How do I tell the gp the mess I'm in

[pleasedontjudgemeidontneedit]

I'm hugely dependent on codeine, it is prescribed but I take way over what I'm meant to 500-600mg daily which means I run out early every time. This means I can't taper done properly because I run out then have to buy otc and then it starts again. My husband has forced me to call the gp and tell them, I'm just waiting for them to call. I'm terrified though. Terrified they're going to call ss on me. I'm a normal person, I'm not a druggie on the streets, I'm not a scumbag, I'm a young mother of 3 kids who are my whole life.
I have my own home, job, husband etc but I am addicted to codeine through being prescribed them years ago for back pain which was never investigated. I now know that back issue is a herniated disc and it causes sciatica. I can't stop taking them as I get horrible withdrawal symptoms and I can't function. Please help me I don't know what I'm meant to do

Well done OP for keeping on taking steps forward. Call the GP and see what they say.

What would deem a patient 'high risk'
I would really prefer to be able to do a weekly pick up as I don't drive so I'd have to take the kids with me everyday in the double buggy, and I'd find that pretty humiliating to be honest !
An injection would be great though.

Yeah I get it's upto the gp but if I speak to the same one surely he would have to keep prescribing me the 15 a day until I am assessed and prescribed by the clinic?
Even if that's means going every few days to pick them up, I don't mind that.

I feel quite proud of myself now, I am determined to get off the codeine and get my life back.

The pain is caused by a herniated disc, L5 or something so the very bottom one. What other pain options are there ? A gp before mentioned nerve blockers ? Nothing was mentioned today about alternative pain relief and I'm worried now I won't get anything that'll touch the pain.

Bupronorphine is a strong pain relief, so hopefully that will help your pain

My understanding is that it would be someone who is a risk of taking all their medication at once and overdosing, or maybe selling the medication on, etc. Your children would be a potential risk (in terms of them accessing the medication at home), but the service would provide you with a lock box to ensure they don’t have access.

Hi everyone

So I have an update kind of, the local clinic called me for my assessment and my key worker should be in touch next week with a date of when I will talk to their prescriber to start the subotex.
In the meantime I received a message off my gp saying they had called the local clinic and also they had spoke to the practice pharmacist who is supposed to be calling me tomorrow "to see what we can do regarding a reducing dose" and that they will work with me to reduce my medication down until I'm seen by the service.
Now I'm worrying they're going to push me to go lower than I'm comfortable with. Also, there's been nothing mentioned about the gp calling me tomorrow so I won't have any medication for over the weekend, does a practice pharmacist prescribe medication does anyone know ?

You are doing so well @pleasedontjudgemeidontneedit, I hope you realise that. With all due respect, the GP will push you to be lower than you will probably want to- their job is to get you free of them safely and as quickly as possible, and it is their job to know how best to achieve that.

You’re doing brilliantly @pleasedontjudgemeidontneedit , you’ve done one of the hardest bits, remember that if things get tough.

You’re right, the dr’s and pharmacist will probably want to push you further than you’re entirely comfortable with. That’s their role and why, whether you realise or not, exactly why you’ve reached out for help. You don’t need to be thrilled with it and can have a strop but you know this is the direction you need a push in.

make sure you bring up alternative pain medications with them. There are medications specifically for nerve pain that might be suitable and the last thing you need pushing you off course is pain flaring up.

Yes I know and I want to be off codeine but I also want to be off it as comfortably as possible if that makes sense. I need to function and I don't want anything to scare me off this path.

When the clinic called they said I'm to stay on the same dose until they see me, which should be within the next two weeks. She said as I'm on such a high dose it's the safest thing to do, and that if needs be the gp can call them to discuss why.

Glad there is a light at the end of the tunnel.

So the pharmacist should be calling this morning.
I'm not looking forward to this phonecall it's making me feel ill. The nurse who called me from the clinic was so lovely and understanding, I've got it on my head this morning won't go that way

You are doing so well. The people you have talked to so far have all been helpful, even if some have felt kinder or more brusque than others. Each call so far has taken you a step closer to where you want to be.
You have no reason to suppose that this next call will be any different, other than that inner part of you who judges yourself and so thinks others will too.
Don’t let that inner voice of shame speak too loudly to you. Be kinder to yourself and think kindly of the people who will support you.
You’ve got this 💐

Trust in others. They want you to succeed as much as you do and they will find a way forward with you. Good luck.

THIS is why being addicted to a substance is such a pain in the absolute arse.

The withdrawals, the worry about running out.

Clinics may give platitudes and nod and agree but it's actually up to the doctor what gets prescribed- or not.

The Doctors are the ones who have all the power.

No one wants to be cut off from their drug of choice, even if they say they want to be 'clean'.

Codeine is short acting {this is in your favour when it comes to transferring to buprenorphine} You do actually need to be in withdrawal before the transfer to avoid precipitated withdrawal

It's not comfortable, and you will just have to accept it's probably going to make you feel rough for a few days, til the buprenorphine takes effect.

{But the feeling rough might not be as yukky for codeine as other longer lasting opioids as it's short acting}

A very good booklet {but old} is this one. {Online version}

www.portsmouthrecovery.org/wp-content/uploads/2022/05/P302-The-Detox-Handbook.pdf

TLDR, the subutex part of the booklet is here:

Buprenorphine
Buprenorphine (which has the trade name Subutex) is now often prescribed for opiate detox.
Subutex gives some opiate effects (but less ‘euphoria’ than heroin or methadone) and can significantly reduce the physical withdrawal symptoms of detox. However, it does not offer a completely pain-free detox and, as with methadone, the different feelings can take some getting used to at the start of treatment.
Subutex is taken once a day, by putting a tablet under the tongue and letting it dissolve – it has little or no effect if chewed or swallowed.
If people are transferring from methadone they usually have to be on a dose of 30 mg or less, as the changeover from higher doses can cause withdrawal symptoms.
If you are taking methadone you will have to go
at least 24 hours from the last methadone dose before taking Subutex for the first time, and if you are using heroin there should be 4 to 6 hours between your last heroin dose and your first Subutex tablet. This is because Subutex can send you into withdrawals if you start treatment without waiting for opiates to begin to clear out of your system.
A Subutex detox can be completed in 12 to 14 days, or it can be done gradually over a longer period.

Thank you everyone for the pep talk. It's so hard. I think more than anything it's just that feeling of knowing something is being taken away that's been a part of my normal day for so long, but I know it's the right thing to do which is why I haven't gone back on this plan for one second, but that doesn't mean I'm not frightened of feeling normal, I guess I don't even know what my normal is anymore.
And to think codeine is one of the milder opiates ? Wow I'd hate to know what heroin felt like.

So I have spoken with the pharmacist, and at first she tried to say that they would only prescribe me 8 a day, which would be a huge drop from the usual dose my body is used to, when I explained this she was straight away understood and agreed I should stick to the 15 a day with otc top ups until the clinic are in touch with the date I speak to their prescriber. So I have 100 tablets until next Friday and then hopefully at that point I can update them with a date and then I will be given more to get me through to then.

I worked it out yesterday I only had 539mg in total. Which yes that's massive for a normal person but for me it's over 200mg less !! So I'm happy about that.

It's very important to understand that tolerance disappears very fast. {with everyone}
Within days.

You mention ''Normal person'' but a week without codeine, {or any other opioid/opiate your tolerance also resets to zero.

This is why in the past {and probably now} people detoxed as they simply couldn't afford to sustain their habits, and why people die when relapsing after a detox, if they take their 'usual' dose.

Everyone finds the thought of detox scary- if they didn't, they wouldn't be an addict.

I think your normal will be the way you feel on the codeine now. It loses effectiveness when you take it every day and will just be stopping you feeling crap from withdrawal

Hi OP,

Thanks for updating us, I'm finding it really helpful to learn what is potentially ahead for me.

You're really very brave and I admire you for having the strength to be honest and ask for help.

I live with the deep dark secret that nobody knows...

Best wishes x

Hi

This is why I'm updating more than anything, to help others hopefully, I've searched and searched and never found anything informative enough so I'd like to do this for anyone else in my situation. Also it's good to be able to let it all out as in real life only my husband knows.

Can I ask if it's codeine you're struggling with and if so how much do you take ? Is it prescribed too?

Yes codeine. I'm prescribed 8 × 30mg per day (56 30mg tabs per week) so am 'allowed' the maximum 240mg, but over about 5 years I've ended up taking more to get the same effects. Now it's routine to take about 130mg at a time 3 times a day so around 400mg daily. I have to spend loads of money on Solpadeine Max and Nurofen Plus to top up my prescribed tablets. My normal dosage is -usually take 2 Solpadeine Max, 1 nurofen plus and 3 x 30mg codeine tablets. I'm careful to stay within the limits for ibuprofen and paracetamol.My Dr's wouldn't give me more than the 8 tabs a day so it's stressful to manage the quota over the week. Is especially stressful that they recently stopped selling Solpadeine Max in boxes of32, now only sell boxes of 24 so that's more often I have to go pharmacy shopping.

On the outside I'm functioning. I'm turning 44 in a few weeks, I have a 6 yr old daughter who's thriving and a grownup 1. I'm a good mum and meet all my child's needs. I am very ill though with MH, but suppose I'm the poster child for addiction having experienced childhood sexual abuse so live with BPD and CPTSD.

Sorry I blurted all that out but I've never said ANY of that out loud before 😞

@OldBird79 Well done for being open, it isn't easy is it. The shame we live with, and fear of being judged or that we can't care for our children.
I would say you're on the slippery slope that got me to where I am now though, 400mg daily is a much better position to be in to taper down without any medical help (hopefully anyway)
Try and stick to that dose, I know it's hard though as the more you take, the more you need to get the same effect.
What was the tablets prescribed for ? In my case it's my back issues causing sciatica. Funny how that's the least of my problems now!! lol

I don't have any advice but just wanted to say I'm following @pleasedontjudgemeidontneedit and I guess @OldBird79 as well. You've got this!! 💪

Be really careful about the cumulative effects of ibuprofen and paracetamol- The deaths that occurred in an Australian study were mainly due to these causing damage to the organs.

The codeine contained in these OTC pills is so tiny, and so expensive it's barely worth it.

Pharmacy staff are definitely getting wiser to misuse of OTC meds - some won't care - but responsible pharmacists DO care, and point people in direction of help.

Re CSA {child sex abuse} almost all heroin users have suffered from this. The women at least.

Of all classes from wealthy to poor backgrounds.

Originally had them prescribed for pain in my neck and shoulders, mri found bulging discs. But I have pain every single day. Normally headaches and migraines - hereditary! My mum and sister suffer as does my 23yr old daughter. I ALWAYS have a headache, to some degree. I've recently been diagnosed with fibromyalgia too.
I'm really feeling the darkness rolling in too ☹️

I've just had a call from someone who had been assigned my case. She told me that the prescriber wants me to be completely off prescribed codeine from the go before I'll be considered to have the buprenorphine. So that's really upset me as I had a plan in my head, and now it's all gone to shit. So they will only give me treatment if I'm taking otc codeine. Which seems fucking stupid to me because I'm taking so so much on a daily basis it's going to take absolutely forever

Sorry I just need to vent in say here sobbing now feeling so rubbish today