![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 25 to 49 of 170. Go back in thread:
Posted by Michele on May 9, 2001, at 13:25:09
In reply to Methadone - Cece , posted by DianeD on May 9, 2001, at 13:17:03
I can't believe you are seriously recomending this drug to somebody. Please be careful!!!! I am so shocked at this......
I'm sorry you are so addicted to these narcotics, but please refrain from pushing them on other people. Sure... lets make a bad situation worse.
Talk about avoidance..... yah.. lets get high and not deal with the problem. I'm sorry Dr. Bob.. but this is totally ridiculous.
Posted by Sunie on May 9, 2001, at 14:08:21
In reply to Re: Methadone - Cece » DianeD, posted by Michele on May 9, 2001, at 13:25:09
It might be helpful for you to go back and read All of this thread...
I don't think anybody is "pushing" anything...
I am gratefull to all who post their experiences here at Psycho-Babble; Depression is a deadly and disabling disease, as I know full well myself.
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.
Best of luck to any who seek similarly,
Sunie
Posted by Dr. Bob on May 9, 2001, at 18:03:28
In reply to Re: Methadone - NikkiT2, posted by DianeD on May 9, 2001, at 12:44:47
> How can you say Methadone is a nasty nasty drug when you have never been on it yourself? How closed minded. Childish.
Please don't call others names, thanks.
Bob
PS: Any follow-ups regarding civility, if not redirected to Psycho-Babble Administration, may be deleted.
Posted by shelliR on May 9, 2001, at 20:49:23
In reply to Re: Methadone - AndrewB and all interested, posted by Cece on May 8, 2001, at 14:58:46
Cece,Thanks for sharing your experience. My first post on this board, about one year ago had to do with taking hydrocodeine and not understanding why my pdoc and therapist were giving me such a really hard time about it. My dose was very low and I had been taking it for about 2 1/2 years without increasing. My pdoc threatened to terminate with me if I didn't stop, yet in spite of about 15 med trials within one year, nothing touched my depression once Nardil lost effectiveness. (Actually lamictal helped, but I gained 15 lbs in a two week period and started having distorted body feelings.)
So even though there is a lot of contraversy on the board re opiates, each time I read about someone who they are helping and who doesn't wind up immediately self-destructing, I feel understood.
Especially thank you for saying:
"I don't generally feel that addiction is a serious issue in the face of life-threatening depression."
My depression is life-threatening and without the hydrocodeine, I don't think I could have made it through the last two years. I used to take 1/2 pill (3.75mg in the early evening) tolerating the depression during the day. I work a lot in the evening; also do the treadmill then. Lately, however, it is occurring to me that in some way I am buying into my former pdoc's prejudices and I have allowed myself some days to split one pill (7.5mg) throughout the day. Some might say my "habit" is increasing. I think I am learning to be a bit nicer to myself.
So thanks again. Shelli
Posted by Cece on May 10, 2001, at 2:36:52
In reply to Methadone - Cece , posted by DianeD on May 9, 2001, at 13:17:03
I think that I said pretty clearly that I was just sharing my experiences and thoughts.
I also said that Vicodin works well for me- I don't have the problems that you did with it.
I don't want to get into a dialogue with you- it feels like you are being argumentative.Hopefully, by the sharing of experience here, we can all help ourselves find our own ways. It doesn't help when someone has an agenda that they want to push on others. Your thoughts and experiences are valid- for you- and so are mine, for me. We each have something to offer.
Cece
Posted by Cece on May 10, 2001, at 2:47:56
In reply to Re: Methadone - AndrewB and all interested » Cece, posted by shelliR on May 9, 2001, at 20:49:23
Thanks for your message, Shelli- it helped soften the feeling of having been put on the hotseat for speaking up.
I remember your posts about the Codeine problem with your pdoc and therapists. Can't remember if I joined the thread, but there do seem to be a lot of us dealing with access to this drug that can be so helpful.
I am somewhat concerned about the Tylenol component, but most of the time I need to take something like Tylenol or a NSAI for my progressing arthritis anyway. It's all a trade-off, weighing risk/benefit. I take Milk Thistle extract tablets, which are strengthening for the liver.
Sorry to hear about your Lamictal problem- it is helping me, and if I've gained any weight it is very minimal. I wish that I could tolerate Topomax, the great pound-buster, but it makes me too stupid. Even at a very low dose I can't put sentences together in the right order.
Cece
Posted by NikkiT2 on May 10, 2001, at 5:57:59
In reply to Re: Methadone - NikkiT2, posted by DianeD on May 9, 2001, at 12:44:47
You call me closed minded and childish.. yet you tell me ALL medications are addictive. I';m sorry. No, I ahven't taken it myself, but I ahve some very very close friends who have to take it, and simply watching what they go through is a nightmare. Sitting there with a grown man crying and shaking as he feels so bad.. nto coming off heroin, but methadone. I ahve heard too many staories from friends trying to kick it to ever ever condone its use. As I said, they have all said it makes them feel alot worse than heroin when coming off it.
No, if you'd like to be vaguely polite to me in the future I might take you more seriously than I ajhve here, cos your reaction to me being childish etc is one pathetic peice of writing. if you wanna slag me fine, but what I said was *my* experiences with it.
You seem to be the childish one by claiming that methadone is OK... IT IS NOT OK TO TAKE.
Nikki
Posted by NikkiT2 on May 10, 2001, at 6:00:51
In reply to Re: Methadone - NikkiT2, posted by Michele on May 9, 2001, at 13:21:18
Thanks for backing me up... If a doctor was prescribing this for anything other than in a programme for kicking heroin, he should be struck off immiediately. I really really can't believe that someone is coming on here and saying its an ok drug to take/. It is highly addictive and highly dangerous... very dangeous. I'm still in shock that this "person" is talking like this. Problem is, there are people coming here who are desperate... they might read this, and get black market methadone (dunno if theres a huge black market for it in US, but there is in the UK) and become hooked on that... so sad.
nikki xx
> > 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 Elizabeth on May 10, 2001, at 6:53:39
In reply to Re: Methadone - , posted by NikkiT2 on May 8, 2001, at 9:09:29
> 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."Addictiveness" is a property that isn't easy to measure; however, methadone is, if anything, *less* addictive than heroin since methadone is a long-lasting drug with a gradual onset of action (no "rush").
Because methadone is so long-acting, withdrawal symptoms upon discontinuation can be quite protracted (although less intense than withdrawal symptoms from, say, heroin). As a result, methadone can be especially hard for people who are physiologically dependent on methadone to get off it.
Methadone is probably more effective as maintenance treatment than for "weaning off" a long-term opioid habit. Once a person with a long established addiction stops taking methadone, opioid cravings are likely to return. A short-term methadone taper might be more helpful for those with brief and mild addiction histories.
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
-------------------------------------------------------------------------------------------------------------------------------------------------
> > 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.
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