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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Annie Z. on December 9, 2001, at 11:13:55
Can someone give me the name of a doctor that will prescribe opiates for depression in Baltimore, MD? You may post your answer or send your answer to jaklnn@yahoo.com
I've been to many doctors, and they all have turned me down. They won't even read the medical journal articles that I give them about opiates and depression.
I recently moved from another city where my general physician was prescribing opiates for me. After beginning the opiates, my life began for the first time to become tolerable. (I am still on a low dose of opiates, and hope to increase my dosage for even better results.)
I have been depressed for 15 years, and I've tried every other category of antidepressants, as well as many different combinations of treatments and alternative treatments for depression. I have never felt better than I have now. I cannot go back to the miserable life I had before taking opiates – my life was hardly worth living.
These doctors ought to be ashamed of their selves. They lobby to keep the prescription privilege theirs, and then they put up so many hurdles for us to get the medications, leaving many people to unnecessarily suffer greatly and legally extorting thousands of dollars in the process.
Posted by stjames on December 9, 2001, at 12:24:59
In reply to Need Doctor to Prescribe Opiates in Baltimore, posted by Annie Z. on December 9, 2001, at 11:13:55
For people taking highly controled meds; it is important, when switching docs, that your chart goes with you to the new doc.
james
Posted by Elizabeth on December 9, 2001, at 21:14:35
In reply to Need Doctor to Prescribe Opiates in Baltimore, posted by Annie Z. on December 9, 2001, at 11:13:55
Annie --
I can't recommend a doctor (I don't know Baltimore at all) but I wanted to tell you I'm sorry you're having so much trouble. Where were you living before, and what have you been taking? Also, would you be willing to travel a bit, and if so how far?
> These doctors ought to be ashamed of their selves. They lobby to keep the prescription privilege theirs, and then they put up so many hurdles for us to get the medications, leaving many people to unnecessarily suffer greatly and legally extorting thousands of dollars in the process.
I doubt that psychologists would be any better if they could prescribe meds, but you're right -- it's as if they think that suicide is preferable to the possibility that someone might get high. There are more and more people coming out of the woodwork who find that only opioids help with their depression and who've realized that they have a right to effective treatment. Doctors who deny it to them are potentially forcing them to try to get drugs on the street. It's time to trash the notion that doctors know what a patient's best interest is better than the patient does.
-elizabeth
Posted by Bill L on December 10, 2001, at 7:04:22
In reply to Need Doctor to Prescribe Opiates in Baltimore, posted by Annie Z. on December 9, 2001, at 11:13:55
You can try Paul Beals who is a physician in Laurel. His number is in the phone book. I don't know if he will prescribe opiates but he does alternative treatments so maybe he will.
> Can someone give me the name of a doctor that will prescribe opiates for depression in Baltimore, MD? You may post your answer or send your answer to jaklnn@yahoo.com
>
> I've been to many doctors, and they all have turned me down. They won't even read the medical journal articles that I give them about opiates and depression.
>
> I recently moved from another city where my general physician was prescribing opiates for me. After beginning the opiates, my life began for the first time to become tolerable. (I am still on a low dose of opiates, and hope to increase my dosage for even better results.)
>
> I have been depressed for 15 years, and I've tried every other category of antidepressants, as well as many different combinations of treatments and alternative treatments for depression. I have never felt better than I have now. I cannot go back to the miserable life I had before taking opiates – my life was hardly worth living.
>
> These doctors ought to be ashamed of their selves. They lobby to keep the prescription privilege theirs, and then they put up so many hurdles for us to get the medications, leaving many people to unnecessarily suffer greatly and legally extorting thousands of dollars in the process.
Posted by mair on December 10, 2001, at 16:09:56
In reply to Need Doctor to Prescribe Opiates in Baltimore, posted by Annie Z. on December 9, 2001, at 11:13:55
>Anne - I don't know Baltimore either. However if you do find someone, including the doc recommended by Bill L could you please post a message to that effect. There's a thread up above on Methadone started by Shelli R. She's in the same boat in DC. Im pretty sure she considers Baltimore an acceptable distance to travel if need be.
Thanks
Mair
Posted by Annie Z. on December 12, 2001, at 9:35:55
In reply to Re: Need Doctor to Prescribe Opiates in Baltimore, posted by Elizabeth on December 9, 2001, at 21:14:35
>Where were you living before, and what have you been taking?
In Philadelphia, I started off with Oxycontin, but then my insurance started to hassle me about the very expensive Oxycontin. I decided not to appeal my insurance companies decision, since I was going to be moving to Baltimore in short time. So, instead, I changed my medication to Codeine. I am taking 30 mg, four times per day. I like the drug. It has a relatively long half-life compared to the other non-time-release narcotics, and I am not too constipated on it. The downside to this drug is that it can’t be taken in more than 60 mg dosages without people getting seriously uncomfortable side effects. I can’t remember what the side effects are, but nausea is one of them. Note that 60 mg Codeine has the same analgesic effect of about 20 mg Oxycontin; therefore, no one can never take a very high dosage on Codeine. (It would seem to me that these facts are the reasons why Codeine in low dosages and in combination with some non-narcotic analgesics are sold over the counter: Codeine isn’t one of the easiest narcotics to abuse.)
Also, would you be willing to travel a bit, and if so how far?Well, given my health, traveling isn’t the easiest. But, ultimately, I will do what I have to do (within the law).
I have made six more appointments with three psychiatrists and three internists in Baltimore, who all went to medical school at John Hopkins or Harvard, or schools of this caliber, so I hope one of these doctors will come through with my opioids.
Today, I talked to a professor in John Hopkins’s affective disorder department; he said his department tried buprenorphine several years ago with less than stellar results. I was thrilled to hear that he heard about the studies done at McLean; I never talked to a psychiatrist that has heard about opioids being used for depression (before I showed a doctor the my medical journal articles.) He recommended that I have a one-time consultation with someone in the John Hopkins faculty, and then they would set me up to see one of their senior residents on an ongoing basis. I know that I am not guaranteed a doctor who will prescribe me opiates, but I should be able to get opioids here. After all, John Hopkins, as I am sure you know, is one of the top medical schools and hospitals in the United States. If not, there is even more wrong with the world than I already thought there was, and I will be very disillusioned.
Posted by Elizabeth on December 12, 2001, at 16:14:05
In reply to Re: Need Doctor to Prescribe Opiates in Baltimore » Elizabeth, posted by Annie Z. on December 12, 2001, at 9:35:55
> In Philadelphia, I started off with Oxycontin, but then my insurance started to hassle me about the very expensive Oxycontin. I decided not to appeal my insurance companies decision, since I was going to be moving to Baltimore in short time. So, instead, I changed my medication to Codeine.
Oof! Morphine would probably have been a better choice -- codeine is very weak (as you've no doubt discovered), and its effect really relies on metabolism to morphine.
> I am taking 30 mg, four times per day. I like the drug. It has a relatively long half-life compared to the other non-time-release narcotics, and I am not too constipated on it.
That's surprising. Well anyway, consider morphine, which does come in a sustained-release formulation.
> The downside to this drug is that it can’t be taken in more than 60 mg dosages without people getting seriously uncomfortable side effects. I can’t remember what the side effects are, but nausea is one of them.
They're probably typical opioid side effects -- itching, constipation, dry mouth, sweating, etc.
> > Also, would you be willing to travel a bit, and if so how far?
>
> Well, given my health, traveling isn’t the easiest. But, ultimately, I will do what I have to do (within the law).I meant just to southern MD or the DC area. Shelli is getting opioids from a psychiatrist in DC, I think, so you might ask her about that.
> I have made six more appointments with three psychiatrists and three internists in Baltimore, who all went to medical school at John Hopkins or Harvard, or schools of this caliber, so I hope one of these doctors will come through with my opioids.
Good luck to you!
> Today, I talked to a professor in John Hopkins’s affective disorder department; he said his department tried buprenorphine several years ago with less than stellar results.
I wonder what type of patients they tried it on. I think opioids aren't right for all depressed patients, and some may even feel worse on them. Also, the dose and route of administration can affect the efficacy and reliability of bupe quite a bit.
Again, good luck to you!
-elizabeth
Posted by Annie Z. on December 12, 2001, at 20:55:23
In reply to Re: Need Doctor to Prescribe Opiates in Baltimore » Annie Z., posted by Elizabeth on December 12, 2001, at 16:14:05
Thanks for the replies. In a month or two, I will let you know if I need some doctors from the MD-DC area.
> > Today, I talked to a professor in John Hopkins’s affective disorder department; he said his department tried buprenorphine several years ago with less than stellar results.
>I wonder what type of patients they tried it on. I think opioids aren't right for all depressed patients, and some may even feel worse on them. Also, the dose and route of administration can affect the efficacy and reliability of bupe quite a bit.
I, too, am wondering why their bupe results weren’t impressive. If I get to John Hopkins, I’ll see if I can get the get some more info.
Posted by Elizabeth on December 13, 2001, at 15:22:37
In reply to Re: Need Doctor to Prescribe Opiates in Baltimore » Elizabeth, posted by Annie Z. on December 12, 2001, at 20:55:23
> I, too, am wondering why their bupe results weren’t impressive. If I get to John Hopkins, I’ll see if I can get the get some more info.
I assume they published it -- if you can just get the name of one of the authors, that alone would be very useful.
Thanks, and good luck with your search for a doctor!
-elizabeth
Posted by cisco on December 15, 2001, at 2:05:35
In reply to Re: JHU buprenorphine research » Annie Z., posted by Elizabeth on December 13, 2001, at 15:22:37
> Remember, one of the esteemed founders of Johns-Hopkins was a life-long Morphine addict!
How hypocritical of them not to prescribe an opiate for legitimate purposes!!!
Bup can be purchased rather cheaply from Offshore OP's. less than 40 bucks for 50 tabs of the 0.2mg sublingual tabs.
I use opiates for self-medicating my depression. They work to a point. The short acting nature of the more popular meds (Oxycodone, Hydrocodone) means that as you chase the effect, with increasing tolerance, the withdrawals are an ever present risk!
My experience with Bup is that it works well. No real euphoria, but depression goes away. They are also excellent for trying to stop short acting opioids. Buprenorphine stops withdrawals completely! Tabs must be held under tongue without swallowing for ten minutes!!!! Takes a while to get to the brain. But the effects last a long time. Unlike vicodin or Oxy, where you start thinking about more every 3-4 hours!!!
Anyway, thats all 4 now. Good luck
-Cisco
PS: Is it just me, or does it seem like all AD's are a bad joke, sugar pills foisted on us by greedy Pharmaceutical companies? Just wondering....
Posted by Elizabeth on December 15, 2001, at 9:47:53
In reply to Re: JHU buprenorphine research, posted by cisco on December 15, 2001, at 2:05:35
> > Remember, one of the esteemed founders of Johns-Hopkins was a life-long Morphine addict!
>
> How hypocritical of them not to prescribe an opiate for legitimate purposes!!!Lots of people in the 19th and earlier centuries used opiates -- primarily, opium, laudanum (tincture of opium), and morphine -- for depression and anxiety, and lots were probably dependent on them. Opium was the very first effective pharmacological antidepressant, after all, and it remains one of the few effective "herbal food supplements." :-) (Opium and its derivatives have been in use for treating depression and anxiety for thousands of years; the word "addictive" in its modern sense, I learned recently, was first seen in English sometime in the 1930s, which lends credence to my belief that it was the drug prohibition laws that created the drug problem). I'm sure that some of the Founding Fathers used opiates for reasons other than nociceptive pain, and probably later Presidents too. (IMHO, the FFs would be horrified to learn about the War on [Some] Drugs and the things the government has done in the name of said "war." I consider the prohibition of certain drugs to be unconstitutional; I don't get how it is that the government feels it can freely criminalize drugs when it knew full well that a Constitutional amendment would be required to criminalize alcohol.)
Anyway, most of the "reasons" that doctors give for not wanting to prescribe opioids are lame excuses. (Fear of the state medical board coming after them is one I might buy, if they were going to prescribe opioids to a lot of patients; if it's just a couple patients, and they can provide solid justification showing that the particular patients need the opioids and so forth, they shouldn't have much to worry about. This most likely depends to some degree on what state they're practicing in: some states may have very right-wing medical boards.)
> Bup can be purchased rather cheaply from Offshore OP's. less than 40 bucks for 50 tabs of the 0.2mg sublingual tabs.
That's interesting, although I always have this hangup about everything I do having to be "legitimate." (In my defense, part of this concern is that I expect OPs to become harder and harder to use, at least when you're talking about controlled substances, and I want to be assured of a steady supply of my chosen medication. OTOH, sublingual bupe may be available in the US soon -- although I feel like I've been hearing this for years.)
I wonder what the equivalent SL dose is to the IN [intranasal] dose I take (1 mL t.i.d.). From what I've read, it seems that IN~=IM (the recommended doses for IM injection are the same as what I take, although IM bupe probably kicks in faster and doesn't work as long as IN). I think I'll post about this to a separate thread.
> I use opiates for self-medicating my depression. They work to a point.
Which do you use (dare I ask?) and what do you mean by "to a point?" Do you use them every day, or just as-needed? Do you have tolerance problems? I've found that some effects, such as the intense feelings of contentment and "connection" to people that I experience at first, can't be maintained over time, but buprenorphine does continue to help with a wide range of problems as no other medicine does (such as depressed mood, anergia, anhedonia, inability to feel like I fit in with others, extreme self-consciousness, and even attention problems, believe it or not).
> The short acting nature of the more popular meds (Oxycodone, Hydrocodone) means that as you chase the effect, with increasing tolerance, the withdrawals are an ever present risk!
Buprenorphine is pretty short-acting, IMO (maybe it would last longer if taken SL).
> My experience with Bup is that it works well. No real euphoria, but depression goes away. They are also excellent for trying to stop short acting opioids. Buprenorphine stops withdrawals completely!
That's what I've heard from people who've used it that way (mainly, people who have some problems with addiction to full-agonist opioids). I've never actually experienced opioid euphoria, so I can't be *sure* that what bupe does to me isn't the same, but *I* sure wouldn't call it "euphoria."
> Tabs must be held under tongue without swallowing for ten minutes!!!! Takes a while to get to the brain. But the effects last a long time. Unlike vicodin or Oxy, where you start thinking about more every 3-4 hours!!!
About how long does bupe take to kick in, and how long does it last, when taken SL? By the nasal route, it lasts around 4-6 hours (once it kicks in), and takes about 1 hour to start working (that's when the dry mouth hits). I've read that it's quicker IM and quicker still IV, although for odd reasons IV bupe doesn't work immediately. (There's another weird one for Cam to explain.)
> PS: Is it just me, or does it seem like all AD's are a bad joke, sugar pills foisted on us by greedy Pharmaceutical companies? Just wondering....
Well, it's not just you; I know plenty of others who feel the same way. I'm ambivalent about this myself: modern ADs seem to help a lot of people, but those of us who need something stronger seem to be out of luck in today's highly politicized medical world. I just wish that the medical establishment would recognize our needs as legitimate -- they have a lot of political clout and could use it to help us if they wanted to.
Argh -- sorry this is so long! I get this way when I'm upset about something political, especially something that hits so close to home.
-elizabeth
Posted by Annie Z. on December 15, 2001, at 20:32:40
In reply to Re: JHU buprenorphine research » Annie Z., posted by Elizabeth on December 13, 2001, at 15:22:37
>I assume they published it -- if you can just get the name of one of the authors, that alone would be very useful.
I believe the John-Hopkins doctor just meant that they just tried buprenorphine on some of their treatment-resistant depressed patients in their hospital clinic.
Posted by cisco on December 15, 2001, at 21:07:44
In reply to opioid scripts; buprenorphine pharmacokinetics » cisco, posted by Elizabeth on December 15, 2001, at 9:47:53
Dear Elizabeth:
I couldn't agree with you more. Worldwide Drug Prohibition is Terrorism at its worst.
Don't get me started.
The Founding Fathers are boiling in their graves. Our Democracy is a flimsy facade. Vote for President? Does it matter when all candidates are corporate shills anyway?
Jefferson demanded "Life, Liberty and the Pursuit of Happiness". That dream is officially dead in the USA.Yes, absolutely, the worldwide drug prohibition is the cause of worldwide drug problems. Strict distribution of Pharmaceutically pure drugs, sold at a sensible price, works. And works well: As Drug price's go down, The black market goes away. Criminal empires lose major funding. jails empty. Police catch criminals. Drug Corruption
goes away, etc, etc. The whole house of cards crumbles. This makes too much sense. It's too easy.Drug Prohibition gives our government the right to operate 'Secret Police' organizations in the name of 'drug control'. And we do it on an international basis. We can send guns and money to any country we want, as long as its under the guise of 'The War on Drug's'.
I'm sorry. I go on and on and on. It is such an outrage!
I took hydrocodone for a couple years, pretty much everyday. Then Oxycontin became available, and I began using that. It was cheap and strong. And pure: No acetaminophen to poison the body.
After the DEA figured out it was being diverted from Mexico, they put a stop to it. So now I'm taking Hydrocodone again. The Norco is 10/325, so the paracetamol content is low.Since I self-medicate, I work the edges of the system. I get the Hydro from willing OP's after a short Dr. consult. Its filled by their own pharmacy, and dropped off by UPS.
Yes, I am dependent. Severe short coming of opioids. Tolerance is annoying. And when you run out, by choice or not, withdrawals are bad. I have gone through withdrawals 5 or 6 times. But is just no good. After WD's comes that horrible phase of severe depression, dysphoria and general malaise. Getting out of bed to do anything, say wash the dishes, feels like you are being asked to run the Boston Marathon! And the simple act of taking a little opioid or two makes you feel like the King of the world again. Well, you can imagine what happens: I start medicating again.
When I first tried the Bup (to help with WD agony) the sublingual tabs didnt work for me. Then I read somewhere that you had to hold them under your tongue for 10 minutes. Voila!
I was surprised how well they worked. Now, I usually take 0.4mg (two 0.2mg). In an hour or so, I begin to feel the effects, or should I say, 'Normal'. Lasts 6 - 7 hours at least.
I read that when Bup is given IV to Heroin addicts, they think it's Heroin. I also read that some people crush up the Sublingual tabs, and snort them!I have taken Prozac, Effexor, Wellbutrin, Celexa, Zoloft, Paxil, and a few others. After a few days of side effects, I then feel nothing. Weeks and Months of no real effect. However, when I take an Opioid, I feel better within an hour!
What a joke! Oh, but Opioids are addictive. Damn right. Anything that makes you feel good, you will continue doing. Has anyone ever stolen Effexor from a Pharmacy?
Hope I answered your questions.
-Cisco
Posted by Elizabeth on December 15, 2001, at 23:38:34
In reply to Re: opioid scripts; buprenorphine pharmacokinetics, posted by cisco on December 15, 2001, at 21:07:44
> Yes, absolutely, the worldwide drug prohibition is the cause of worldwide drug problems.
And a lot of it is due to the U.S. putting political and economic pressure on other countries to pass antidrug laws similar to its own. Still, there are places where things are better.
> Strict distribution of Pharmaceutically pure drugs, sold at a sensible price, works.
I would imagine the pharmaceutical companies would like being able to sell whatever they wanted, too. Except their claim to legitimacy rests on drawing a line between their "good" drugs (such as SSRIs) and "bad" illegal drugs. They have to go along with things like the Controlled Substances Act (which really is bad for them) while doing their best to make drugs that won't be Scheduled. That means that drug companies aren't looking for newer opioids with fewer side effects or that don't cause tolerance, because that's not where the money is. And they're definitely not interested in demonstrating the antidepressant effects of opioids.
> And works well: As Drug price's go down, The black market goes away. Criminal empires lose major funding. jails empty. Police catch criminals. Drug Corruption
> goes away, etc, etc. The whole house of cards crumbles. This makes too much sense. It's too easy.But there are huge industries built around the War on Some Drugs. The prison industry (which is now being "privatized" in many places), the law enforcement industry, a number of government agencies. The WoSD creates jobs, and many people have built their careers on it.
> I'm sorry. I go on and on and on. It is such an outrage!
I understand. You are right to be outraged.
> I took hydrocodone for a couple years, pretty much everyday. Then Oxycontin became available, and I began using that. It was cheap and strong. And pure: No acetaminophen to poison the body.
Yes, don't you love how drugs are supposedly made "safer" (presumably less "abuse potential") by adding poison to them?
> After the DEA figured out it was being diverted from Mexico, they put a stop to it. So now I'm taking Hydrocodone again. The Norco is 10/325, so the paracetamol content is low.
I've heard of the 10/325s -- I suggested to my mother (who has osteoporosis) that she ask for them: it's not like the APAP is doing anything for her.
> Since I self-medicate, I work the edges of the system. I get the Hydro from willing OP's after a short Dr. consult. Its filled by their own pharmacy, and dropped off by UPS.
I wish people didn't have to go through all this. Of course, poor people don't have the option; they're stuck trying to score heroin on the street.
> Yes, I am dependent. Severe short coming of opioids. Tolerance is annoying. And when you run out, by choice or not, withdrawals are bad.
As you've seen, bupe is much better that way: there are withdrawal symptoms, but you don't get sick like you do with full agonists.
> I have gone through withdrawals 5 or 6 times. But is just no good. After WD's comes that horrible phase of severe depression, dysphoria and general malaise. Getting out of bed to do anything, say wash the dishes, feels like you are being asked to run the Boston Marathon!
That's one of the symptoms of my depression -- I had this problem before I ever took opioids.
> I was surprised how well they worked. Now, I usually take 0.4mg (two 0.2mg).
I wish I knew how to figure out the equivalent to my dose (0.3 mg), because I'm seriously thinking that I should try this. It takes an hour for it to work for me too (which is a pain: I have to get up early in the AM and take it so that I'll be okay when I need to be), but it sounds like it lasts longer for you.
> I read that when Bup is given IV to Heroin addicts, they think it's Heroin.
I'm *very* skeptical. It might feel like a low dose of heroin (relative to their tolerance) to them, but AFAIK it doesn't cause a rush (even IV). It also supposedly takes a while for the effect to kick in even when given IV.
> I also read that some people crush up the Sublingual tabs, and snort them!
Well, that's probably similar to how I take it, although I bet it doesn't work as well to snort the powder. I "snort" the injectable solution. I have to do it lying down and hold my head back (hyperextending my neck) in order for it to be absorbed adequately (this also prevents it from going down my throat).
> I have taken Prozac, Effexor, Wellbutrin, Celexa, Zoloft, Paxil, and a few others. After a few days of side effects, I then feel nothing. Weeks and Months of no real effect. However, when I take an Opioid, I feel better within an hour!
Ever tried MAOIs?
> What a joke! Oh, but Opioids are addictive. Damn right. Anything that makes you feel good, you will continue doing. Has anyone ever stolen Effexor from a Pharmacy?
If it helps, I will keep using it (I'm just at 75 mg now). And if it made me functional and I couldn't afford it -- I don't know, I might steal in order to pay for it. Being able to live, to function, to do all the other things that "normal" people do -- that's what I want.
-elizabeth
Posted by Andy123 on December 20, 2001, at 16:20:43
In reply to Need Doctor to Prescribe Opiates in Baltimore, posted by Annie Z. on December 9, 2001, at 11:13:55
Hi Annie,
I was reading through the JH psychiatry homepage earlier in the year. I moved out here recently and was also looking for a psychiatrist. They don't seem to be the kind of folks who are going to try that form of therapy (buprenorphine.) The dr who was involved in publishing "Buprenorphine for Treatment Resistant Depression" in 95 has long since left JH. There has been quite a bit of research at JHU on BUP for cocaine or heroine addiction. The guys who do most of this research aren't MD's but PhD's and alot of the testing had been on animals. Anyhow, after reading up on the affective disorders page and looking through some of the dr's recent publications, I kinda concluded that they aren't all that progressive.> These doctors ought to be ashamed of their selves. They lobby to keep the prescription privilege theirs, and then they put up so many hurdles for us to get the medications, leaving many people to unnecessarily suffer greatly and legally extorting thousands of dollars in the process.
I agree.
-Andy
This is the end of the thread.
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