![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 170. Go back in thread:
Posted by SalArmy4me on May 1, 2001, at 14:07:54
In reply to Methadone - SalArmy4me - Mexico?, posted by DianeD on May 1, 2001, at 11:03:45
Give me your e-mail address and I'll tell you how.
> > Get the methadone in Mexico.
>
> How? Have you done it before? HOW? Give me all the details.
Posted by Neal on May 4, 2001, at 0:16:23
In reply to Re: Methadone - SalArmy4me - Mexico? » DianeD, posted by SalArmy4me on May 1, 2001, at 14:07:54
Sal - How much cheaper are meds down there? Like for instance Wellbutrin or Effexor, what would be the comparison?
Posted by SalArmy4me on May 4, 2001, at 1:12:05
In reply to Re: Meds Cost - Mexico? » SalArmy4me, posted by Neal on May 4, 2001, at 0:16:23
I don't know how much cheaper meds are down there. But you can always call up or write to the place I got some cheap Aurorix from (and the pharmacist speaks English and he is a nice guy):
Farmacia Madero
Esquina Calle 3ra Y Av. Madero
No. 2050 Telephone: 685-01-57 (ask an operator or someone knowledgeable about dialing this type of number)
Tijuana, Baja California> Sal - How much cheaper are meds down there? Like for instance Wellbutrin or Effexor, what would be the comparison?
Posted by H. Vincent MacGruder on May 7, 2001, at 9:32:55
In reply to Methadone - AndrewB and all interested, posted by DianeD on May 1, 2001, at 10:52:16
> My arguments for methadone over other pain meds will be
Several of your arguments are ture, however, several are incorrect. Specifically:
> 1. It doesn't incapacitate you. There is no "High".
This is just false. Methadone is a full mu-agonist and has effects essentially the same as those of morphine. The myth that it doesn't produce a high derives from its use in maintenance of heroin addicts. The reason it doesn't produce a high in this case is simply that the dose is titrated exactly to the limits of the subject's tolerance. In maintenance, you are not trying to produce any effect -- you are only trying to stave off withdrawal. If you wanted to produce an effect, you would have to give a higher dose, and that dose would produce all of the typical morphine-like effects. If an average, opioid-naive individual takes 10 to 20 mg of methadone, that person will be knocked on his or her ass for two days.
> 2. Is long acting (24 - 36hrs) No ups then downs.True.
> 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.
False. Methadone produces tolerance just like all other full agonists. Again, when used in maintenance, you are not *trying* to produce any effect, so the dose never needs to be increased. This is *not* true for use in pain, depression, or anything else.
> 5. Does not impair ones mental or physical faculties.
Again, false, for all of the above reasons. Methadone's effects are pretty much interchangable with morphine's, although the time course (pharmacokinetics) are very different.
It really should be obvious that methadone does all of these things. I mean, it isn't a Schedule II drug for no reason at all.
> 6. It is non toxic. It does not damage your liver etc. I have Hep C (had Hep.B).
This is true, as it is of most opioids. They're among the most non-toxic of all drugs for prolonged use.
Posted by DianeD on May 8, 2001, at 0:11:48
In reply to Re: Methadone - AndrewB and all interested, posted by H. Vincent MacGruder on May 7, 2001, at 9:32:55
> Several of your arguments are true, however, several are incorrect. Specifically:
> > 1. It doesn't incapacitate you. There is no "High".
> This is just false. Methadone is a full mu-agonist and has effects essentially the same as those of morphine.Wrong. I've taking liquid morphine and sustained release morphine and methadone and heroin and many other opiates. Methadone is NOTHING, nothing at all like Morphine or other
opiates. Morphine knocks you out! Makes you weak. Turns you into a drooling idiot. Morphine is dangerous. A little too much and poof your gone. Not so with methadone.>The myth that it doesn't produce a high derives from its use in maintenance of heroin addicts. The reason it doesn't produce a high in this case is simply that the dose is titrated exactly to
the limits of the subject's tolerance.Wrong. Clinics start you off at 40mg no matter what you claim your habit to be. I've been on methadone twice. The 1st time I had a huge habit. They put me on 40mg. Second time I had
a tinny $25 day habit. They put me on 40mg. They titrated nothing. Most clinics have a 100mg limit. Within that limit you can go where ever you want.After so many days/weeks you are clean of heroin anyway so there is no difference twik the pain patient and the methadone maintenance client. So their reaction to methadone will be the
same.>If you wanted to produce an effect, you would have to give a higher dose, and that dose would produce all of the typical morphine-like effects.
Wrong. I've gone from 40mg to 60mg to 80 in as many days (3) and didn't get high. And again methadone is nothing like morphine.
>If an average, opioid-naive individual takes 10 to 20 mg of methadone, that person will be knocked on his or her ass for two days.
That I can't speak to. I don't think they'd be knocked on their ass for two days tho, but I've never taken it while clean so I can't say for absolute. And even I wouldn't take 20mg from the
get. I'd start at 10mg. Better safe than sorry.
> > 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.
> False. Methadone produces tolerance just like all other full agonists. This is *not* true for use in pain, depression, or anything else.Wrong. I was on 80mg of methadone for 6yrs. And if there is anybody who's gonna want more, more, more whether they need it or not it's a junky. I didn't need more. I can't speak from
personal experience, to methadone tolerance with regard to pain, depression, or anything else. BUT I've read on a few boards where pain patience are maintained on a consistent dose
for yrs. No tolerance. No increase in dosages. No problems. That is one of it's great draws.
> > 5. Does not impair ones mental or physical faculties.
> Again, false, for all of the above reasons. Methadone's effects are pretty much interchangeable with morphine's, although the time course (pharmacokinetics) are very different.Wrong again. I was never impaired in any way shape or fashion. I was on 80mg of methadone for 6yrs. And I worked as a union linoleum, soft tile and hardwood (on the sly) floor
covering installer. Using all manner of tools in all price range of homes and businesses. No complaints. No one had a clue I was "under the influence". Except that I was suddenly full of
life and working. Methadone gave me physical and mental STRENGTH! It didn't make me weak, clumsy or tired like morphine. Heroin didn't make me weak, clumsy or tired either,
after the rush. But ya might as well throw me in the closet with morphine. Morphine is good for emergency situations or where the patients is bed ridden. That's about it. If you want relief
and the ability to live your life fully functioning, get methadone."Methadone is preferred for chronic pain, Dr. Balazy says because of its potency and because methadone doesn't dull the mind as do some other narcotics. "
How you can keep comparing methadone with morphine is beyond me. THEY ARE NOT interchangeable ! Have you ever taken morphine and methadone? We're talking apples to
oranges here.
> It really should be obvious that methadone does all of these things. I mean, it isn't a Schedule II drug for no reason at all.Methadone is a Schedule II because of fear, ignorance and prejudice. The three REGRESSIVES.
I gave you all the references in that report. I didn't make these things up. I speak from my own years of experience as well and the experience of others, be they patients or professionals.
I am 16 yrs clean of heroin. 8 yrs clean of methadone (not by choice)
Posted by DianeD on May 8, 2001, at 0:13:39
In reply to Re: Methadone - SalArmy4me - Mexico? » DianeD, posted by SalArmy4me on May 1, 2001, at 14:07:54
> Give me your e-mail address and I'll tell you how.
Posted by SalArmy4me on May 8, 2001, at 0:29:57
In reply to Methadone - SalArmy4me - email address, posted by DianeD on May 8, 2001, at 0:13:39
I just found out that methadone is a controlled substance. I don't know how to get controlled substances in Mexico.
> > Give me your e-mail address and I'll tell you how.
>
> dmd54@home.com
Posted by NikkiT2 on May 8, 2001, at 9:09:29
In reply to Re: Methadone - AndrewB and all interested, posted by H. Vincent MacGruder on May 7, 2001, at 9:32:55
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 Cece on May 8, 2001, at 14:58:46
In reply to Methadone - AndrewB and all interested, posted by DianeD on May 1, 2001, at 10:52:16
Here's my experience and info on these subjects/drugs.
I am one of the people for whom Vicodin is a great anti-depressant. It also helps me a lot with chronic pain: spinal problems, headaches, fibromyalgia, and arthritis, and it calms me down when I am having an anxiety freakout. I have been using it, under a prescription written for headaches, for about 8 years. My tolerance has very slightly increased over this time- so slowly that I am not worried.
When I began using it, 1/2 of a tablet, 1 to 2 times a day did me just fine. I did not take it daily. I still do not take it daily, but more days than not. Now I take a whole tablet 1 to 2 times a day. If I have a migraine, or am really deeply depressed, or have really racked out my back, I will take up to 3 tablets that day.
I should probably say here that I am BPII, have tried many, many meds, and currently take a fairly (but not absolutely) effective mix of mood stabilizers, 1 AD, and xanax. I also take thyroid med and hormone replacement (BP women very often get a flare-up of symptoms when peri-menopause hits).
For many (8) years, I went outside my HMO to a pdoc who was very open minded. I kept telling him that Vicodin was the best anti-depressant that I had found. He felt that my level of usage was fine, and was willing to write me a script "for headaches". I tried Buprenorphine, but it didn't work as an AD for me, and it also made me feel stoned and stupid. So I've stuck with Vicodin.
For financial reasons, (and also doctor/patient burnout), I recently changed to a very good pdoc at my HMO. He is skeptical about, and not used to prescribing opiates for mood disorders, but has written me a script for the time being.
I was very interested when I started reading peoples' comments about Methadone on this board. I don't generally feel that addiction is a serious issue in the face of life-threatening depression. In fact, I think that it is a non-issue that is based on fear and prejudice, although something that patients should be educated about before being treated with a potentially addictive med. I wondered if I should give Methadone a try.
But many years ago, I worked at a heroin detox center. I myself never used heroin, but my co-workers were ex-junkies. One of them, a really great guy, had been, in the past, on Methodone maintenance for many years. He really hated the drug and considered it evil. He said that kicking it was the hardest, most painful thing that he had ever faced- much, much harder than kicking heroin. I think that he chose to quit it because of the ethic in the recovery community that addiction to any drug is bad. Perhaps he would have been fine if he had been willing to continue on maintenance. But in the end, several years after kicking, he committed suicide- he had started using heroin again, hated himself for it, and couldn't face going on Methadone again. Obviously, this made a big impression on me.
So, I'm not sure what to think. I respect other peoples' experiences that they have shared here, but can't help but be afraid of Methadone- despite my feelings about the issue of addiction vs. suicidal depression and anxiety.
Cece
Posted by DianeD on May 9, 2001, at 12:44:47
In reply to Re: Methadone - , posted by NikkiT2 on May 8, 2001, at 9:09:29
How can you say Methadone is a nasty nasty drug when you have never been on it yourself? How closed minded. 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.
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 DianeD on May 9, 2001, at 13:17:03
In reply to Re: Methadone - AndrewB and all interested, posted by Cece on May 8, 2001, at 14:58:46
> Here's my experience and info on these subjects/drugs.
>
> I am one of the people for whom Vicodin is a great anti-depressant. It also helps me a lot with chronic pain: spinal problems, headaches, fibromyalgia, and arthritis, and it calms me down when I am having an anxiety freakout. I have been using it, under a prescription written for headaches, for about 8 years. My tolerance has very slightly increased over this time- so slowly that I am not worried.LOOKS TO ME THAT METHADONE JUST MIGHT HELP YOU. God give it a try. It took me a month on 40mg to get up and running. And the rest of my story is in the above posts.
Vicodin always killed my stomach and the acetaminophen or asprin it's usually teamed with is not good for your liver.
> So, I'm not sure what to think. I respect other peoples' experiences that they have shared here, but can't help but be afraid of Methadone- despite my feelings about the issue of addiction vs. suicidal depression and anxiety.
WHAT EXACTLY ARE YOU SCARED OF? What are your fears? I'm interested. You're already addicted to vicodin. Vicodin feels sorta kinda like methadone but methadone is more energizing, cleaner, etc, etc.
Diane
Posted by Michele on May 9, 2001, at 13:21:18
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.
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 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.
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