Addiction and Substance Abuse

Dilaudid Addition/Abuse

08/21/2009

Question:

I HAVE SEVERE BACK PAIN AND MY DOCTOR PERSCRIBED DILAUDID, NOW TAKING AS MUCH AS 15 - 8 MILIGRAM TABS A DAY, THE PROBLEM IS THIS , DUE TO BAD ADVISE I ABBUSED THEM BY CRUSHING 3-8 MILIGRAM TABS AND THEN DISOLVED THEM IN WATER UNDER HEAT AND INJECTED THEM, I OF COUSE 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 ORRALLY BUT EVEN 5 OR 6 --8 MG TABS A TIME WORKS BUT ONLY LASTS A FEW HOURS--WHAT WOULD BE SOME ADVISE 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 AMMOUNT PERSCRIBED VERY QUICKLY OR DO SOMETHING LIKE EVEN CUT ME OFF COMPLETELY, I FEAR I WONT BE ABLE TO HANDLE THE WITHDRAWL AND WILL PANIC TO THE POINT OF SUICIDE--PLEASE HELP ME WITH SOME ADVISE ON BEATING THIS, SHORT OF HAVING TO CONFESS THIS ALL AND GO INTOA REHAB CENTER , I JUST WANT TO TRY TO GO BACK TO ORALLY TAKING THEM AND THEN REDUCE ON A GRADUAL BASIS TILL I HAVE STOPPED ALLTOGETHER

Answer:

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.

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Response by:

Ted Parran, MD
Clinical Associate Professor
Department of Medicine
University Hospitals
School of Medicine
Case Western Reserve University