I’ve never spent much time thinking about problems associated with addiction and dependence. When I hear about other people having one of those conditions, I would usually chalk it up to a mostly controllable inability to simply stop taking the drug in question. Boy, was I wrong.
I learned there is a distinct difference between addiction (a compulsive drug use that effects the function of your daily life) and dependence (a physical adaption to the drug, and possibly, but not necessarily combined with addiction). One can be addicted and dependant, or one can simply be dependent. I was the latter.
After my recent cycling accident I was put on relatively high doses of oxycodone (an opiate). The drug did wonders for my recovery. It allowed me to breath, move, and deal with the severe pain I was experiencing.
After about six weeks, I decided it was time to get off the oxy. I knew hydrocodone (Vicodin) was sometimes used as a “bridge” drug, and so I switched to that. I was on 60mg oxycodone per day. Unfortunately, this plan was a huge mistake. My “only” physical reaction was severe pain (the very pain I was trying to eliminate), and my emotional reaction was a severe bout of depression. It was not pretty.
I went back on the oxy…though, on a slightly smaller dosage.
Then, over the next six weeks, I started a disciplined tapering schedule after visiting my doctor. 60 mg, 40 mg, 20 mg, 15 mg, 10 mg. When I hit 10 mg per day, almost three months after my accident, I thought, “NOW I can stop without any substitute”.
Wrong again. The reaction this time was far worse. The bout of depression was relatively mild (compared to before), but I ended up having most of the typical opiate physical dependence withdrawal symptoms: agitation, loose stools, irritability, endless sneezing bouts, runny nose, high resting heart rate, uncontrollable yawing, and the inability to get to sleep ‘cause I was like an out of control wind up toy in bed.
I went back on the oxy again – though, on yet an even smaller dosage.
Now I was on ½ a pill – 5 mg per day – for a few days. Then I thought, surely, I can quit NOW! Nope. Same symptoms. I was able to handle the symptoms on day one. Well “handle” may be overstating it, as I simply slept the entire day. It’s not hard handling something when you’re unconscious. However, getting to sleep at night was nearly impossible.
Day two was OK, I got some exercise on my indoor bike which felt wonderful, I even worked up a sweat, but still I needed a way to sleep that night.
So, another doctor visit. She said I fell off my taper a bit too quickly. 5mg per day is too quickly? Apparently. Now what?
She gave me three options: cut the pill in ¼ and take 2.5mg at bedtime for few nights, or take ½ an Ambien, or try an OTC sleeping pill. Well, there was NO WAY I was going back to oxy, so I tried the Ambien.
When I asked my doctor why kicking this drug was so hard she said it’s one of the most addictive prescription drugs on the market and some people are particularly susceptible. She said people get dependent on it for two or three primary reasons: first it solves their pain problem, then some people get a slight high from it, and most get an overall good feeling from it.
While on this drug, when life comes at you, you almost always just “feel good”…so who doesn’t want to feel good all the time? Other than The Buddha, I’m not sure any of us feel good all the time, and honestly, if I have to get that feeling out of a bottle, I’ll take not feeling good sometimes, thank you very much. Bring on life, I’m OK with it as it is. I’ll stick with my exercised-induced endorphin high. It’s safer – as long as you stay on the bike!
On night two I took ½ an Ambien and conked out in minutes. I had a restful sleep with no morning side effects. The next day, day three, I felt energized, I got on the bike and did some intervals. It felt wonderful. However, that afternoon I conked out and slept several hours and had zero energy the rest of the day. I may have overdone the workout, but screw it.
When I hit the pillow on night three I felt tired enough that I assumed I could do it “au natural”. Well, I fell asleep but woke up two hours later practically hyperventilating with a racing pulse. Going back to sleep unaided would have been impossible. So ½ Ambian came to the rescue, and I slept till morning.
Day four: could hardly extract myself from the couch to go in the kitchen and make a cup of tea, was mildly depressed, and had zero energy. I forced myself on the bike, indoors of course, ‘cause it was cold, windy, and really unpleasant outside. I think all my energy was expired simply getting ON the bike, so once there the riding part was relatively mild. But it was far better than being huddled in the fetal position on the couch under a pile of blankets.
The next few nights I took a half-Ambien to get to sleep, slept pretty well, and woke with a reasonable amount of energy. Looks like this process will take at least a week, but I honestly think I’m over the worst of it. Getting to sleep may still be a problem for a while, but I can deal with that as long as I’m not a fidgeting mess while trying.
What’s truly amazing to me is that when the doctors gave me the oxycodone prescriptions – a total of 5 doctors over the course of my recovery – not ONE gave me the prescription with a stern warning about how my body might become dependent on the stuff. It was only after visiting my primary doctor after my first failed cold-turkey episode was I told of the problems I was about to face.
The next phase is building my strength and endurance on the bike up to where I was last year. Now that is something I can get excited about!
Warning: oxycodone is nasty shit.