Posted by Caleb462 on December 16, 2003, at 4:03:44
In reply to Re: Question for Caleb ...... bupe, posted by maryhelen on December 15, 2003, at 12:49:41
> Hi Caleb:
>
> I have been on Nardil since November 3rd, am now up to 90 mg. I also have an opiate addiction. Incredibly, I asked my family doctor not to prescribe them to me anymore, but because of the chronic pain he knows that I am in, next visit he offered them to me anyway, like giving candy to a baby and I had no resistance, took the prescription. I take percocett, and tylenol 3, any opiate really, which both help with the pain, but more importantly the percocett relieves the depression. I won't go into all that the meds I have had for the depression or different therapies (including ECT twice) I have tried over almost 20 years, as it is probably much the same as most others here with treatment resistant depression. I met this pdoc when I was in a substance abuse program and he understands the dilemma I am in, knowing my history of fighting this demon depression, that the opiates has been the only thing that helps the depression and that I need something for chronic pain. He even said that he felt like prescribing the opiates, but knows I take too many now to gain the required effect. He also mentioned Lamitcal to augment the Nardil, as it had helped me greatly when it was augmented with Parnate about 7 months ago, it worked quickly but it stopped working after 3 weeks. I had never felt better in my whole 51 years. I also lost so much of my hair, which would have been fine had the med kept working. Better bald and wear a wig than live in this depression. My pdoc then suggested taking Nardil.
>
> During my last vist, he talked about methadone and then buprenorphine. Methadone does not appeal to me at all. Surfing the web last night, it seems to me that I understand that bupe is used for treatment resistant depression, chronic pain, and opiate withdrawal. I have all three. I am thinking of calling him and asking him to prescribe it.Sounds like a great idea. You are right, methadone is probably not an ideal choice in your case. But you may have to consider it on the off-chance that bupe doesn't work. That is a small chance, of course.
>
> If I had a choice of getting complete pain relief without opiates, or not being depressed, I would choose living with pain and not being depressed, hands down. I am probably going to end up in a wheelchair and would still take that and live without this disabling hell of depression.Bupe will probably help your depression greatly. Also, it WILL help your pain. Buprenorphine is also used for pain control. An 8 mg tab of Suboxone (which is what is described for opiate maintainence) is nearly 30 times the normal doses for pain relief (0.2 mg, 0.3 mg).
>
> Is it your understanding that bupe helps with what I have mentioned above? Did it help you with both the opiate withdrawal and depression in conjuction with Nardil? Does it make you not crave the other opiates?Absolutely. In the doctor's office, I took my first doses in 4 mg increments. Once I hit 12 mg, my cravings shut off like a lightbulb - and they have been gone ever since. I mean, I still get some MILD cravings every once in a while - but I'd say bupe provided about 90% relief from cravings initially, and at my current dose of 20 mg, my cravings have reduced by about 99%. It really is amazing.
You should know though, that I was not completely PHYSICALLY addicted, and was primarily psychologically addicted. Meaning I was not going through intense physical withdrawals, thus I can't comment on that - though I'm certain that will be no problem either, you shouldn't have to worry about physical withdrawal either, once you get up to the dose that is right for you.
Speaking of doses, another thing I should mention is that bupe is a very funny drug. Perhaps this comes from its mixed agonist/antagonist actions, but every person is different in what dose they will respond to. You can't just take your level of tolerance and then calculate your bupe dose with that, it probably won't work. I had a relatively small habit compared to say, a heroin addict - yet I had to go to 20 mg, where I know several H addicts who never had to go past 8 mg.
Some more interesting things:
You can't get high on bupe. You may feel a nice buzz the first few days, but that will fade quickly. You will go back to feeling normal, the way you felt before you ever got hooked (and that is a wonderful feeling). But anyway, bupe has antagonist properties meaning its effects stabilize and eventually bupe has the ability to block its own effects. While the difference between say, 2 mg and 8 mg is fairly drastic. The difference between 8 mg and 16 mg is much subtler - because the effects have already begun to level off. 32 mg is the max dose. After that, bupe's antagonist activity will take over, and will send an addict into withdrawals. Anyway, since you can't get any kind of real high with bupe, you don't have to worry about potentially abusing it either.
One more note on the pain relief - while bupe IS a pain reliever like any narcotic, you have to consider the fact that it simply may not be strong enough to ease all your pain. It will certainly help you mentally, you'll just have to wait and see how it effects you pain-wise. Hopefully, it will be effective.
As for your doctor prescribing it, I'm a little wary on this. The Goverment approved a certain number of U.S. doctors to use bupe (in the forms of subutex and suboxone) to treat opiate addiction. If your doc is not one of these, I'm not sure if he will be able to prescribe subutex or suboxone (the difference: suboxone contains naltrexone, thus if it is crushed and injected it will cause withdrawals. The naltrexone will not has no effect when taken sublingually however - which is how you will be directed to take it).
He can prescribe Buprenex I'm certain of. Buprenex is the original version of buprenorphine that was/is used solely to treat pain. However, I think Buprenex only comes in small doses (0.2 mg) that will not work for opiate maintainence.
I really don't know if un-approved docs can prescribe suboxone/subutex or not. You will just have to ask him. If he can't, you can look for a doctor near you who can. There are many. You can find one by looking here:
http://buprenorphine.samhsa.gov/
I think I've covered everything. Whew, that was a long post. I was going fast, so sorry if it came out sloppy. Anyway, good luck.
>
> Sorry for all of the questions, but I really am at the end of my rope.I understand completely, so was I. No need to apoligise, I am glad to help.
> I am very happy for that you have found a combination that works for you.
>Thanks!
poster:Caleb462
thread:289561
URL: http://www.dr-bob.org/babble/20031213/msgs/290393.html