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Re: Methadone for Depression? » skills

Posted by Elizabeth on May 22, 2002, at 14:32:16

In reply to Re: Methadone for Depression? (Lisa), posted by skills on May 18, 2002, at 10:42:55

> i am in the u.k. and was detoxed rapidly using lofexadine. It is a good drug and the whole process to about a week to stabilize. Buprenorphine is not really used over here.

Lofexidine is just an alpha-2 adrenergic agonist, like clonidine. We don't have lofexidine here in the States; the only alpha2-agonists I know of that are used here are clonidine and guanfacine (Tenex). Clonidine is often used for opioid detox, and while it relieves some of the symptoms, it doesn't have a very good reputation. It definitely doesn't block craving, and it isn't suitable for maintenance treatment.

Buprenorphine is an actual opioid, although as a partial agonist its abuse potential is very limited (it's also very hard to kill yourself by ODing on it). I know that buprenorphine is used at least in some places in the UK, although I don't know how popular it is. It's marketed there as Temgesic, I believe. Maybe the clinic you were at just didn't use it, for whatever reason. It's used for maintenance tx in a lot of countries, and I know some people who say that it makes it *much* easier to get off of heroin and other full agonists. Many people are able to detox using only an alpha2-agonist (often because they aren't given a choice), but buprenorphine makes it a lot less horrific. Buprenorphine blocks opioid withdrawal symptoms in general (as opposed to treating one or two of them, as the alpha-agonists do), but the withdrawal symptoms of buprenorphine are so mild that many people can switch to buprenorphine for a couple days and then simply stop. Personally, I think that forcing people to undergo full-blown opioid withdrawal is a human rights violation. (I've watched people withdraw with no treatment, with clonidine and benzos only, and with buprenorphine, so it's not like I have no basis to form an opinion. I'm particularly recalling Shelli's story of how she was forced to go off methadone in the hospital with only a single small dose of buprenorphine.) I'm glad you were able to get through it with lofexidine only, but I think people should be able to choose how they want to detox.

On a related subject, I think you're right that people who really want to get off opioids are the most likely to succeed in staying off them. I know someone who just quit and didn't even have cravings when he watched other people taking drugs, simply because he was fed up with the junkie lifestyle ("sick of being sick" -- that must be an NA catch phrase, I'm guessing).

-e


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poster:Elizabeth thread:105910
URL: http://www.dr-bob.org/babble/20020517/msgs/107300.html