Borderline Personality Disorder,  Pain,  Substance Abuse,  Treatment

Buprenorphine for BPD?

This is an excellent blog post with a letter included from an ex-addict suffering from BPD. I’ve written about opiod issues and borderline personality disorder before. The thing that struck me about this article was this line: “The opioid made me feel unlike I had ever felt– like I was “normal” in a way, and happy, which was unusual for me.” My wife has reported exactly the same thing. She doesn’t feel “normal” or “happy” (typically) without a small dose of opiates in her system. She reports that they make her feel “normal”. However, she doesn’t take them often, because she understands the danger of addiction.

Anyhow, here is the article:

Buprenorphine for BPD?
By J.T. Junig, MD, PhD
I would like to discuss a comment from a reader:

I have been a recovering addict for 12 years. I was addicted primarily to Lortabs (active ingredient is hydrocodone) and Ultram. I was never an extreme user but I was consistently trying to modulate my feelings and feel better. I also have been battling BPD (Borderline Personality Disorder) for a very long time which appears to be my primary issue. I have been married for 17 years and let’s just say our relationship is difficult due to my inability to be present and emotionally and psychologically sound.

As with most other addicts, I distinctly remember the first opioid I took, even though I don’t remember my first sexual experience. The opioid made me feel unlike I had ever felt– like I was “normal” in a way, and happy, which was unusual for me.

Since I quit using 12 years ago I have only had a few days, yes, days, where I have truly felt good, and that was after intense work with someone for hours and hours at a time to help me get through an intense emotional roller coaster ride. I will feel “normal and happy” for a few hours or maybe a day and then I feel the despair creeping back in. I cut my thumb the other day and the first thought that I had was, I wonder if this injury will be sufficient enough to allow me a Lortab? I just never feel right without an opioid in my system.

I have been researching drugs available to help me. I have tried many different antidepressants which were never helpful. I am wondering about a small dose of Suboxone (maybe 2 mg/day) which I have read may decrease some of the problems associated with BPD. I have been reading that persons with BPD have shown to have an opioid deficit and that 40% of those with BPD are addicts.

Over the last 12 years I have only taken a handful of narcotics (not at one time!) for legitimate pain. In fact, when I was using I really used a very small amount, like an average of 2-3 Ultram/day or 2 Lortab (5mg)/day. I was able to see how I could get my use out of control so when I found out that my brother was an addict I quit using.

I have gone to therapy consistently for over 7 years, I have been involved with the 12 step community and currently attend about 3 meetings per week, I work with recovering addicts 2 days/week, I meditate every morning, I pray, I read the Bible, and I still feel like s$#@. I have trouble remembering things, I get angry and can’t seem to control the inner dialogue in my head, I dissociate… but I can function in the outside world.

My marriage is a different story. (I am) unable to feel the love. Prior to me stopping my drug habit, I felt like I was able to be more ‘myself’ within my marriage. I was more relaxed and happier. I have a fantastic husband, but most of the time I don’t care.

Do you think that a low dose Suboxone each day could help me?

This is a great letter, for a number of reasons. The writer is operating at a high level of function; I made no corrections of spelling or grammar, and she expresses herself in a very coherent and organized way. At the same time, she describes constant, severe suffering. One can understand, by the end of the letter, why people with BPD sometimes cut themselves, in an attempt to focus vague emotional suffering into focus of physical pain, or to gain a sense of control over their suffering.

I invite readers to stick with me on this one. Spend some time reading the letter, as I believe that the writer does a good job of expressing where many of my patients find themselves. There are a number of areas to take the discussion:The increased risk of addiction for someone who feels the way the writer feels, if she were to develop a chronic pain condition such as low back pain.

Whether it is appropriate to start buprenorphine or Suboxone in a person with a low opioid tolerance.

Whether buprenorphine or Suboxone should ever be used to stabilize mood—or to reduce EMOTIONAL suffering.

Which medications are helpful for BPD?

She is off substances now, but feels like she was more ‘herself’ when she was using…. she could tolerate closeness with her husband, and thinks she was ‘happier’ then. Now she is active in the steps. Which is the ‘real’ her?

I will discuss these issues in the next post, and I hope you’ll watch for it.

I am a Psychiatrist and PhD Neuroscientist in solo, private practice in NE Wisconsin. I treat adults, children and adolescents for all psychiatric conditions, with an emphasis on improving the strength of the doctor/patient relationship through longer appointments, greater access, and frequent e-mail communication. I teach psychiatry at the Medical College of Wisconsin, and provide psychiatric servicies for the U of WI Oshkosh Campus. Finally, I provided expert witness testimony for a wide range of cases related to psychiatry, neurology, addiction, and chronic pain. I am Board Certified by the American Board of Psychiatry and Neurology, and lifetime-Board Certified by the American Board of Anesthesiology.

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