Citation: monoamine. "Kind of Like Negative Reinforcement: An Experience with Buprenorphine (exp49652)". Erowid.org. Mar 1, 2006. erowid.org/exp/49652
Unlike most people I know, my first real profound drug experience occured not as a teenager drinking at a party or smoking weed, but with prescription opioids. At about the age of eight, I was unfortunate enough to be diagnosed with a non malignant tumor behind my inner ear that required extremely painful surgery. They basically cut a long slit down the side of my head, folded it over, and removed the tumor. (The surgery took so long because the tumor was so close to a nerve behind the ear that transmits taste sensations. Damaging the nerve could have caused a permanent metallic like taste derangment; and since taste and smell are so closely linked neurologically, also damage to my sense of smell.)
Coming out of the OR was about the worst experience of my life. Even though I was still heavily drugged, the whole side of my face burned like it was on fire. Even thinking about it makes me cringe. I remember screaming curse words at the nurse to give me some pain meds, and for some odd reason, it took a couple hours. Finally the nurse came in with a needle. (Normally I'm not a big fan of needles, but I was in so much pain she could have poked me in the eye with it and I probably wouldn't have noticed.) I still don't know what exactly was in that syringe, but it was probably morphine or meperidine (Demerol). It might have been an IM (musclular) injection, but the needle was not very long and considering the circumstances, it was probably IV (vein).
Anyway, the nurse injected me, and while I knew it would help the pain, I didn't expect it to be as nearly effective as it was. Literally one minute I was in intense agony, the next the pain was gone. Actually let me clarify: the pain was still there, it just didn't matter anymore. It was miles away, almost like I was observing it from a third person viewpoint. (About ten years later, I almost dropped the copy of PIHKAL I was reading when Alexander Shulgin described almost the same thing when he received morphine for a serious thumb injury while in the navy.) I remember asking myself at the time, a question I still haven't fully answered, how the hell can a drug that doesn't even really directly kill pain but just change the perception of it work so well? This single profound realization at such a young age launched my lifelong fascination with all things psychoactive drug related, much like Shulgin half a century earlier.
I was released a couple days later from the hospital with a prescription for a fairly heavy dose of Percocet (oxycodone). For the first few days, the 'Percs' worked wonders for the pain, but I though little of the euphoric properties of the drug. Over about a week or so, the pain gradually subsided, but I still continued to take the pills. This was the time I went back to school, and for the first time in my life, I didn't dread approaching that brick building at the ass crack of dawn. My natural shyness and unease around my fellow classmates didn't bother me for the first time in my life either. This was my second profound realization. Just as opiates don't directly kill pain but just change the perception of it, they change the perception of just about everything else too. School still sucked ass, I was still an awkward kid, and homework was still boring, but I just didn't care. All that shit just didn't matter anymore. I had a heavy layer of chemical insulation, and all that crap was on another planet as far as I was concerned.
I only stayed on the Percocet for about a month, and I don't remember going through any kind of physical withdrawals or anything, but the third realization that I would have to eventually return to 'default consciousness' really made me depressed. Stuff indeed did start to matter again, and I didn't much like it.
Fast forward to early high school and those younger teenage years...
I forgot about those pills mostly, but somewhere that memory lay dormant in the dark recesses of my mind. School still sucked the big one, I still stuttered like a moron around members of the opposite sex, and I was still unhappy. Only this time I could actually do something about it. Taking a couple of pills in the morning made getting out of bed a little easier, talking to girls a little easier. A couple years down the line when I was arrested for prescription fraud and landed up in NA meetings, I didn't get this 'first step' (the 'I am powerless...' one). I felt plenty powerful. I could actually do something about my unhappiness and boredom for once, and if that required downing a handful of pills everyday, so be it.
That's really all she wrote. I continued to use painkillers (mostly hydrocodone and oxycodone, but anything else I could get my hands on that was in any way narcotic: morphine, codeine, dihydrocodeine, hydromorphone, meperidine, propoxyphene, tramadol...)They were easy enough to get. It seemed like my own or friend's medicine cabinets were always stocked full of them, or if all else failed I could always hit up the grungy looking seniors that sold my classmates Ritalin for cramming sessions for pills. It wasn't some 'street' drug like heroin or cocaine, so it was even socially acceptable to a certain extent.
Fast forward to the year or so after gradution. I had dropped acid a fews times (and just about everything else found in Hunter Thompson's Fear and Loathing In Las Vegas kit), and while it was a lot of fun and let me see the beauty in the world, it wasn't all that profound, kind of just like a really intense weed high. Then I started doing mushrooms. Being the wannabe hardass that I am, I didn't settle for taking a gram or two my first time out, basically just eating them until I was about the puke. The resulting trip was not a pleasant one. Even my beloved opiates couldn't stop that ontological smack upside my head. However, coming down several hours later left me in a very reflective mood. Here I was still alive physically intact to my amazement. Suddenly, all that everyday shit didn't mean a thing. I had been to hell and back, and being uncomfortable around my peers was so trivial it made me laugh. It was so obvious. How could I not see this? (This helped me find out that I can learn a lot from so called 'bad trips'). Who the hell was I fooling? I couldn't continue using painkillers and lead any kind of productive life. Even if the drug laws were stupid and counter productive, I could not procure a readily available, legal, and most important of all -- an inexpensive supply indefinitely. Something would have to give. I could continue down that road and possibly end up a heroin junky, in jail, or dead from suicide.
What were my options though? I was unhappy without the pills, and staying on them was no longer a viable option. I had tried NA meetings,rehab, and all that other crap, and it didn't work. I heard about this stuff called buprenorphine. I would still be taking opiates, but it would at least be legal and readily available. Using the one thing I actually did learn in rehab, I figured 'one step at a time'.
So a week or two later, I started looking for doctors that could prescribe it. It wasn't easy. There were only a few doctors around that used it and there was a waiting list. And fuck driving across town every morning to the methadone clinic. If I was going to do that, I might as just stay with what worked (or didn't work). I had no choice but to wait it out. My pill sources, at least the good ones, had dried up. Even though I wasn't really physically dependent, I was depressed as hell. I took tramadol (Ultram), a half assed pseudo opiate for a couple months before I saw the doctor. I sucked but it was better than nothing.
The day I saw the doctor went suprisingly well. Was he going to be a dick? Was he going to tell me that since I wasn't shooting up smack and that I wasn't even really physically dependent that he wasn't going to give me Subutex/Suboxone? Nah, he was actually pretty damn reasonable for a doctor. He listened to what I had to say, and he even agreed that although I didn't have much of a habit right then, if something wasn't done I would soon. So he gave me a three day script for Subutex. Subutex and Suboxone both contain buprenorphine, but Suboxone also has the drug Naloxone in it which blocks the effects of opiates. The reasoning is that you would start out with Subutex for the first few days since you were probably coming off heroin or something, and then they would give you Suboxone so you couldn't crush it up and shoot it since it would activate the naloxone, which is normally inactive when taken sublingually (under the tongue).
The first day or two was kind of tough. It felt like an opiate alright, but certainly not a conventional one. While I'm sure opiate naive people could get high off it, there isn't much euphoria when one is used to the extreme high of Oxycontin. It also made me kind of jittery, something I expressly used opiates to advoid. And even though it didn't produce much of a 'high', it felt quantitatively strong - too strong in fact. I puked the first day several times and just felt kind of crappy. However, by the third day I was getting used to it. No high or anything, but I wasn't nervous and I didn't drool everytime I saw the letters 'OC' (imprint on Oxycontin tablets) so I was basically happy.
That changed on the fourth day when the doc switched me to Suboxone, the version containing naloxone. The nalaxone isn't supposed to be active sublingually, but I must have had an unusual reaction or something, because it put me in full withdrawal mode, with aches, depression,and lacrimation (tearing of the eyes, runny nose, sweating). At this point I almost said 'fuck it', but I'm glad I didn't. After a few days, the doc put me back on Subutex. Everything was good again. No high really (maybe a very minor one to be honest), but no withdrawal,anxiety, or craving either, for the most part. Yeah, it's not perfect and certainly no substitute for conventionsal opiates or even methadone, but it worked well enough.
I stayed on it for about nine months or so. After being on it for about six months, the doc tried a new combo of antidepressants. I had been on antidepressants before and they didn't work. I figured what the hell though. They took a couple months to kick in, but after that they actually worked. I now longer craved opiates and in fact didn't need as much Subutex. After about nine months, I tried to come off the Subutex. It didn't work the first few times. The withdrawal from Subutex isn't that bad compared to conventional opiates, but it lasts a really long time. The third time I tried I knew what to expect, so I just toughed it out with a fast taper. I was also given a hypertension drug called clonidine (Catapres) that helped with some of the more physical manifestions of withdrawal.
The physical withdrawal was gone after maybe a week, but I was still depressed for probably six weeks. Things started to get better after that though. Besides my antidepressants, and the occasional bong hit and shroom trip, I haven't touched any mind altering substances (besides caffeine and sugar and whatnot) in almost a year. I no longer have any cravings and often turn down free pills I would have payed out the ass for a year ago. I now longer have much interest in opiates. I think the Subutex was just unpleasant enough to color my perceptions of all opiates in a negative fashion, kind of like negative reinforcement. That, the antidepressants, and old fashion elbow grease really helped.
I urge anyone who has a problem with opiates and has been considering buprenorphine to give it a try. I doesn't work for everyone of course, but you probably won't end up worse off than you were. It's better than having Mr. Brownstone (heroin) on your back all the time. And it beats going to a clinic everyday for methadone.
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