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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 33 to 57 of 57. Go back in thread:
Posted by Phillipa on December 3, 2017, at 21:04:59
In reply to Re: Everything is good, except for depression, posted by baseball55 on December 3, 2017, at 18:28:04
And that is how it all started docs prescribing too many opiods agree 100%. Now at least here being judicially prescribed in low and small amounts. I've been prescribed opiods also but didn't take the full script. Just because one has the meds doesn't mean you should take them all. When fell off bike last summer I refused pain meds in the ER took motrin instead generic. I see a lot of people have surgeries now one recently where I live for breast cancer double mastectomy wasn't given more than three days RX for them. Lidocaine inserted into the incision which slowly drained into the wound. I had this also with a tummy tuck over 10 years ago. Less than three days of half the amount of vicodin I was precribed I stopped them as the pain had subsided. No withdrawal no addiction. Phillipa
Posted by SLS on December 3, 2017, at 22:11:33
In reply to Re: Everything is good, except for depression, posted by baseball55 on December 3, 2017, at 18:28:04
> In fact, many of "the addicts" were average people who got hooked on opioids prescribed by doctors. I did.
In what ways were you addicted?
- Scott
Posted by Phillipa on December 4, 2017, at 9:15:44
In reply to Re: Everything is good, except for depression » baseball55, posted by SLS on December 3, 2017, at 22:11:33
Scott good question as addict is someone who escalates doses and then lots of times actively seeks out the drug or begins to abuse now those meds. Where one can develop a tolerance to the meds and require higher doses just to feel the same. I know personally I just didn't like the spacy feeling of them so go off them fast. No fear of withdrawal as so short term. Phillipa
Posted by baseball55 on December 4, 2017, at 19:07:55
In reply to Re: Everything is good, except for depression » baseball55, posted by SLS on December 3, 2017, at 22:11:33
>
> In what ways were you addicted?
>
> I was prescribed oxycontin, 10 mg, 2/day plus vicodin for breakthrough pain. Within months, I was altering prescriptions, then forging prescriptions. But the end, I was taking about 80mg oxycodone a day. I had DEA numbers for 3 doctors, made prescription blanks in their names and filled them, not using insurance, in three different pharmacies. I ordered drugs from Mexico by Fedex. I had not yet graduated to street purchases. I was not caught and jailed, amazingly (I did this for four years).My nephew was prescribed percocet in high school for football injuries and eventually went on to heroin. He was in and out of jails and rehabs and has now been clean for a year.
Phillipa - Yes, people should throw out what they don't need and not use more than they need for pain. Key word is "should." It's judgmental. What you don't seem to get is that some people just plain get addicted. The euphoria of opiates is too alluring to them. Once started, they can't stop. It's like alcohol. yes, some people can use moderately and stop themselves before becoming drunk, but others just can't. Whether it's genetic or characterological, we don't know. But we know that some people are likely to get addicted.
Posted by baseball55 on December 4, 2017, at 19:19:10
In reply to Re: Everything is good, except for depression, posted by baseball55 on December 4, 2017, at 19:07:55
One more thing. By the end 80-100mg oxycodone didn't do anything for me anymore but keep me from getting dope-sick. I started trying to stop then, because I knew the next step was heroin. It's hard to describe how absolutely horrible opiate withdrawal is, which is why addicts won't stop even when they want to and know they need to.
Eventually, I got on suboxone and tapered off that.BTW, this is not some story of a young person, succumbing to peer pressure or just being an irresponsible youth. I was 44 when I started opiates and 49 when I stopped.
Posted by Phillipa on December 4, 2017, at 22:51:09
In reply to Re: Everything is good, except for depression, posted by baseball55 on December 4, 2017, at 19:19:10
Baseball you don't need to plead a case as know this is true worked in chemical dependency for years. I really felt for those whose body /Brain wouldn't allow them to just take as prescribed. But this is only some. Those that don't share this problem should not be denied pain meds. A good doctor should not prescribe many pain killers or sending now to pain management clinics patients who do require long term pain meds and some do. I'm so sorry this happened to you. The good new is you know now you can't take this form of medication. Phillipa
Posted by SLS on December 5, 2017, at 8:05:17
In reply to Re: Everything is good, except for depression » baseball55, posted by Phillipa on December 4, 2017, at 22:51:09
My fear is that oxycodone will be taken off the market. It has been unjustly demonized in the court of public opinion. Oxycodone is an important tool to relieve people of excruciating pain. Unfortunately, some people have a psychobiology that leaves them predisposed to opioid addiction. I wish I knew what are the percentages. My best guess is that the majority of people do NOT experience euphoria with oxycodone. The thing that makes it difficult for many people to discontinue oxycodone is physiological dependence, not addiction.
- Scott
Posted by Phillipa on December 5, 2017, at 9:06:37
In reply to Re: Everything is good, except for depression, posted by SLS on December 5, 2017, at 8:05:17
I absolutely agree with all the statements you make. My fear also is they will be taken off the market. You can't "punish" people for something that is most likely an inheritated gene. So what happens to those who get operated on or have cancer they have nothing to give them? Here have a tylenol? Each person experiences pain at different thresholds also. Keep the opiods as someone addicted not tolerant or someone tolerant that seeks more meds on their own their docs and the RN's need to be aware of the "Clock Watchers" and intervene then. Phillipa
Posted by Christ_empowered on December 5, 2017, at 9:17:21
In reply to Re: Everything is good, except for depression » SLS, posted by Phillipa on December 5, 2017, at 9:06:37
I think this latest "epidemic" shows us how much better life would be in these United States if they'd just legalize drugs, tax them, and regulate them. I don't think "treatment, not prison" helps enough, nor do I think decriminalization is sufficient. I think anti-drug laws have been a massive waste of resources and a source of way, way, way too much suffering. if people want drugs, they should be able to buy their drugs safely, legally, and carry on with their lives.
Posted by Phillipa on December 5, 2017, at 9:38:33
In reply to Re: Everything is good, except for depression, posted by Christ_empowered on December 5, 2017, at 9:17:21
No definitely not opiods. They can cause respiratory depression leading to death. Legalization of drugs is a different category. Phllipa
Posted by Christ_empowered on December 5, 2017, at 9:54:51
In reply to Re: Everything is good, except for depression » Christ_empowered, posted by Phillipa on December 5, 2017, at 9:38:33
I do not do drugs myself, but I think its time to stop criminalizing drug use. I think anti-drug laws make the situation far, far worse than it would be if drugs were legalized, plus the harsh end of The War on Drugs falls on poor people and minorities, in a big way.
Posted by Phillipa on December 5, 2017, at 11:35:48
In reply to Re: Everything is good, except for depression, posted by Christ_empowered on December 5, 2017, at 9:54:51
Opiods do they or can they cause addiction or tolerance? In some yes in others no. Phillipa
Posted by baseball55 on December 5, 2017, at 15:46:32
In reply to Re: Tolerence vs Addition of Opiods pain meds » Christ_empowered, posted by Phillipa on December 5, 2017, at 11:35:48
1. People become tolerant to opioids, addicted or not. This is why people with chronic pain conditions need higher and higher doses, even when they are not "addicted."
2. Opioids cause physical dependence, whether or not people are "addicted" (in the sense of abusing them, taking more than prescribed, engaging in drug-seeking behavior). Nobody who has used opioids long-term can simply stop them without painful withdrawal. They need to be tapered.
3. Opioids always cause euphoria. This is why they control pain. They don't stop the pain, they merely move people into a psychological state where the pain becomes tolerable. It's not that some people don't feel euphoria when on opioids. It's just that, for many (hopefully most?) people, that euphoria doesn't fulfill some psychological need that makes them want more even when the pain is gone.
4. I agree that oxycodone should not be taken off the market. It is an amazing and absolutely necessary drug for post-surgical pain and pain from terminal cancer. It is an absolutely terrible drug for chronic, non-terminal pain, like orthopedic pain. Way too addictive, builds tolerance requiring higher and higher doses and doesn't even work as well as physical therapies and mind-body work. Personally, I believe insurance companies should start covering Feldenkrais, which is the very best way, I have found, to help people with chronic orthopedic pain.5. Some countries have legalized, or at least de-criminalized opioids. Addicts need to register to get drugs, so they can be monitored medically. I don't know of any country where they are just over-the-counter legal (at least any developed country). I see this as highly unlikely in the US, where drug use still evokes these moral responses - she's lazy, undisciplined, needs to suffer for her sins. Phillipa is absolutely right. Without regular monitoring and counseling, overdoses are way too common. The problem with legalization is that, though currently illegal in the US, they are almost unbelievably easy to obtain. Maybe some form of decriminalization would allow the government to regulate what's sold - so heroin laced with fentanyl could be taken off the market.
6. Most addicts want to quit. Currently, drugs like methadone and suboxone, which make quitting much easier and safer, are very difficult to get access to. Methadone is only available through clinics, where addicts need to line up daily to get their dose. Suboxone can be prescribed, but few doctors are licensed and the DEA limits the number of patients they can treat. As a result, suboxone prescribing has become a gold-mine for licensed prescribers - few take insurance and charge hundreds of dollars for visits.
Posted by SLS on December 5, 2017, at 17:05:18
In reply to Re: Tolerence vs Addition of Opiods pain meds, posted by baseball55 on December 5, 2017, at 15:46:32
Hi, BB55
I like what you wrote.
> 3. Opioids always cause euphoria.
Where did you get this idea from?
- Scott
Posted by Phillipa on December 5, 2017, at 17:19:33
In reply to Re: Tolerence vs Addition of Opiods pain meds » baseball55, posted by SLS on December 5, 2017, at 17:05:18
Same question on Euphoria. I just felt tired and spacey and didn't like they way they felt so went off them.
Definitely agree on PT for any orthopedic pain other than post surgical. I go to PT one time a week for my severe back disorders. Never had surgery as it's said that a very high percentage of back surgeries fail. Unless a as example broken back that can be fixed. Or knee replacement, Hip replacement. But the people I know personally in real life that have had the replacements are gotten out of bed the first day and PT started immediated. Only med I ever take is 1 generic Motrin.
Posted by SLS on December 5, 2017, at 18:56:27
In reply to Re: Tolerence vs Addition of Opiods pain meds, posted by Phillipa on December 5, 2017, at 17:19:33
> Same question on Euphoria. I just felt tired and spacey and didn't like they way they felt so went off them.
My mother recently had spinal fusion surgery. Oxycodone 10 mg every 3-4 hours was necessary to relieve her pain.
No euphoria.
No dysphoria.
Confusion.
Memory impairment.
Somnolence.
Ataxia.The stuff worked well. It effected robust antinociception (analgesia). It allowed her to get through rehab sessions and then enabled her to come home. She was able to discontinue oxycodone herself without an extended taper. The only major withdrawal symptom was agitation. She took oxycodone for just over three months. I don't know how that compares to others. I will say this, though. I think the introduction of tramadol may have made the discontinuation of oxycodone easier.
- Scott
Posted by baseball55 on December 5, 2017, at 20:52:48
In reply to Re: Tolerence vs Addition of Opiods pain meds » baseball55, posted by SLS on December 5, 2017, at 17:05:18
Opioids don't take away pain. They take you away from the pain. That's how they work. Some people don't think of this as euphoria - a brightening/lift in mood - but the actual neuro-psychological effect is the same for everyone. It's just that, for some people, that mood lift is very notable and addicting. If you don't think opioids cause euphoria in everyone, just think about (if you've ever had surgery) how you feel after those early injections of morphine. To be sure, some people don't like the neuro-psychological feeling of opioids, just like some people find that the mood enhancement from a glass of wine makes them feel tired and spacey. But many people find that tired and spacey feeling very addictive.
I suspect that many people prone to addiction suffer from low mood and self-esteem, so that their brains react to the euphoria rather than the accompanying sleepiness. People who are generally happy, upbeat and tend toward high-mood, mostly remember the sleepiness.
> > 3. Opioids always cause euphoria.
> Where did you get this idea from?
>
>
> - Scott
Posted by Phillipa on December 5, 2017, at 22:31:07
In reply to Re: Tolerence vs Addition of Opiods pain meds, posted by SLS on December 5, 2017, at 18:56:27
Scott how is your Mom doing? If don't mind me asking age bracket? So glad she tapered off with Tramadol. About three years ago my Neuro Spinal doctor wanted me to take Tramadol but refused the med as had read they didn't go with any AD most likely was SSRI. Wasn't controlled then and is now. Phillipa
Posted by SLS on December 6, 2017, at 6:17:44
In reply to Re: Tolerence vs Addition of Opiods pain meds, posted by baseball55 on December 5, 2017, at 20:52:48
> Opioids don't take away pain. They take you away from the pain. That's how they work.
Who taught you this? You might want to read up on the neurobiology of nociception, and how and where opioids affect it.
> Some people don't think of this as euphoria - a brightening/lift in mood - but the actual neuro-psychological effect is the same for everyone.
This logic would be more applicable were everyone's psychobiologies to be identical. They manifestly are not. I wish I could provide statistics, but euphoria is not experienced by everyone who takes oxycodone at medically relevant dosages. I have personally seen oxycodone effectively reduce pain without producing euphoria in both of the people I know who used it. Out of 10 people, how many will experience euphoria? I really don't know. If I remember, I'll discuss this issue with my mother's orthopaedic surgeon.
Regarding the rest of your post, your suppositions and theories are interesting.
- Scott
Posted by SLS on December 6, 2017, at 6:33:16
In reply to Re: Tolerence vs Addition of Opiods pain meds » SLS, posted by Phillipa on December 5, 2017, at 22:31:07
> Scott how is your Mom doing?
Mom is doing very well. Thanks for asking. She now takes Celebrex and tramadol for residual arthritic pain. The goal of the surgery was to reduce lumbar spinal stenosis. It was successful, and she can now walk for much longer distances.
If don't mind me asking age bracket?
She is 78 yrs.
> So glad she tapered off with Tramadol.
She was able to take oxycodone and tramadol at the same time, although dosing had to be separated by a minimum of four hours. Without the tramadol, I don't know if she would have been able to discontinue the oxycodone so easily.
> About three years ago my Neuro Spinal doctor wanted me to take Tramadol but refused the med as had read they didn't go with any AD most likely was SSRI.
Tramadol inhibits the reuptake of serotonin, so I guess there is concern that serotonin syndrome is a possible adverse effect when it is combined with a SSRI.
Are you taking anything for pain?
- Scott
Posted by Phillipa on December 6, 2017, at 9:06:32
In reply to Re: Tolerence vs Addition of Opiods pain meds » Phillipa, posted by SLS on December 6, 2017, at 6:33:16
Scott I take a total of 2 ibuprophen's a day both spaced 4 hours apart one with dinner and 1 before bed ( take with 1/4 banana and 1/4 cup of non fat Greek yogurt). My thoughts are that the back and neck pain during sleep will disappear which they do and wake pain free in the am. I have about what your Mother has no surgeries though. And keep cutting down on the same doses of meds I've taken for years. I have to wonder what would happen if just stopped them all one at a time. Doses are so low. 2.5mg of lexapro, under 25mg of luvox keep chipping pieces off the pill. Then the 10 mg of valium cut in half and chipped smaller also & .75mg total xanax . Half the benzos take at sleep and then when wake during the night the second half. I do know that something is giving me nightmares or just strange dreams of trying to find my home. I don't know where real home is. How strange is this? I've asked the pdoc who just writes the scripts and he acts like he has no idea. And there are is no need for a pdoc as they don't talk anymore like the old timers did. So I just continue to ride pedal bike outside 6 miles daily, and mow both leaves and grass when I can. I find the times I've out of the house are the times I feel the best. As they say getting old isn't for sissies and now 71 years old. Sorry to write so much. Phillipa
Posted by SLS on December 6, 2017, at 10:25:31
In reply to Re: Tolerence vs Addition of Opiods pain meds » SLS, posted by Phillipa on December 6, 2017, at 9:06:32
Hi, Phillipa
> Scott I take a total of 2 ibuprophen's a day both spaced 4 hours apart one with dinner and 1 before bed ( take with 1/4 banana and 1/4 cup of non fat Greek yogurt). My thoughts are that the back and neck pain during sleep will disappear which they do and wake pain free in the am.
I'm glad your experimentation led to a treatment that helps you. I am amazed that you can profit from so little ibuprofen. That's excellent. What are your thoughts on naproxen?
> I have about what your Mother has no surgeries though. And keep cutting down on the same doses of meds I've taken for years. I have to wonder what would happen if just stopped them all one at a time. Doses are so low. 2.5mg of lexapro, under 25mg of luvox keep chipping pieces off the pill. Then the 10 mg of valium cut in half and chipped smaller also & .75mg total xanax . Half the benzos take at sleep and then when wake during the night the second half.
I hope you can discontinue everything without losing quality of life.
> I do know that something is giving me nightmares or just strange dreams of trying to find my home.
Would you say that you have any kind of PTSD? You might want to research prazosin (Minipress) as a treatment for nightmares, especially if you have a history of repeated trauma early in life. For me, prazosin acts as an antidepressant, despite my not having nightmares.
https://www.google.com/search?&q=prazosin+ptsd
- Scott
Posted by Phillipa on December 6, 2017, at 17:44:00
In reply to Re: Tolerence vs Addition of Opiods pain meds » Phillipa, posted by SLS on December 6, 2017, at 10:25:31
Scott since they do nothing except when under a huge amount of stress. Seems only the benzos will allow sleep then. Last night cut down to less xanax and felt fine.
Since my BP runs low I don't feel the minipress would be a good idea. Phillipa
Posted by SLS on December 7, 2017, at 6:30:04
In reply to Re: Tolerence vs Addition of Opiods pain meds » SLS, posted by Phillipa on December 6, 2017, at 17:44:00
> Scott since they do nothing except when under a huge amount of stress. Seems only the benzos will allow sleep then. Last night cut down to less xanax and felt fine.
>
> Since my BP runs low I don't feel the minipress would be a good idea. PhillipaPrazosin is a crappy antihypertensive. It has not resulted in a drop in my blood pressure. Nor has it produced orthostatic hypotension, despite my taking a large dosage of Parante. The main concern is the body's reaction to the first few doses of prazosin. Even 1 mg can cause syncope. So, it is standard procedure to take 1-2 mg as an initiation dose immediately before going to bed. I have been taking 30 mg/day for several years. For nightmares, doctors have been using 3 mg h.s. The really smart doctors go higher and dose t.i.d. to treat the daytime anxiety and depression that accompany PTSD.
https://www.ncbi.nlm.nih.gov/pubmed/24490030https://www.ncbi.nlm.nih.gov/pubmed/24490030
- Scott
Posted by SLS on December 7, 2017, at 6:35:20
In reply to Re: Tolerence vs Addition of Opiods pain meds » Phillipa, posted by SLS on December 7, 2017, at 6:30:04
Sorry. I posted the wrong link regarding high-dose prazosin. Here is the right one.
> For nightmares, doctors have been using 3 mg h.s. The really smart doctors go higher and dose t.i.d. to treat the daytime anxiety and depression that accompany PTSD.https://www.ncbi.nlm.nih.gov/pubmed/24490030
- Scott
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