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Dr. Bob is Robert Hsiung, MD,
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Posted by FredPotter on August 14, 2007, at 23:09:26
In reply to Re: Getting Doctors to prescribe opiates » Quintal, posted by Quintal on August 14, 2007, at 19:01:21
ah I'm been taking a generic with only 8mg
Posted by Quintal on August 15, 2007, at 1:09:49
In reply to Re: Getting Doctors to prescribe opiates » Quintal, posted by FredPotter on August 14, 2007, at 23:09:26
The Paramol + Nurofen Plus combo contains the equivalent of ~50mg codeine in total. Because codeine needs to be metabolized in vivo there's a ceiling effect to the amount that can be processed as a single dose, and 60mg is usually given as that amount. So we're getting pretty close to that using my combo, and if you can metabolize codeine properly (some people lack the enzyme) then you should feel some effect at that dose. If you can't, then you may be deficient in the liver enzyme CYP2D6, which according to Wiki, is the one that does all the donkey work in converting codeine into morphine.
Q
Posted by Quintal on August 15, 2007, at 1:29:22
In reply to Re: Getting Doctors to prescribe opiates, posted by linkadge on August 14, 2007, at 21:56:13
>It took us 100's of years to conlcude the opiates were habbit forming, but only 20 years to conlcude the same about SSRI's.
I'm not aware of any research that concludes SSRIs are habit forming. It's been known since time immemorial that opium is habit forming. There were some spurious claims about lack of addiction potential of morphine when it was first isolated, but that was disputed fairly quickly. It's been a pattern repeated with cocaine, barbs, amphetamines and benzos.
>For the 2 cents it is worth restating, I have gone on and off opiates before, one time upto 120mg codine a day (Wisdom teeth), and found SSRI withdrawl to be more profound.
Some questions link. How long were you taking codeine for? How long were you taking SSRIs for? How did you withdraw from each? This feels like a recurring theme.
>I am permitted to take upto 1mg of clonazepam on a daily basis.
Incidentally, if you are permitted to take up to 1mg clonazepam as required, why did you need to go to the ER for three nights of insomnia? Did the clonazepam not work?
http://www.dr-bob.org/babble/20070604/msgs/762423.htmlQ
Posted by Jamal Spelling on August 15, 2007, at 2:26:05
In reply to Re: Getting Doctors to prescribe opiates, posted by linkadge on August 14, 2007, at 21:56:13
> It took us 100's of years to conlcude the opiates were habbit forming, but only 20 years to conlcude the same about SSRI's.
With all due respect, Linkadge, I don't think it is generally accepted that SSRIs are habit forming. At best, they are recognised to have a discontinuation syndrome associated with them, which, I admit, is just a euphemism for withdrawal.
Jamal
Posted by confuzyq on August 16, 2007, at 20:59:38
In reply to Re: Getting Doctors to prescribe opiates » FredPotter, posted by Quintal on August 14, 2007, at 18:57:02
> I'm not sure how you'd go about asking a doctor to prescribe you opiates for depression. I suppose you could take along one of those bupe studies if you think that would help.
Yup, that's how it's done, it can work, did for me (tramadol). But actually there are quite a few seeds of earlier tramadol studies to be found at reliable sources; involving reputable researchers; whose findings were going in encouraging directions, to bring along also. Chances of succeeding are much better at someplace like a teaching hospital/research center also.
This may be a stretch but I even read once that chances can be better if you not only go someplace like the above, but to a pdoc there who specializes in addiction. Since, they may feel more in control, more capable of being able to spot any signs of trouble at any point. I get the logic of that, but don't know how well it translates in reality.
Aside from being able to show a "highly evolved" pdoc at least a decent amount of credible evidence, someone like that will probably also understand and factor in that a big part of why tramadol (for depression and/or OCD and more) research stopped going anywhere wasn't because early indications weren't encouraging, but because no one was willing to pay for it anymore. Since, little money could have been made from it either way anymore, as it was already out in generic form.
But yes, true that "by far the majority would still refuse though." And I'd imagine, almost definitely if it was anything besides tram or bup.
Posted by jhj on August 18, 2007, at 4:06:55
In reply to Re: Getting Doctors to prescribe opiates, posted by confuzyq on August 16, 2007, at 20:59:38
If i were to ask my Pdoctor to give me Opiates and somebody informs the Police about our conversation,both of us would be find ourselves behind the bar.
Posted by confuzyq on August 18, 2007, at 12:11:11
In reply to Re: Getting Doctors to prescribe opiates, posted by jhj on August 18, 2007, at 4:06:55
>
> If i were to ask my Pdoctor to give me Opiates and somebody informs the Police about our conversation,both of us would be find ourselves behind the bar.Not in the U.S. It wouldn't be illegal, unless your doc was charged with and found guilty of acting as a mere drug dealer, prescribing when there was little rationale for it, or in quantity. But you, you would have a legal prescription from someone who was a licensed doc at the time.
But sure if you literally just walked in and asked a pdoc for an opiate, you may be seen as drug-seeking; and if he just gave it to you without knowing you or using much criteria for the decision, he could end up being seen as a doc who doesn't use his privilege lawfully enough.
So of course legalities can be related, such as the doc worrying what the DEA may think of a practice. While we hear occasional horror stories of docs being unfairly accused of basically acting as drug dealers, it's not that prescribing (in this case) an opiate in itself was illegal. Obviously a lot of careful judgment and moderation has to be used in the prescribing.
Posted by kingcolon on August 18, 2007, at 19:12:52
In reply to Re: Getting Doctors to prescribe opiates, posted by confuzyq on August 18, 2007, at 12:11:11
Here's an article from Elle magazine that another member referred to in a previous post. It's amazing that a Harvard psychiatrist who did a pioneering study on buprenorphine for depression would not prescribe it for this case of refractory depression because she wasn't an addict and doing so would be off-label dispensing of an opioid, which could arouse the DEA.
http://www.elle.com/featurefullstory/11334/beyond-the-valley-of-the-dolls.html
Posted by confuzyq on August 19, 2007, at 3:10:28
In reply to Re: Getting Doctors to prescribe opiates, posted by kingcolon on August 18, 2007, at 19:12:52
Fabulous article kingcolon, just fabulous. Thank you. (Read all 13 pages!) So many things I could say, but for now suffice to say... I am of the mind that it's pure insanity to consider the perils of carefully controlled opiate usage for treatment resistent depression any worse than those suffered from "approved," mainstream meds. The only other thing I will add at this time is... GRRRRR! ;-)
> Here's an article from Elle magazine that another member referred to in a previous post. It's amazing that a Harvard psychiatrist who did a pioneering study on buprenorphine for depression would not prescribe it for this case of refractory depression because she wasn't an addict and doing so would be off-label dispensing of an opioid, which could arouse the DEA.
>
> http://www.elle.com/featurefullstory/11334/beyond-the-valley-of-the-dolls.html
>
>
Posted by confuzyq on August 19, 2007, at 15:47:09
In reply to Re: Getting Doctors to prescribe opiates, posted by jhj on August 18, 2007, at 4:06:55
Ah, ok I just saw down below that you are in India. So my U.S. opiate prescribing legality post will not have been helpful obviously. :-)
>
> If i were to ask my Pdoctor to give me Opiates and somebody informs the Police about our conversation,both of us would be find ourselves behind the bar.
Posted by Paulbwell on August 20, 2007, at 1:47:50
In reply to Re: Getting Doctors to prescribe opiates » Quintal, posted by FredPotter on August 14, 2007, at 20:41:04
> Yes you're right we have Panadeine and Nurofen. Unfortunately I've never noticed anything when I take them. They can't even take away a headache.
Yes here downunder you can get OTC:
-Codeine #2 (USA), called Panadeine+ =15mgs Codeine + 500mgs Paracetamol.
-Nurofen Plus=13mgs Codeine + 200mgs Ibu. They have recently changed the formulation after health ministry requests, because too many people found out the two sides were simply stuck together, and would split them, therefore taking a large dose of Codeine only, i'm sure to the companies reluctance-and sales.
Posted by Quintal on August 20, 2007, at 2:09:25
In reply to Panadeine Plus » FredPotter, posted by Paulbwell on August 20, 2007, at 1:47:50
I've heard of this, but I could never see any dividing marks on my tablets, and I forgot which side was supposed to contain the codeine. When did they alter the formulation?
Q
Posted by Paulbwell on August 20, 2007, at 2:17:19
In reply to Re: Panadeine Plus » Paulbwell, posted by Quintal on August 20, 2007, at 2:09:25
> I've heard of this, but I could never see any dividing marks on my tablets, and I forgot which side was supposed to contain the codeine. When did they alter the formulation?
>
> QHey,
I remember hearing it on TV about 2 years ago i think, where people were being interviewed who had become dependant.
Cheers
Posted by Quintal on August 20, 2007, at 2:27:38
In reply to Re: Panadeine Plus, posted by Paulbwell on August 20, 2007, at 2:17:19
Considering the motives most people would have for isolating the pure codeine, are you sure they weren't addicted? Do you know if the company altered the formulation in the UK?
Q
Posted by Paulbwell on August 20, 2007, at 2:37:47
In reply to Re: Panadeine Plus » Paulbwell, posted by Quintal on August 20, 2007, at 2:27:38
> Considering the motives most people would have for isolating the pure codeine,
They didn't 'isolate' the Codeine so much, as in they showed someone, very quickly and easily, spliting a whole pack, then taking it.
are you sure they weren't addicted?
Well the item said so much....
Do you know if the company altered the formulation in the UK?
Don't know about UK, but aparently the company who made them there used to produce the tabs in two different half colours, white and pink, which they soon changed to all white.
Cheers
>
> Q
Posted by Quintal on August 20, 2007, at 2:38:36
In reply to Re: Panadeine Plus, posted by Paulbwell on August 20, 2007, at 2:37:47
Posted by FredPotter on August 20, 2007, at 15:50:14
In reply to Panadeine Plus » FredPotter, posted by Paulbwell on August 20, 2007, at 1:47:50
Thanks Paul how's it going? I got some Nurofen Plus and took it with ordinary Panadeine but didn't notice anything. Partly I want to alleviate painful muscles but they don't seem to respond. I'm pretty undepressed at the moment so perhaps that's why I had no AD response Fred
Posted by Paulbwell on August 21, 2007, at 4:08:03
In reply to Re: Panadeine Plus, posted by FredPotter on August 20, 2007, at 15:50:14
> Thanks Paul how's it going? I got some Nurofen Plus and took it with ordinary Panadeine but didn't notice anything. Partly I want to alleviate painful muscles but they don't seem to respond. I'm pretty undepressed at the moment so perhaps that's why I had no AD response Fred
Hi,
Looking good, feeling good thanks. I hope you find a satisfactory remedy for your muscles, i wonder what treatments you have tried. Good to hear your feeling well-keep it up!
Cheers
Posted by FredPotter on August 21, 2007, at 15:20:37
In reply to Re: Panadeine Plus » FredPotter, posted by Paulbwell on August 21, 2007, at 4:08:03
Thanks Paul. I'm glad to hear you're well. Where in NZ are you? Nice weather we're having
Posted by Larry Hoover on August 27, 2007, at 20:52:19
In reply to Re: Getting Doctors to prescribe opiates, posted by confuzyq on August 16, 2007, at 20:59:38
I don't know where else to put this, but I need to vent.
My son, 15, has the sad luck of having chronic ingrown toenails. I cannot understand how he can even wear shoes. The swelling. The bleeding. The infections.
He's had doctors take the nails off three times already, so I have some idea of his pain tolerance. He handles pain better than I do. I doubt I'd be able to wear shoes with those toes.
For some reason known only to the doctors, they've refused up until now to permanently block the regrowth of the offending nails. Finally, we got a doctor to do this for him. (Their argument: "He's so young!" Uhhh....so?)
They send him home with 18 Tylenol 3s. It soon became apparent that he's got his dad's 2D6 capacity. Your liver uses 2D6 to convert some codeine to morphine, and he's getting no relief. My son was screaming through the night, banging his head on the wall to block his sensation of the pain. He chewed a hole through his blankets, clenching them in his teeth. The doctors would not prescribe anything for his pain. They didn't want to make him into an addict!
What is wrong with these doctors? 1 out of every 10 Caucasians gets no (or limited) analgesia from codeine. Asking for something else is not drug seeking. You can't get better when you're in that kind of pain.
I drove 2 hours to bring him some Percocets, and within 20 minutes his face relaxed. Another 10 and he was asleep. When he awoke a couple hours later, I had my son back.
Lar
Posted by Paulbwell on August 27, 2007, at 21:30:53
In reply to Re: Getting Doctors to prescribe opiates, posted by Larry Hoover on August 27, 2007, at 20:52:19
> I don't know where else to put this, but I need to vent.
>
> My son, 15, has the sad luck of having chronic ingrown toenails. I cannot understand how he can even wear shoes. The swelling. The bleeding. The infections.
>
> He's had doctors take the nails off three times already, so I have some idea of his pain tolerance. He handles pain better than I do. I doubt I'd be able to wear shoes with those toes.
>
> For some reason known only to the doctors, they've refused up until now to permanently block the regrowth of the offending nails. Finally, we got a doctor to do this for him. (Their argument: "He's so young!" Uhhh....so?)
>
> They send him home with 18 Tylenol 3s. It soon became apparent that he's got his dad's 2D6 capacity. Your liver uses 2D6 to convert some codeine to morphine, and he's getting no relief. My son was screaming through the night, banging his head on the wall to block his sensation of the pain. He chewed a hole through his blankets, clenching them in his teeth. The doctors would not prescribe anything for his pain. They didn't want to make him into an addict!
>
> What is wrong with these doctors?I'm sorry for your son-and he was in real physical pain! imagine the nightmare TRD patients go through when they have only found pain meds to help to work.
It's because authorities will bar an MD to practice if they discover they have scripted/more of, a pain med than the law deems acceptable, whether they're doing well or not, the laws the law, it's not medicine. It's this threat that causes Docs to withhold pain meds-even to thoes with chronic pain, the Doc is simply too scared to script them.
> I drove 2 hours to bring him some Percocets, and within 20 minutes his face relaxed. Another 10 and he was asleep. When he awoke a couple hours later, I had my son back.
>
> LarGood you were able to help him out, interesting that you were able to aquire something effective for him when he wasn't.
Cheers
Posted by Phillipa on August 27, 2007, at 21:37:00
In reply to Re: Getting Doctors to prescribe opiates, posted by Larry Hoover on August 27, 2007, at 20:52:19
Lar one of the first things they teach in nursing is that you will get written up in a hospital if you withold pain meds from a patient. This is gross and horrible for your son. I wouldn't worry about addiction as he heals his need for the pain meds will diminish. Phillipa
Posted by Quintal on August 27, 2007, at 22:06:28
In reply to Re: Getting Doctors to prescribe opiates, posted by Larry Hoover on August 27, 2007, at 20:52:19
I'm sorry to hear about your son Lar. I had a similar experience when I had cellulitis - the codeine I was given had no effect, then I figured out that might be because of the SSRI I was taking. I was given tramadol and that worked a charm, not sure if that uses 2D6 but it worked anyway.
Q
Posted by FredPotter on August 27, 2007, at 23:44:30
In reply to Re: Getting Doctors to prescribe opiates » Larry Hoover, posted by Paulbwell on August 27, 2007, at 21:30:53
I've got a friend who's a brilliant sax player who's also an amputee. They keep chopping extra bits off at the knee. He drinks to help take his mind off the pain because they won't prescribe him any pain control (oh take some paracetamol etc). And when he drinks he can can get a bit nasty. They presumably know he drinks so assume he'll abuse painkillers. Actually recently they prescribed tramadol and he seems much happier and doesn't need drink
Posted by Larry Hoover on August 28, 2007, at 19:01:19
In reply to Re: Getting Doctors to prescribe opiates » Larry Hoover, posted by Paulbwell on August 27, 2007, at 21:30:53
> Good you were able to help him out, interesting that you were able to aquire something effective for him when he wasn't.
>
> CheersI've got a good supply of oxycodone. I've got causalgia a.k.a. reflex sympathetic dystrophy a.k.a. complex regional pain syndrome. He accidentally grabbed my pill bottle by mistake, I believe.
The war on drugs mentality should not pervade in the realm of acute pain relief. E.g. my friend's mom, dying of bone cancer, denied opiates because of their addictive potential. It was near unbearable to be near her, towards the end. But what else could you do?
Lar
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