Ex-Drug Addict Clean 20yrs Now Needs Morphine for Pain?

Question by chezzam: Ex-drug addict clean 20yrs now needs morphine for pain?
My friend is an ex-heroin addict who has been clean for 20yrs. She now runs a drug rehab facility with her husband. They have always believed that they can never use any type of pain-killer again because it could lead back to addiction. They also stay away from alcohol and anything else potentially addictive. However she has recently fractured her spine and the dr is saying she needs disk replacement surgery and morphine. She is refusing both because of her fears that morphine will send her backwards. I’ve tried to convince her that it would only be for a short time and would be monitored closely to ensure she doesn’t get hooked but she is adamant. She is in agony and finding it hard to function and I wonder how long she can keep it up.
Can anyone share experiences of ex-drug addicts in this position?
What about alternative pain methods? Has anyone had surgery or similar, that would normally require the use of opiates, but successfully used some other form of pain relief?

Best answer:

Answer by Jess Hellmich

What an unfortunate and tough situation. Hopefully I can add some helpful insight.

Heroin is chemically different from morphine because it contains two acetyl groups, the inactive 3-monoacetylmorphine and the active 6-monoacetylmorphine (6-MAM), that make it more fat soluble. In conjunction with that, when administered intravenously, heroin bypasses first-pass metabolism. First-pass metabolism helps dilute the chemical resulting in less of that chemical entering your system. While bypassing first-pass metabolism, the two acetyl groups making it more fat soluble also allows it to pass through the blood-brain barrier much more easily and rapidly, again, resulting in more of the chemical entering your brain which bind to ?-opioid receptors, resulting in the drug’s euphoric, analgesic (pain relief), and anxiolytic (anti-anxiety) effects. Once in the brain, the two acetyl groups break off and dissolve and it basically becomes a very large, very potent amount of morphine in the brain. Because morphine does not have those two acetyl groups it is less potent. Morphine does not pass through the blood brain barrier as easily which results in the chemical being broken down more before entering the brain.

It is possible that taking morphine could trigger cravings for narcotic drugs and potentially relapse. However, if she works very carefully with her doctor and possibly a drug counselor, she may be able to take the medication for a short period of time following the surgery. All of the opiate based drugs will have similar effects and other pain killers (e.g. acetaminophen, naproxen, ibuprofen) are not strong enough on their own to combat the pain associated with the surgery but she could try them. Since morphine does not have the acetyl groups like those of heroin and will most likely be administered orally after surgery and in a precise dosage, I would venture to say the risk is there but manageable.

In oral administration only about 75% of the drug is absorbed into the brain over the course of 2-3 hours minimizing the intense euphoric feelings of injecting heroin. Orally administered medications also have to pass through first-pass metabolism diluting some of its potency. This combined with close supervision and communication with your friend’s doctor should result in a low risk situation. There are also anti-withdrawal and anti-craving medications such as Vivitrol, Buprenophine, or Suboxone used to help minimize the risk of dependency.

Answer by Gareth Carter
hey Chezzam

Dissecting the chemical compounds that make up various drugs isn’t going to help. It’s like debating the relative speeds with which heroin is absorbed by the blood stream whether you snort, smoke or inject it… the end result is the same.

I’m an internationally accredited addictions counsellor, have held the ‘Head of Treatment’ position in 2 countries (South Africa and the UK) and have 18 years of personal recovery from all sorts of drugs, including alcohol, ingested in all sorts of ways. I was once so desperate I shot (injected) tequila!

I feel for your friend as I’ve broken my spine in 2 places, burst 4 discs, broken my femur (thigh bone) patella (knee bone) both wrists (one horribly 2 years ago), heels and um a few more bones I couldn’t be bothered to trawl my memory banks to retrieve.

Surprisingly all of this was achieved in recovery – yes totally clean, straight and sober – by crashing various motorcycles at different times, whats that they say about repeating the same mistakes and expecting a different results hey?

The key point here is that I’ve been through all those operations, 8 in total, inserting and removing pics etc without any mind or mood altering chemicals, so getting through it clean is possible.

The anti-inflammatory drugs are wonderfully helpful and I’ve not needed anything else, thus far! You see the danger for me is that my body doesn’t know the difference between medication used to treat legitimate pain and drugs that I used to get high, and the risks are just too great for me to try mind and mood altering drugs as a means of managing pain – and see how it pans out.

The WHO and all leading medical authorities have deemed drug addiction a chronic, incurable disease. Even after 18 years your friend is still bodily and mentally different from the earth people out there. Once she has some drugs (strictly in a controlled environment, for a very real cause and under doctors orders) is she at risk of changing colour, growing horns and being back out there drinking and using and running amok on the streets again?

This is what it means to be a drug addict, even one in solid and active recovery for 20 years. I know that’s the danger for me.

Addiction recovery has given us great tools to use – ‘this too shall pass’ is a slogan that comes to mind. Yes, it hurts like I just broke my spine (probably because I just broke my spine) but the pain will subside over time, pain will not kill me despite how my head says it will. Morphine on the other hand may very well kill me.

So hanging in there, trusting the team of doctors (knowing that they call their offices a ‘practice’) and that ultimately God’s in charge may be reassuring. In the end the pain subsides and passes, it always does.

I’ve had friends in similar painful positions and if they choose a different route to my experience, saying the pain is unbearable I’ve also advocated for good communication with, and close supervision by, the medical team and less intensive forms of ingestion.

Whatever route she chooses, she’ll get through this and be OK. She can call me if she likes, I’ll gladly share my experience and my hope with her.

Big love from Cape Town, Sunny South Africa (aka – The Promised Land)



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