In Praise of Opioids

My leg, six weeks after surgery, with intramedullary rod placement.

My leg, six weeks after surgery, with intramedullary rod placement.

Yes. That’s an odd title for a blog about opioid addiction, but my recent experience with a broken leg gave me some new insights into opioids

While walking my dog four weeks ago, I fell and broke my tibia and fibula (both bones of the lower leg). The break was obvious; I had to hold my foot to keep it from moving to an odd and painful angle. I sat on the ground, thinking, “Oh shit. This is going to hurt, and I’m going to have to go to the hospital emergency room on a Friday night to get a cast.”

And of course it did hurt. It was the worst pain I’ve ever had. I couldn’t get into a car to go to the hospital, since both hands were busy holding my foot. If I let go, my foot drooped to a sad angle. I wasn’t going anywhere under my own steam. So my fiancé called 911.

First to arrive was a huge fire truck, with ladders, hoses, etc. One of three or four firemen took my blood pressure, asked me a few questions, and said EMS would be there soon. When EMS arrived, three or so more young men sprang from their vehicle. They asked the same questions all over again. At one point there were five or six burly young men who all responded to the 911 call, standing around me in a semi-circle. It felt like a bit of overkill, but I didn’t mind.

The worst part of my whole ordeal was when EMS workers tried to splint my leg with a device obviously meant for a much taller person. Putting the splint on caused my foot to move to an angle that God did not intend. The grinding of my bones made me sick to my stomach, to the dismay of EMS personnel. I’m told my screaming and cursing, punctuated by intermittent vomiting, gave neighbors quite a show.

Once I finally got inside the ambulance, the EMS worker easily slid an IV into my arm and gave me a dose of fentanyl.

I have never taken any IV opioids, to my knowledge. Immediately, I felt hot all over, and then started weeping with relief. I wouldn’t say I felt euphoria, so much as a profound relief that the pain no longer hurt. That also sounds odd; I still had pain… but it didn’t bother me, and I felt like everything was going to be OK. In that moment, I had a better idea what my opioid-addicted patients describe when they tell me of the allure of opioids. Under the influence, I felt like nothing would bother me, physically or emotionally. Then my eyes felt like they were spinning around in my head like pinballs, but I didn’t care about that, either. Then I got very chatty and talked nonstop to the hospital.

The emergency room doctor ordered X-rays that showed the tib/fib fracture. I thought I would get a cast, and then go home. Wrong. The nurse told me I was being admitted for surgery on my broken leg. I wasn’t happy about this, especially since I hadn’t even talked to the orthopedic surgeon who would operate. I had questions. Why couldn’t I go home with a cast? What was he going to do at surgery, and why was it better than a cast?

So I stayed in the hospital that night, edgy about what surgery was proposed and full of questions. My leg hurt, but the emergency room staff had placed a plaster-type splint, or partial cast, on my leg, which kept the bones from moving around. As long as I kept it still and elevated, the pain wasn’t too bad. I had several shots of morphine through the night. I didn’t feel high from the morphine, but the shots put me to sleep, a good thing.

The surgeon came into my hospital room mid-morning, and talked to me about the advantages of having an intramedullary rod place through the center of my tibia to hold the broken sections together. This sounded extreme, but the surgeon said in “someone your age,” with simple casting the bones would take longer to heal. At my age, there was a relatively high rate of non-union, which would result in surgery at a later date anyway.

It took me longer to process the information than it should; I was stuck on that “someone your age” comment. I’m a young-looking 52, and finally realized I had to be much older than this young surgeon. Maaaaaybe the comment fit.

Anyway, I agreed to the surgery. Pre-op, the anesthesiologist gave me fentanyl, and again I had the feeling my eyeballs were spinning in circles and I got chatty. Then he must have given me something else that put me out completely, because the next thing I remember I was waking up back in my hospital room. I was upset when I didn’t see a cast, because I thought that meant I didn’t have the surgery. I didn’t know that an intramedullary rod takes the place of a cast…kind of like having a cast on the inside.

Since that surgery, I haven’t had much pain. I took my last morphine injection the night after surgery.

I’m no martyr. If I have pain, I want pain medication. The surgeon, knowing what I do for a living, asked me if I wanted to go home with any opioids. I said yes. I told him please prescribe what you would for anyone else. He prescribed twenty-five Percocet. I took two the morning after I got home, and they relieved the pain, but left me a little groggy and sleepy. I’d had enough of that in the hospital, and was eager to do some reading and writing, so that was the last dose of opioids that I have taken for my broken leg. After making it a week with no opioids, I flushed the remaining twenty-three pills.

I had one bad spell after falling on my crutches, twisting the broken leg a little. The rod held my tibia in place, but the fibula hurt intensely for about twenty minutes before I was able to calm the pain with elevation, ice, and ibuprofen.

I think I’ve done well during my recovery from the broken leg. This surgery allowed me to heal much faster. It’s now almost six weeks since my surgery, and the above x-ray was taken today. My leg hurts only when I walk around. Ibuprofen and Tylenol have worked fine. I’ve been careful, especially during the first few weeks, to keep my leg elevated and use ice for swelling. I’m convinced elevation and ice helped a great deal.

This week I can walk with the help of a cane. It does hurt to walk, but it’s the kind of hurt that’s necessary to build back my muscles. If the pain gets too bad, I sit down and elevate my leg again.

I know I’m very lucky. The fracture happened in a place where help was readily available. It was less than thirty minutes from the time I broke my leg until I got a shot of a powerful opioid, fentanyl. This medication was a godsend to me.

I have health insurance, and could afford to get the surgery to help my leg heal quickly. My surgeon did a wonderful job, even if I do have underwear older than he is. I was able to take several weeks off work to keep my leg elevated for better healing and less pain. I have a loving fiancé who didn’t mind being my legs for a few weeks. Some people don’t have any of those things, so I’m very grateful.

What is the point of this blog, other than to blather on about my surgery and broken leg? It’s this: opioids are great when used the in the right situation. For acute pain, they are truly a blessing to mankind. But these drugs produce pleasure, and anyone can get addicted to that intensely good feeling.

Doctors have to find a balance between empathy and caution. Let’s not be stingy with opioids during acute medical situations with intense pain. Even in a patient with known addiction, opioids shouldn’t be withheld for an acutely painful medical situation, because that would be unethical. But we can’t ignore the dangers of addiction, particularly if opioids are used for more than a few weeks. Even if we feel uncomfortable talking about addiction, we have to have those conversations with our patients. And please, fellow doctors, see patients with addictions as people with a treatable disease, who deserve the same respect as patients with any other disease. You don’t need to kick them out of your practice; you do need to refer them for help.

19 responses to this post.

  1. Posted by William F. Taylor, MD on June 27, 2013 at 10:05 pm

    Thanks for sharing your story. A lot of docs get up on their soapbox to proclaim how awful opiates are, but I think they reveal their ignorance of just how painful acute injury or illness can be. For opiate-addicted patients, it’s worthwhile to review a plan with them for unexpected injury or painful illness.

    I’m glad you’re recovering.
    William F. Taylor, MD (Lake Norman ER 1992 to 1995, now at Hickory Metro Treatment Ctr.


  2. Posted by Benjamin Keith Phelps on June 28, 2013 at 12:56 am

    Wow! I had NO IDEA you’d never had an opioid in your entire life (to your knowledge)! I’m rather taken aback at that. I would’ve imagined EVERYBODY’s had them by that age for one reason or another, since I’ve had them NUMEROUS times over my 39 years – for a chest tube, for lung surgery & a chest tube again a year later, for coughs, for sinus infection pain at 1 point…. I would’ve AT LEAST guessed you’d had codeine at some point (& maybe you have & don’t realize it or something… who knows.) But that’s not the point of my response. I always appreciate a doctor’s curiosity & willingness to learn more about addiction, in whatever way that may be. My previous doc at my former clinic (a WONDERFUL woman & doctor, I might add) turned up at the AATOD Conference in Orlando, FL in 2004, when I was down there in my own vehicle & on my own dime to become certified in MMT advocacy. I was very moved by that, seeing as there weren’t even 40 people in the room, so that meant not even 1 doctor from each state attended – at least not that meeting I was in. More than being moved, though, I was happy to know my doc cared enough to want to be on the cutting edge of MMT best practices, rather than blindly issuing policy at my clinic as medical director – keeping dose caps & other silly stuff in place that should have been gone long before due to having been disproved.
    So anyway, as for your story – so you explained how you felt when the rush of opioids hit you…. Now imagine that from that moment on, you could not, for the LIFE of you, go back to feeling normal w/o that. And that you spent year after year in treatment centers all around the state & the country, even, trying to regain some sense of normalcy in your life! That’s been the experience most of us have had. Some of us had this happen after a shot or bump or pill of illicit opioids. Others of us had it happen after a prescribed dose that was taken as it should’ve been. You already know this, but it’s just one extra thing to be grateful for (that it didn’t turn out to be the bane of your existence getting an opioid shot – wouldn’t THAT have been ironic as all hell??) As for your flushing the Percocet down the toilet, I’ve known many people who do this, only to regret it when something happens like you twisting your still-sore leg again after surgery. I personally have never been able to convince myself this would be a good idea, for that VERY reason. I’m always CERTAIN that the moment I depress the flush lever, I will fall over backwards & destroy my collarbone or some other part of my body that will DESPERATELY cry out for pain medication – for which I will then have nothing to reply with! And truth be told, I have had that happen a few times, anyway. Back in 2002, after dabbling with opioids regularly for MONTHS w/no real pain, I stopped buying them for about 3 weeks before going to start MMT, & no sooner did I do that when I suddenly got a horrendous toothache in a molar & suffered terribly through an entire day before being able to see a dentist to fix the problem with a filling & some medication around the root underneath the filling. Of course, then I didn’t need pain medication. But that day with the toothache was absolute torture! And of course, I lamented all the opioids I’d had in my possession as recently as a couple of days prior, only to not have a single dose now. The “threat” of that happening doesn’t bother me while in MMT – but boy did it ever when I wasn’t.
    I’m happy you had the opportunity to have a peek into the world of opioids, & their exact effect (as opposed to simply having heard stories about what they are like – which can’t POSSIBLY suffice for having the actual experience). I will say that I’ve never quite heard the feeling explained as having your eyeballs spinning, but I DEFINITELY know all about getting chatty when the opioids take effect. I talked my hospital nurses to DEATH when I was in there for my lung surgery, upon getting my first shot of Demerol. I sang to her, talked, & generally just laughed & carried on like she was my best buddy in the world & had known me for years. She MUST have thought I was crazy! But I cared not 1 iota. And I’m glad it helped you understand us just a little more, as I said before. I wouldn’t wish addiction on anybody in the world – it is far too sinister & terrible. But if a person can experience the feeling that led me there w/o becoming an addict themselves, I think it always helps when they understand what that feeling was, instead of having to take my description on face value. That’s kinda like trying to explain how sex feels to someone who’s never done it. It just ain’t the same as the experience!! And I don’t think anybody could understand the drive to have sex repeatedly if they’ve never had it the 1st time yet. And what about trying to explain sex addiction to an asexual person? I wonder, though – do you think it gave you any more appreciation for treating your pain patients now with opioids? In other words, did it make it clearer to you just how much of a difference opioids can make in the treatment of moderate-to-severe pain? Or do you still view it the exact same as you did before in every way? I know (obviously) that you know you have to exercise great caution in prescribing them – & you likely know that even more than most docs, since you treat addiction everyday. But I just mean do you now believe in the power of opioids more than you did before experiencing them? Or has there been any other change you can think of in your thinking (positive or negative)? Just curious. Thanks for your post of the experience you had with this. It’s not often that any of our treatment team (doc, counselor, nurse, etc) is willing to convey personal experiences from THEIR lives to us.


    • I’ve taken opioids by mouth; I meant I have never had intravenous opioids.


      • Thanks for sharing! I believe your ability to flush the other 23 down the toilet is the difference between your brain and mine, an addict.

        I would have stored in a locked safe (stock piled) for the fear of anything ever happening in future and no dr treating an addict, which most addicts do this!

        There’s definitely different wiring of brain, I believe. Where some docs say it’s all about willpower – it’s truly more than that.

        And the not caring that you mentioned- that’s what traps people like me. If its abuse, PTSD, or whatever that I don’t want to “feel” I know all I gotta do is take the medicine to make that unpleasurable hurt go away. Then for addicts it starts a vicious cycle that we don’t know how to stop!

        I made it on 4 8mg subutex yesterday 🙂 first time in 3 years! I have been at such a low (extremely high in reality dose). So I have jumped from 6.5-8mg subutex pills to 4 subutex 8 mg pills/ day within a week.

        I find myself clinging to your words- there is no difference between 4 or 8 🙂

        Thanks for sharing this and for all of your help!!

      • Posted by Benjamin Keith Phelps on June 28, 2013 at 4:51 pm

        Okay… that makes more sense. And I see you DID say that – for some reason, the “IV” word just didn’t jump out at me when I read it. Still, my points are the same though. Thanks for the article.

  3. Posted by Benjamin Keith Phelps on June 28, 2013 at 12:57 am

    I forgot to check the follow-up email box.


  4. Posted by Jason on July 12, 2013 at 10:47 pm

    Hey Benjamin! Just checking in to see how you’re doing. Please let me know. Jason


    • Posted by Benjamin K. Phelps on July 13, 2013 at 10:56 am

      Hi Jason,
      Thanks for asking. I’m actually doing great! I FINALLY found a job that is full-time, has benefits, & is paying me enough to live w/o constant worry about paying my bills (& clinic costs, especially, since we only have a 2-day grace period & get a 10-day fee-tox if we can’t make it). You have NO IDEA how much of a relief that is, considering how long I’ve been trying to find such security since being laid off in 2008 from my last full-time job. I’ve worked since then, but it’s been either part-time, low pay, horrible treatment by management, or some combination of the 3 at each job until now. My job is currently at Romano’s Macaroni Grill, as a server. It’s not my dream job or what I went to college for (IT), but I’m making plenty of money, & I really like the people I work with. SUCH a great change! Plus, I can transfer next year when I am looking to move back to Washington, DC (in May). There are plenty of these restaurants around up there & elsewhere, so I have lots of options now! Loving it :o)
      Anyway, I’m still being jerked around by my clinic – but that’s not unusual. That’s been going on at this particular clinic for as long as I’ve been there, really. But now that I have this job, I am capable of leaving there – “voting w/my feet”, as Dr. Burson calls it. I plan to do EXACTLY THAT – & very soon. I just want my takehomes back so that I can transfer w/them instead of having to earn them from scratch at the new clinic. But I’ve had to do that before, so if it comes to that, I’ll do it again.
      And how are YOU doing? Have you made any moves as far as your treatment? You had said you were rethinking coming off… Did you decide to stick with it? Man, I SO know that pendulum – you love having a normal life & feeling decent all the time, instead of like absolute crap & craving…. But you HATE dealing with being under someone else’s thumb (doc, nurse, pharmacist, whatever…) & knowing that if ANYTHING happened – even an arrest for something you didn’t do & eventually are totally cleared of, or a blizzard that sticks you somewhere w/o your meds – you’re in a WORLD of trouble, in the form of unbearable pain & misery – often to the point of delirium. I know all about it & I hate it every bit as much as you & everyone else does, believe me. But I also know how much I despise falling flat on my face every time I try to do abstinence-based sobriety. Meetings do NOTHING to help me. Groups suck. I enjoy & do well from 1-on-1 counseling, but it doesn’t keep me clean. And I inevitably end up passing scripts to keep from getting sick when money runs out & I have to choose between a single bag of heroin for $25 or a bottle of 50 hydrocodone 10mg tabs for $20, which obviously will last MUCH longer than a single bag of dope. So when I add up both sides & weigh them out, I have to say I’d prefer to stick w/where I am. And it’s the staying stopped thing that gets me – not the w/drawal fear. We’ve ALL w/drawn a million & 1 times & lived to see another day. It sucks worse than anything I know, but we’ve all made it through many times over. So I know I’d live through coming off methadone, even if I did it suddenly. But on a side note, coming off methadone OR Suboxone doesn’t have to suck – it’s when you get totally impatient & decide you just have to jump the last 20mg off methadone or the last 1mg off Suboxone… THAT’S when it sucks like hell & makes you think there was no benefit to going slow at all. I’ve learned that jumping from 20mg of methadone is every bit as bad as jumping from 100mg/day. So why not just drop like 2mg every few days, or even just 1? But back to my point – I would get through w/drawals, whether fast or slow. But I’ve NEVER been able to stay away from opioids for a long period of time – either I mess up right away, or I last 2-3, MAYBE 4 weeks. Then I have a bad day & end up giving in. So I hope you thought about all this stuff as you considered your situation, & kept it real w/yourself, as far as whether or not YOU personally can stay stopped when you get down to zero. Some can, but they tend to be few & far between, from my experience in the world (unfortunately). I hope you are well though, either way, & I hope you’ll let me know how you’re doing sometime soon. Take care! – Keith


  5. Posted by Jason on July 13, 2013 at 12:38 pm

    Hey Keith! I’m glad to hear you’re doing great and congrats on the new job! I love that restaurant.I would love to move back east and get out of this desert so good luck with that.
    I’m doing the same only I have zero energy. My Doctor is a pain specialist and a opiod addiction specialist which is good in some ways because of my pain issues, but bad becasue I have procedure after procedure like nerve blocks, RFA’s, etc. that usually have me in more pain and to topit all off, my insurance stopped covering my prescription so what was a $50 co-pay turned into $690 for 30 day supply.I’m not rich by any means so this absolutely ruined me for a little while. I told my Dr. this and I asked if there was a generic for suboxone (I’m almost positive there is) and he said “No, I’m going to keep you on the Suboxone.” So, I am at the point where I’m just so tired, stressed, always lethargic. and My Doc is just interested in my next procedure that I won;t be able to pay for.I’m actually interested in MMT and wanted your thoughts on that. My only thing is it will be next to impossible to go to a clininc every morning because of my work schedule. How does the take home thing work exactly?
    Well take care man and congrats on everything!


    • Posted by Benjamin K. Phelps on July 16, 2013 at 12:27 am

      Hey Jason, thanks (for the congrats on the job)! I’ll preface this by saying sorry it’s so long… A couple of things: 1st, you are right – there IS a generic for Suboxone & Subutex (both, though they are obviously 2 different drugs – the former has naloxone in it & the latter does not). I cannot BEGIN to imagine why a doc would refuse to allow you to at least try the generic, particularly when your money is prohibiting you to continue in treatment on your current med & this would be extremely helpful. If you had insurance that was covering it, then I would understand. The next thing I wanted to tackle is your interest in MMT. Personally, I have been on bupe & wasn’t able to do well on it. Methadone made ALL the difference in the WORLD for me. There is no ceiling effect – & don’t get me wrong – not having a ceiling effect doesn’t work as people w/o any experience would think. It does NOT mean you can keep going up until you eventually feel something – it just means you have unlimited room for an effective dose. If 100mg isn’t enough to hold you all day or stop cravings completely, you can go up to 110mg, & so on until you’re at whatever dose it may require. But that doesn’t mean that the higher you go, the more likely you are to feel anything. Most addicts mistakenly believe that going into MMT, so they try to raise up higher & higher in the beginning (which is typical for our nature), & only end up disappointed when what little feeling they might get for a couple of days is gone on day 3 or thereabouts – no matter how far up they go! I don’t say this b/c I think that’s what you are seeking – I say it just to make the point that no ceiling has nothing at all to do w/any of that – only with keeping you stable if you cannot achieve FULL stability w/Suboxone. I’ve yet to see someone who absolutely cannot achieve it w/MMT IF they work w/their doc to find it. Some docs won’t go higher than some arbitrary number, as is true of some clinics in general. In those cases, you’re likely to find several patients that aren’t stable b/c they can’t get to the dose they need to be stable. That’s so unfortunate, & so unnecessary. But nevertheless, MOST of us in MMT require only between 80-120mg or so to fully block illicit opioid effects AND to block cravings. And yes, the cost is MUCH cheaper – a dose of methadone costs (wholesale) a few pennies. So those savings DO end up passing over to you, the patient (though the clinics also are charging you for their services of watching you drink that dose, as well as groups, counseling, doc visits, etc, obviously). But anyway, I think the takehome policies are what you really are wanting to know more about, & here’s what I can tell you: Federal guidelines allow up to 1 month, but state guidelines can be tighter (& often are). MY state (NC) allows up to 30 days, but many don’t. Just the same, while my state allows a patient to get 2 takehomes after the 1st 90 days in the program w/clean U/A’s, yours may only allow 1 after that many days. I don’t know what state you are in, or I could look it up for you. I have MANY links to websites & MANY contacts in various states & even countries, since I’ve been an advocate for about 10 years now. In addition, I’m on the Watchdog board, which is for MMT patients. You can join that board w/o being on MMT, if you just have questions or interest. If you’d like to do that, here’s the link:
      There are many people on that board from many states & countries, so asking a question there would likely yield you answers from somebody from your state, & maybe even from the clinic you would end up going to, were you to opt for MMT in the end. But while I strongly am in favor of MMT, you are right to think long & hard about the restrictions of it versus Suboxone. It’s unfair & unfortunate, since some of us MUST have methadone b/c Sub doesn’t work for us, that we get penalized b/c of that need in the form of not being able to be treated at an office (in most places), not being able to get takehomes quickly, & now having to listen to people extol Suboxone as though it’s not being abused like hell on the streets & methadone is. I know MUCH better than that – almost EVERY addict I’ve run into at work places & such has Suboxones on them that they’ve purchased illegally on the street from a person in treatment. I can’t count how many of such people I’ve run into, while it’s a rare thing I run into anybody that has illicit methadone, unless it’s coming from a person w/a pain script. My previous clinic (the only other clinic here in Raleigh than the 1 I’m currently in) gave tablets as takehomes from 2001-2011 or 2012, in the form of 40mg tabs, & I can HONESTLY say that I NEVER ran into a single person that ever had a 40mg methadone tablet on them. They’ve since switched over to liquid & pharmacies can’t (since 2008) dispense 40’s anymore, so I’m not likely to ever see anybody w/one now. I got up to monthly takehomes at that clinic, & it was very convenient to get a bottle of tablets once monthly, instead of a bunch of little bottles of liquid. But nonetheless, to give you an idea of a typical takehome schedule, here’s my current clinic’s (it’s a public clinic that accepts Medicaid – those tend to be much slower in giving out takehomes sometimes): After the 1st 90 days, you get 2 weekly. After 180 days, you get 4 weekly. After 1 year, you get 5 weekly. After 1.5 years, you get 6 weekly (in other words, you go once a week). After 3 years, you go once every other week. That’s all you can get now at my clinic (they did away w/monthlies b/c they’re assholes). At my last clinic, it was quite a bit faster (they were private). I paid $12/day there, while I pay $9/day at my current clinic. But here’s the schedule of the private clinic I was at: From day 1, you get 1 weekly on Sunday. After 90 days, you get another (2 weekly). After 120 days, you get 3 weekly. After 150 days, you get 4 weekly. After 6 months, you get 5 weekly. After 1 year, you get a week’s worth. At 2 years, you get 2 weeks. After that, you work your way up towards monthlies, which you reach at the 4 year mark. At every clinic I’ve been to, you lose half your takehomes if you pop a dirty urine. I’ve had 10 false positives in 10 years now. 7 of these, I proved false by paying for a confirmation via GC/MS. 1 was clinic error, & 2 I never could find the reason for or prove to be false. At my last clinic, the 2nd positive in a row meant you started all the way over on earning takehomes. At my current clinic, you just lose the other half, but gain them back on an accelerated pace (1 phase every 2 months. A “phase” is a step from whatever you’re at to the next level – so if you’re at 2, you’d step up to 4, just like when you were originally earning them, after 2 months, & so on). I know I’ve typed a novel here, but I’m trying to give you some REAL idea of how things work, rather than a half-assed notion that leaves you shocked when you switch over. I wish somebody would’ve given me ALL the info instead of some of it when I was about to start! I hope this helps you make an informed decision. The bottom line, as far as I’m concerned, is this: MMT is a wonderful thing – it totally saved my life, no questions about it. BUT, it’s a hassle & a half, it’s not ever fair in the way you’re treated at any of the places I’ve been thus far, you get dogged out by staff at most places, you get talked to any kind of way by dosing nurses sometimes or by other staff b/c they believe they can do you any which way they get ready b/c you need them – they don’t need you (or at least that’s the way they think…) So while there’s much good that can come from it, you DO definitely need to know & be prepared for the burden it can put on you if your clinic isn’t a well-run place. Some are – that I know. I’ve just not been lucky enough to be at one, though my last one was very close to it for the first few years I was there. When the owner died, they got a new doc AND & new program director at the same time – both of whom sucked (the original ones were great!) It was at that point that I began having very serious problems there & eventually almost tapered all the way off, which would’ve been disastrous. I ended up transferring instead. That was almost just as bad, since this clinic is poorly run & has rules that are draconian (like refusing to dose you if you can’t squeeze out a urine sample on demand – I’d rather them just count me positive in that case than to send me home to get sick, & best practices state that a clinic should NEVER refuse to dose a patient except over safety concerns (REAL ones…) like the patient presenting to dose under the influence of other substances or alcohol. My clinic believes in using a dose as punishment or reward for behaviors bad or good, respectively, & that’s just stupid. No other treatment in the WORLD uses such guidelines. But let me get off the soapbox. I hope you get a decent idea of what you are wanting to know from this. Let me know if you want me to look up your state’s guidelines for takehomes & I’ll try to do so for you. Also if you have other questions, just let me know. Take care.


  6. Posted by Jason on July 17, 2013 at 2:45 pm

    Thank you SO much, Keith! That is great information and I truly appreciate it. I honestly thought it would be an easy decision, but you pointed out a lot that I hadn’t considered.
    Can I contact you directly through email? If so, I will give you my generic email until I hear from you, which is: If not, I completely understand.
    Thank you again for taking the time to help. I hope your new job is still going good. Take care!


    • Posted by Benjamin K. Phelps on July 17, 2013 at 6:43 pm

      Jason, I sent you an email from my email address to the one you left here. The job is still going very well, & I was glad to help you in any way I can. That’s what being an MMT advocate is all about – helping others that have questions, problems, or concerns about MMT… whether before starting, while on, or about coming off! Any way I can help, let me know.


  7. Hello – I know you posted this a while back, but I thought I’d reply. Thank you for sharing this story. It is important for addicts like myself to realize that pain medications are great for SHORT term use. You would think that my years and years of struggling with opiate addiction and chronic pain would have taught me that they don’t work well for chronic pain especially for people like me. Seeing how a non addict is able to stop themselves from taking pain medication they don’t really need is really, really hard for my addict brain to grasp, but I see that most people are able to do it. It reinforces to me that my brain, through addiction, has wired itself completely differently from the normal brain. When you talked about falling down later on and having some pain that was resolved without narcotic pain meds, I knew that if it I had been me and if I’d have had any of the percocets left, I would’ve felt immediately justified to take them.
    Thanks for the reinforcement that unless I am experiencing severe ACUTE pain, I need to stay away from opiate/opioid pain medications. Without the suboxone, I have absolutely no control when I have them in my possession.
    Also, another huge reason I wanted to reply to your post is that although I am not what you would call a tree-hugger, I was very concerned when I saw that you flushed your medication down the toilet. I beg of you and everyone else in the world. Please DO NOT flush any kind of medication down the toilet. These medications end up in our rivers, lakes, streams and eventually even the ocean. They are wreaking havoc on aquatic wildlife. This is a fact. Please dispose of medications properly. I know that twice a year, a locked up depository is brought to our office building where we can bring unneeded and expired medications for proper disposal. Please consider something similar. I’m sure if nothing like that is available to you a local pharmacy would have suggestions.
    Thank you for sharing all that you do on your blog!


    • Good information, thank you.

      although…I’ve always wondered how much difference it makes. When we take medication, the byproducts end up in the waste product system anyway, whether in uring or feces. Not sure how we can stop that. I’m sure much more opioid material is consumed & excreted in urine & feces than is ever discarded in pill form.


    • Posted by Linino Martino on March 30, 2017 at 4:06 pm

      i was in a car wreck and my knee was crushed and my tibia was fractured. My surgeon prescribed hydrocodone which helped, but not totally. Everybody is so crazy about not getting people addicted, they undertreat pain. At my GP’s office, I get Tramadol because my pain is about a 7 every day; I had a bad surgeon and only Medicare so…you know how that goes. I was in the hospital 2 weeks. I was taking hydrocodone one a day at night to help my leg not wake me up when it’s are on fire with pain, but all this craziness about addiction and the DEA (omg) getting in the act, AND getting access to medical records (omg), I stopped the hydrocodone because I want a low profile with any gov’t agency that can harass me in any way. Then, they moved Tramadol (which is like Ibuprofen-plus and barely effective) up a schedule notch so now I still have to pee and get a paper prescription, every month. It’s a huge hassle (the car wreck left me handicapped), and it *really* burns me that the DEA is noodling around in medical records. And, as a result of their actions, docs are really hesitant to prescribe adequately. So, I know there’s an addiction problem, but I bet there are 20 better ways to catch addicts than making EVERYONE who gets an opiate have to get a paper prescription for 30 days worth, and I have to pee at the docs office every time. Casting a wide net is an ineffective and expensive strategy.


    • Posted by Benjamin K. Phelps on September 27, 2013 at 9:05 pm

      I HAVE seen pharmacy labels on opioid drugs that called for flushing the unused portion immediately upon deciding they’re no longer needed to avoid them getting into the wrong hands. The FDA guidelines (on the above site) call for you to flush if the label says to. Just letting you both know. No idea if the pharmacy that put that on there was knowledgeable as to whether it was okay to do so or not. Also, I have seen the unused medication return programs at local pharmacies in the Raleigh, NC area. Specifically, Kerr Drug (I know that’s only a local store, though… Plus it was just bought out by Walgreens, from what I was told) had one in place. I asked what they do with the drugs, b/c I was curious – if you can’t flush or otherwise put certain ones in the water, what DO you do w/them? They answered that they weren’t positive, but they THOUGHT they were incinerated. Interesting – I didn’t ever even have that idea cross my mind while I was standing there trying to think of other ways than the water supply or burying them (which would go into the water supply….) to dispose of them.


  8. Posted by Eric M on April 30, 2018 at 4:43 am

    Years before I ever used heroin, the only surgery I’ve every had was a gallbladder removal. I live in downtown Chicago, so I could walk to what is perhaps the best ER in the state in about 15 minutes, not knowing why my abdomen felt like it was dying. Still, I vomited on the way and felt terrible in the ER until they have me IV opioids (I think it was Dilaudid, but can’t remember for sure). My experience was quite similar to your description. That and the pre-surgery meds are the only time I’ve had IV opioids (I only every snorted heroin), and they were a true miracle, enabling me to actually talk to the doctors without being in agony.


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