Posted by Elizabeth on May 15, 2001, at 6:54:57
In reply to Re: Methadone » Elizabeth, posted by NikkiT2 on May 13, 2001, at 16:01:19
> Yet again, i will state, by medical LAW Effexor is NOT addictive, the withdrawal symptoms are your seratonin levels re-balancing bacially.
That's interesting that you should say that. Cocaine is a drug that works by nonselective monoamine reuptake inhibition, just like Effexor. Cocaine also has withdrawal symptoms when a person has been using it chronically. These withdrawal symptoms are, like those associated with Effexor, presumed to be the result of the same "re-balancing" process you speak of.
> Methadone by medical law IS addictive.
I requested that you provide a definition for "addictive" (yours, although ambiguous, is clearly not consistent with the accepted medical definition, BTW). I infer from your post that you define it to mean "the government [of your country] says that it is addictive [at the present moment in history]." I think you said you're in the UK, so I can't say what the laws are there, but I can give you a rundown of the laws here (USA) on the subject of Effexor vs. methadone.
By US law, venlafaxine is not a controlled substance, while methadone is (according to the Controlled Substances Act of 1970). Venlafaxine is not believed to have significant potential for abuse; therefore, it is not placed in any of the controlled substance categories (Schedules). Methadone is considered to have high potential for abuse and accepted medical uses, so it is a Schedule II controlled substance. (Drugs considered to have *no* accepted medical use and a high potential for abuse are placed in Schedule I, although a number of these, such as marijuana and LSD, are not addictive.) Methadone is a controlled substance because it is considered (rightly) to have *abuse potential* -- *not* because it is considered "addictive."
On the other hand, the US government, at least, makes some egregious mistakes in evaluation of "abuse potential." For example, sibutramine (Meridia) -- a serotonin/norepinephrine reuptake inhibitor that is extremely similar both chemically and pharmacodynamically to venlafaxine (Effexor), is a Schedule IV controlled substance while Effexor is not a controlled substance at all! The reason? Effexor is marketed as an antidepressant while Meridia is marketed for weight loss (traditionally, diet pills have been abused because most of the effective diet pills are stimulants). That's *it*. Meridia likely has no more potential for abuse than does Effexor.
Personally, I choose to be informed on medical matters by science rather than by law. Laws are determined by cultural values and are subject to change at any given time; the pharmacological properties of a substance are not changed simply by legalising or criminalising a substance, nor by travelling to a country where the drug laws are different.
Even if you believe that [current] law [in your country] should govern questions of medical ethics, it is perfectly ethical to prescribe opiates for depression (or any other off-label use), since it is legal (in the US, at least; I imagine the laws are similar in the UK since the cultural attitudes are similar).