Posted by Larry Hoover on April 14, 2003, at 8:49:02
In reply to Re: Xyrem = GHB. Please don't., posted by utopizen on April 13, 2003, at 23:35:15
> It's simply not rational to attempt to extrapolate the effects of drug withdrawl in someone who abuses a drug to someone who takes it for a clinically therapeutic indication.
At present, the only clinically therapeutic indication for GHB is narcolepsy.
> Withdrawl effects are HEAVILY dependent on dosing prior to withdrawl, which are clearly different in therapeutic vs. recreational use.
No, actually, that is false. There is near total overlap in the dosing of the two groups. It is the physiological differences in the subjects which determines the sequelae. Only the extreme cases of recreational use (i.e. the true abusers) fall outside the dosing regimes of the therapeutic users.
> That makes about as much sense as me research methamphetamine abuse withdrawl and concluding that I will get addiction to my Desoxyn for my ADD.Your argument is reductio ad adsurdum, i.e. ridiculing an extreme case, and applying the ridicule to the whole argument.
In the case of certain pathologies, the ideal treatment has effects on the subject population which differ from the effects in the general population. Illustrative examples are:
Chronic pain syndromes. For these subjects, large doses of opiates, given at high frequencies, normalize the pain-receptor hyperarousal which disables them. The total doses far exceed the generally accepted doses for pain management, and probably lie above those doses used by abusers with high tolerance. The development of sustained-release oxycodone (Oxycontin) has been a godsend to these sufferers, but it has coincidentally created an abuse potential that has devastated some peoples' lives. What separates these two populations is the absence of tolerance in the pain group; all other users find that the effects diminish rapidly over time. This has been the main reason why opiates are not useful as a chronic treatment for mood disorders.
ADD and ADHD. The discovery that stimulant drugs help to relieve the symptoms of what many call a disorder of over-stimulation seems paradoxical, but it works. For those with this syndrome, it is believed that there are underactive inhibitory mechanisms at work, whose regulatory effect is enhanced by the stimulant drug. In other populations, again, we see the tendency to develop tolerance, the first physiologically change leading to frank addiction. In the post you quoted where I am advising caution in the use of stimulants, it is because the person wanted to use the drugs as an augment for the treatment of depression. As the post-drug period has characteristics closely matching the presenting symptoms of depression, and with the well-known tolerance in chronic use, caution is warranted, in my humble opinion.
And so we find ourselves debating the use of GHB. Are narcoleptics a special population, one which is constitutionally predisposed to never develop tolerance? And what about depressives and those with anxiety? It has already been clearly demonstrated that the latter populations are particularly prone to substance abuse, in a process we like to call self-medication. It is precisely that very human process which needs illumination here.
I've been down that road myself. I know full well the thinking pattern, "I know what I'm doing. I can handle it." The problem is, the rules change along the way, and there is no warning given. It's just different one day.
You may not be able to walk a mile in my moccasins, but I invite you to look at the wear pattern and debris they've accumulated.
Lar
poster:Larry Hoover
thread:218347
URL: http://www.dr-bob.org/babble/20030411/msgs/219177.html