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opioid scripts; buprenorphine pharmacokinetics cisco

Posted by Elizabeth on December 15, 2001, at 9:47:53

In reply to Re: JHU buprenorphine research, posted by cisco on December 15, 2001, at 2:05:35

> > Remember, one of the esteemed founders of Johns-Hopkins was a life-long Morphine addict!
> How hypocritical of them not to prescribe an opiate for legitimate purposes!!!

Lots of people in the 19th and earlier centuries used opiates -- primarily, opium, laudanum (tincture of opium), and morphine -- for depression and anxiety, and lots were probably dependent on them. Opium was the very first effective pharmacological antidepressant, after all, and it remains one of the few effective "herbal food supplements." :-) (Opium and its derivatives have been in use for treating depression and anxiety for thousands of years; the word "addictive" in its modern sense, I learned recently, was first seen in English sometime in the 1930s, which lends credence to my belief that it was the drug prohibition laws that created the drug problem). I'm sure that some of the Founding Fathers used opiates for reasons other than nociceptive pain, and probably later Presidents too. (IMHO, the FFs would be horrified to learn about the War on [Some] Drugs and the things the government has done in the name of said "war." I consider the prohibition of certain drugs to be unconstitutional; I don't get how it is that the government feels it can freely criminalize drugs when it knew full well that a Constitutional amendment would be required to criminalize alcohol.)

Anyway, most of the "reasons" that doctors give for not wanting to prescribe opioids are lame excuses. (Fear of the state medical board coming after them is one I might buy, if they were going to prescribe opioids to a lot of patients; if it's just a couple patients, and they can provide solid justification showing that the particular patients need the opioids and so forth, they shouldn't have much to worry about. This most likely depends to some degree on what state they're practicing in: some states may have very right-wing medical boards.)

> Bup can be purchased rather cheaply from Offshore OP's. less than 40 bucks for 50 tabs of the 0.2mg sublingual tabs.

That's interesting, although I always have this hangup about everything I do having to be "legitimate." (In my defense, part of this concern is that I expect OPs to become harder and harder to use, at least when you're talking about controlled substances, and I want to be assured of a steady supply of my chosen medication. OTOH, sublingual bupe may be available in the US soon -- although I feel like I've been hearing this for years.)

I wonder what the equivalent SL dose is to the IN [intranasal] dose I take (1 mL t.i.d.). From what I've read, it seems that IN~=IM (the recommended doses for IM injection are the same as what I take, although IM bupe probably kicks in faster and doesn't work as long as IN). I think I'll post about this to a separate thread.

> I use opiates for self-medicating my depression. They work to a point.

Which do you use (dare I ask?) and what do you mean by "to a point?" Do you use them every day, or just as-needed? Do you have tolerance problems? I've found that some effects, such as the intense feelings of contentment and "connection" to people that I experience at first, can't be maintained over time, but buprenorphine does continue to help with a wide range of problems as no other medicine does (such as depressed mood, anergia, anhedonia, inability to feel like I fit in with others, extreme self-consciousness, and even attention problems, believe it or not).

> The short acting nature of the more popular meds (Oxycodone, Hydrocodone) means that as you chase the effect, with increasing tolerance, the withdrawals are an ever present risk!

Buprenorphine is pretty short-acting, IMO (maybe it would last longer if taken SL).

> My experience with Bup is that it works well. No real euphoria, but depression goes away. They are also excellent for trying to stop short acting opioids. Buprenorphine stops withdrawals completely!

That's what I've heard from people who've used it that way (mainly, people who have some problems with addiction to full-agonist opioids). I've never actually experienced opioid euphoria, so I can't be *sure* that what bupe does to me isn't the same, but *I* sure wouldn't call it "euphoria."

> Tabs must be held under tongue without swallowing for ten minutes!!!! Takes a while to get to the brain. But the effects last a long time. Unlike vicodin or Oxy, where you start thinking about more every 3-4 hours!!!

About how long does bupe take to kick in, and how long does it last, when taken SL? By the nasal route, it lasts around 4-6 hours (once it kicks in), and takes about 1 hour to start working (that's when the dry mouth hits). I've read that it's quicker IM and quicker still IV, although for odd reasons IV bupe doesn't work immediately. (There's another weird one for Cam to explain.)

> PS: Is it just me, or does it seem like all AD's are a bad joke, sugar pills foisted on us by greedy Pharmaceutical companies? Just wondering....

Well, it's not just you; I know plenty of others who feel the same way. I'm ambivalent about this myself: modern ADs seem to help a lot of people, but those of us who need something stronger seem to be out of luck in today's highly politicized medical world. I just wish that the medical establishment would recognize our needs as legitimate -- they have a lot of political clout and could use it to help us if they wanted to.

Argh -- sorry this is so long! I get this way when I'm upset about something political, especially something that hits so close to home.





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