![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Iago Camboa on April 19, 2002, at 4:49:10
Please allow me to call the attention of members of this message board (first and foremost all 'Shrink-kind') to an immoral, 'illegal'? and despicable article I happened to come across during a casual navigation through the Web.
Please don't fail to point your browsers to...http://nepenthes.lycaeum.org/Drugs/Opiates/safe.and.fun.html
...and be indignated just as I was.
I know there are sacred things like 'The First Amendment', immortal guarantee of the 'Freedom of Expression and Choice' and legitimate pride of the most powerful nation of this century.
But should not the aforementioned 'article' be 'dispatched' to the 'Schedule II' and be delivered only under a prescription of an honorable member of the 'Shrinkhood'?
What do you think of this Elizeth?
All the best,
Iago
Posted by cmcdougall on April 19, 2002, at 11:41:03
In reply to can heroin ever be safe ? (even without alcohol)?, posted by Iago Camboa on April 19, 2002, at 4:49:10
As a libertarian, I think ALL drugs should be available to ANYONE, WITH appropriate monitoring, counseling, registration, and taxation. Thats a whole different issue, though.
Heroin is probably the safest, most effective painkiller with the fewest side effects ever known. To deprive people in chronic pain of this drug is criminal (in my humble opinion).
I have not ever taken heroin (hope I never need to), but all the OBJECTIVE research has shown great promise for safety and effectiveness. It is only "opiaphobes" that freak out about heroin, NOT legitimate and honest researchers. Even the addictive issues are not as great as once thought. Lets face it, its harder to give up nicotine than heroin.
Some in the medical community are finally realizing the safety and promise of opioids and benzos for all kinds of medical uses - lets not start regressing now.
Posted by Elizabeth on April 19, 2002, at 14:10:07
In reply to can heroin ever be safe ? (even without alcohol)?, posted by Iago Camboa on April 19, 2002, at 4:49:10
I have to wonder how closely you read the article that has you so upset and offended. What is it specifically that you're taknig issue with? In the actual article, that is, not just the title.
Keep an open mind. People who are so rigid in their political beliefs (and this is a political opinion, not a medical or scientific one) that they can't bear to hear arguments that support opposing beliefs, it just might be that their beliefs are too weak to stand up to criticism. Anyway, it's generally good (and mentally healthy) to be open to change (or at least, to have the capacity for change).
The pharmacological properties of a substance are not dependent on the law. This should be obvious, but to many people it's a potentially "dangerous" proposition. But in any case, it's hardly fair to insist that the *US* antidrug laws capture the "truth" when other Western countries have different -- in some cases radically different -- laws. The drug diamorphine (known in the USA as heroin) is legally available in the UK, for example, and is used as an analgesic.
Diamorphine is a semisynthetic derivative of morphine. Pharmacodynamically, it's a nonselective opioid receptor agonist, like morphine. It readily crosses the blood-brain barrier, acting more rapidly than morphine. Because it is short-acting, it's best suited to the treatment of acute rather than chronic pain. It is a very powerful drug, often effective even for people who have grown tolerant to other very strong opioid analgesics. I have a hard time with the idea of refusing to provide diamorphine to a dying person for whom morphine no longer works, on the grounds that they could become addicted. But maybe that's just me.
The essay behind the link you gave was very reasonable, actually. Certainly it doesn't fall in any of the categories of speech that are sometimes considered okay to censor (in free societies, that is): it's not pornography, incitement to violence, libel, fraud, harrassment, etc. It's an opinion, and it's even backed up by some sound reasoning and medical research. Furthermore, it's political speech, which is considered especially important to protect -- a free society doesn't have laws against criticizing government policy or saying things that are controversial, and no government can be considered "free" if it censors the certain opinions on the grounds that they are controversial or are opposed to government policy. This author has a right to express these opinions, and we have a right to read them. If the USA ever does start censoring this kind of material, we might as well burn the flag and the Constitution.
The idea of allowing access to this material only to certain professionals is interesting, especially since the article appears to have been *written* by a non-professional! I'm curious to learn why you would wish to do this. In any case, though, governmental limits on who can access this type of material would be just as illegal as censoring the essay entirely. All the citations in the essay are from books and journals that are available to the public, and it doesn't reveal any classified information. It may be hard for people who aren't very well educated to understand some parts of the essay, but that's no more a ground for censorship than is its criticism of government policy.
I really am startled that something like this makes you so angry. I'm sure that many people disgree with it, but it's just somebody's opinion. May I ask if you have some personal involvement in this issue?
-elizabeth
Posted by Elizabeth on April 19, 2002, at 14:10:34
In reply to It is safe and much maligned-don't freak out, posted by cmcdougall on April 19, 2002, at 11:41:03
> As a libertarian, I think ALL drugs should be available to ANYONE, WITH appropriate monitoring, counseling, registration, and taxation.
Without arguing over the exact way to go about it, I agree: legalization and regulation is the only rational solution to the drug problem. Apart from moral and Constitutional concerns, what we're doing now, the so-called "war on drugs," simply isn't working. It's costing lives and taxpayer money, taking police power away from fighting real crimes, etc., and it's not making a dent in the demand for drugs in this country. (Are you a libertarian, or a Libertarian, out of curiosity?)
> Heroin is probably the safest, most effective painkiller with the fewest side effects ever known.
What makes you think that -- about the side effects, I mean? It seems like all the strong opioids, like fentanyl (& analogs), Dilaudid, NuMorphan, etc., have similar side effect profiles. I'd guess that fentanyl is a bit better tolerated than the morphinelike ones.
> I have not ever taken heroin (hope I never need to), but all the OBJECTIVE research has shown great promise for safety and effectiveness.
I've never used it either, but pharmaceutical-grade diamorphine is no more dangerous than other powerful opioids. The illegality is what makes it dangerous. Heroin was singled out for criminalization because some people enjoy it a lot, yet the same people would be thrilled to find a big bottle of Dilaudid lying around. A few years ago, flunitrazepam was similarly singled out as a "date rape drug" -- and placed in Schedule I -- despite the fact that all benzos, and other types of sedatives, have similar synergistic CNS depressant effects with alcohol. Indeed, I seem to recall a case where Klonopin was used as a "date rape drug." That had me really worried -- Rohypnol wasn't ever that commonly used, but lots of people really need Klonopin, and if it were banned there wouldn't be anything that would replace it because of its uniquely long duration of action.)
> It is only "opiaphobes" that freak out about heroin, NOT legitimate and honest researchers.
This is an important (IMO) point. There's a lot of intellectual dishonesty involved in attempts to rationalize the drug war.
-elizabeth
Posted by Cisco on April 20, 2002, at 20:53:16
In reply to Re: safe and much maligned » cmcdougall, posted by Elizabeth on April 19, 2002, at 14:10:34
I have to concur: Diacetylmorphine is basically a superior form of Morphine. Developed by Bayer, it acts faster, and thus feels stronger, but is inherently a child of Morphine. I vote for 'Harm Reduction'/legalization. Call it what you want.
Cisco.
Posted by Iago Camboa on April 21, 2002, at 2:36:49
In reply to It is safe and much maligned-don't freak out, posted by cmcdougall on April 19, 2002, at 11:41:03
Please don't take my words too litterally. As a matter of fact I was ironizing most of the time in that 'most important' leaflet. The only statement that was not ironic was the one about the 'First Amendment' to the US Constitution, about which contents I think just what I said. (This is why I put that statement separated by blank lines from the rest of the text).
The reason why I was ironic and not plain is because I was writing on an 'alien' message board as opposed to on a 'domestic' one and I thought it should be others who should speak about what I was only passing by.
But just 'not to freak out' I attest here I find the article spoken about in my post both well written, courageous and just 'great'. Unfortunately I'm not competent to judge about the medical & scientific side of the script, though.Best regards,
Iago
Posted by Iago Camboa on April 21, 2002, at 4:20:02
In reply to don't freak out II » Iago Camboa, posted by Elizabeth on April 19, 2002, at 14:10:07
> I have to wonder how closely you read the article that has you so upset and offended. What is it specifically that you're taknig issue with? In the actual article, that is, not just the title.
>
> Keep an open mind. People who are so rigid in their political beliefs (and this is a political opinion, not a medical or scientific one) that they can't bear to hear arguments that support opposing beliefs, it just might be that their beliefs are too weak to stand up to criticism. Anyway, it's generally good (and mentally healthy) to be open to change (or at least, to have the capacity for change).
>
> The pharmacological properties of a substance are not dependent on the law. This should be obvious, but to many people it's a potentially "dangerous" proposition. But in any case, it's hardly fair to insist that the *US* antidrug laws capture the "truth" when other Western countries have different -- in some cases radically different -- laws. The drug diamorphine (known in the USA as heroin) is legally available in the UK, for example, and is used as an analgesic.
>
> Diamorphine is a semisynthetic derivative of morphine. Pharmacodynamically, it's a nonselective opioid receptor agonist, like morphine. It readily crosses the blood-brain barrier, acting more rapidly than morphine. Because it is short-acting, it's best suited to the treatment of acute rather than chronic pain. It is a very powerful drug, often effective even for people who have grown tolerant to other very strong opioid analgesics. I have a hard time with the idea of refusing to provide diamorphine to a dying person for whom morphine no longer works, on the grounds that they could become addicted. But maybe that's just me.
>
> The essay behind the link you gave was very reasonable, actually. Certainly it doesn't fall in any of the categories of speech that are sometimes considered okay to censor (in free societies, that is): it's not pornography, incitement to violence, libel, fraud, harrassment, etc. It's an opinion, and it's even backed up by some sound reasoning and medical research. Furthermore, it's political speech, which is considered especially important to protect -- a free society doesn't have laws against criticizing government policy or saying things that are controversial, and no government can be considered "free" if it censors the certain opinions on the grounds that they are controversial or are opposed to government policy. This author has a right to express these opinions, and we have a right to read them. If the USA ever does start censoring this kind of material, we might as well burn the flag and the Constitution.
>
> The idea of allowing access to this material only to certain professionals is interesting, especially since the article appears to have been *written* by a non-professional! I'm curious to learn why you would wish to do this. In any case, though, governmental limits on who can access this type of material would be just as illegal as censoring the essay entirely. All the citations in the essay are from books and journals that are available to the public, and it doesn't reveal any classified information. It may be hard for people who aren't very well educated to understand some parts of the essay, but that's no more a ground for censorship than is its criticism of government policy.
>
> I really am startled that something like this makes you so angry. I'm sure that many people disgree with it, but it's just somebody's opinion. May I ask if you have some personal involvement in this issue?
>
> -elizabethI appreciated very very much your response to my little post. But, as you perhaps now know through my response to our 'co-boarder' Cmcdougall, most of your criticism simply does not apply either to my person or to my convictions. And no, I have never took heroin and I have NO personal involvement in that issue.
But I DID take - never on a regular basis but once during some three weeks - dexedrine (that is almost as maligned as heroin both in the USA and in Europe) and I NEVER felt any tolerance for it (in the sense that I never had to up the dose to keep feeling the same stimulation as the day before) NEITHER ANY withdrawal effects after three weeks of taking it daily and have NOT become an addict. To speak the whole truth, I just began to take an IMAO (by the name of Niamid (from Pfizer)) the day following my last dexedrine intake. And I attest here that I consider the said drug (dexedrine or dexto-amphetamine) very effective, very safe and very clean. And I took it without any prescription from a 'shrink'. A dermatologist (friend of mine) did prescribe to me that superb and so injustly 'vilipended' medicine. Voila.
Thank you again,
Iago
Posted by beardedlady on April 21, 2002, at 5:42:19
In reply to It is safe and much maligned-don't freak out, posted by cmcdougall on April 19, 2002, at 11:41:03
I am wondering how many former or current heroin addicts you know. I ask because I know quite a few. I also snorted heroin once when I was in my twenties, and I have probably tried every drug known to man. I picked my favorites and stuck with them. Speedy drugs, mostly. No, it doesn't make me an expert, but I suppose I am as knowledgeable as you about the subject. And I see things differently.
Sure it is much maligned. No, it is not safe.
When pain is an issue, there are many far wiser choices than heroin. In fact, that one, in my opinion, is a bad choice.
beardy : )>
P.S. After fifteen years as a smoker, I haven't had a cigarette in five years.
Posted by Cisco on April 21, 2002, at 15:02:00
In reply to Re: It is safe and much maligned-don't freak out » cmcdougall, posted by beardedlady on April 21, 2002, at 5:42:19
Dear BL:
The assumption here is that we are discussing pharmaceutical quality Diamorphine, as opposed to 'Street Heroin', whose purity has been compromised.
There is much emotion attached to names such as Heroin, and Methadone, that cloud the simple fact that they are both useful Opioids.
Cisco
Posted by Elizabeth on April 23, 2002, at 22:47:32
In reply to Re: don't freak out II » Elizabeth, posted by Iago Camboa on April 21, 2002, at 4:20:02
Hi Iago. Thanks for clarifying that. I'm glad to hear you didn't actually mean that!
It's sometimes difficult to recognize irony on the internet because you don't have tone of voice, facial expressions, etc. to go on. And sadly, some people actually believe the things that you said in your post. That's why I thought you were being serious -- I didn't see any indication that it was meant as irony.
> And no, I have never took heroin and I have NO personal involvement in that issue.
Why would that matter?
> But I DID take - never on a regular basis but once during some three weeks - dexedrine (that is almost as maligned as heroin both in the USA and in Europe) and I NEVER felt any tolerance for it (in the sense that I never had to up the dose to keep feeling the same stimulation as the day before) NEITHER ANY withdrawal effects after three weeks of taking it daily and have NOT become an addict.
Dexedrine is, of course, a different drug entirely from diamorphine. Three weeks probably wouldn't be long enough to become tolerant to amphetamine, but some people taking it long-term for narcolepsy, attention-deficit disorder, daytime sleepiness, etc. do have to raise the dose with time. What were you taking it for, BTW?
> To speak the whole truth, I just began to take an IMAO (by the name of Niamid (from Pfizer)) the day following my last dexedrine intake.
We don't have nialamide in the USA, only phenelzine, isocarboxazid, and tranylcypromine. How does nialamide compare to these? Are you still taking it? Why did you stop taking the Dexedrine?
> And I attest here that I consider the said drug (dexedrine or dexto-amphetamine) very effective, very safe and very clean.
Yeah, it's not nearly as unpleasant as most antidepressants can be. It lacks the sexual side effects of SSRIs, the anticholinergic side effects of TCAs, and the food and drug interactions of MAOIs. It doesn't cause weight gain, orthostatic hypotension, sedation, etc. either. I guess that's why it's considered "bad:" it's not unpleasant or annoying enough to take. :-)
-elizabeth
Posted by Elizabeth on April 23, 2002, at 23:15:24
In reply to Re: It is safe and much maligned-don't freak out » cmcdougall, posted by beardedlady on April 21, 2002, at 5:42:19
> I am wondering how many former or current heroin addicts you know. I ask because I know quite a few.
So do I. I don't think that's terribly relevant (it could even result in bias, one way or the other).
> I also snorted heroin once when I was in my twenties, and I have probably tried every drug known to man.
Can you provide a list? I know someone who probably has tried more (unless you work for a pharmaceutical company and routinely steal, ah, "office supplies," that is :-) ).
> I picked my favorites and stuck with them. Speedy drugs, mostly. No, it doesn't make me an expert, but I suppose I am as knowledgeable as you about the subject. And I see things differently.
I don't think that trying drugs is what gives one knowledge of how they work,
> Sure it is much maligned. No, it is not safe.
There's no such thing as a completely "safe" drug. All drugs have side effects, many can have dangerous effects if taken in overdose, and many have dangerous but rare effects in usual doses. I think it's pretty clear that what's meant here is that diamorphine is safe when it's pharmaceutical-grade (unadulterated, amount in a single dose is fixed and predictable, etc.). As Cisco said, street drugs, being unregulated, aren't going to be reliable, and therefore aren't safe. Similarly, the availability of sterile injection apparatus would eliminate risks of disease transmission, injecting particulate matter, etc. This doesn't necessarily say anything about whether the drug is safe in its own right, independent of cultural factors (such as laws); these dangers result exclusively from unregulated drug traffic.
> When pain is an issue, there are many far wiser choices than heroin. In fact, that one, in my opinion, is a bad choice.
Obviously it's not the right choice for a mild headache! But what makes you think that diamorphine (pharmaceutical diamorphine, mind you) is so terrible compared to, say, Dilaudid? (As an aside, have you ever taken Dilaudid, NuMorphan, fentanyl, or the like?)
> P.S. After fifteen years as a smoker, I haven't had a cigarette in five years.
Hey, congratulations. (Now *there's* a dangerous drug.)
-elizabeth
Posted by cmcdougall on April 24, 2002, at 20:01:30
In reply to Re: It is safe and much maligned-don't freak out » beardedlady, posted by Elizabeth on April 23, 2002, at 23:15:24
Hello,
I graduated from college in 1977. What a wonderful time to grow up! I am completely serious when I say that. Anyway, I knew more than a few junkies - I am still in contact w/ one woman my age who has been addicted to heroin for over 30 years. She is an attorney in DC with a very prominent corporate law firm. To look at her, you would never guess she used. So much for stereotypes...
My opinion of the safey and effectiveness of heroin is purely anecdotal. My friend in DC shows me how safe heroin can be... As far as its effectiveness as a pain killer, I was present at the death of two beloved family members, both from cancer. One was my 23 year old sister who died in Texas 10 years ago last Sept. The other was my father-in-law who died in England 2 years ago.
Both received LOTS of meds. My sister had a porta-cath, so we were able to inject massive amounts of morphine directly into her bloodstream. Near the end of her life, she was receiving about 4ccs every 15 minutes. Some of you may think I am bullsh**ng, but it is true. All of this was under the supervision of both the MD and the nurse from hospice. I couldn't understand how we could give my sister so much morphine w/out killing her. The hospice nurse explained that morphine works on pain receptors and as long as there is pain, the morphine will not affect respiration or cardiac function. I do not know if that is true. We started out giving her 1/2cc every 4 hours and we were forced to increase the dose constantly to keep Sis comfortable. Strangely, she never seemed sedated no matter how much morphine she received. Sis was alert and very cognitive as long as her pain was under control. Eventually, the morphine quit working and we augmented w/ Valium. From that point until her death about 24 hours later, she suffered MISERABLY. I cannot convey in words the horror that all of us endured, except to say that it profoundly changed my life. Carpe diem - seize the day. Right now is all we have, right? My sweet sister, who had 2 little boys under 3 years of age, moaned and sometimes screamed out loud in agony for 18 hours before her death. All of us moaned and cried and screamed right along with her. And I kept pumping in the morphine and valium and nothing helped.
In contrast, as my father-in-law lay dying he received sublingual heroin (diamorphine). We never had to increase the dose and we never needed to augment. After 6 days, he slowly went into respiratory failure (from the cancer that had invaded his nervous system) and died peacefully. It was a lot easier on the whole family than what we had gone through with my sister in Texas. Pop was cognitive, alert and comfortable. His last days are some of my fondest memories - we all sat around and told stories and laughed and loved a lot.
So there... thats my opiate story and thats how I have formed my "heroin opinion".
Posted by Iago Camboa on April 25, 2002, at 4:47:33
In reply to Re: don't freak out II » Iago Camboa, posted by Elizabeth on April 23, 2002, at 22:47:32
> Dexedrine is, of course, a different drug entirely from diamorphine. Three weeks probably wouldn't be long enough to become tolerant to amphetamine, but some people taking it long-term for narcolepsy, attention-deficit disorder, daytime sleepiness, etc. do have to raise the dose with time. What were you taking it for, BTW?
I shall begin by the end: I began to take amphetamine on a regular basis (during the said 3 weeks, which could have turned out to be 6 or more as well) because I was left with no alternative at the time...
I was previously taking nialamide (the MAOI) in fairly high doses during a very difficult and critical time (I was then in my 20s): enough to say I was far from my homeland and had a lot of men under my command and I was doing my mission with an energy and success due in great part to that remarkable drug, the best thing I have ever taken and at the very zenith of its full power (nialamide was without pair between 1 and 6/7 months of daily intake and I was between month 1 and month 2). I was at the time a heavy smoker and a heavy drinker and for me much alcohol and MAOIs always made me kind of aggressive (I'm pacific by nature in stead) which quality was perhaps further enhanced (or rather aggravated) by constant use of hypnotics: all things put together were like dynamite...
I must now explain that the drug (i.e. the MAOI) was regularly dispatched to me by my father by mail. (Hypnotics (and amphetamines) were available locally). Now a beautiful day, mail services somehow got 'kaput' and I was left without the precious chemical... And I could NOT 'afford' to have either a 'withdrawal syndrome' or a 'nasty depression'... I could not assemble my men and tell them: now, kids, you are going to stand by for a while and to behave properly while I'm having a little depression next door...
I had already experimented with dexedrine many times before as 'sports medicine' (though never during more than a couple of days or so in sequence) and I knew it was a powerful stimulating drug. I got two prescriptions from a dermatologist friend of mine with whom I was dividing my suite, and all went on even better than before... With too much 'scotch', too much gambling and too many whores, though.> > To speak the whole truth, I just began to take an IMAO (by the name of Niamid (from Pfizer)) the day following my last dexedrine intake.
>
> We don't have nialamide in the USA, only phenelzine, isocarboxazid, and tranylcypromine. How does nialamide compare to these? Are you still taking it? Why did you stop taking the Dexedrine?For me nialamide was not very distinct from phenelzine (the only two MAOIs then available to me and the only ones I have ever taken) except in that it was even more powerful than the latter; but it diminished its power in less than 7 months or so and it was not the kind of drug which could be uped without all manner of nasty side effects. But it was very easy to switch from the one drug to the other without any intervall (not even a single day) between the two... When nialamide's availability was discontinued in this country I imported it from Spain for a few more years; but that drug's star was an unlucky one: it vanished from Spain too and I suspect it vanished altogether. Perhaps Pfizer one day resurrects it...
As for dexedrine I continued to use it but only sparingly and always as 'sports medicine'...> > And I attest here that I consider the said drug (dexedrine or dexto-amphetamine) very effective, very safe and very clean.
>
> Yeah, it's not nearly as unpleasant as most antidepressants can be. It lacks the sexual side effects of SSRIs, the anticholinergic side effects of TCAs, and the food and drug interactions of MAOIs. It doesn't cause weight gain, orthostatic hypotension, sedation, etc. either. I guess that's why it's considered "bad:" it's not unpleasant or annoying enough to take. :-)It can be a lot of fun and enrich one's life IMHO ;-).
Many kind regards,
Iago.
Posted by Iago Camboa on April 26, 2002, at 4:01:00
In reply to Re: It is safe and much maligned-don't freak out » beardedlady, posted by Elizabeth on April 23, 2002, at 23:15:24
Hi Elizabeth, Cmcdougall and you all,
I've been experimenting lately with 'adrafinil' at weekends (but NOT every weekend!, have manners...) and I've got to share it with you all: it's kind of a whole new world I have before my eyes waiting to be explored... Ahh, heaven. Wish I had Carly's talents to convey to you'all the sentiment of liberty and supreme communion with all Nature that I feel... 'Carpe diem', seize the day: it is a great Latin maxim, yes...
And you kids (Beardy, Cisco, etc.), behave!All the best,
Iago
Posted by cmcdougall on April 26, 2002, at 18:17:39
In reply to Re: It is safe and much...(Take Two) » Elizabeth, posted by Iago Camboa on April 26, 2002, at 4:01:00
Hello Iago,
Thanks for the compliment on my writing - <sigh> if only I could verbally communicate as well.
I have been thinking of giving adrafinil a try. I printed some info from the web for my pdoc - he will give me a prescription if I ask. I am taking adderal now...
Love and luck,
Carly
*always searching for the perfect fix*
Posted by Elizabeth on April 26, 2002, at 19:20:11
In reply to For Bearded and all...., posted by cmcdougall on April 24, 2002, at 20:01:30
> I graduated from college in 1977. What a wonderful time to grow up!
I dunno, some of the styles of dress left much to be desired.... :-}
> Anyway, I knew more than a few junkies - I am still in contact w/ one woman my age who has been addicted to heroin for over 30 years. She is an attorney in DC with a very prominent corporate law firm. To look at her, you would never guess she used. So much for stereotypes...
There are a lot of people out there who are like that (addicts who have good jobs, education, money, etc.). You never hear about them because they have the resources to get their drugs without having to resort to dealing, stealing, etc.; and they only interact with the "drug scene" as buyers. They don't have to spend all their time or money getting drugs. Their lives lack the chaos often seen in the life of addicts who don't have the advantages they have. They provide a picture of what addicts' lives would be like if drugs were affordable and easy to get; and they cast doubt over the assumption that the chaotic lifestyle of many addicts is caused by the drugs themselves.
> My opinion of the safey and effectiveness of heroin is purely anecdotal.
It happens to be right anyway, though. :-)
> Near the end of her life, she was receiving about 4ccs [of morphine] every 15 minutes.
Umm...what was the concentration (how many mg in a cc)? Was it a continuous drip, or did she get discrete injections once every 15 minutes? (People can take surprisingly large amounts of medication on an IV drip. I'm told that at one point when I was in the hospital last February, they had me on 120 mg/day of Ativan.)
> I couldn't understand how we could give my sister so much morphine w/out killing her. The hospice nurse explained that morphine works on pain receptors and as long as there is pain, the morphine will not affect respiration or cardiac function. I do not know if that is true.
Uh, well, morphine works on mu opioid receptors. I'm not sure what the nurse meant. But it is true that tolerance to the respiratory depression from morphine develops more rapidly than tolerance to the analgesia.
> Strangely, she never seemed sedated no matter how much morphine she received. Sis was alert and very cognitive as long as her pain was under control.
Not everybody feels sedated on morphine. I found it moderately activating. But also, pain seems to "eat up" opioids, just as (in my experience, anyway) anxiety eats up benzos. (What I mean, for example, is that if I take 2 mg of Xanax, ordinarily I'd get really groggy, but if I take 2 mg of Xanax when having a panic attack, I feel fine.) Your sister's (no doubt massive) tolerance to morphine may have played a part as well.
> Eventually, the morphine quit working and we augmented w/ Valium.
My god. They didn't even try giving her fentanyl or anything? Every opioid has a limited effect size -- eventually, after you've become tolerant to very high doses, it will plateau and it won't do anything more no matter how much you increase the dose. (Buprenorphine, a "partial" agonist, plateaus at a much lower effect size.) At that point you need to find a stronger drug.
I'm very sorry to hear what happened to your sister. Nobody should have to die in pain, especially in a hospital or hospice.
> In contrast, as my father-in-law lay dying he received sublingual heroin (diamorphine). We never had to increase the dose and we never needed to augment.
Sublingual? Huh. I didn't know it was given by that route. I wonder what the bioavailability is compared with oral (low) and IV (high...so to speak).
> After 6 days, he slowly went into respiratory failure (from the cancer that had invaded his nervous system) and died peacefully.
How long was your sister on the morphine? If your father-in-law didn't become even a little bit tolerant to the diamorphine, that suggests that he was in relatively less pain than she was, and I'm also guessing that he wasn't on it very long. Still, I have little doubt that if it had been available, diamorphine would have been of help to your sister.
Unfortunately, your story isn't at all unusual. Many people suffer in their last days or months because doctors or nurses aren't willing to give them adequate pain medication. My mother, who is on the ethics committee at a teaching hospital, sees it regularly. I hope that I never have to watch someone die that way.
-elizabeth
Posted by Elizabeth on April 26, 2002, at 19:27:11
In reply to Re: don't freak out II, posted by Iago Camboa on April 25, 2002, at 4:47:33
> I shall begin by the end: I began to take amphetamine on a regular basis (during the said 3 weeks, which could have turned out to be 6 or more as well) because I was left with no alternative at the time...
Ahh -- for depression, then?
> I was at the time a heavy smoker and a heavy drinker and for me much alcohol and MAOIs always made me kind of aggressive (I'm pacific by nature in stead) which quality was perhaps further enhanced (or rather aggravated) by constant use of hypnotics: all things put together were like dynamite...
MAOIs can be kind of disinhibiting, and sedative-hypnotics are too, of course. I expect that's why you got aggressive on them.
> I must now explain that the drug (i.e. the MAOI) was regularly dispatched to me by my father by mail. (Hypnotics (and amphetamines) were available locally).
Where were you at the time, and where are you from? (I assume your father was in your home country?)
> Now a beautiful day, mail services somehow got 'kaput' and I was left without the precious chemical... And I could NOT 'afford' to have either a 'withdrawal syndrome' or a 'nasty depression'...
You did right. MAOI withdrawal symptoms can be very unpleasant, to say the least. I've often thought that amphetamine would probably be a good substitute in a pinch, too.
> I could not assemble my men and tell them: now, kids, you are going to stand by for a while and to behave properly while I'm having a little depression next door...
What do you mean when you say, "I could not assemble my men..." ? Were you in the military?
> For me nialamide was not very distinct from phenelzine (the only two MAOIs then available to me and the only ones I have ever taken) except in that it was even more powerful than the latter; but it diminished its power in less than 7 months or so and it was not the kind of drug which could be uped without all manner of nasty side effects.
Phenelzine and nialamide are both hydrazine MAOIs, so it's not surprising that they felt similar. When I took phenelzine, it started losing its effect after I'd been taking it for something between 6 and 12 months; I even started getting symptoms that I hadn't had before taking it. Increasing the dose didn't help. After I stopped, the new symptoms (irritability, agitation, impulsivity, etc.) didn't go away for many months. I thought maybe it was a dysphoric mania, but none of the several antimanic drugs that I tried during that time helped at all. (Also, I was usually feeling lethargic and slept a lot -- not exactly my idea of "mania.")
> But it was very easy to switch from the one drug to the other without any intervall (not even a single day) between the two...
If you're trying to avoid withdrawal symptoms, that's the way to do it. (I once switched from tranylcypromine to isocarboxazid with just two days in between -- risky, but my doctor thought that waiting would be riskier.)
> When nialamide's availability was discontinued in this country I imported it from Spain for a few more years; but that drug's star was an unlucky one: it vanished from Spain too and I suspect it vanished altogether. Perhaps Pfizer one day resurrects it...
I think it may still be used somewhere. If it is, though, it's not here (US) or Canada.
> As for dexedrine I continued to use it but only sparingly and always as 'sports medicine'...
What do you mean by "sports medicine?" (Recreational use, just for fun? Performance enhancement? Both? Something else?)
I'm glad to hear that you're enjoying the adrafinil. Have you every taken modafinil, and if so do you know how the two drugs differ? (While many people find modafinil useful as a stimulant or antidepressant, I've never heard anyone use the phrase "communion with all Nature" in describing it.)
-elizabeth
Posted by cmcdougall on April 27, 2002, at 13:13:47
In reply to death » cmcdougall, posted by Elizabeth on April 26, 2002, at 19:20:11
> > I graduated from college in 1977. What a wonderful time to grow up!
>
> I dunno, some of the styles of dress left much to be desired.... :-}Hey, I still dress like that! ;-)
> There are a lot of people out there who are like that (addicts who have good jobs, education, money, etc.). You never hear about them because they have the resources to get their drugs without having to resort to dealing, stealing, etc.; and they only interact with the "drug scene" as buyers. They don't have to spend all their time or money getting drugs. Their lives lack the chaos often seen in the life of addicts who don't have the advantages they have. They provide a picture of what addicts' lives would be like if drugs were affordable and easy to get; and they cast doubt over the assumption that the chaotic lifestyle of many addicts is caused by the drugs themselves.
>I agree 100%
> > Near the end of her life, she was receiving about 4ccs [of morphine] every 15 minutes.
>
> Umm...what was the concentration (how many mg in a cc)? Was it a continuous drip, or did she get discrete injections once every 15 minutes? (People can take surprisingly large amounts of medication on an IV drip. I'm told that at one point when I was in the hospital last February, they had me on 120 mg/day of Ativan.)
>
I don't have a clue what the concentration of morphine was... The hospital pharmacy delivered it to the house - at first they brought 1cc glass ampules. When we started using so much, they brought little bottles containing 10cc each. She had a porta-cath (tiny little catheter inserted into a vein and going all the way into her heart - originally used to deliver her chemo) in her arm and I slowly injected the morphine directly into it.> > Eventually, the morphine quit working and we augmented w/ Valium.
>
> My god. They didn't even try giving her fentanyl or anything? Every opioid has a limited effect size -- eventually, after you've become tolerant to very high doses, it will plateau and it won't do anything more no matter how much you increase the dose. (Buprenorphine, a "partial" agonist, plateaus at a much lower effect size.) At that point you need to find a stronger drug.
>Nothing else was ever offered - at the time, I didn't know very much about meds. I felt the docs were doing everything they could. They were soooo generous w/ the morhpine.
> > After 6 days, Pop slowly went into respiratory failure (from the cancer that had invaded his nervous system) and died peacefully.
>
> How long was your sister on the morphine?She started it on a Thursday afternoon and died the next Wednesday morning. So, 5 1/2 days.
>If your father-in-law didn't become even a little bit tolerant to the diamorphine, that suggests that he was in relatively less pain than she was, and I'm also guessing that he wasn't on it very long. Still, I have little doubt that if it had been available, diamorphine would have been of help to your sister.
>Thank you for your response and kind words. I always enjoy reading your posts and learn a lot from them.
Love and luck,
Carly
Posted by Iago Camboa on April 28, 2002, at 10:17:13
In reply to Re: don't freak out II » Iago Camboa, posted by Elizabeth on April 26, 2002, at 19:27:11
Hi Elizabeth,
> Ahh -- for depression, then?
I guess so, yes. But also to 'enjoy' fully an 'enervating' feeling of danger (that was in 'the air' almost everywhere) and a little feeling 'of power' too, I think. 'Adrenergic effects?' may be...
> MAOIs can be kind of disinhibiting, and sedative-hypnotics are too, of course. I expect that's why you got aggressive on them.
One way or the other, I gave up drinking - and smoking - altogether and I think I'm no more 'aggressive', perhaps only a little 'assertive' now & then...
> Where were you at the time, and where are you from? (I assume your father was in your home country?)
You assumed right.
I was born & bred in Portugal and I was in the military, serving in Angola (West Africa) during the ending days of Colonial Portuguese Administration there (the exact point in time was Aug.-Sep.1975, the very same year of American withdrawal from Vietnam and when chronical anarchy almost draw us into a bloody Civil War in [Continental/European] Portugal). I belonged to the 'better-dead-than-red' faction. I was only a (2nd.)lieutenant but I think I was one among 'the good ones' (and thankgod there were many of those) and had NO doubt I would be able to conquer a whole province IF I was given 100 men chosen by myself. Many of my comrades (in arms) who were in Angola thought perhaps the same...The Portuguese troops were NOT at war with any of the 3 armed factions which were bitterly & bloodly disputing between themselves the control of the territory. We were oftentimes the 'sole protectors' of the routed factions and litteraly saved hundreds of lives from 'certain' massacres (POW, there were no such thing...): we took their weapons, offered them shelter and food, and 'negotiated' with the winners of the day their destinies - deportations most of the time...
I was at the time in the second largest city of Angola -Nova Lisboa, 'New Lisbon', now Huambo (which had been indeed its (native) former name). I said we were not at war but, you know, there were too many weapons in the city and 'safety' was a laughable word, lootings and murders were not uncommon and fightings in bars or pubs with dead people were constant: we controlled perhaps 2/3 of it, the remaining 1/3 having been divided into 2 parts between the local 'winners' (the 3rd faction having been driven out of business there and deported to another town where the situation was the reverse).> You did right. MAOI withdrawal symptoms can be very unpleasant, to say the least. I've often thought that amphetamine would probably be a good substitute in a pinch, too.
It was indeed a pinch and amph proved to be safe, reliable and of sustained and never fading effects (at least during that remarkable period of time). I don't know why, but I miss sometimes those 'risky' happy days. I visited even a few times, alone, the 'bars' were the Portuguese officers weren't supposed to enter, in the very heart of the zones controlled by the Blackmen's guerrilas, under the pretext to have friendly conversations with their leaders. I was always treated with respect and gentlemanship by those tough men. I knew the shooting of a Portuguese officer would be a 'serious' thing not to be undertaken by anyone in their right mind, but at 5 a.m. amidst large amounts of alcohol and clouds of smoke, who could be certain of anything? And I needed to feel the 'smelt of danger'. I think I got addicted to the 'adrenaline' released in my blood in those moments...
> What do you mean by "sports medicine?" (Recreational use, just for fun? Performance enhancement? Both? Something else?)
I mean by 'sports medicine' a stimulating drug I use with 'moderation', for fun and not on a regular basis. But I would better describe its nature using the words a great French author (Stendhal) used to define 'Art'. 'Art', he said, 'is a promise of happiness' (or 'a pledge' or 'an assurance', if you prefer).
> I'm glad to hear that you're enjoying the adrafinil. Have you every taken modafinil, and if so do you know how the two drugs differ? (While many people find modafinil useful as a stimulant or antidepressant, I've never heard anyone use the phrase "communion with all Nature" in describing it.)
I think I should better put 'harmony' in the place of 'communion', a feeling of peace toward whatever lives around us. No, I havn't taken modafinil but I will and I promise you'll be the first to know what I think about.
Take care.
Iago
Posted by Elizabeth on April 28, 2002, at 14:23:28
In reply to Re: death » Elizabeth, posted by cmcdougall on April 27, 2002, at 13:13:47
> Hey, I still dress like that! ;-)
OMG! :-)
> I don't have a clue what the concentration of morphine was...
It would have been written on the labels of the ampules or vials. Morphine injection is available in various concentrations, and I'm not sure how much she would be getting if she was taking it every 15 minutes. (I guess that's about equivalent to a continuous infusion?)
> Nothing else was ever offered - at the time, I didn't know very much about meds. I felt the docs were doing everything they could. They were soooo generous w/ the morhpine.
Hmm. I wonder what was going on. When (year) was this?
> She started it on a Thursday afternoon and died the next Wednesday morning. So, 5 1/2 days.
People develop tolerance at different rates, and there might have been factors involved (in your sister, but not your father-in-law, becoming tolerant, that is) other than which drug was used. Still, it's an impressive and noteworthy difference.
> Thank you for your response and kind words. I always enjoy reading your posts and learn a lot from them.
I'm sorry I can't do much to comfort you; I can't imagine what it must have been like for you, but I know I'd be devastated if my sister died, especially under circumstances like those. *hug*
Be well.
-elizabeth
Posted by cmcdougall on April 29, 2002, at 13:20:22
In reply to Re: death » cmcdougall, posted by Elizabeth on April 28, 2002, at 14:23:28
> > I don't have a clue what the concentration of morphine was...
>
> It would have been written on the labels of the ampules or vials. Morphine injection is available in various concentrations, and I'm not sure how much she would be getting if she was taking it every 15 minutes. (I guess that's about equivalent to a continuous infusion?)
>As far as I know, the concentration stayed the same at the end as it was in the beginning. The frequency and dose was entirely left up to us (the family). As long as Sis was suffering, we just kept upping the dose.
> > Nothing else was ever offered - at the time, I didn't know very much about meds. I felt the docs were doing everything they could. They were soooo generous w/ the morhpine.
>
> Hmm. I wonder what was going on. When (year) was this?
>1991
Thanks again for your kind words. As awful as the whole ordeal was, time is a great healer. All of my family have vowed that we will do ANYTHING necessary to make sure none of us suffers like that.
Love and luck,
Carly
Posted by Iago Camboa on April 30, 2002, at 4:23:00
In reply to hello and thanks » Iago Camboa, posted by cmcdougall on April 26, 2002, at 18:17:39
> Hello Iago,
>
> Thanks for the compliment on my writing - <sigh> if only I could verbally communicate as well.
>
> I have been thinking of giving adrafinil a try. I printed some info from the web for my pdoc - he will give me a prescription if I ask. I am taking adderal now...
>
> Love and luck,
> Carly
> *always searching for the perfect fix*Hello my friend,
Please don't thank me: you ARE the number 1 storyteller in all PB. I've even been looking up for recent posts of yours...
But to-day I'd like to speak about the adrafinil. I am aware you already tried modafinil (= Provigil) and 'it was very agitating' to you, but I've read the translations of the (French) inserts of the two drugs into English and I think one can safely assume one pill (100mg) of modafinil is worth in strength two pills (2x300mg) of 'adrafinil' so the amount I'm proposing to you (1 pill = 300mg of adrafinil at wake-up or breakfast) is just a little more than 'symbolic'. So please maintain all drugs you are used to and feel comfortable with and just add the adrafinil preferably at the begining of a stress-free day (I for myself always choose Fri., Sat. & Sun. or only two of these in sequence) and just tell me whether you felt any difference. If you are like me you'd perhaps better augment the dose of your sleeping-aid pill (I for myself just add 1/2 pill of Ambien (here called 'Stilnox') i.e. 5mg at bedtime). I feel a little 'break' in the effect of the adrafinil 4 or 5 hours after I took it but that ONLY during the first day and also am surprised to feel a gentle (welcome) extra stimulation each time a take a banal cup of coffee which habitually makes me feel nothing at all. Voila.Love and luck,
IagoP.S. The daily dose of adrafinil recommended by the manufacturers of the drug (Lafon, France) is 2-4 pills (one pill = 300mg.), so feel free to up if you like. Enjoy. Still, adrafinil is 6 times cheaper than modafinil!! I.
Posted by cmcdougall on April 30, 2002, at 9:03:59
In reply to just a little extra stim » cmcdougall, posted by Iago Camboa on April 30, 2002, at 4:23:00
Posted by Elizabeth on May 2, 2002, at 23:33:47
In reply to Re: death » Elizabeth, posted by cmcdougall on April 29, 2002, at 13:20:22
> As far as I know, the concentration stayed the same at the end as it was in the beginning.
But we don't know what that concentration was! Also, the frequency with which you were administering it when she became more tolerant would affect the pharmacokinetics -- I don't know why she would need to have it so often, or how the levels (serum and elsewhere) resulting from a q15min dosing schedule would compare to the levels after an equal total daily dose divided into just six doses (that is, q4h). I might be able to figure this out on paper...if I had any paper!
> The frequency and dose was entirely left up to us (the family). As long as Sis was suffering, we just kept upping the dose.
That's nice, that the doctors were flexible about that. If my sister or one of my parents was in the same situation, I'd want them to be able to stay at home, not in a hospital or a hospice. And of course, I'd want a lot of leeway regarding changing the dose. And I'd want to be able to get in touch with their doctor quickly in case I needed to ask a question (for instance, if I wanted to ask them to switch to a stronger analgesic).
[I'm feeling particularly "up in arms" about the importance of giving patients some freedom to make small changes, at least, in their medication regimens, before seeing the doctor again, because my own pdoc is very rigid on that point -- compared to the other pdocs I've seen, at least. I ranted some about that and other stuff in a recent thread: http://www.dr-bob.org/babble/20020416/msgs/103496.html]
> Thanks again for your kind words. As awful as the whole ordeal was, time is a great healer. All of my family have vowed that we will do ANYTHING necessary to make sure none of us suffers like that.
It's terrible that you all had to go through that. But it is good that you now have a better idea of what to do if something similar comes up again. Maybe someone else will be spared an even worse experience as a result of having thought about what to do in that kind of situation.
love,
-elizabeth
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