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Re: Methadone for Depression? (Lisa) paxvox

Posted by Elizabeth on May 18, 2002, at 9:38:32

In reply to Re: Methadone for Depression? Lisa Simpson, posted by paxvox on May 16, 2002, at 19:33:19

> Well, Lisa, I guess you have to decide which "evil" bothers you more. But first, you never answered about the acetaminaphen. Does your codeine have ACP in it? That really concerns me because of the possibility of liver damage.

I was sort of confused how to read what she said, but it sounded like the tabs are codeine on one side and something else (probably APAP, maybe aspirin or ibuprofen) on the other, so she could just split them and take the codeine half. AFAIK, the opioid-APAP (or whatever) combination pills available in the USA have the active ingredients mixed together so you can't do this. It sounds weird.

> You could decide to get clean and sober, and find some other medical treatment for your depression and other ills. In the U.S., we have a rapid detox process that is available. Basically, they sedate you with benzos (most likely Versed - which is midazolam HCL) then they take you off your opiate/opioid quickly. You are kept sedated during the process (where you otherwise would be suffering withdrawal, DT, etc... if conscious).

I don't think benzos will prevent or cover opioid withdrawal -- you can get general anaesthesia instead of or addition to a sedative, and I think that'd be less unpleasant (of course, there are certain risks with GA, but I think the risk would usually be outweighed by the benefit). Anyway, I think that GA is almost always used. If a person was given only a benzo for opioid withdrawal, I'd expect him/her to suffer a lot.

I had Versed a couple times during minor office procedures (e.g., steroid injection, dental stuff) and maybe it's just me, but I thought it was really, well, weak. I once had what I think was considered to be a pretty high dose (like, 10 mg IM, I think -- they started at a much lower dose but kept repeating it), and I was fully conscious and aware, which I don't think was the intent. Good thing I wasn't very nervous anyway. (I don't have any benzo tolerance.)

Getting back to rapid opioid detox...naltrexone or naloxone is also used. This is what makes it "rapid" -- the antagonist precipitates withdrawal.

> The success rate for this process is about 75% w/o relapse, as long as the person WANTS to be clean. One would obviuosly need a strong support group to have this work.

Yeah, addicts need good psychosocial support in order to stay off drugs. Getting off them is difficult enough, but remaining "clean" in the long term is the really tough part. Opioid withdrawal can be protracted, and for some people the cravings never go away completely.

I don't have any personal experience with drug dependence, but I empathize strongly with the feelings of isolation that you [Lisa] describe. My friends are scattered all over the country -- Boston, New York, DC, Atlanta, San Francisco, LA, St. Louis: basically all over -- and I seldom see any of them.

> Personally, I would think it MORE depressing to be addicted to narcotics and/or alcohol than to have to take "conventional" antidepressants.

I think that a major problem here is that ADs don't necessarily substitute for opioids. (FWIW, I've heard some remitted addicts say that Remeron was pretty good for them.)

MMT seems like it could be a decent solution for a lot of people. In the US, the clinic system is very oppressive in a lot of ways; I don't know anything about how it works in the UK. Of course, going on methadone as a substitute for codeine seems more than a little bit peculiar. Is Temgesic used for maintenance treatment over there?





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