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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 53 to 77 of 77. Go back in thread:
Posted by BrittPark on December 30, 2002, at 14:32:50
In reply to Re: Buprenorphine Approved, posted by Peter S. on December 30, 2002, at 14:27:12
> BTW a special waiver or advanced training is required in substance abuse in order for an MD to be allowed to dispense buprenorphine. There is a limit on the number of patients also.
Does anyone else detest the DEA as much as I do? ;)
Posted by BrittPark on December 30, 2002, at 14:48:41
In reply to Use of opiates in treating depression, posted by MoQ on December 19, 2002, at 16:39:59
You've probably found your references already. Here's another one: http://opioids.com/tramadol/tramadol.html
You may find other opioid positive abstracts on the same website.Cheers,
Britt
Posted by ShelliR on December 30, 2002, at 18:37:49
In reply to Buprenorphine Approved, posted by Peter S. on December 30, 2002, at 14:21:11
> On October 8, 2002 Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) received FDA approval for the treatment of opioid dependence.
>
> Apparently doctors will be able to starat prescribing it starting this month.
Hi Peter,Where did you read that doctors will be able to start prescribing it this month? (And does "this month" mean December 2002 or January 2003)?
My pdoc (who is not anti-buprenorphine) read that it was not going to be approved (or maybe he meant distributed) for another year, in one of his journals. He won't prescribe drugs with codeine for depression anyway, but he's fine with me getting them from my pain doc.
It's hard for psychiatrists to prescribe narcotics for depression because there are so few studies supporting its success. The buprenorphine studies at Harvard/McLean Hospital have really small sample sizes. So that leaves them open for a law suit if the patient turns around and sues them for getting them "addicted". Especially with all the passion about opiate use and the lack of understanding of the concepts of habituation vs. addiction.
Shelli
Posted by MoQ on December 30, 2002, at 19:04:46
In reply to Re: Use of opiates in treating depression » MoQ, posted by BrittPark on December 30, 2002, at 14:48:41
> You've probably found your references already. Here's another one: http://opioids.com/tramadol/tramadol.html
> You may find other opioid positive abstracts on the same website.
>
> Cheers,
>
> Britt
>Thanks! I did actually find that one via a post that Shelli sent me, but all help is GREATLY appreciated!
Posted by MoQ on December 30, 2002, at 19:07:21
In reply to Re: Buprenorphine Approved » Peter S., posted by ShelliR on December 30, 2002, at 18:37:49
> > On October 8, 2002 Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) received FDA approval for the treatment of opioid dependence.
> >
> > Apparently doctors will be able to starat prescribing it starting this month.
>
>
>
> Hi Peter,
>
> Where did you read that doctors will be able to start prescribing it this month? (And does "this month" mean December 2002 or January 2003)?
>
> My pdoc (who is not anti-buprenorphine) read that it was not going to be approved (or maybe he meant distributed) for another year, in one of his journals. He won't prescribe drugs with codeine for depression anyway, but he's fine with me getting them from my pain doc.
>
> It's hard for psychiatrists to prescribe narcotics for depression because there are so few studies supporting its success. The buprenorphine studies at Harvard/McLean Hospital have really small sample sizes. So that leaves them open for a law suit if the patient turns around and sues them for getting them "addicted". Especially with all the passion about opiate use and the lack of understanding of the concepts of habituation vs. addiction.
>
> Shelli
>You know, I so wish that people would take some personal responsibility, don't you? I mean I work for a law firm and I know that a signed Release doesn't really carry all that much water anyway, but I would be willing to swear before a notary and anyone else who will listen that I promise to never sue my doctor for prescribing me something I ASKED FOR. My family physician had mentioned that doctors are now being sued by patients who asked for narcotic pain relievers and then turned around and blamed the doc for getting them "hooked." It's CRAZY!!!!
Posted by Peter S. on December 31, 2002, at 14:06:42
In reply to Re: Buprenorphine Approved » Peter S., posted by ShelliR on December 30, 2002, at 18:37:49
Hi Shelli,
I read in my local paper (Oakland Tribune) that it could be prescribed starting sometime in January of 03.
> > On October 8, 2002 Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) received FDA approval for the treatment of opioid dependence.
> >
> > Apparently doctors will be able to starat prescribing it starting this month.
>
>
>
> Hi Peter,
>
> Where did you read that doctors will be able to start prescribing it this month? (And does "this month" mean December 2002 or January 2003)?
>
> My pdoc (who is not anti-buprenorphine) read that it was not going to be approved (or maybe he meant distributed) for another year, in one of his journals. He won't prescribe drugs with codeine for depression anyway, but he's fine with me getting them from my pain doc.
>
> It's hard for psychiatrists to prescribe narcotics for depression because there are so few studies supporting its success. The buprenorphine studies at Harvard/McLean Hospital have really small sample sizes. So that leaves them open for a law suit if the patient turns around and sues them for getting them "addicted". Especially with all the passion about opiate use and the lack of understanding of the concepts of habituation vs. addiction.
>
> Shelli
>
Posted by MoQ on January 1, 2003, at 9:22:49
In reply to Re: Buprenorphine Approved, posted by MoQ on December 30, 2002, at 19:07:21
> > > On October 8, 2002 Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) received FDA approval for the treatment of opioid dependence.
> > >
> > > Apparently doctors will be able to starat prescribing it starting this month.
> >
> >
> >
> > Hi Peter,
> >
> > Where did you read that doctors will be able to start prescribing it this month? (And does "this month" mean December 2002 or January 2003)?
> >
> > My pdoc (who is not anti-buprenorphine) read that it was not going to be approved (or maybe he meant distributed) for another year, in one of his journals. He won't prescribe drugs with codeine for depression anyway, but he's fine with me getting them from my pain doc.
> >
> > It's hard for psychiatrists to prescribe narcotics for depression because there are so few studies supporting its success. The buprenorphine studies at Harvard/McLean Hospital have really small sample sizes. So that leaves them open for a law suit if the patient turns around and sues them for getting them "addicted". Especially with all the passion about opiate use and the lack of understanding of the concepts of habituation vs. addiction.
> >
> > Shelli
> >
>
> You know, I so wish that people would take some personal responsibility, don't you? I mean I work for a law firm and I know that a signed Release doesn't really carry all that much water anyway, but I would be willing to swear before a notary and anyone else who will listen that I promise to never sue my doctor for prescribing me something I ASKED FOR. My family physician had mentioned that doctors are now being sued by patients who asked for narcotic pain relievers and then turned around and blamed the doc for getting them "hooked." It's CRAZY!!!!O.K., I admit that I am a bit confused with regard to the Buprenorphine. Gosh, and I'm not even sure how to phrase this. Does the bup still act like an opiate acts with regard to controlling and treating the depression, depersonalization, anxiety, panic attacks, etc.? Or is it merely to stop you from using opiates? I guess I don't understand how stopping opiate use is going to help me when it is the opiate itself that has helped my symptoms and suffering/discomfort for the past five years. Please enlighten me! Thanks!
Posted by BrittPark on January 1, 2003, at 14:19:35
In reply to Re: Use of opiates in treating depression » MoQ, posted by BrittPark on December 30, 2002, at 14:48:41
Here's a link to a disheartening article (to those of us who respond well to opioids as ADs) about OxyTrex and MorViva:
http://www.annieappleseedproject.org/ullownaltopr.html
OxyTrex and MorViva are preparations of Oxycodone and Morphine respectively, in clinical trials by a company called Pain Therapeutics.
Posted by ShelliR on January 1, 2003, at 19:53:55
In reply to Re: Buprenorphine Approved » MoQ, posted by MoQ on January 1, 2003, at 9:22:49
> O.K., I admit that I am a bit confused with regard to the Buprenorphine. Gosh, and I'm not even sure how to phrase this. Does the bup still act like an opiate acts with regard to controlling and treating the depression, depersonalization, anxiety, panic attacks, etc.? Or is it merely to stop you from using opiates? I guess I don't understand how stopping opiate use is going to help me when it is the opiate itself that has helped my symptoms and suffering/discomfort for the past five years. Please enlighten me! Thanks!
Since you don't use opiates to get high, the part about detoxing *doesn't* really apply to you. Doctors think that since buprenorphine is only a partial opiate, it is not as addictive, and would still satisfy the addict's cravings. Especially since it will be mostly used mixed with naltrexone, which would make street drugs feel very unpleasant. So an "addict" could either stay on buprenorphine or bupe plus naltrexone, or could get off all opiates, since it is easier to get first switch to bupe, then detox.
I was anxious to try buprenorphine because I was hoping that I would not become habituated on it, yet it got rid of the depression in the same manner that full opiates did. That didn't happen for me; I did have to go up and finally it became impossible for me to get over the internet, anyway. At this point my doctor doesn't really think there's much benefit in bupe over methadone for me, as I was hoping.Elizabeth was able to keep the same small dose for several years--using it as an adjunct to effexor. If it is truely coming out this month, I'm going to bring it up with my pain doctor, get his take on it.
Hope this does make some sense to you.
Shelli
Posted by rally on January 3, 2003, at 18:33:19
In reply to Re: Use of opiates in treating depression » MoQ, posted by BrittPark on December 30, 2002, at 14:48:41
it is great i have found this
i have been taking dihydrocodeine for a long time for pain but this last few yers to try and ward of on coming depression
can any one tell me which came first opiates causing the depression or the depression
Posted by BrittPark on January 3, 2003, at 19:00:03
In reply to Re: Use of opiates in treating depression » BrittPark, posted by rally on January 3, 2003, at 18:33:19
It's very hard to say whether the depression is made worse by opiates or better. My guess though is that since you've been taking opiates for a long time that they are doing little one way of the other. I think, on average, more people are made to feel better by opiates than worse. However, tolerance to opiates tends to develop rapidly for most people. You might try tapering off the opiates, wait a little bit and try again. You might find improvement then. Also if you aren't seeing a psychiatrist I suggest that you do so. An AD might be the thing you need. I believe that opiates are very effective ADs (for some people) but the currently available opioids are with perhaps a few exceptions (tramadol, buprenorphine) not effective for long term use. Tolerance builds all too rapidly.
Feel Better,
Britt
Posted by Cisco on January 4, 2003, at 12:34:01
In reply to Re: Use of opiates in treating depression » rally, posted by BrittPark on January 3, 2003, at 19:00:03
Opioids will absolutely relieve many depressive symptoms.
However, due to the unavoidable progression of tolerance and dependence, or withdrawals and abstinence syndrome, opioids are a "Pandora's Box", which should not be opened, except for emergent nociception, IMHO.Cisco
Posted by rally on January 4, 2003, at 17:51:36
In reply to The Cure is Worse than the Disease, posted by Cisco on January 4, 2003, at 12:34:01
cisco could you please elaborate on what you have said and explain to me what you mean as i do not really understand the phrases used
Posted by MoQ on January 5, 2003, at 8:15:11
In reply to The Cure is Worse than the Disease, posted by Cisco on January 4, 2003, at 12:34:01
> Opioids will absolutely relieve many depressive symptoms.
> However, due to the unavoidable progression of tolerance and dependence, or withdrawals and abstinence syndrome, opioids are a "Pandora's Box", which should not be opened, except for emergent nociception, IMHO.
>
> Cisco
Cisco, I still would much rather live with a few days every once in a blue moon (in my case, everyone is different, I know) of "withdrawal" and then re-start the 1 pill per day of Vicodin and relieve my symptoms than live 24/7, 365 days a week with the awful suicidal, depersonalization, depressive, and panic problems. Doesn't that seem to make some sense at all? I know it is probably hard to relate to how different things affect different people if it is not that way for oneself. People with Crohn's disease (at a very progressed state) are on CONSTANT morphine, in the form of a pump, 24 hours a day. Would it be better to take them off the morphine and just have them suffer? Sorry, I'm soap-boxing now, and this is not at all directed at you, Cisco. I just am completely and utterly perplexed at why a substance would be invented to help people and then people are told they are not allowed to use it. I have never tried ecstacy (nor will I), but I have watched a lot of documentaries on it and (as I am sure just about all of you are familiar with) it was invented as an antidepressant to help those who really were not responding to anything. The doctors had FABULOUS results!!!! But then MDMA got into the wrong hands and people who didn't need it for MEDICAL reasons ruined it for everyone. It is still out there for people to obtain illegally, but those who may really benefit from it are not allowed access to it. I for one am not the type of person that is going to dabble in something that is only available on the street. I want my treatment to be supervised by a doctor, psychiatrist, psychopharmacologist, etc., so I am doing everying in the most possible "correct" way. All I want and hope for is to be healthy once again and enjoy life. I work a hard job, am a very responsible person, am a wife and mother, and am certainly a "benefit" to society by whatever standards "THEY" have given. So I am at a loss as to what it is that I am doing that is so taboo.
Posted by MoQ on January 5, 2003, at 8:19:45
In reply to Re: Use of opiates in treating depression » rally, posted by BrittPark on January 3, 2003, at 19:00:03
> It's very hard to say whether the depression is made worse by opiates or better. My guess though is that since you've been taking opiates for a long time that they are doing little one way of the other. I think, on average, more people are made to feel better by opiates than worse. However, tolerance to opiates tends to develop rapidly for most people. You might try tapering off the opiates, wait a little bit and try again. You might find improvement then. Also if you aren't seeing a psychiatrist I suggest that you do so. An AD might be the thing you need. I believe that opiates are very effective ADs (for some people) but the currently available opioids are with perhaps a few exceptions (tramadol, buprenorphine) not effective for long term use. Tolerance builds all too rapidly.
>
> Feel Better,
>
> Britt
>Britt, quick question for you. I have been reading various posts about the buprenorphine and how it is basically an antagonist to opiates. I have asked for some clarification from people and although they have responded I am still a bit confused. Especially now with you indicating, seemingly, that bupinorephrine is a form of an opiate that may have a longer lasting potential. If I am benefiting from Vicodin (1-1.5 tabs a day), if that is substituted for the "medically acceptable" bup at my upcoming psychopharmacological appointment, does that mean I will have adverse effects if I take Vicodin, or will it act in the same manner Vicodin does insofar as my symptoms are concerned? Thanks so much for your courtesies and informative feedback!
Posted by Larry Hoover on January 5, 2003, at 8:32:01
In reply to Re: The Cure is Worse than the Disease » Cisco, posted by rally on January 4, 2003, at 17:51:36
> cisco could you please elaborate on what you have said and explain to me what you mean as i do not really understand the phrases used
Cisco said that opiates should be reserved for the short-term treatment of pain, as long-term treatments of any sort tend to require escalating doses to retain efficacy.
Posted by BrittPark on January 5, 2003, at 10:16:13
In reply to In response to Britt, posted by MoQ on January 5, 2003, at 8:19:45
It's my understanding that buprenorphine is a partial opiate agonist. It therefore works like any other opiate up to a certain dosage but after that it starts working as an opiate antagonist. It's therefore self limiting which is why it is used to treat opiate addicts. Someone with a better handle on the pharmacology, please post and corect any errors.
Cheers,
Britt
Posted by Cisco on January 16, 2003, at 0:39:46
In reply to Re: The Cure is Worse than the Disease » Cisco, posted by rally on January 4, 2003, at 17:51:36
That was a myopic post. I apologise.
Allow me, (forgive me) to re-phrase:
Opioids can be a God-send to Chronic pain sufferer's. A restoration of a semblance of a life.
I was referring to healthy individuals considering a regimine of opioids for depressive relief.
The "Pandora's Box" is mostly due to the War on Drugs, secondarily to inherent shortcomings of the opioids: Dependence, Tolerance, and withdrawal.
Yeah, right: Are there any SSRI's that don't fall into the same category?
Judge what drug is right and correct for your particular situation. Don't rely on the Medical/Pharmaceutical complex for answers.
Lies are more prevalent than truth.
Be cautious and aware of the pitfalls of ALL drugs.
Have I made myself obtuse?
Cisco
Posted by reese1 on February 6, 2003, at 8:09:34
In reply to Re: Buprenorphine Approved » Peter S., posted by ShelliR on December 30, 2002, at 18:37:49
> > On October 8, 2002 Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) received FDA approval for the treatment of opioid dependence.
> >
> > Apparently doctors will be able to starat prescribing it starting this month.
>
>
>
> Hi Peter,
>
> Where did you read that doctors will be able to start prescribing it this month? (And does "this month" mean December 2002 or January 2003)?
>
> My pdoc (who is not anti-buprenorphine) read that it was not going to be approved (or maybe he meant distributed) for another year, in one of his journals. He won't prescribe drugs with codeine for depression anyway, but he's fine with me getting them from my pain doc.
>
> It's hard for psychiatrists to prescribe narcotics for depression because there are so few studies supporting its success. The buprenorphine studies at Harvard/McLean Hospital have really small sample sizes. So that leaves them open for a law suit if the patient turns around and sues them for getting them "addicted". Especially with all the passion about opiate use and the lack of understanding of the concepts of habituation vs. addiction.
>
> Shelli
>
hi shelli, we've talked before the reason the testing for buprenorphine was so small is the doctor was screwed over and forced to stop i've talked to a doctor at mcclean who has found opiates to be very very very helpfulreese
tanyagrover96@yahoo.com
give me an emai
if you need help or more info
Posted by Chairman_MAO on October 25, 2005, at 17:41:28
In reply to Use of opiates in treating depression, posted by MoQ on December 19, 2002, at 16:39:59
If your doctor deems "opioid therapy" appropriate, there will be no reason for him to Rx you anything with an NSAID in it; they just add toxicity. There's really no reason for him to start with anything less than OxyContin.
That said, I recommend buprenorphine as the first-line opioid for depression. Far milder withdrawal than full agonists, vastly increased safety in overdose, and a unique receptor binding profile (kappa antagonism, conferring antipsychotic/antimanic activity possibly) make it ideal for depression. Many people prefer buprenorphine to traditional opioids for depression because it tends to be more activating as well. It's also superb for anxiety; I believe it should be prescribed in lieu of benzodiazepines in many circumstances (hell, its withdrawal syndrome is a lot easier to deal with and never life-threatening!).
Posted by SLS on October 25, 2005, at 18:03:56
In reply to Re: Use of opiates in treating depression, posted by Chairman_MAO on October 25, 2005, at 17:41:28
Hi.
> If your doctor deems "opioid therapy" appropriate, there will be no reason for him to Rx you anything with an NSAID in it; they just add toxicity. There's really no reason for him to start with anything less than OxyContin.
I agree...
> That said, I recommend buprenorphine as the first-line opioid for depression. Far milder withdrawal than full agonists, vastly increased safety in overdose, and a unique receptor binding profile (kappa antagonism, conferring antipsychotic/antimanic activity possibly) make it ideal for depression. Many people prefer buprenorphine to traditional opioids for depression because it tends to be more activating as well.
I agree...
> It's also superb for anxiety; I believe it should be prescribed in lieu of benzodiazepines in many circumstances (hell, its withdrawal syndrome is a lot easier to deal with and never life-threatening!).
I gotta think about this one for awhile. The nice thing about buprenorphine is that it is self-limiting with regard to any possible euphoriant effects.
- Scott
Posted by Chairman_MAO on November 1, 2005, at 9:27:49
In reply to Re: Use of opiates in treating depression, posted by SLS on October 25, 2005, at 18:03:56
advantages over benzos:
--antidepressant instead of depressant
--better analgesia
--no cognitive impairment (users of opioids at doses equivalent to the max intrinsic activity of bupe often report cognitive enhancement)
--withdrawal syndrome is mild, even milder than full agonists, whihc is still way better--even at its worst--than benzo withdrawal can be.
--less abuse potential
--no impairment of motor coordination
--profound anti-craving activity in opioid addicts, many times in abusers of other substances and sufferers of other addictions as wellWhat else needs to be said?
Posted by SLS on November 1, 2005, at 10:08:21
In reply to buprenorphine vs. benzodiazepines » SLS, posted by Chairman_MAO on November 1, 2005, at 9:27:49
> advantages over benzos:
>
> --antidepressant instead of depressant
> --better analgesia
> --no cognitive impairment (users of opioids at doses equivalent to the max intrinsic activity of bupe often report cognitive enhancement)
> --withdrawal syndrome is mild, even milder than full agonists, whihc is still way better--even at its worst--than benzo withdrawal can be.
> --less abuse potential
> --no impairment of motor coordination
> --profound anti-craving activity in opioid addicts, many times in abusers of other substances and sufferers of other addictions as well
>
> What else needs to be said?
How about "Hi"?I am recommending to a friend of mine that he consider buprenorphine over methadone to treat heroin abuse. I have had buprenorphine on my list of things to try for quite awhile, but I have had a few other things I wanted to try first. For many people using buprenorphine to treat depression, dosing schedules are critical. I guess I didn't want to get too wrapped up with a drug that acted so acutely.
- Scott
Posted by ed_uk on November 1, 2005, at 15:32:52
In reply to Re: buprenorphine vs. benzodiazepines, posted by SLS on November 1, 2005, at 10:08:21
>How about "Hi"?
LOL, you're too funny Scott!
Ed
Posted by mike21 on November 3, 2005, at 19:42:23
In reply to buprenorphine vs. benzodiazepines » SLS, posted by Chairman_MAO on November 1, 2005, at 9:27:49
> advantages over benzos:
>
> --antidepressant instead of depressant
> --better analgesia
> --no cognitive impairment (users of opioids at doses equivalent to the max intrinsic activity of bupe often report cognitive enhancement)
> --withdrawal syndrome is mild, even milder than full agonists, whihc is still way better--even at its worst--than benzo withdrawal can be.
> --less abuse potential
> --no impairment of motor coordination
> --profound anti-craving activity in opioid addicts, many times in abusers of other substances and sufferers of other addictions as well
>
> What else needs to be said?I tried buprenorphine for its anxiolytic effects. If I remember correctly, the typical dosage was 1 ml, up to 3 times a day. I was barely able to tolerate one tenth of a normal 1ml dose. I got extremely sick to my stomach if I took any more, even vomiting at least once. About the only thing I wanted to do while taking this med was lie on my couch and wait for it to wear off.
I've been told that opioids are notorious for being hard on the stomach, but other opioids don't seem to have this effect on me (codeine, for example). At any rate, it turns out buprenorphine is not for everybody.
Mike
This is the end of the thread.
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