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Monday, December 9, 2013
Addiction and Substance Abuse
Treating Dilaudid Addiction without Rehab?
I have severe back pain and my doctor prescribed Dilaudid, I am now taking as much as 15-8 milligram tabs a day. The problem is this, due to bad advice, I abused them by crushing 3-8 milligram tabs, and then dissolved them in water under heat and injected them.
I, of course, have found now that I am of course addicted- I want to stop and have really been trying but find it extremely difficult. After about 6 hours, the pain starts to come back very bad and I suffer many other problems, sweating anxiety, mixed up thoughts, panic, you name it.
I have been trying to go back to taking them just orally but even 5 or 6-8 milligram tabs a time works but only lasts a few hours. What would be some advice on how I can break this difficult problem?
I am scared to tell my doctor what I have been doing in fear that he will drop the amount prescribed very quickly or do something like even cut me off completely. I fear I won’t be able to handle the withdrawal and will panic to the point of suicide.
Please help me with some advice on beating this, short of having to confess this all and go into a rehab center. I just want to try to go back to orally taking them and then reduce on a gradual basis until I have stopped all together.
Thank you for your good questions. You are clearly in a very difficult position. Your increase in drug dose indicates an addiction problem in addition to a back pain problem. The fact that you have changed your route of administration from the intended one (taking it by mouth) to crushing and injecting the medication IV also indicates that you have a serious addiction problem in addition to your pain problem.
When this is the case (a person having both problems), it is rarely effective to try to taper the dose as an outpatient and generally requires admission to a detoxification unit in the hospital for safe medically-supervised withdrawal.
The other alternative that might be available in your region is a methadone maintenance program, where you could receive daily dosing of methadone at the facility to help with addiction and also with pain, and then use your own doctor for non-controlled drugs and other pain management strategies.
Again, once a person is in your current position of having substantial and active addictive disease in addition to a chronic pain problem, tapering as an outpatient just does not tend to work.
Ted Parran, MD
Associate Professor of General Medical Sciences
School of Medicine
Case Western Reserve University