Permanent damage to opioid receptors? (from opioid abuse)

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Mumin
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Permanent damage to opioid receptors? (from opioid abuse)

Post by Mumin » Mon Sep 24, 2018 3:00 am

Hi!

I've recently started using Suboxone to get on with my life. I've been using all kinds of opioids (and other drugs) but what really destroyed my life was heavy abuse of Fentanyl. I've been twice on the 12-step program and i never managed to get sober, once i got sober i only got depressed and filled with anxiety. Longest period that i fought against this totally without any drugs was for about a year, then another year i tried Xanax and Lyrica (with and without each other) for also about a year. The Xanax did not help at all, it just made my anxiety worse, but the Lyrica helped me quite well, just not well enough like opioids/bupe does.

I talked to my therapist about a year or two after i got out of my last session in the 12-step program and she said that i might have _permanent_ damage to my opioid receptors from the heavy Fentanyl abuse (i've been doing insane amounts during a pretty long time, especially the last 6 months before i searched for help) and that i might need Methadone/Subutex/Suboxone for the rest of my life to feel OK. Is there such a thing as this? Any studies that back this up? I don't feel whole without opioids, and buprenorphine helps me very much to get back to a normal life. Can i have done permanent damage to my opioid receptors? Is it possible that i might need bupe for the rest of my life? It really doesn't matter to me as long as i feel OK, cos i don't want to return to that depression ever again. I'm just looking for information for future discussions with my doctor.

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Re: Permanent damage to opioid receptors? (from opioid abuse

Post by jennjenn » Mon Sep 24, 2018 11:24 am

Hey Mumin.

I don’t know about permanent damage plus I’d think if that were true it could happen to more than just ppl abusing fentanyl long term. So it could be true for any opiate.... fentanyl, heroin, morphine, oxycodone, hydromorphone..... any of those could apply to that and there very well may be a study done to prove this, I just don’t know about studies and stuff, that’s more Amy’s territory.

What I do know is some ppl do need suboxone long term or for life. I think I’m one of those ppl. Is it because I’ve permanently destroyed my brain somehow, maybe I don’t know why certain ppl only need buprenorphine a year or two and others several years and then others for life. I don’t know what makes us different in that way but what I do know is it’s true that some of us need lifelong treatment and some don’t.

I have theories of why some of us may be lifers on this medication but they’re just theories, so they aren’t anything special. In my mind I always look at how ppl acted when we were using. Bk in active addiction I used to envy other addicts I knew that still somewhat functioned better than I did. I saw ppl that would get just as sick from withdrawal as I would but they were able to still go to work or they were able to pretend everything was ok. Myself, I couldn’t function at any level unless I had an opiate in me. I worried myself to death, I couldn’t eat or anything until I had that dose. I would pace bk and forth, almost in a 24/7 state of panic, until I had something to take and ease the chaos in my head. I know I’m not the only addict that acted this way so I have to wonder if maybe ppl like myself are the ppl that will need lifelong treatment. That’s just my personal theory, I’m sure there’s a more scientific reason, who knows. It makes sense in my head though lol :)

I have a doctor that doesn’t believe in lifelong treatment. I’ve been with this doctor for almost 7 years. He keeps asking if I’m ready to start tapering off and I keep saying no. I know that one day he’ll either change his stance on lifelong treatment or I’ll have to find a doctor that will. So don’t feel bad or panicked if your doctor doesn’t have the same views on it as you do, you can approach that issue as it comes. Don’t overwhelm yourself by worrying about it right now (not saying you are, just saying for future reference).

Glad you found the forum!!!! Hopefully you stick around!!
Jennifer

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Re: Permanent damage to opioid receptors? (from opioid abuse

Post by Amy-Work In Progress » Mon Sep 24, 2018 12:32 pm

Unfortunately, I can't answer your simple question without a complicated answer that may be beyond my ability to answer anyway.

The best I can do is offer a couple of articles talking about brain science and opioid addiction.

https://www.drugabuse.gov/news-events/n ... ansmission

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054/

The first article would take me about 3 days to fully read and comprehend. It's heavily scientific. The second article is more understandable, but has a lot of information.

The reason that answering your question is difficult is because the neurobiological systems that facilitate dependence and addiction are quite complicated. Some brain receptors, which are intricately involved opioid addiction, are understimulated, while others are overstimulated. These processes occur at the same time. It's impossible to narrow it down to one area of damage. And some areas of damage may heal or return to normal at different rates.

I'll give you one example I got from the first article, in simple terms that I can comprehend! Lol!

When the mu receptor of the brain first receives a large amount of opioid, the brain responds by producing lots of dopamine. Dopamine is our primary "feel good" neurotransmitter. It is very involved with the pleasure/reward circuitry in the brain.

Certain areas of the brain pay close attention to anything that produces a large amount of dopamine and cues us to repeat the behavior that caused that large production of dopamine. When we take oxycodone, for example, it produces a large amount of dopamine (the reward) which causes us pleasure.

Usually dopamine is produced when our brain's mu receptor is stimulated by our own endorphins. Endorphins are produced during certain activities, like eating food, drinking fluids, sleeping, having sex. Basically the things that cause us to survive as a species. But when opioids take the place of our own endorphins in stimulating the mu receptor, the dopamine response is so large that the brain thinks,

"Ok, this is the best thing to help us survive, because we are deriving so much pleasure from it. We need to have opioids stimulating the mu receptor all the time, 24/7."

Ironically, the mu receptor becomes less receptive to both endorphins and opioids as it is flooded with opioids. (I don't know why it becomes less receptive.) Therefore, our brains tell us that we must take more opioids to return to that pleasurable feeling. The cycle then continues: mu receptors less receptive = using more opioids to duplicate that original pleasure. This is how tolerance occurs.

For some folks, dependence/tolerance is a side effect of using opioids to treat their pain, and decreasing their pain is all opioids do for them. It doesn't create the pleasurable effect that addicts feel. So, although they are still needing to take more opioids because of tolerance, the pleasure/reward system in the brain is not activated like it is for addicts.

The reasons that some of us experience that pleasure response to opioids are multiple. One large component that causes addiction is genetic predisposition. Even more complex than genetics, epigenetics is the modification of gene expression without any changes in your DNA. Epigenetics help to explain why one identical twin may be an opioid addict, and the other identical twin is not. Beyond genetics, there are environmental factors that can predispose someone to addiction. For example, a traumatic childhood may make a person more susceptible to addiction.

So, is there permanent damage to opioid receptors from opioid abuse? Well, it seems that the mu receptor, which becomes less receptive to large amounts of opioids, can become more receptive again once it isn't flooded by opioids. There are other processes in the brain that can be impacted long term by opioid abuse, including the pleasure/reward circuitry. It seems that the pathways set by addiction in the brain will always remain. However, the brain does have the capacity to create new neural pathways that can become more prominent than the problematic pathways causing addiction.

In other words, it's complicated.

Where does buprenorphine fit into all this? Buprenorphine has such a strong binding affinity to the mu receptor, that it acts as a barrier against any other opioid which may enter the brain. If you are on a therapeutic dose of buprenorphine, you can shoot heroin and fentanyl and not feel it or overdose from it. Because buprenorphine is a partial agonist (not a full agonist like heroin), it does not cause euphoria to an opioid tolerant person.

Buprenorphine also has a ceiling limit on how much it will depress the central nervous system, which also means there's a limit to how much the drug will depress breathing. By itself, buprenorphine will not cause overdose in an opioid tolerant person. Only the addition of another CNS depressant, like alcohol or a benzodiazepine may cause a person to overdose in combination with buprenorphine.

During the time you are on buprenorphine your mu receptors will remain less sensitive to opioids. In other words, your mu receptors remain "damaged" during MAT. However, other parts of your brain can be returning to normal. We have experienced that several of our forum members, who had been on buprenorphine for 2 or more years, can slowly taper off and maintain a life of sobriety. I, personally, will probably remain on my low dose for several more years. In October it will be 7 years in recovery on buprenorphine for me! The benefits, for me, far outweigh any negatives.

I apologize for making my post so long! Anyone who makes it through the entire post gets a lollipop!

Amy

P.S. Jen's explanation is spot on. I think we were posting at about the same time. :D
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Re: Permanent damage to opioid receptors? (from opioid abuse

Post by Mumin » Tue Sep 25, 2018 12:41 pm

Wow! Impressive answers! And thanks for the lollipop ;)

I'll have to study those links when i feel less tired. But you pretty much covered my question in your answers. Thanks guys! And i'll surely stick around :)

If anyone else has anything else to add (if there is any, haha!) feel free!

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Re: Permanent damage to opioid receptors? (from opioid abuse

Post by jeffg » Fri Sep 28, 2018 5:34 am

Don't believe everything a Doctor, therapist or addiction specialist tells ( sells) you particularly if using the word "Anhedonia" and unless they are safely distanced from any vested interest in your continued use of a product or service being promoted.
If there is one thing science has delivered on it's the understanding of the brains ability to rewire the pathways necessary to continue a full life.
Your age, history of use and underlying medical conditions would impact on any regime of medication and any medical proffessional suggesting you should medicate with suboxone as a life-long pescription has to be questioned by a second and third opinion.
There are many many cases of people suffering the worst mental illnesses that swore opiates were the only answer who have found the right medical help and through that a full life, yes sometimes with medication and many times without.
If you choose a life of daily opiate medication well obviously that is your choice, it's also my choice at the moment but i am 60 and only started opiate medication several years ago.
You can change your point of view anytime you want.

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Re: Permanent damage to opioid receptors? (from opioid abuse

Post by jonby » Fri Sep 28, 2018 7:44 am

Hi'. i used to be Johnboy here on this forum years ago. iany one no suboxone and zubzolv have the same half life? i am on Suboxone for 13 years 20mg. stared on zubzolv 2 months ago and feel withdrawl when i awake in morning. not complete sure its the med. i took an injection of triamcinolone and prednisone 9 months ago (STEROID) And still trying to recover from BRAIN FOG- DEPRESSION MOOD SWINGS. AND JUST UN EXPLAINABLE CRAP. IF ANY ONE TOOK THIS MED I AM SURE SOME OF YOU WENT THROUGH THIS?

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Re: Permanent damage to opioid receptors? (from opioid abuse

Post by jonby » Fri Sep 28, 2018 7:52 am

I Would like Dr Jeff Junig to Give Some LITE in this STEROID EFFECT taking suboxone and Zubzolv? THANKS jonby

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Re: Permanent damage to opioid receptors? (from opioid abuse

Post by razor55 » Fri Sep 28, 2018 10:42 am

Welcome back Jon. I remember you well.

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Re: Permanent damage to opioid receptors? (from opioid abuse

Post by Amy-Work In Progress » Mon Oct 01, 2018 12:01 pm

Jon, I would like to say that Dr. J will be along any time now, but that's not necessarily the case. Aside from his full load of patients, he also works at a methadone clinic. He is also studying for his boards.

Please don't take it personally if he doesn't see your post or takes a long time to answer it. He's just super busy!

Amy
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Re: Permanent damage to opioid receptors? (from opioid abuse

Post by SisterMorphine » Sat Oct 06, 2018 6:16 am

my therapist, who has no association with the clinic or dr i got suboxone thru, has many times told me that my receptors will be permanently damaged. now, she at different times gave me different percentages. once she said 7% will not be restores and once she said 3%.

i can live with that. what i've learned thru therapy, which i've continued after a year post suboxone has taught me several ways to cope with my anxiety without using. i even tappered off lexapro.
Get your shit together and live your life." Black Snake Moan

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Re: Permanent damage to opioid receptors? (from opioid abuse

Post by 2whitelights » Wed Dec 05, 2018 11:15 pm

jennjenn wrote:Hey Mumin.

I don’t know about permanent damage plus I’d think if that were true it could happen to more than just ppl abusing fentanyl long term. So it could be true for any opiate.... fentanyl, heroin, morphine, oxycodone, hydromorphone..... any of those could apply to that and there very well may be a study done to prove this, I just don’t know about studies and stuff, that’s more Amy’s territory.

What I do know is some ppl do need suboxone long term or for life. I think I’m one of those ppl. Is it because I’ve permanently destroyed my brain somehow, maybe I don’t know why certain ppl only need buprenorphine a year or two and others several years and then others for life. I don’t know what makes us different in that way but what I do know is it’s true that some of us need lifelong treatment and some don’t.

I have theories of why some of us may be lifers on this medication but they’re just theories, so they aren’t anything special. In my mind I always look at how ppl acted when we were using. Bk in active addiction I used to envy other addicts I knew that still somewhat functioned better than I did. I saw ppl that would get just as sick from withdrawal as I would but they were able to still go to work or they were able to pretend everything was ok. Myself, I couldn’t function at any level unless I had an opiate in me. I worried myself to death, I couldn’t eat or anything until I had that dose. I would pace bk and forth, almost in a 24/7 state of panic, until I had something to take and ease the chaos in my head. I know I’m not the only addict that acted this way so I have to wonder if maybe ppl like myself are the ppl that will need lifelong treatment. That’s just my personal theory, I’m sure there’s a more scientific reason, who knows. It makes sense in my head though lol :)

I have a doctor that doesn’t believe in lifelong treatment. I’ve been with this doctor for almost 7 years. He keeps asking if I’m ready to start tapering off and I keep saying no. I know that one day he’ll either change his stance on lifelong treatment or I’ll have to find a doctor that will. So don’t feel bad or panicked if your doctor doesn’t have the same views on it as you do, you can approach that issue as it comes. Don’t overwhelm yourself by worrying about it right now (not saying you are, just saying for future reference).

Glad you found the forum!!!! Hopefully you stick around!!
This is interesting you say that. I have actually thought the same thing. I had friends who even in the worst withdrawal could still seem to function somewhat. I'm like you though. My body would literally shut down. I always felt like i dealt with withdrawal (both the physical and the mental) much harder than anyone else i'v ever met. I don't consider myself a lifer because i like to think that maybe one day i wont be on it anymore. Although after 7 years of being on it, i dont intent to try and stop anytime soon. Every day out of those 7 years my life has improved more and more. My life is still improving, between my credit, financial situation, work, training, relationships. Constnatly growing and getting better. Subs have their downsides, but are more than worth it to me. I'm not willing to risk what happens when i come off them anytime soon. Eventually i may be in a situation more suitable to try coming off, but not yet or anytime soon.

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Re: Permanent damage to opioid receptors? (from opioid abuse

Post by jennjenn » Thu Dec 06, 2018 12:20 pm

It makes sense right?! I may not be a lifer on this medication, you never know what may happen in the future especially financially, but I guess I mean I’m willing to be a lifer if I need to be, so I totally agree with what you are saying.

I would wake up in the morning with that pit in my stomach yearning for a dose of medicine and convincing myself I was already in full blown withdrawal. I couldn’t carry on a normal conversation so I definitely couldn’t have worked like some ppl I knew did. Heck I couldn’t even focus on a shower, it just consumed my whole existence. I know all addicts are consumed but others could somewhat still get things done or go about their day but I couldn’t. I think that kind of behavior makes us a little different as far as recovery goes. It’s just a theory of mine, I may be completely wrong or way off the mark. I was always jealous of the ppl that were still able to smile or even eat when they didn’t have anything that day because I was in a corner freaking out somewhere lol.
Jennifer

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Re: Permanent damage to opioid receptors? (from opioid abuse

Post by chyrl » Mon May 27, 2019 10:13 pm

The beauty is that we can forge new neural pathways and lubricate them with repetition, practice, desire, and time. I believe and have studied that we can repair many circuits and yet our knowledge is limited. It’s new territory. I have not been successful in tapering.
One notion that resonated is that when you feel the urge to use or engage in any repetitive habit to just pause fir a moment and become keenly aware of your inner state, self messaging, all of it. Then grow that moment and observe , allow it , without harsh self judgment , just observe.

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Re: Permanent damage to opioid receptors? (from opioid abuse)

Post by TeeJay » Thu Dec 05, 2019 12:24 am

I don't know if using the word "damaged" is helpful. Damaged suggests the changes are irreversible. However I've seen people who have been on huge doses of methadone (150mg+) for years manage to find their way down, off and into a life of opioid abstinence. Sure they have to remain extremely vigilant, and they may find themselves often gravitating to other obsessive pleasure-seeking distracting behaviours. But it CAN be done.

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