right off by confronting me about what I’d told Arthur. I confessed thit it was true.

It got me no where.

She says that I’m on too many pills and she doesn’t want to add anymore. Apparently, this is her rational for not giving me medication that might actually have helped me.

I’ve been practically begging for something for my anxiety that only get’ s increasingly more consuming with each passing day

This whole school year has been like a nightmare.

She doesn’t want to give me more pills? Bull!! It is not her choice to decide whether what other doctors prescribe me for illnesses she knows even less about than I do.

She has repeatedly used this as an excuse not to give me something that could prevented me from my brake down. I have high cholesterol, my thyroid is out of whack, I have chronic horrible lower back pain, I have FM, RA, OA, a facial tick (probably stress related), PTSD, and have recently been diagnosed with IBS-d. It’s a crap load of stuff, but they have all been dealt with by someone more intelligent than she is.

I’ve asked each and every visit for something to help with the burning anxiety. She refuses. She gives me fewer chill pills.

Does she think I like taking a handful of pills twice a day? Moron.

I’ve finally had a breakdown. I blame her. In December I confessed I’d been having thoughts of harming myself. I’d hidden that for years, but at that point it was too much, and I confessed it.

She did nothing.

If I can’t trust my med provider to guard my mental wellbeing, than who will? There aren’t many options here.

I’ve started to shake, Twitter, and twitch again. I’m graduating today. My anxiety that mixes like a charm with my mania and depression making my constant mixed state even more confusing and painful. It’s too much to handle anymore.

I’m firing her. She truly doesn’t have my best interests in mind. I don’t need one of my medical professionals contributing to my madness. That’s just sick.

Insidious Black Box

I apologize for the length of this post. Please consider reading the entire post. It’s very important. Your life could depend upon it. (Robin)

Emotionmasks insane faces

I take two medications that I considered to have a Black Box warning. They both depress breathing. Together they can stop my breathing altogether… There are other dangers.

I have chronic pain with Bipolar Disorder and Generalized Anxiety. I am prescribed both Oxycodone and Clonazepam by two different providers. They both know that I take both medications.

I see a pain management specialist for my pain. I have for some time now. To be treated there, I have had to sign a contract that governs my behavior with regards to taking pain medications, I have to take a pee test every time I go in and they count my pills every time as well.

My med provider handles my Clonazepam prescription for anxiety. I suffer from extreme anxiety. Sometimes I feel like my brain is going to explode. Recently, this woman, who is the 4th or 5th provider I’ve had since I started going to this clinic, told me that I’m more likely to kill myself because of anxiety rather than depression. I was always told that a depressed person was more likely to commit suicide when they started to feel better. When they started feeling better, they finally would have the energy to follow through with their suicidal inclinations. Apparently, there is more to it than that.

My counselor and every med provider I’ve had is intimately aware of my massive anxiety and my inability to get it under control. We’ve tried all the counseling type of solutions including Cognitive Behavioral Therapy (talk therapy), mindfulness and other techniques. I’ve not had success with any of them.

My med provider is content for me to only take Lamotrigine, which is primarily to treat my Bipolar Disorder depression symptoms, and not to take anything other than Clonazepam for anxiety. From talking to her, it appears that this is primarily to treat the depressive symptoms that I experience. I have not been able to get any of the med providers who have treated me to give me anything for anxiety other than Clonazepam.

She, my med provider, told me at our second meeting, that people with anxiety are more likely to commit suicide than people with depression. Since I suffer primarily from anxiety, you would think someone would have warned me of this. I understand now why I feel so self-destructive while I’m exploding with anxiety.

She has told me that her goal is to get me off the Clonazepam completely. Now that I’m taking my runaway anxiety and the real chance I will kill myself because of it more seriously, I’m also taking the mix of these two medications seriously. I always have, but my frantic response to my anxiety has created a situation where I’m so afraid of what might happen if I stop taking the drug for anxiety.

I’ve always felt like I’m most insane when my anxiety is at its peak.

I understand that long-term opioid use for chronic pain is not the most effective way to treat it. I’ve wanted to find a different solution for a long time. My pain management provider doesn’t offer other alternatives than pain medications.

I normally don’t want to die. I’ve always had urges that are normally short in duration towards it, but I haven’t had times when I sit there with my bottle of Oxycodone ready to take it all. But, I could.

I’ve never told any of my mental health caregivers that I have suicidal thoughts. I know that my community does not have good facilities to treat acute mental health emergencies. I don’t want to become one of those people who is shuffled into a hospital emergency room with a guard sitting outside my little room. That’s what they do. I have first-hand knowledge of this.

So what’s the answer? Do I chance dying in my sleep? Or do I chance ending my life while I’m awake? Both are real dangers.

I’ve decided to deal with my feelings of self-destruction now. With the danger of the two medications and my new understanding the relationship between anxiety and suicide, I have promised my family that I will talk to my counselor on Wednesday when I see him. I will admit that I think about suicide. That’s a huge step for me.

I’m afraid. Admitting how I’ve been feeling for years is like admitting that I can’t control the one area of dealing with my mental health that I always felt I could say I didn’t have a problem with. I’ll finally be admitting I have no control over my depression or my anxiety in relationship to staying alive.

As I say, I don’t want to die. When my anxiety runs away I cannot always control myself. I can become violent and destructive. I break down and cannot function. I become paralyzed yet also hysterical.

Yesterday I talked to my mother and all three of my kids and admitted the truth to them. My youngest who is a psych major at the same university that I attend (so is her partner) said she had been wondering if that was a problem for me. They all agree that they would rather I call them than I call a suicide line. I’ll talk to my therapist about that.

I have tried to learn to practice mindfulness several times in the past. I never fully committed to it. Mindfulness was just part of the learning experience in one of my classes I just finished. It’s time for me to review the materials I have about it, I have lots. I need to try to learn how to harness it’s potential in earnest this time. My life depends upon it.

I have a particular fear: I’m terrified of my anxiety. I know what it does to me. I sometimes feel the insidious devil of insanity creeping through my mind trying to take over, and it literally shreds my mind.

If you have any Black Box warnings for medication yourself, please take it seriously. Now that I am self-aware of my true situation I’m ready to find a way to deal with my symptoms.

 

My main medications:

Chronic Pain – Oxycodone / Nucynta

Anxiety / PTSD – Clonazepam / Benzodiazepines

Bipolar Disorder / Depression – Lamotrigine

 

Oxycodone – Warnings

“To make sure this medicine is safe for you, tell your doctor if you have:

  • a history of drug abuse, alcohol addiction, or mental illness
  • if you use a sedative like Valium (diazepam, alprazolam, lorazepam, Ativan, Klonopin, Restoril, Tranxene, Versed, Xanax, and others)”

https://www.drugs.com/oxycodone.html

Clonazepam – Warnings

Risks from Concomitant Use with Opioids
Use of benzodiazepines, including Clonazepam, and opioids may result in profound sedation, respiratory depression, coma, and death. Because of these risks, reserve concomitant prescribing of benzodiazepines and opioids for use in patients for whom alternative treatment options are inadequate.

Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioids alone. If a decision is made to prescribe Clonazepam concomitantly with opioids, prescribe the lowest effective dosages and minimum durations of concomitant use, and follow patients closely for signs and symptoms of respiratory depression and sedation.
(The above Warning is taken from: https://www.drugs.com/pro/clonazepam.html)
Concomitant: (synonyms: attendant, accompanying, associated, related, connected)

Lamotrigine – Warnings

To make sure lamotrigine is safe for you, tell your doctor if you have:

  • A history of depression or suicidal thoughts or actions
  • Some people have thoughts about suicide while taking this medicine. Your doctor will need to check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

https://www.drugs.com/mtm/lamotrigine.html

Nucynta – Side Effects for Health Care Professionals

Psychiatric – Common (1% to 10%): Insomnia, confusion, abnormal dreams, anxiety, depression, irritability, nervousness, drug withdrawal syndrome, restlessness, sleep disorder, hallucination, depressed mood.
https://www.drugs.com/sfx/nucynta-side-effects.html

 

Benzodiazepines

Benzodiazepines may be used in the treatment of anxiety, panic disorder, seizures, or sleep disorders.
https://www.drugs.com/drug-class/benzodiazepines.html

 

Bipolar – Anxiety Rising

(Sept. 04) I’ve been sitting here trying to think of how to begin writing this and I’ve been getting nowhere. School is coming and I’m stressed out about that.

I have tremendous back pain and I go to a pain management doctor for my pain medication. The doctor that I’ve been seeing for like two years has stopped working in pain management and has opened a family practice. She was great. She really worked with me and worked to manage my pain knowing that I have Bipolar Disorder, PTSD, GAD, ADHD and so on. She was the one who prescribed my chill pill (medication anxiety) that I started taking during the school year last year when I had an anxiety meltdown.

The new pain management doctor started out by accusing me of selling my oxycodone and refused to refill my chill pill. I had a prescription of Oxycodone at the pharmacy to pick up which she didn’t take into account. I didn’t do anything wrong. I don’t like her. I don’t trust her with my health. My next visit to her she accused me of breaking my pain management contract by not bringing in the second pain medication I’m on. I was never told to bring the bottle in with me. Oxycodone yes, the other stuff, no.

My back has been bothering me.

My facial tick is back. It comes with anxiety like snow falls in the mountains… when the cold and precipitation is sufficient, the snow comes. Actually the vicious tick came with my beginning to take Gabapentin gain instead of Lyrica (Gabapentin can also be used for anxiety as well as for FM, which is why I tried taking it again).

FAST FORWARD TO TODAY Sept 28

I’ve been taking my chill pill daily. I survived my first day of classes because of the pill. I usually wake up in a cold sweat whenever anything remotely stressful is going to happen during the day. Like, for instance, going back to school.

Anxiety is such a huge part of my being right now that although I’ve lived in my new house for about two months I haven’t been to the grocery store by myself even once. I needed to buy some poetry books from the bookstore about 20 minutes from my house and instead of just going and getting them I called my eldest daughter and bribed her (I’d buy her a book if she’d come with me) to come with me. I just find it stressful to do things alone. I do not have a rational reason. I’ve done all the thinking and reasoning about my anxiety that my counselor and I have come up with and the anxiety does nothing but get worse.

I stopped taking the Gabapentin and the facial tick immediately started going away. When I’m stressed it comes back. I hope it isn’t permanent.

I see my med. Provider (the gal who manages my mental health medications) Sara in the morning. I’m asking her for something to treat the sever anxiety on a long term basis. The chill pill is great but it’s for a crisis and not meant for long-term consumption.

I get so wigged out about things that earlier tonight I already mapped out in my head the route that I would take to get to see Sara and then called my daughter to make sure that I could get to the grocery store from where I was coming from. I’m planning on going to get some milk on my way home in the morning. I need to do it on my own. I think if I have the chill pill I can.

It’s amazing. I wish I could take it all the time. I’ve been having to use it to go to sleep at night. When I don’t take it I’m awake until after 2 or 3 in the morning. Then I wake up sweating. I’ve even resorted to listening to relaxing meditative music/waves on YouTube all night. I found a channel on my TV provider to listen to that works as well called Soundscapes.

The struggle I’m having with anxiety is so severe that I’ve not been willing to blog and that makes me sad. My counselor has put forth the idea that perhaps my mania is manifesting as anxiety and that It’s really part of my Bipolar Disorder. I sort of hope that’s the case. If it is, I’m confident we can deal with it.

Why haven’t I been in to see my med. Provider sooner? She’s been booked. It’s been over a month since I last saw her. I’ve talked to her on the phone and my counselor talked to her on my behalf too.

Hopefully tomorrow I can communicate clearly how absolutely painful this anxiety is. My counselor is supposed to go to that meeting with me. I hope she can actually make it. It would give Sara a clearer picture of what’s going on with me.

Now, I’m going to listen to Rachel Platten’s “Fight Song” then I’m going to go to bed. I might read for a few minutes. Maybe one or two. Seriously, that’s as long as I’ll read.

I have high expectations for my visit with Sara and Rebecca (my counselor) in the morning. We got this. I have to believe, we got this.

A Bipolar House Hunting & Being Successful

3falling
I got up yesterday close to on time and took the Bailey out and fed the cats. Bailey doesn’t eat early in the day. It distresses me I have to admit it. Yesterday afternoon we went house hunting. It’s been almost a month since the broker last took us out. The market here is really low on inventory. Houses are being bought the day they go on the market. You can imagine I might be feeling some stress about this. I am.

I spent time playing ball with Bailey before we went out. She helps me calm down. We played soccer. I kick it and she catches it and brings it back. We play in the house. When I down size I probably won’t be able to kick the ball around like this. We’re looking for a place with a fenced yard.

I’m stressed. I took a chill pill before I left to meet my mom because I started to feel really anxious. I started tapping my legs violently, which is one of the physical signs I’m having anxiety. After playing ball and taking the pill I started to calm down.

I chose to be positive about looking for houses yesterday. I don’t mean that I believed that because I was thinking positively that we’d find a house. What I do mean is that I chose to go looking with my broker and my mother and be positive towards them and the situation in general. I accepted that we might find the perfect house. I accepted we might not find anything remotely good. We saw some interesting houses. Let’s just leave it at that. We’re still looking.

As of yesterday I hadn’t seen my son in a couple weeks. Since he’s moved out and into town I don’t see him much. Sometimes I feel like seeing me is more like I’m a chore that needs to be done. I know that’s how he feels when grandma asks him to do something – like she’s a chore he doesn’t want to give his time off from work to. I feel that he feels that way towards me too. It makes me sad. He does mow my lawn every other week and I’m thankful for that because with my back pain and arthritis I can’t do it myself.

Today I met with my brother at Shari’s restaurant. I’d gone over his business website and taken notes about changes I’d make and problems I found. It needs a lot of work. I was kind of hoping he’d pay me a little for doing it, but he didn’t. I got a strawberry lemonade out of it and an hour of time with him. I don’t see him very often.

I would say I’ve had a successful week. Success doesn’t always come in making a lot of money or getting a new job. Sometimes success comes in little packages like being able to get the medicine down the cat’s throat and not all over her.

Although my brother didn’t think to pay me I still look at it as a success. I set out to survey the website and take complete notes and I did it. Then I wanted to meet with him and communicate to him what I’d found and make recommendations. I did that too. I wanted to go to the mattress store and exchange my mattress and I did that. Another success. Now I’m blogging. Another success. I have another project that’s important to me that I’ll work on next.

What kind of successes have you had this week? Today? It’s hard when I’m sad/depressed to feel like I’ve been successful, but when I’m fair and I really think about it I can see them. Being bipolar doesn’t mean I can’t be successful. But sometimes, I have to look for successes a little more closely.

I refuse to give up. I’m going to keep pushing and poking things till I reach my main goal. It’s not easy. I’m tired and my arthritis is flaring up in my shoulders, elbows and hands. It would be easy to just watch TV tonight. But I’m not going to do that just yet. I’m going to move forward towards my main goal.

I’m a little depressed. We’re probably going to have to put down one of my cats soon, so as I say, depressed. But I’m not going to give up. Excuse me now please, I have something I need to work on. I’ll see you soon dear Reader.