Been On Hydromorphones And Narcos. Have A Painful Crohn's Disease. Overdose Of Percocet. Damaged Liver?

Posted on Sun, 8 Jul 2012

Question: I have been taking about 12-14 hydromorphone's a day and 5-6 narco's a day for a few weeks now (i have very painful crohn's disease then got in a car accident). I ran out of the hydromorphone (i have half a pill left for the morning), and went to the er tonight and they looked up my history and would only give me ten 5/325 percocet. So, I took 8 of them within two hours. I do not feel high, just tired and anxious bc I just realized that i could have damaged my liver. I probably took 5-6 vicodin earlier today and 6-8 hydromorphone's earlier today. What should I do?

Answered by Dr. Susanta Padhy (7 hours later)

Hi

Thanks for the query

You seem to have chron's disease, chronic pain, a recent car accident and perhaps opioid dependence or fear of opioid dependence.

Percocet contains oxycodone, a opioid and paracetamol; hydromorphone is a variant of morphine, an opioid again.

The management of such case is ideally done by a multidisciplinary team involving gastroenterologist (specialised in chrons disease), palliative care team ( responsible for chronic pain management), a psychiatrist for evaluation of dependence.

A psychiatrist will also be able to differentiate weather it is opioid addiction or pseudoaddiction, do you have any risk factors for dependence ?, if already dependent how to handle that etc. Hence consultation should be sought with abovementioned specialists in a coordinated and collaborative manner.

If you are getting forced to take opioid for getting high, not for getting relief of pain; or if your pain is disproportionate o the severity of chrons disease as evident from investigations; or you develop another set of symptoms like lacrymation, running nose, loose motion, abdominal or body pain, sneezing, sleeplessness apart from usual pain of chrons disease; then opioid dependence is likely and yo should consult a psychiatrist, too.

Hope I could address some of your query

I am available for further discussion
Wish you good luck

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Susanta Padhy (3 hours later)

I want to ween off the pain killers. I have 5 10/325 narcos left, 10 5/325 narcos left, and 2.5 5/325 percocet's left. And Zero hydromorphone. I have been taking about 10-13 hydromorphone's a day until this morning, when I took my last half of one. How should I best ween off now with what I have?

I also have some Tramadol, will that help? I am just not sure how to detox off these pain killers and am scared.

Answered by Dr. Susanta Padhy (12 hours later)

Hi,

Thanks for the response

Weaning off of opioids in dependent individual is by both medication and counseling. Medicine alone without any simultaneous counseling may not be helpful. Because weaning off is a "process".

This is ideally best done by getting admitted in a deaddiction centre or by consulting a deaddiction specialist or psychiatrist. The steps followed there would be:

a) 1st detoxification (the excess opioid in your body will be removed from your body) either by giving replacement therapy with alternative opioids in appropriate dose - to be calculated based on your current usage pattern; or by non opoid drugs.
b) And psycho education, relapse prevention counseling (strategies to handle craving, pain etc).

Yes, tramadol helps, but alone may not help, unless you are combining above mentioned strategies.

I would strongly suggest you to consult a deaddiction centre or psychiatrist. Self medication with too many drugs might complicate the picture and increase your sufferings.

Hope I have addressed your concern. Let me know if you have any more queries; I am available for further query.

Wish you a pain free life.

Regards

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Above answer was peer-reviewed by : Dr. Prasad