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Re: Unconventional reaction to drugs.Opposite to norm

Posted by Adam on October 19, 1999, at 21:57:13

In reply to Re: Unconventional reaction to drugs.Opposite to norm, posted by Elizabeth on October 19, 1999, at 20:10:19

Shoot. I knew some of that at one point, so why do I have it in my head that there's some association btw. opiates and benzodiazepines? I must have read something someplace...
Sophomore alert. Oh well, my bad. Anyway, I've actually seen a reference by the good Dr. Bodkin where he used buprenorphine in an attempt to treat refractory depression. (I read
up on the guy before I got into his selegiline study). I guess some people responded very well, others didn't. At any rate, it seems there are other indications for buprenorphine
than, if I understand Diane's post, helping to treat drug abuse. Is that another completely dead end?

As for my assumptions about addiction: True, it is nowhere stated. I assumed that Diane was taking methadone, as many do, to help break heroin addiction/dependance. It seems a
bit strange to treat an unaddicted person with what Diane says is an addictive substance (since it's clear Diane was not treated with methadone to relieve the symptoms of a depression).
I also don't understand completely the difference between addiction and experiencing withdrawl from chronic use. But, in truth, I've never completely understood the term "addiction",
as there are so many varieties ("psychological" vs. "physical", whatever that means, etc.). But, in truth, I was imagining something sort of "Trainspotting"-esque where a "chemical
dependancy", such that quitting would be very painful without some chemical help, existed. Diane, if I'm out of line here, please let me know. I meant no disrespect in any case. I
personally don't have anything but sympathy for those who self-medicate. The idea that so many are punished in this society for trying to dull the pain of life makes me quite angry,
sometimes. I am, myself, essentially dependant on drugs to function, and coming to grips with that has not always been easy, I think in large part because such dependancies are seen
by society as a weakness. Am I an addict? I wonder.

I really hope you find something, Diane. I think you are putting your computer to extremely good use. There are a lot of very knowledgeable people here who can help you get some
good ideas. Perhaps you can also get some pointers to a good pdoc in your area who's not afraid to experiment a little. Best of luck.


> (The below contains my understanding of the law on methadone maintenance. If anyone knows otherwise I'd like to know.)
> >Umm, this may be a silly suggestion, but aren't benzodiazapines very similar to opiates?
> No. They're not very good antidepressants, for one thing. For another the mechanism of action is just completely different.
> Benzodiazepines are basically sedatives, and this is the same mechanism responsible for their antianxiety effects. They potentiate the inhibitory neurotransmitter GABA.
> Methadone & co. work on a completely different system, the opioid system. The relevant receptor is the subtype known as mu (as in the Greek letter).
> Don't equate naltrexone with what are normally considered opiates. Naltrexone is an opioid *antagonist* - in other words, it blocks opioid receptors (most prominently the mu receptor, but also kappa and delta). Because of all the hype, I asked Dr. Bodkin about it, and his experience using it in depressed patients is that it tends to be dysphoric, if it has any effect on mood.
> A small number of case reports have suggested it has an augmenting effect on SSRIs in some people. Whether this is a specific effect, and if so how often it happens, is not known.
> >Again there are addiction issues with
> >benzos, but from what I understand, benzo abuse is a rare.
> I think careful monitoring can minimize the risk of abuse, but Diane does not seem to feel that this is a problem for her. (Not to put words in your mouth, Diane; that's just how I read it. See below.)
> >If Diane can beat heroin addiction (about
> > the worst there is, from what I understand), I'm sure she could handle having some Klonapin lying
> > around.
> I'm a little confused. I didn't think she said anywhere that she'd been addicted to heroin. Also there's a big difference between being addicted to a drug and simply experiencing withdrawal from chronic use.
> > Not knowing anything really about methadone except that it helps one make the transition from heroin
> > abuse to abstainance, is it impossible to be in methadone indefinitely? Are there no legal ways to
> > procure this drug if it makes you euthymic and productive? Is methadone just a milder narcotic?
> Methadone is interesting. It's not much "milder" than morphine or heroin, as such, but it doesn't produce so much euphoria, for the most part.
> The legal aspects of treating opioid addiction with opioid agonists are also peculiar. It's only legal if it's done through special clinics dedicated to the purpose of treating heroin addiction. Methadone can't be prescribed for this purpose on an outpatient basis - addicts have to go to the clinic to get their dose. It's given orally, usually dissolved in orange juice (this is to prevent them from tonguing it). Altogether dehumanizing, if you ask me (not that anyone ever has).
> However: if pain is what is being treated, methadone has the same status as any other CII drug. You can get a month's supply, no refills, with a written prescription. (Details may vary from state to state.) Ditto for off-label uses, such as depression or dysthymia.
> So all you have to do is convince a doctor to do it. Oh, wait....




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