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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 41. This is the beginning of the thread.
Posted by cactus on June 22, 2008, at 4:07:10
OK, so stock standard panadeine forte (30mg codeine, 500mg paracetamol) makes me puke. So does tramal, etc...
I'm bad with most pain killers in general, but for the last 2 weeks I have been in dental agony, long story. My GP knows my reaction to pain killers and gave me 2 different types to try Digesic (Darvon) and oxycodone.
I tried the digesic 1st and wow, no puking but not strong enough for the pain. So my lovely sis did the late night dash to the chemist for me to collect my oxycodone script after I learnt the meaning "It hurt so much I was ripping my hair out," which I was actually doing but didn't notice because I was in so much pain. She just said give me the script and was off out the door.
Now the first oxy took the pain away, but it did make me sick, but for the last 2 weeks it's been fantastic and not just for pain.
The sad realisation of this though is that it's so addictive, I'm a recovering alcoholic and I can see the attraction of this drug, and no I don't have any left or plan on trying to get anymore.
The AD properties of oxy for me were amazing, I just wish they could find a way to manufacture it without the addictive nature of it. I feel if that could be done, it would blow the AD market out of the freaking water.
Is it possible to isolate that magical mechanism without addiction??? Can it be done? I know opiates are tricky and that's why they are so addictive because of the endorphin reward.
I was social, had no anxiety/panic and felt fantastic, NOT EUPHORIC! I was able to go about my daily business without dwelling on anything and had all negative thoughts erased from my psyche and it stopped what I refer to as spin cycle on a washing machine in my brain. It also didn't numb my emotions or thought processes after a 2 day adjustment period
I'm also on 200mg of modafinil and 3mg of clonazepam daily. Maybe that was my magic bullet combo, but I'm not going to mess with fire. I have clonazepam to deal with and I've managed to ween down to 3.5-3mg daily now without too much drama at all.
I'd love to hear what others with more knowledge have to say about this and try to make sure you NEVER have to have part of your jaw bone removed. Peace, C
Posted by dbc on June 22, 2008, at 12:06:38
In reply to Opiates, oxycodone, posted by cactus on June 22, 2008, at 4:07:10
Lighting up your opiod receptors tends to make everyone happy. Its the worlds oldest antidepressant. The AD properties dont last and you soon plummet into strung out depression. Theres no way to activate those receptors without getting someone high as far as we know.
Its just like amphetamine, the stuff is magical as an AD but theres no way to make a version people dont want to abuse.
Posted by Phillipa on June 22, 2008, at 12:11:14
In reply to Re: Opiates, oxycodone, posted by dbc on June 22, 2008, at 12:06:38
Percocet even the lowest dose was great. Phillipa
Posted by bulldog2 on June 22, 2008, at 14:47:14
In reply to Opiates, oxycodone, posted by cactus on June 22, 2008, at 4:07:10
> OK, so stock standard panadeine forte (30mg codeine, 500mg paracetamol) makes me puke. So does tramal, etc...
>
> I'm bad with most pain killers in general, but for the last 2 weeks I have been in dental agony, long story. My GP knows my reaction to pain killers and gave me 2 different types to try Digesic (Darvon) and oxycodone.
>
> I tried the digesic 1st and wow, no puking but not strong enough for the pain. So my lovely sis did the late night dash to the chemist for me to collect my oxycodone script after I learnt the meaning "It hurt so much I was ripping my hair out," which I was actually doing but didn't notice because I was in so much pain. She just said give me the script and was off out the door.
>
> Now the first oxy took the pain away, but it did make me sick, but for the last 2 weeks it's been fantastic and not just for pain.
>
> The sad realisation of this though is that it's so addictive, I'm a recovering alcoholic and I can see the attraction of this drug, and no I don't have any left or plan on trying to get anymore.
>
> The AD properties of oxy for me were amazing, I just wish they could find a way to manufacture it without the addictive nature of it. I feel if that could be done, it would blow the AD market out of the freaking water.
>
> Is it possible to isolate that magical mechanism without addiction??? Can it be done? I know opiates are tricky and that's why they are so addictive because of the endorphin reward.
>
> I was social, had no anxiety/panic and felt fantastic, NOT EUPHORIC! I was able to go about my daily business without dwelling on anything and had all negative thoughts erased from my psyche and it stopped what I refer to as spin cycle on a washing machine in my brain. It also didn't numb my emotions or thought processes after a 2 day adjustment period
>
> I'm also on 200mg of modafinil and 3mg of clonazepam daily. Maybe that was my magic bullet combo, but I'm not going to mess with fire. I have clonazepam to deal with and I've managed to ween down to 3.5-3mg daily now without too much drama at all.
>
> I'd love to hear what others with more knowledge have to say about this and try to make sure you NEVER have to have part of your jaw bone removed. Peace, C
>
>
>
>
>Subutex low dose can help with pain and depression. For some the ad effect can last for quite a long time.
Posted by cactus on June 24, 2008, at 6:27:11
In reply to Re: Opiates, oxycodone, posted by dbc on June 22, 2008, at 12:06:38
> Lighting up your opiod receptors tends to make everyone happy. Its the worlds oldest antidepressant. The AD properties dont last and you soon plummet into strung out depression. Theres no way to activate those receptors without getting someone high as far as we know.
>
> Its just like amphetamine, the stuff is magical as an AD but theres no way to make a version people dont want to abuse.
Thanks, I thought that might be the case, but has anyone actually tried to manipulate it?? Is there studies that you know of, etc...
Posted by undopaminergic on June 25, 2008, at 2:59:58
In reply to Opiates, oxycodone, posted by cactus on June 22, 2008, at 4:07:10
Buprenorphine rarely produces a high (never, in my experience - not even with stimulants), and may have a reduced tendency for inducing tolerance. Moreover, it's a kappa-opioid receptor antagonist, which reduces the incidence of many unpleasant effects. It also has a milder withdrawal syndrome than other opiates.
Combining opioids with NMDA-antagonists is a useful strategy for preventing or at least attenuating tolerance. The most useful options for NMDA-antagonists are memantine and dextromethorphan; amantadine might be an option.
Opioid rotation strategies may also be effective in the long run. In short, because cross-tolerance is often incomplete, switching to a different opioid drug may restore efficacy as one is failing.
Posted by cactus on June 25, 2008, at 13:36:49
In reply to Re: Opiates, oxycodone, posted by undopaminergic on June 25, 2008, at 2:59:58
Posted by okydoky on June 26, 2008, at 10:44:51
In reply to Re: Opiates, oxycodone, posted by undopaminergic on June 25, 2008, at 2:59:58
The more I read about Memantime the more alluring for me it sounds. I think we have corresponded. I believe I found a doctor that will prescribe Subutex for me so I plan on trying to go from now 30-40mg bid Oxycontin to Subutex. And then perhaps adding Memantime to it. If the Subutex does not pan out perhaps adding the Memantime to the Oxycontin instead. For five years I have been fine with an average of 20mg bid and now I need at minimum 30mg at many days 40. I have a difficult time believing this is a tolerance issue. I think it is more likely pain increase. Hard for me to know for sure?I see a lot written on this site about Subutex or Suboxone at low doses for depression but nothing at higher doses? Of course that is not the primary reason I want to try it but it is in the mix. The Mementime would be kind of dual use for me also. Improving cognitive issues and now I am reading the tolerance stuff. I've got a perhaps short time span here when I am not on Lyrica and my brain is functioning better so I need to get off my *ss and get these things started else I won't be able to do it. I realize I can be a pain in the *ss and I apologize once again. I only have a brief interlude here where I am going to be able to function a bit to accomplish any changes so I need to take advantage. As always all input and help is abundantly appreciated.
oky
Posted by undopaminergic on June 27, 2008, at 17:36:33
In reply to Re: Opiates, oxycodone » undopaminergic, posted by okydoky on June 26, 2008, at 10:44:51
>
> I see a lot written on this site about Subutex or Suboxone at low doses for depression but nothing at higher doses? Of course that is not the primary reason I want to try it but it is in the mix.
>It appears that higer doses than about 4 mg of buprenorphine yield little additional benefit, except for more effective blockade of the actions of other opioids such as heroin - this is one of the reasons why it is used as substitution therapy for addicts. For depression and pain, in all cases I've seen described, there seems to be little reason to exceed 4 mg.
Posted by bottlecappie on June 29, 2008, at 0:39:19
In reply to Re: Opiates, oxycodone, posted by undopaminergic on June 27, 2008, at 17:36:33
I have been taking Suboxone for the past 8 months. Prior to that, I had suffered from treatment resistant double depression since my early teens (I'm mid-30's now). I also have chronic pain due to fibromyalgia, and I was addicted to oxy, morphine and dilaudid.
Suboxone is without a doubt the best antidepressant I've ever taken. Since I started sub, I've had the longest unbroken span of time without a depressive episode or decompensation.
I currently take 8mgs a day, in a split dose because I get the best analgesic effect that way. I've tapered down to this dose from 16mgs, and some days I get by on only 4mgs. The main difference I perceive between 4mgs and 8mgs is the amount of time my pain is controlled. It seems that even though buperenorphine binds to the opiate receptors for a really long time, the analgesic effect still wears off after 4-6 hours.
I disagree that there is no added benefit to the higher dose, just based on my personal experience. I definitely feel it when my afternoon dose kicks in, physically and mentally. It doesn't really get me high or anything, but it does make me feel better.
I really hope that more research on the antidepressant effects of buprenorphine will be done. My best friend suffered horribly from refractory depression and ptsd, and since she's been on suboxone she's like a new person. It's amazing, really.
Posted by Crotale on July 4, 2008, at 8:49:42
In reply to Re: Opiates, oxycodone, posted by undopaminergic on June 27, 2008, at 17:36:33
> It appears that higer doses than about 4 mg of buprenorphine yield little additional benefit, except for more effective blockade of the actions of other opioids such as heroin - this is one of the reasons why it is used as substitution therapy for addicts. For depression and pain, in all cases I've seen described, there seems to be little reason to exceed 4 mg.
I take approximately 0.2mg (0.7cc Buprenex). I would think a dose anywhere near 4mg would make me sick to my stomach! I can't imagine how anyone can tolerate such a high dose, other than drug addicts.
Posted by undopaminergic on July 4, 2008, at 12:09:06
In reply to Re: Opiates, oxycodone » undopaminergic, posted by Crotale on July 4, 2008, at 8:49:42
>
> I take approximately 0.2mg (0.7cc Buprenex). I would think a dose anywhere near 4mg would make me sick to my stomach! I can't imagine how anyone can tolerate such a high dose, other than drug addicts.
>I think you could easily reach 4 mg without nausea by raising the dose in small steps, as tolerated, over a few weeks or so.
Posted by Crotale on July 4, 2008, at 20:54:27
In reply to Re: Opiates, oxycodone, posted by undopaminergic on July 4, 2008, at 12:09:06
> I think you could easily reach 4 mg without nausea by raising the dose in small steps, as tolerated, over a few weeks or so.
But why *would* I???
-Crotale
Posted by undopaminergic on July 6, 2008, at 2:23:28
In reply to Re: Opiates, oxycodone » undopaminergic, posted by Crotale on July 4, 2008, at 20:54:27
> > I think you could easily reach 4 mg without nausea by raising the dose in small steps, as tolerated, over a few weeks or so.
>
> But why *would* I???
>
> -CrotaleI don't know, but maybe to attempt to determine the optimal dose?
Posted by blueboy on July 6, 2008, at 7:00:00
In reply to Opiates, oxycodone, posted by cactus on June 22, 2008, at 4:07:10
It's ironic, isn't it, that the most helpful drugs are addictive? I have a little bipolar problem, and the only thing that brings me relief during painful mixed states is clonazepam -- not as addictive as oxy, but 'tis enough, 'twill suffice. I'm also an alcoholic and like you I'm extremely careful.
I will say, I often wonder if some of the drug laws are not puritanical in nature rather than rational. Many of the commonly prescribed psychoactive drugs seem to me to be "addictive": one becomes increasingly tolerant as they are taken over time and so one needs higher doses, they make you feel better, and sudden discontinuation can cause very uncomfortable withdrawal symptoms.
I suppose one difference is that illegal or "scheduled" drugs (the US term for drugs that not only require a prescription, but have stricter criminal penalties for nonprescription use) are used for pleasure by people without a diagnosed illness.
(There are five levels of scheduled drugs. Heroin is Schedule 1, meaning that a doctor cannot prescribe it for any reason, and it can only be possessed for experimental purposes with a special license. Oxycodone is Schedule 2 (very strictly controlled), Clonazepam is Schedule 4.)
It seems rather silly, in some ways, that oxycodone cannot be prescribed to you for your lifetime, since it helps you so much. So what if you get "addicted"? That just means that you have to take it for the rest of your life.
My (layman's) understanding of opiates is that they have fairly mild long-term damage compared to a lot of drugs prescribed over a person's life. If heroin were discovered today, and administered over a period typically required by the FDA to find a medication safe, it would be approved.
Its deleterious effects , at least compared to other addictive recreational drugs like meth, cocaine, alcohol, etc., seem comparatively minor. In fact, as far as I can tell, heroin addiction is dangerous almost entirely because it is illegal. Overdose is uncommon unless it is taken with another drug, and the greatest dangers come from adulterants, ingestion problems (HIV, damage to blood vessels), and fluctuations in purity. In other words, most of the danger of heroin usage stems from its extreme illegality.
Long term, the problems associated with opiate use are less severe than a great number of drugs commonly taken over one's lifetime, including both legal recreational drugs (alcohol, tobacco, even sugar) and prescription drugs.
Assuming that oxycodone relieves your symptoms better than anything else, I'd be interested in a rational comparison of the damage it would do if taken over a long period, compared to other drugs you might take. Also, it would be interesting to see a profession cost/benefit analysis.
I have faced this problem myself. The only drug that has given me full relief from hypomanic and mixed states of Bipolar II is clonazepam, which is certainly habituating and arguably "addictive". It is, however, a controlled (scheduled) drug.
My thought is that, perhaps, an ongoing course of treatment from clonazepam in whatever amount is needed to control my symptoms would be as safe as, and more effective than, unscheduled prescription drugs that a doctor is much more willing to prescribe over a long duration.
This is especially interesting because, if a doctor in the US prescribed oxycodone for a long period of time to a person to treat a "psychological" condition, he would lose his license and be sent to prison.
(Oh well, who expects the government to make sense? Just look at the tax laws.)
Posted by undopaminergic on July 6, 2008, at 9:50:33
In reply to Re: Opiates, oxycodone, posted by blueboy on July 6, 2008, at 7:00:00
>
> This is especially interesting because, if a doctor in the US prescribed oxycodone for a long period of time to a person to treat a "psychological" condition, he would lose his license and be sent to prison.
>That's not true. There is nothing illegal about prescribing opiates for depression or other conditions where they are found useful. It's also being done, but not as often as it ought to.
Posted by Phillipa on July 6, 2008, at 18:53:37
In reply to Re: Opiates, oxycodone, posted by undopaminergic on July 6, 2008, at 9:50:33
I need to find that doc then as l percocet makes me happy and being old means I really don't care about addiction. Valium for over 37 years prescribed at the time 70's was not considered bad and it worked. I went on to raise my family, run a business, and be magna cum laude in nursing school. Also many times over the years I simply stopped the valium and felt fine. No withdrawl was on the same dose then as now. But benzos do not work any longer pdoc said keep me out of withdrawal and to continue them. It's kind of sad to me that the newer meds that docs use some are involved in lawsuits. Makes me wonder. Like the fact that both these classes of meds have been around for decades and no bad things have come out. This is just my opinion. Love Phillipa
Posted by blueboy on July 7, 2008, at 18:21:49
In reply to Re: Opiates, oxycodone, posted by undopaminergic on July 6, 2008, at 9:50:33
> >
> > This is especially interesting because, if a doctor in the US prescribed oxycodone for a long period of time to a person to treat a "psychological" condition, he would lose his license and be sent to prison.
> >
>
> That's not true. There is nothing illegal about prescribing opiates for depression or other conditions where they are found useful. It's also being done, but not as often as it ought to.I've reviewed some literature on the internet and it seems that I was wrong about this. My apologies.
Posted by cactus on July 8, 2008, at 3:03:38
In reply to Re: Opiates, oxycodone, posted by blueboy on July 7, 2008, at 18:21:49
it's the same in my country too, the only way to get it is if you are a know heroin user
Posted by okydoky on July 8, 2008, at 8:26:40
In reply to Re: Opiates, oxycodone, posted by undopaminergic on July 4, 2008, at 12:09:06
I am seeing this new doctor today and am told he will prescribe opiates if I provide evidence I am already on them or anything else for that matter. In that vein I am going specifically to ask him to prescribe Subutex. I know he prescribes it too but not sure about the DEA problem like I had with the previous doc. Even with the DEA letter he was too afraid. Anyway from every conversion thing I read that I could find and there were few, It looks like 3.6mg would be an equivalent dose. Of course at least as a [pill it does not come in this dose anyway. I read one is supposed to start with less than equivalent dose when changing pain meds. Any suggestions on how to "manipulate" the conversation with him to my advantage. (Him prescribing the Subutex) And suggestion as to starting dose? I plan on bringing a copy of the letter with me bu perhaps it would be better not to bring it up unless absolutely necessary? I want to ask him for something to sleep too. Perhaps it would be advisable to do one thing at a time and not bring that up today? Of course I will be influenced by his demeanor ect. Originally I wanted to try it because my urologist suggested it for pan and it was suggested on this site on theory that t*t might work better with Amineptine. I also thought it might help with any tolerance as I will be taking opiates probably the rest of my life. Recently I have had to increase my oxycontin use from 20mg bid to 30mg bid. The last month or so after about 5 years use. But in the last few weeks I had a lot of breakthrough pain and was very depressed and started snorting my 5mg ir oxys. The last week or so I started snorting 10 or 15mg at a time and not of pain necessity. I think it would be better if I left this information out today, although it might be usefull?
My appointment is at 1pm. I know this is last minute so no one might get to this before I go. It would be appreciated if anyone has the time.
Thanks,
oky
Posted by okydoky on July 8, 2008, at 14:21:36
In reply to Re: Opiates, oxycodone, posted by okydoky on July 8, 2008, at 8:26:40
I went to this new doctor and he said that I was pretty much a mess. He said he was willing to help me and had dealt with complex cases before and with interstitial cystitis but was insistent that I had to trust him an not further complicate things by not being compliant. Said it was ok to have input but... Then he prescribed methadone and said something about NMDA and long and short term pain relief was better with it.I am upset as I do not know him yet to trust him. I have been mistreated and treated poorly by several doctors in the past and have difficulty trusting anyway. I just met him! He said he did not prescribe Suboxone or Subutex and said it was not used for pain even while I told him it was. I was told by the person who suggested him that he did prescribe Suboxone so I am left to ponder.
What about Methadone for pain and it being better as far as my depression is affected?
oky
Posted by bottlecappie on July 8, 2008, at 16:23:29
In reply to Re: Methadone NMDA, posted by okydoky on July 8, 2008, at 14:21:36
It's my understanding that methadone is better for chronic pain than buprenorphine (active ingredient in subutex/suboxone). Subutex & suboxone are only approved in the US for treatment of opiate dependency.
If you are suffering a lot of chronic pain and also have breakthrough pain, subutex might not be a good choice for you because buperenorphine binds so tightly to opiate receptors that it basically renders all other opiate medications ineffective. So, if the subutex wasn't handling your pain, you'd be stuck.
There are some doctors who prescribe subutex/suboxone for pain, but it's my understanding that this is usually done in cases where addiction/dependency is also an issue. It's more difficult to abuse suboxone/subutex because buprenorphine has a ceiling effect.
I currently take suboxone for opiate dependency and it works wonderfully to supress withdrawals and the desire to use. It's a mediocre pain-reliever, in my opinion. It works well for my fibromyalgia but is not great for acute pain or headaches. I do believe it works well as an antidepressant, as that has been my experience, and I was able to discontinue Wellbutrin since I've been on suboxone.
I also took methadone in the past and found it to help with my depression and it was an extrememly effective pain reliever. It lasts for a long time and didn't produce the cravings associated with shorter-acting opiates. It is addictive, as all opiates are, so you might want to be aware of that.
Good luck, and I hope you'll be feeling better soon.
Posted by Sigismund on July 8, 2008, at 19:00:54
In reply to Re: Methadone NMDA, posted by bottlecappie on July 8, 2008, at 16:23:29
I wonder if any opiate (given a flattish blood level) will, once dependence is attained, be of very minimal use?
That said, the advantage of bupe as I understand it, is that there is less depression than with methadone and it is not so difficult to get off.
Certainly methadone is strong enough. But what this means in practice with once a day doseage is that you are affected (pain relief) for maybe weeks, and then you arrive at a steady state situation where you feel better for a few hours after your dose and that is it for the day.
More frequent doseage will not make this better. Blood levels will be flatter still, and therefore the incremental improvement will be extremely shortlived after a dose.
Of course there are worse things than being on methadone, like being in terrible pain. But I don't know how much pain relief you can expect long term.
What is the NMDA thing about?
Posted by okydoky on July 8, 2008, at 20:15:33
In reply to Re: Methadone NMDA, posted by bottlecappie on July 8, 2008, at 16:23:29
It was referenced for me about antidepressants but I cannot remember where. Here is one of many I found when searching psycho-babble not to do with me though: http://www.dr-bob.org/babble/neuro/20080204/msgs/820576.html
I just don't understand nor remember the information . I feel like a jerk.
oky
Posted by okydoky on July 8, 2008, at 20:36:39
In reply to Re: Methadone NMDA, posted by okydoky on July 8, 2008, at 20:15:33
I forgot to say the doctor had made mention of NMDA and kind of mumbled something about it and methadone and depression. Which is the reason I brought it into the conversation.
I know I make everything into a crisis. I just had been feeling quite hopeless and unrealistically had pinned everything on this one meeting with a doctor I had never met.
oky
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