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Re: Methadone NikkiT2

Posted by Elizabeth on May 12, 2001, at 18:42:54

In reply to Re: Methadone Elizabeth, posted by NikkiT2 on May 10, 2001, at 10:57:23

> Effexor is NOT addictive. Methadone IS addictiove. Its simple.

You pointed to withdrawal symptoms (including rebound depression) as proof that a drug is "addictive." How, exactly, are you defining "addictive?" I don't believe that this is as "simple" a question as you suggest. There is a medical definition (refer to Goodman & Gilman's Pharmacological Basis of Therapeutics -- the standard medical school pharmacology text -- or to "substance dependence" in DSM-IV), but I'd like to know what you mean when you say it.

> No one shoukd be prescribed an addictive drug in my opinion.

At all? Or just for people who "only" have a "mental" condition? (As opposed to, say, pain -- which is just about as "mental" a condition as anything!)

> I was also reffering to a number of friends who have had serious heroin addictions for many years and their experiences.

I know. I have friends who've been in that situation as well (two of them died of it, one just a month before his 25th birthday). It is a tragedy. True addiction, however (I'm using the medical definition of "addiction," BTW), has very little to do with properly monitored medical use. It is very unusual for people prescribed opioids for pain to become addicted (again, in the medical sense). I personally believe that depression can be as serious or more serious as nociceptive pain for which opioids are the standard of care.

> In the UK its very easy to buy black amrket methadone, as people get their script int he morning, and then sell it to buy them selves heroin zs the methadone is so awful.

A big problem with the "war on drugs" is that it's easier (for anyone) to get unsafe, unmonitored, unregulated black market drugs than it is for pain patients who don't respond to other treatments to get the medicine they need. It's harder still for depressed patients who don't respond to anything else to get the medicine *they* need.

Also, the UK isn't the best example -- the UK and US are extremist countries when it comes to drug laws. I could easily counter with a description of the drug laws in other Western countries. The Netherlands -- as an example of the opposite extreme (although their policies and cultural attitudes toward drugs are moderate, not extremist) -- focuses primarily on intensive harm reduction programs; criminal prosecution is largely limited to international drug trafficking. Methadone is readily available to anyone who is registered as an addict -- Dutch addicts don't have to be subjected to the debasing and extremely inconvenient form of maintenance programs that we have in the US. Dutch drug addicts aren't denied jobs or otherwise stigmatised the way they are in the US. Dutch employers don't require employees (or job applicants) to undergo drug testing. And you know what? There's virtually no "drug problem" in the Netherlands -- certainly nothing compared to all the violence associated with the illicit drug trade, the overcrowding of prisons with nonviolent offenders, spread of disease through needle sharing, and other problems that are rampant in the US. Addicts in the Netherlands have a real opportunity to remake their lives
because the government spends its money on proven effective treatments rather than on ineffective law enforcement as our government does. The rate of addiction in the Netherlands is low and has been stable for a long time. As a percentage of the population, the rate of heroin addiction is less than half of that in the US; the murder rate is less than 1/4 that in the US; the rate of incarceration is about 1/9 that in the US. The Netherlands spends 1/3 the amount of money per capita that the US does on drug enforcement. And their less expensive drug policy *works* (by this time it is beyond any reasonable dispute that the US war on drugs is a pathetic failure -- and an international embarrassment).

> i am just totally against this drug being prescribed for depression as I could see it beocming alot more dangerous.

It's more dangerous for depressed people than typical antidepressants because it causes substantial respiratory depression that can lead to shock, hypoxic brain damage, and even death if it's taken in overdose. Tricyclic antidepressants and MAO inhibitors also carry substantial risks, the former being potentially lethal in overdoses of less than one month's supply.

I also believe that there is a significant possibility that methadone would cause tolerance in patients taking it for depression, as it does in pain patients. However, there have been a number of reports (published and peer-reviewed ones, as well as the cases that I've discussed with my own doctors and teachers) in which patients have been treated for depression with morphine, oxycodone, oxymorphone, and other typical opioid agonists, at a fixed dose, for periods of a year or more without loss of efficacy.

> It is, in my opinion, stupid for someone to suggest this, as, what ever you may feel or think about methadone, IT IS a dangerous drug. This cannot be argued against.

I have a question. Do you think it's okay to call someone "stupid" if you preface it with "in my opinion?"

Many medications that are recognised as being necessary in certain situations are dangerous. Antineoplastic drugs are extremely toxic. The misuse of antibiotics (which is frequent on the part of both patients and doctors) poses a risk to the public as well as to the individual to whom they are prescribed. I could go on, but I'm sure you see my point.

> If you feel I am in the wrong by pointing this out, that is your business, but please do not do things like your little "DR Bob" bit as I am not be abusive toward anyone, name calling etc etc at all.

I disagree with your claim that you aren't engaging in name-calling. You've called people "stupid," "childish" (in the "I'm rubber, you're glue" context), "pathetic," and even referred to someone as a "'person'" in quotes!

If someone else calls you a name, that does not mean you are justified in calling them names in return. I'm sure you're aware that two wrongs don't make a right. This is a moderated board with rules which are quite reasonable and fair, and which, IMO, make it a lot safer a place for people to get support than, say, unmoderated Usenet groups.

> I am stating a case of my personal opinion and experience. completely different circumstances that are largely irrelevant to the discussion here. My own experience which I have cited here (together with the relevant scientific literature) involved the use of opioids under an experienced doctor's supervision in a medical context. I don't consider my experience with street drug addicts to be relevant to the issue of whether methadone has merit as an AD, which is why I haven't emphasised it until now.

I think it's a terrible idea for people to get Vicodin or whatnot under false pretenses and attempt to self-medicate with it, especially if there is a possibility that safer monoaminergic antidepressants might help. (I also think it's a terrible idea to buy monoaminergic ADs over the internet and try to self-medicate with those.) But I also know how hard it is to get a prescription for opioids for nociceptive pain, let alone psychic pain, which is rarely taken as seriously as it needs to be. I think (as a result of my personal experiences and friendships with heroin addicts as well as my discussions on the subject with professionals who are familiar with the treatment of dually-diagnosed patients) that many patients who do not respond to typical ADs but do respond to opioids would get involved with street drugs if they were unable to get a prescription. And that, as far as I'm concerned, is an absolutely unacceptable risk.

A final note: I said before that I've had friends who were junkies. I know how emotional an issue this can be. Please understand that those are entirely different circumstances from the medical use of opioids, which rarely results in addiction (again, I am using the accepted medical definition). This is a loaded debate -- lots of people (including you and me) have strong feelings about it -- but let's all try to remember to be polite and respectful of those who disagree with us, okay?

Thank you.





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Psycho-Babble Medication | Framed

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