![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 34 to 58 of 170. Go back in thread:
Posted by Elizabeth on May 10, 2001, at 7:10:13
In reply to Methadone - Cece , posted by DianeD on May 9, 2001, at 13:17:03
> You're already addicted to vicodin. Vicodin feels sorta kinda like methadone but methadone is more energizing, cleaner, etc, etc.
What Cece describes -- intermittent (not daily) use with little tolerance after a long period of time -- does not sound like addiction to me. Under such circumstances, I would be surprised if quitting the drug even led to withdrawal symptoms.
Just as some people prefer Zoloft while others do better on Prozac, it is impossible to predict a person's response to any particular opioid based on the response of another person. Although methadone maintenance is a life-saver, some people do feel that the methadone makes them groggy and not (as you seem to be suggesting) activated. (Personally, I have tried a number of different opioids and found all of them to be activating. But that's *just me*. I thought Zoloft was neutral with regard to activation, but I know some people who are sedated by it and others who get jittery beyond belief on it.)
Vicodin seems like a poor choice to me since it contains acetaminophen ("APAP" -- i.e., Tylenol) as well as hydrocodone. (There is no pure hydrocodone preparation currently available in the United States, although there used to be.) On the other hand, the toxicity of APAP depends on the amount taken at a time, so if you only require a low dose of Vicodin then the toxicity of the APAP is probably not an issue. If you need to take the opioid daily there is a possibility that you may need ever-increasing doses, in which case a combination product such as Vicodin is an absolute no-no.
There are a million different hydrocodone/APAP preparations. The least toxic ones are those containing 10mg of hydrocodone and 325mg of APAP (I think this is the equivalent of one regular-strength Tylenol). Regular Vicodin is 5/500; Vicodin HP is 7.5/500.
Posted by Elizabeth on May 10, 2001, at 7:23:28
In reply to Re: Michele, posted by Sunie on May 9, 2001, at 14:08:21
> Opiates as first-line AD treatment would be foolhardy, yes, but that is not the situation with these folks here. They are searching for a solution, not a high.
Exactly! Depressed people who respond to opioids do not report a "high" from the antidepressant dose.
I've said this before: if someone is getting "high" (or hypomanic) on an AD, that person is taking too much or perhaps needs a different drug altogether. We use ADs to eliminate existing dysfunction, not to create new dysfunctions. Those of us who use opioids as antidepressants are well aware of this and do not seek to get high from our medication.
Maybe those who assume that opioid responders are "addicts" or "drug seekers" ought to take pause and read carefully rather than be so quick to judge.
Posted by Elizabeth on May 10, 2001, at 7:46:13
In reply to Re: Methadone - NikkiT2 » DianeD, posted by NikkiT2 on May 10, 2001, at 5:57:59
(Uhhh, Dr. Bob?)
Nikki: it sounds like your friend was trying to get off methadone too rapidly. Withdrawal sickness also occurs with many monoaminergic antidepressants, not just opioids. (Effexor and Paxil have particularly bad reputations, and from my personal experience and research, MAOIs have terrible withdrawal syndromes as well.)
Invoking your own experience is fine, but that's not all you're doing: you've also tried to generalise your experience into a conclusion about what is or is not "okay." Please take this into consideration in the future. Thank you.
Posted by Elizabeth on May 10, 2001, at 8:55:00
In reply to Methadone - AndrewB and all interested, posted by DianeD on May 1, 2001, at 10:52:16
> Question: Can doctors track your medical history? Meaning, could this pain doc without my knowledge somehow find out and contact past docs of mine? in order to discuss my
> medical/drug history?No. Confidentiality laws vary from state to state, but your permission will be required for any doctor to talk to anyone -- including another doctor -- about your medical history.
> My arguments for methadone over other pain meds will be
> 1. It doesn't incapacitate you. There is no "High".If you are taking the correct dose to treat your depression, you shouldn't be getting high from methadone. (It's a myth that it is impossible to get high from methadone, although methadone does not produce the intense "rush" that results from the intravenous use of short-acting opioids such as heroin, hydromorphone, oxymorphone, etc. Addicts who are on MMT don't get high from it because they are on a stable dose to which they are tolerant.)
> 3. Once right dose is reached you can be maintained on that dosage indefinitely. You don't need more, more, MORE! like all other pain meds.
We're talking about using it as an AD -- not for pain or opioid dependence. Most people using *any* full opioid agonist (including methadone) for pain will continue needing larger amounts. Most people in MMT will be stable on a fixed dose (often quite a high dose).
Most of the reports I have heard from doctors and patients about the use of opioids for depression indicate that many people do not become tolerant to the AD effects -- they are able to continue using the same dose (of morphine, oxycodone, etc.) indefinitely. However, if you become tolerant to the antidepressant effects of other opioids, you are also likely to become tolerant to the antidepressant effects of methadone.
> 5. Does not impair ones mental or physical faculties.
That depends on your reaction to it (highly individualised). Some people feel "foggy" on it.
> 6. It is non toxic. It does not damage your liver etc. I have Hep C (had Hep.B).
Opioids in general are nontoxic at therapeutic doses. It's the Tylenol, aspirin, and ibuprofen that are often added to them (e.g., Vicodin, Vicoprofen, Percocet, or Percodan) that can cause liver damage or GI bleeding.
> The excerpt below is from a legal proceeding Re BAART (a MMT program I was on for awhile in SF) and the city of Antioch.
You can't assume that the principles that apply to MMT will also be true of the use of methadone (or other opioid agonists) for depression. People on MMT are using the drug not to create an effect (such as mood elevation or pain relief), but to *block* an effect (protracted opioid withdrawal syndrome).
I hope this helps clarify some things. Take care and good luck.
Posted by NikkiT2 on May 10, 2001, at 10:57:23
In reply to Re: Methadone » NikkiT2, posted by Elizabeth on May 10, 2001, at 7:46:13
You want Dr Bob to come tell me off??? (And I was called childish!!)
Effexor is NOT addictive. Methadone IS addictiove. Its simple. No one shoukd be prescribed an addictive drug in my opinion. yes, they are used, such as Vicodin (which isn't lisenced int he UK by the way due to its additive nature), but I believe they shouldn;'t be. I was also reffering to a number of friends who have had serious heroin addictions for many years and their experiences. In the UK its very easy to buy black amrket methadone, as people get their script int he morning, and then sell it to buy them selves heroin zs the methadone is so awful.
i am just totally against this drug being prescribed for depression as I could see it beocming alot more dangerous. It is, in my opinion, stupid for someone to suggest this, as, what ever you may feel or think about methadone, IT IS a dangerous drug. This cannot be argued against.
If you feel I am in the wrong by pointing this out, that is your business, but please do not do things like your little "DR Bob" bit as I am not be abusive toward anyone, name calling etc etc at all. I am stating a case of my personal opinion and experience.
nikki
> (Uhhh, Dr. Bob?)
>
> Nikki: it sounds like your friend was trying to get off methadone too rapidly. Withdrawal sickness also occurs with many monoaminergic antidepressants, not just opioids. (Effexor and Paxil have particularly bad reputations, and from my personal experience and research, MAOIs have terrible withdrawal syndromes as well.)
>
> Invoking your own experience is fine, but that's not all you're doing: you've also tried to generalise your experience into a conclusion about what is or is not "okay." Please take this into consideration in the future. Thank you.
Posted by Michele on May 10, 2001, at 13:42:20
In reply to Re: Methadone - NikkiT2 » Michele, posted by NikkiT2 on May 10, 2001, at 6:00:51
> Nikki.... No problem. I'll back you on this one anytime... She's probably so angry because she knows your right! Oh well... I think we did what we could.... I talked to my father again this morning... on babble admin I wrote that he was a doctor and told me that "There is no way a doctor will prescribe methadone for these reasons." He was suprised. What they don't realize is that we are trying to help them! I've been there and seen it too,.. I wouldn't wish that upon my worst enemy.. let alone someone who is depressed. Not only do they need a pdoc to prescribe the RIGHT stuff.... they need an incredible therapist... if they believe what they are saying. I'm still shocked over this thread... Oh well, I did what I can.
>
>
>
>
> > > How can you say Methadone is a nasty nasty drug when you have never been on it yourself? How closed minded. Childish.
> >
> > Who's being childish exactly? And Methadone is just as bad, if not Worse than horoin... I also know a heroine addict trying to get off of it. How can you recommend this type of drug to somebody? And he's childish.
> > >
> > > Methadone is not worse than heroin. Sheeeeet how off the wall can you get. Heroin is an occupation. Heroin is taken and cut with all kinds of crap (sugar, starch, powdered milk, quinine, strychnine or other poisons). Not to mention possible exposure to AIDS, hepatitis, abscesses, infections of the heart lining and valves, bacterial infections and on and on. To the heroin addict methadone is FREEDOM. And to some people with certain types of depression, I believe from my own personal experience, that it just might be the ticket to freedom as well!
> > >
> > > Methadone is harder to kick YES, BUT we are talking about remaining on Methadone forever if it works for you.
> >
> >
> > What doctor in their right mind is going to prescribe this for depression? I'll tell you one thing... if found out, he'll probably loose his liscence quick.
> >
> > > When you want to get off methadone you come off S L O W L Y. Maybe 1mg a day at the very very fastest.
> > >
> > > And as for it being addictive. So what! Your body becomes "addicted" to all things that are given to it continually. It adjusts, it adapts to whatever you are filling it with, be it synthroid, ADs, vitamins, cancer meds, whatever! The body evolves.
> > >
> > >
> > >
> > > > I ahve never used methadone, but have a very close friend who is currently using to help kick his heroin habit.
> > > >
> > > > It is a nasty, nasty drug. He says it is worse than the heroin... it is HIGHLY addictive and the "come downs" are terrible.
> > > >
> > > > I would never reccomend use fo this drug.
> > > >
> > > > nikki
Posted by Michele on May 10, 2001, at 13:53:07
In reply to Re: Michele, posted by Elizabeth on May 10, 2001, at 7:23:28
Elizabeth,
Don't fool these people. Dr. Bob???????????? You must be able to input something here.
Opiates DEFINATELY give you a high!!!!! Why do you think there is such an underground business for them??????????
That's why I stupidly used them. Especially vicoden and percocet.... the high is fantastic. You can't even imagine how many people that i know here(las vegas) that will move heaven and earth to get these drugs.... why is that do you think? Because they produce a HIGH.
I'll tell you.... in my earlier years I got a higher high with pain killers...then with street drugs. Did you say they werent addictive??? I won't comment on that one... since I can't remember what you said.
I'm going to shush before I get kicked off. But one more thing.... kind of like Nikki said in getting off methadone and seeing a grown man shake and cry. Now THATS a withdrawal. People who use methadone maintance to get off heroin... don't feel they are getting off of any addiction. My step father is on it now..... he can't get off it!!!!! It is sooo sad. He knows a lot about this stuff.... and um, trust me.. he knows. He's spent 6 years in sing sing prison... he knows what drugs do to you.... and in his opinion, this is the worst. Not to mention... he has to go every single day for methadone. They don't just give it to you to take on your own.... that's how serious a drug this is.
Posted by Michele on May 10, 2001, at 13:55:23
In reply to Re: Michele, posted by Elizabeth on May 10, 2001, at 7:23:28
> > Opiates as first-line AD treatment would be foolhardy, yes, but that is not the situation with these folks here. They are searching for a solution, not a high.
You sent me a post referring to the above. Just to let you know..... I didn't write that... that was someone elses. So don't tell me I'm not reading the posts close enough... that isn't even mine!
Posted by JahL on May 10, 2001, at 14:27:54
In reply to Re: Michele, posted by Elizabeth on May 10, 2001, at 7:23:28
I don't want to get involved in this one but I would like to relay a point made by a recognised pdoc in an article I read recently. In it he said that it would be amazing if, out of all the receptor systems, only the opioid receptors were immune from dysfunction.
I'm not attempting to make a point, but I can't disagree with the guy.
J
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> > Opiates as first-line AD treatment would be foolhardy, yes, but that is not the situation with these folks here. They are searching for a solution, not a high.
>
> Exactly! Depressed people who respond to opioids do not report a "high" from the antidepressant dose.
>
> I've said this before: if someone is getting "high" (or hypomanic) on an AD, that person is taking too much or perhaps needs a different drug altogether. We use ADs to eliminate existing dysfunction, not to create new dysfunctions. Those of us who use opioids as antidepressants are well aware of this and do not seek to get high from our medication.
>
> Maybe those who assume that opioid responders are "addicts" or "drug seekers" ought to take pause and read carefully rather than be so quick to judge.
Posted by NikkiT2 on May 10, 2001, at 16:46:20
In reply to Re: Methadone - NikkiT2, posted by Michele on May 10, 2001, at 13:42:20
I think maybe I got upset as I was so utterly shocked about this too.. I really can;t believe ANYONE would condone this, especially a health care professional
nikki
Posted by DianeD on May 11, 2001, at 21:43:54
In reply to Re: Methadone - AndrewB and all interested » Cece, posted by shelliR on May 9, 2001, at 20:49:23
What methadone feels like.
I found that when I did my 6 mile walk down than up this certain grade, half way back
up I'd get this fabulous rush of strength and positive feelings. I assume that's what's
called a "runners high" (?). Anyway THAT'S IT! That is exactly how methadone
effects me, makes me feel 24hrs a day. I don't know about anyone else but that's
what it does for me. (or rather that's what it did for me when I was on it ('85-'92))I'd still be walking that grade but being a Hwy. it just got too hairy. Dangerous for me
and drivers alike. Even Sunday 5am.*Dr. Bob, I wasn't attacking NikkiT2. I was attacking that type of regressive
ATTITUDE. I think it's wrong for people to condemn or dismiss something they
personally know nothing about. Peoples minds should remain open at all times.
Posted by Dr. Bob on May 11, 2001, at 23:50:25
In reply to Re: Methadone - NikkiT2 » DianeD, posted by NikkiT2 on May 10, 2001, at 5:57:59
> your reaction to me being childish etc is one pathetic peice of writing...
>
> You seem to be the childish one...Please be civil even if someone else isn't. Two wrongs don't make a right. Thanks,
Bob
PS: Any follow-ups regarding civility, if not redirected to Psycho-Babble Administration, may be deleted.
Posted by rogdog on May 12, 2001, at 13:28:15
In reply to Re: Methadone - AndrewB and all interested, posted by H. Vincent MacGruder on May 7, 2001, at 9:32:55
MY EXPERIENCE WITH METHADONE HAS BEEN THAT IT IS A GOOD ANTI-ANXIETY MED. AND ALSO A GREAT ANTI-DEPRESSANT. i WAS ON IT FOR 3 AND A HALF YEARS THE THING THAT WAS THE WORST WAS THE FACT THAT YOU HAVE TO GET UP EVERY MORNING AND DRIVE DOWN TO THE CLINIC TO GET YOUR "DAILY DOSE". I THINK DOCTORS SHOULD BE LIBERATED IN THERE PRESCRIBING OF DRUG. A LOW DOSE OF METHADONE COULD END UP ON BEING A LIFE SAVER FOR SOME PEOPLE. WE SHOULD ACCEPT THE OPIATES AS A "REAL" TREATMENT FOR DEPRESSION AND ANXIETY. TO GET OFF IT REALLY IS NOT THAT BAD THERE ARE NUMEROUS WAYS TO DETOX FROM METHADONE AND NOT BE TO UNCOMFORTABLE. I HAVE DETOXED FROM METHADONE "COLD TURKEY" AND A GRADUAL DOSE REDUCTION. OPIATES ARE NOT A "BAD DRUG!!!!! PEOPLE REACT TO MEDICATION DIFFERENTLY, SOME MAY HAVE AN ABSOLUTLY TERRIBLE EXPERIENCE WITH EFFEXOR AND BELEIVES IT IS FROM THE DEVIL, WHILE OTHERS COULDNT LIVE WITHOUT IT. JUST MY 2 BITS! ROGDOG
Posted by Elizabeth on May 12, 2001, at 18:42:54
In reply to Re: Methadone » Elizabeth, posted by NikkiT2 on May 10, 2001, at 10:57:23
> Effexor is NOT addictive. Methadone IS addictiove. Its simple.
You pointed to withdrawal symptoms (including rebound depression) as proof that a drug is "addictive." How, exactly, are you defining "addictive?" I don't believe that this is as "simple" a question as you suggest. There is a medical definition (refer to Goodman & Gilman's Pharmacological Basis of Therapeutics -- the standard medical school pharmacology text -- or to "substance dependence" in DSM-IV), but I'd like to know what you mean when you say it.
> No one shoukd be prescribed an addictive drug in my opinion.
At all? Or just for people who "only" have a "mental" condition? (As opposed to, say, pain -- which is just about as "mental" a condition as anything!)
> I was also reffering to a number of friends who have had serious heroin addictions for many years and their experiences.
I know. I have friends who've been in that situation as well (two of them died of it, one just a month before his 25th birthday). It is a tragedy. True addiction, however (I'm using the medical definition of "addiction," BTW), has very little to do with properly monitored medical use. It is very unusual for people prescribed opioids for pain to become addicted (again, in the medical sense). I personally believe that depression can be as serious or more serious as nociceptive pain for which opioids are the standard of care.
> In the UK its very easy to buy black amrket methadone, as people get their script int he morning, and then sell it to buy them selves heroin zs the methadone is so awful.
A big problem with the "war on drugs" is that it's easier (for anyone) to get unsafe, unmonitored, unregulated black market drugs than it is for pain patients who don't respond to other treatments to get the medicine they need. It's harder still for depressed patients who don't respond to anything else to get the medicine *they* need.
Also, the UK isn't the best example -- the UK and US are extremist countries when it comes to drug laws. I could easily counter with a description of the drug laws in other Western countries. The Netherlands -- as an example of the opposite extreme (although their policies and cultural attitudes toward drugs are moderate, not extremist) -- focuses primarily on intensive harm reduction programs; criminal prosecution is largely limited to international drug trafficking. Methadone is readily available to anyone who is registered as an addict -- Dutch addicts don't have to be subjected to the debasing and extremely inconvenient form of maintenance programs that we have in the US. Dutch drug addicts aren't denied jobs or otherwise stigmatised the way they are in the US. Dutch employers don't require employees (or job applicants) to undergo drug testing. And you know what? There's virtually no "drug problem" in the Netherlands -- certainly nothing compared to all the violence associated with the illicit drug trade, the overcrowding of prisons with nonviolent offenders, spread of disease through needle sharing, and other problems that are rampant in the US. Addicts in the Netherlands have a real opportunity to remake their lives
because the government spends its money on proven effective treatments rather than on ineffective law enforcement as our government does. The rate of addiction in the Netherlands is low and has been stable for a long time. As a percentage of the population, the rate of heroin addiction is less than half of that in the US; the murder rate is less than 1/4 that in the US; the rate of incarceration is about 1/9 that in the US. The Netherlands spends 1/3 the amount of money per capita that the US does on drug enforcement. And their less expensive drug policy *works* (by this time it is beyond any reasonable dispute that the US war on drugs is a pathetic failure -- and an international embarrassment).> i am just totally against this drug being prescribed for depression as I could see it beocming alot more dangerous.
It's more dangerous for depressed people than typical antidepressants because it causes substantial respiratory depression that can lead to shock, hypoxic brain damage, and even death if it's taken in overdose. Tricyclic antidepressants and MAO inhibitors also carry substantial risks, the former being potentially lethal in overdoses of less than one month's supply.
I also believe that there is a significant possibility that methadone would cause tolerance in patients taking it for depression, as it does in pain patients. However, there have been a number of reports (published and peer-reviewed ones, as well as the cases that I've discussed with my own doctors and teachers) in which patients have been treated for depression with morphine, oxycodone, oxymorphone, and other typical opioid agonists, at a fixed dose, for periods of a year or more without loss of efficacy.
> It is, in my opinion, stupid for someone to suggest this, as, what ever you may feel or think about methadone, IT IS a dangerous drug. This cannot be argued against.
I have a question. Do you think it's okay to call someone "stupid" if you preface it with "in my opinion?"
Many medications that are recognised as being necessary in certain situations are dangerous. Antineoplastic drugs are extremely toxic. The misuse of antibiotics (which is frequent on the part of both patients and doctors) poses a risk to the public as well as to the individual to whom they are prescribed. I could go on, but I'm sure you see my point.
> If you feel I am in the wrong by pointing this out, that is your business, but please do not do things like your little "DR Bob" bit as I am not be abusive toward anyone, name calling etc etc at all.
I disagree with your claim that you aren't engaging in name-calling. You've called people "stupid," "childish" (in the "I'm rubber, you're glue" context), "pathetic," and even referred to someone as a "'person'" in quotes!
If someone else calls you a name, that does not mean you are justified in calling them names in return. I'm sure you're aware that two wrongs don't make a right. This is a moderated board with rules which are quite reasonable and fair, and which, IMO, make it a lot safer a place for people to get support than, say, unmoderated Usenet groups.
> I am stating a case of my personal opinion and experience.
...in completely different circumstances that are largely irrelevant to the discussion here. My own experience which I have cited here (together with the relevant scientific literature) involved the use of opioids under an experienced doctor's supervision in a medical context. I don't consider my experience with street drug addicts to be relevant to the issue of whether methadone has merit as an AD, which is why I haven't emphasised it until now.
I think it's a terrible idea for people to get Vicodin or whatnot under false pretenses and attempt to self-medicate with it, especially if there is a possibility that safer monoaminergic antidepressants might help. (I also think it's a terrible idea to buy monoaminergic ADs over the internet and try to self-medicate with those.) But I also know how hard it is to get a prescription for opioids for nociceptive pain, let alone psychic pain, which is rarely taken as seriously as it needs to be. I think (as a result of my personal experiences and friendships with heroin addicts as well as my discussions on the subject with professionals who are familiar with the treatment of dually-diagnosed patients) that many patients who do not respond to typical ADs but do respond to opioids would get involved with street drugs if they were unable to get a prescription. And that, as far as I'm concerned, is an absolutely unacceptable risk.
A final note: I said before that I've had friends who were junkies. I know how emotional an issue this can be. Please understand that those are entirely different circumstances from the medical use of opioids, which rarely results in addiction (again, I am using the accepted medical definition). This is a loaded debate -- lots of people (including you and me) have strong feelings about it -- but let's all try to remember to be polite and respectful of those who disagree with us, okay?
Thank you.
-elizabeth
Posted by Elizabeth on May 12, 2001, at 19:09:30
In reply to Re: Michele » Elizabeth, posted by Michele on May 10, 2001, at 13:53:07
> Opiates DEFINATELY give you a high!!!!! Why do you think there is such an underground business for them??????????
It depends on the amount you take and on your tolerance (including innate tolerance). I believe I even said to someone that it is a myth that you can't get high on methadone.
Buprenorphine is an atypical opioid with partial agonist activity at the mu receptor (responsible for mood elevation). AFAIK, it doesn't cause euphoria at *any* dose. (I have taken it for more than two years, BTW.)
Under a doctor's supervision, it's perfectly possible to take opioids without becoming addicted, simply by sticking to the minimal effective dose. (Only about a third of people find them pleasant anyway -- just like all antidepressants, they aren't guaranteed to work for everybody.)
> That's why I stupidly used them.
I believe you. But that's not why everybody uses them. Many people use them to relieve pain, including the pain of depression. The latter group consists almost exclusively of self-medicators, precisely because opioids are not widely available to us in a medical context.
> Especially vicoden and percocet.... the high is fantastic.
I think you'd feel differently if you'd tried IV heroin, Dilaudid, or NuMorphan! < g >
> I'll tell you.... in my earlier years I got a higher high with pain killers...then with street drugs. Did you say they werent addictive??? I won't comment on that one... since I can't remember what you said.
Obviously! I actually said that not everybody who takes them (or even most people) becomes addicted (contrary to popular myth), and that "medical addiction" is really quite uncommon.
> I'm going to shush before I get kicked off. But one more thing.... kind of like Nikki said in getting off methadone and seeing a grown man shake and cry. Now THATS a withdrawal.
Yup, I remember it well from when I "kicked" Nardil. (Except that I'm not a man. < g >)
> People who use methadone maintance to get off heroin... don't feel they are getting off of any addiction.
Huh? I think anybody who goes into *addiction treatment* has to be aware, at least on some level, that they're addicted! But anyway, I think methadone maintenance is far more
Buprenorphine is probably more effective for the old 28-day detox, as buprenorphine has only mild and short-lived withdrawal symptoms itself, although it blocks withdrawal symptoms of heroin (or methadone, for that matter). Methadone causes a withdrawal syndrome that is quite long-lived and, although it is milder than that associated with heroin, it's still pretty tough. (I believe I've said all this before, too.)
> My step father is on it now..... he can't get off it!!!!!
Maybe he could try a buprenorphine taper (as I suggested above)?
> It is sooo sad. He knows a lot about this stuff.... and um, trust me.. he knows.
I believe you. I also believe -- no, I *know* -- that the context in which a drug is used (the intent, the quantity, the route of administration, and so forth) influences its effects.
> Not to mention... he has to go every single day for methadone. They don't just give it to you to take on your own.... that's how serious a drug this is.
See my previous post, specifically the part about the harm reduction policy in the Netherlands. Methadone is readily available to anyone who needs it, when they need it -- MMT there is not a humiliating process like it is here, and as a result recovering addicts are much likelier to be able to achieve the stability that's necessary in order to live a normal life, hold a job, etc. I live in a suburb where many people have to get on the commuter train at 6am to get to work on time. The nearest methadone clinic is about a half hour in the opposite direction and doesn't open until 8! Unless they have a flexible job situation where they could step out for a half hour or so to get methadone in the city, it is close to impossible for addicts here to get MMT and work at the same time. Protracted opioid withdrawal (the existence of which is well documented) is *hard* to live with, but for recovering addicts in my area, there's seldom any choice.
Posted by Elizabeth on May 12, 2001, at 19:10:48
In reply to Re: Michele_elizabeth... p..s, posted by Michele on May 10, 2001, at 13:55:23
> > > Opiates as first-line AD treatment would be foolhardy, yes, but that is not the situation with these folks here. They are searching for a solution, not a high.
>
> You sent me a post referring to the above. Just to let you know..... I didn't write that... that was someone elses. So don't tell me I'm not reading the posts close enough... that isn't even mine!Sorry about that! Sometimes with posts that include nested quotes, it's hard to keep track of who said what.
Posted by Elizabeth on May 12, 2001, at 19:21:24
In reply to What methadone feels like = Runners high. Dr Bob, posted by DianeD on May 11, 2001, at 21:43:54
> I found that when I did my 6 mile walk down than up this certain grade, half way back
> up I'd get this fabulous rush of strength and positive feelings. I assume that's what's
> called a "runners high" (?).I always thought that was interesting (especially when you consider that runner's high doesn't cause the annoying side effects that exogenous opioids do). It's true that some people don't get runner's high -- I'm one of them. (It's not necessarily a sign of opioidergic dysfunction, though: one of my professors, who used to run marathons, doesn't get it either.)
> I'd still be walking that grade but being a Hwy. it just got too hairy. Dangerous for me
> and drivers alike. Even Sunday 5am.Yeah, running in traffic
> *Dr. Bob, I wasn't attacking NikkiT2. I was attacking that type of regressive
> ATTITUDE.I picked up on that, but I wouldn't call it "childish," although it is perhaps overly simplistic. People get really emotional about this stuff, I wouldn't take it too seriously.
> I think it's wrong for people to condemn or dismiss something they
> personally know nothing about. Peoples minds should remain open at all times.My understanding from her posts is that Nikki believes that her experience with heroin addicts is relevant to medical use of opioids -- IOW, that she _does_ know something personally about the topic at hand. I believe there are significant differences between the situations she is familiar with and the ones that are being discussed here.
Posted by Elizabeth on May 12, 2001, at 19:33:17
In reply to Re: Methadone - AndrewB and all interested, posted by rogdog on May 12, 2001, at 13:28:15
> MY EXPERIENCE WITH METHADONE HAS BEEN THAT IT IS A GOOD ANTI-ANXIETY MED. AND ALSO A GREAT ANTI-DEPRESSANT.
Mine also. Opioids alleviate symptoms of anhedonia (including loss of appetite), anergia, and social withdrawal that have been relatively untouched by the countless other meds I've tried, as well as other symptoms such as despair, guilt, excessive doubt and indecisiveness, sleeplessness, etc.
> i WAS ON IT FOR 3 AND A HALF YEARS THE THING THAT WAS THE WORST WAS THE FACT THAT YOU HAVE TO GET UP EVERY MORNING AND DRIVE DOWN TO THE CLINIC TO GET YOUR "DAILY DOSE".
This is only true if methadone is being prescribed as maintenance treatment for opioid addiction. Pain patients can get it from a pharmacy like any other drug.
> WE SHOULD ACCEPT THE OPIATES AS A "REAL" TREATMENT FOR DEPRESSION AND ANXIETY.
They are. Furthermore, they can work when nothing else does, probably because all conventional ADs target the monoaminergic systems (although some experimental ADs do affect neuropeptides).
> TO GET OFF IT REALLY IS NOT THAT BAD THERE ARE NUMEROUS WAYS TO DETOX FROM METHADONE AND NOT BE TO UNCOMFORTABLE. I HAVE DETOXED FROM METHADONE "COLD TURKEY" AND A GRADUAL DOSE REDUCTION. OPIATES ARE NOT A "BAD DRUG!!!!!
I don't believe there are "good drugs" and "bad drugs" (except for a few things which are simply toxins). I believe there are helpful uses and unhelpful or harmful uses of almost all drugs.
Also, as someone-or-other said, the difference between a medicine and a poison is the dose!
-elizabeth
P.S. Could you try not to type in all caps? By internet convention, typing in caps is generally used to indicate yelling and so can be upsetting or disconcerting to some people. Thanks.
Posted by Cecilia on May 12, 2001, at 23:20:17
In reply to Re: Michele_elizabeth... p..s » Michele, posted by Elizabeth on May 12, 2001, at 19:10:48
I`m quite certain my HMO would never approve of opiates for depression-there`s no way I would even ask. But I`m curious- I received morphine and Percocet following surgery a few years ago and they certainly didn`t make me high or less depressed or give me any desire to take more once the post-op pain was over. Do the people who respond to opiates for depression find they get an anti-depressant effect when these are taken for pain?
I
Posted by Michele on May 12, 2001, at 23:53:24
In reply to Re: Opiates for depression?, posted by Cecilia on May 12, 2001, at 23:20:17
> I`m quite certain my HMO would never approve of opiates for depression-there`s no way I would even ask. But I`m curious- I received morphine and Percocet following surgery a few years ago and they certainly didn`t make me high or less depressed or give me any desire to take more once the post-op pain was over. Do the people who respond to opiates for depression find they get an anti-depressant effect when these are taken for pain?
Same here. They took away my pain... but pretty much just knocked me out.
>
>
>
> I
Posted by Michele on May 13, 2001, at 0:14:09
In reply to Re: Michele, posted by Elizabeth on May 10, 2001, at 7:23:28
Elizabeth... you wrote this to me.... I didn't write it. Check the thread or do whatever you need to do.... but I am soooo tired of people taking pieces of a thread and directing it at me... WHEN I DIDN'T EVEN WRITE IT!!!!!!
> > Opiates as first-line AD treatment would be foolhardy, yes, but that is not the situation with these folks here. They are searching for a solution, not a high.
>
> Exactly! Depressed people who respond to opioids do not report a "high" from the antidepressant dose.
>
> I've said this before: if someone is getting "high" (or hypomanic) on an AD, that person is taking too much or perhaps needs a different drug altogether. We use ADs to eliminate existing dysfunction, not to create new dysfunctions. Those of us who use opioids as antidepressants are well aware of this and do not seek to get high from our medication.
>
> Maybe those who assume that opioid responders are "addicts" or "drug seekers" ought to take pause and read carefully rather than be so quick to judge.
Posted by SLS on May 13, 2001, at 9:20:45
In reply to Re: Methadone - AndrewB and all interested » rogdog, posted by Elizabeth on May 12, 2001, at 19:33:17
> > WE SHOULD ACCEPT THE OPIATES AS A "REAL" TREATMENT FOR DEPRESSION AND ANXIETY.
> They are.
Hi Elizabeth.How prevalent is this recognition among "expert" clinical psychopharmacologists?
I told my doctor about the multiple accounts described on Psycho-Babble of people using oxycodone as an antidepressant. His reply was that it was probably nothing more than the same euphoriant effects that healthy people experience. His tone seemed to indicate that opioids were not within the boundaries of alternatives to be considered for my treatment.
I am getting concerned that my doctor is not the expert he was touted as being (I hope he is not reading this). He is an assistant professor at NYU, and is an active clinician at the hospital. He came highly recommended by the doctor who was recommended by a research clinician at Mass. General / Harvard. The person who was originally recommended had changed his focus to ADD AD/HD, and would not take any cases of affective disorder. Both doctors share an office.
> Furthermore, they can work when nothing else does, probably because all conventional ADs target the monoaminergic systems (although some experimental ADs do affect neuropeptides).
Are you now using, or ever have used, the same opioid consistently as part of your daily regimen for an extended period? If not, why not? If you have discontinued the use of opioids while still moderately to severely depressed, what are the reasons?
I think my last question is one that would best be asked through a more private communication (I'll try not to flirt). I really need to evaluate the personnel whom I am to invest so much time and pain in. If you are willing...
Thanks.
- Scott
Posted by Elizabeth on May 13, 2001, at 13:44:26
In reply to Re: Opiates for depression?, posted by Cecilia on May 12, 2001, at 23:20:17
> I`m quite certain my HMO would never approve of opiates for depression-there`s no way I would even ask.
HMOs vary widely. Mine is a nonprofit that's basically owned by a university (the preferred hospital is the university-affiliated one, of course). The prescription plan is completely separate from the other parts. They recently adopted a formulary, where some drugs are "preferred" and have lower copays, but all prescription drugs are covered at least to some extent. So I can get Buprenex (or the generic that Abbott recently came out with) at any pharmacy that takes my insurance, as long as I have a script.
Most doctors don't even know what buprenorphine is (though some have a negative knee-jerk reaction based on the "-orphine" ending!). I think if they read up on it they'd realise it lacks a lot of the disadvantages associated with other opiates, and they'd be very willing to prescribe it. (The FDA considers it to have less abuse potential than benzos, Ambien, Provigil, and the like.) It would also help if the drug companies would come out with a metred-dose inhaler; right now the only way to administer it effectively requires the use of syringes, which doctors hate to prescribe.
> But I`m curious- I received morphine and Percocet following surgery a few years ago and they certainly didn`t make me high or less depressed or give me any desire to take more once the post-op pain was over.
You and 70% of the population. (Were you depressed at the time?)
> Do the people who respond to opiates for depression find they get an anti-depressant effect when these are taken for pain?
Yes. I was mildly depressed (residually -- I have double depression) when I received Vicodin ES (hydrocodone 7.5mg/APAP 500mg) after having my wisdom teeth out. As soon as I felt it, the not-quite-rightness that I've felt all my life vanished, and my mood returned to normal. A lot of people discover opioids this way. Those who move on to self-medicating with heroin are at high risk for addiction, especially those who take it intravenously (who also risk a number of medical complications such as infections and abscesses). Those who are able to find a doctor willing to prescribe opioids and monitor their use have little risk as long as they use the medication as prescribed.
Codeine in therapeutic doses for pain doesn't seem to have this effect, although it does have the same side effects than stronger drugs like hydrocodone or morphine. I think higher doses of codeine would probably work, but with worse side effects than similarly effective doses of morphine, oxycodone, etc. Buprenorphine works in extremely low doses (i.e., it is very potent, comparable to fentanyl) and is qualitatively distinct from other opioids, although I believe that opioid-experienced people (and rodents) can generally identify it as an opioid.
-elizabeth
Posted by SLS on May 13, 2001, at 15:02:53
In reply to Re: Opiates for depression? » Cecilia, posted by Elizabeth on May 13, 2001, at 13:44:26
Dear Elizabeth,
No need to communicate...
I was able to glean the answer to my question from the content of your post. Thanks.
- Scott> > I`m quite certain my HMO would never approve of opiates for depression-there`s no way I would even ask.
>
> HMOs vary widely. Mine is a nonprofit that's basically owned by a university (the preferred hospital is the university-affiliated one, of course). The prescription plan is completely separate from the other parts. They recently adopted a formulary, where some drugs are "preferred" and have lower copays, but all prescription drugs are covered at least to some extent. So I can get Buprenex (or the generic that Abbott recently came out with) at any pharmacy that takes my insurance, as long as I have a script.
>
> Most doctors don't even know what buprenorphine is (though some have a negative knee-jerk reaction based on the "-orphine" ending!). I think if they read up on it they'd realise it lacks a lot of the disadvantages associated with other opiates, and they'd be very willing to prescribe it. (The FDA considers it to have less abuse potential than benzos, Ambien, Provigil, and the like.) It would also help if the drug companies would come out with a metred-dose inhaler; right now the only way to administer it effectively requires the use of syringes, which doctors hate to prescribe.
>
> > But I`m curious- I received morphine and Percocet following surgery a few years ago and they certainly didn`t make me high or less depressed or give me any desire to take more once the post-op pain was over.
>
> You and 70% of the population. (Were you depressed at the time?)
>
> > Do the people who respond to opiates for depression find they get an anti-depressant effect when these are taken for pain?
>
> Yes. I was mildly depressed (residually -- I have double depression) when I received Vicodin ES (hydrocodone 7.5mg/APAP 500mg) after having my wisdom teeth out. As soon as I felt it, the not-quite-rightness that I've felt all my life vanished, and my mood returned to normal. A lot of people discover opioids this way. Those who move on to self-medicating with heroin are at high risk for addiction, especially those who take it intravenously (who also risk a number of medical complications such as infections and abscesses). Those who are able to find a doctor willing to prescribe opioids and monitor their use have little risk as long as they use the medication as prescribed.
>
> Codeine in therapeutic doses for pain doesn't seem to have this effect, although it does have the same side effects than stronger drugs like hydrocodone or morphine. I think higher doses of codeine would probably work, but with worse side effects than similarly effective doses of morphine, oxycodone, etc. Buprenorphine works in extremely low doses (i.e., it is very potent, comparable to fentanyl) and is qualitatively distinct from other opioids, although I believe that opioid-experienced people (and rodents) can generally identify it as an opioid.
>
> -elizabeth
Posted by NikkiT2 on May 13, 2001, at 15:59:58
In reply to Re: Methadone - AndrewB and all interested, posted by rogdog on May 12, 2001, at 13:28:15
EEFEXOR IS *NOT* ADDICTIVE
METHADONE *IS* ADICTIVE
simple!!!
>
> MY EXPERIENCE WITH METHADONE HAS BEEN THAT IT IS A GOOD ANTI-ANXIETY MED. AND ALSO A GREAT ANTI-DEPRESSANT. i WAS ON IT FOR 3 AND A HALF YEARS THE THING THAT WAS THE WORST WAS THE FACT THAT YOU HAVE TO GET UP EVERY MORNING AND DRIVE DOWN TO THE CLINIC TO GET YOUR "DAILY DOSE". I THINK DOCTORS SHOULD BE LIBERATED IN THERE PRESCRIBING OF DRUG. A LOW DOSE OF METHADONE COULD END UP ON BEING A LIFE SAVER FOR SOME PEOPLE. WE SHOULD ACCEPT THE OPIATES AS A "REAL" TREATMENT FOR DEPRESSION AND ANXIETY. TO GET OFF IT REALLY IS NOT THAT BAD THERE ARE NUMEROUS WAYS TO DETOX FROM METHADONE AND NOT BE TO UNCOMFORTABLE. I HAVE DETOXED FROM METHADONE "COLD TURKEY" AND A GRADUAL DOSE REDUCTION. OPIATES ARE NOT A "BAD DRUG!!!!! PEOPLE REACT TO MEDICATION DIFFERENTLY, SOME MAY HAVE AN ABSOLUTLY TERRIBLE EXPERIENCE WITH EFFEXOR AND BELEIVES IT IS FROM THE DEVIL, WHILE OTHERS COULDNT LIVE WITHOUT IT. JUST MY 2 BITS! ROGDOG
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