Posted by Elizabeth on May 15, 2001, at 8:47:05
In reply to Re: IS THIS FOR REAL????????? » Lisa Simpson, posted by Nichole on May 14, 2001, at 13:52:15
> First of all. I know exactly how these drugs make you feel.
"How these drugs make you feel" varies widely from person to person; most people don't particularly enjoy opioids, particularly if they stick to the relatively low therapeutic doses for common injuries and illnesses (dental work, broken bones, etc., as opposed to cancer). I once took a friend (who'd never taken any opioid before) to the ER after he suffered a knee injury; he had a *dysphoric* reaction to Percocet (whose active ingredient, oxycodone, is considered one of the more mood-elevating opioids).
> If we all start getting scripts from doctors for depression, then soon it will be much harder for people in real physical pain to get a script. They will start monitor so closely. Doctors are monitored as to what they shelve out. Hence, the lawsuits people on here mentioned. Opiates are not desined for this use.
I think that the Feds will start getting upset if this use of opioids becomes *common*. I doubt it will become common, however, because everybody seems to agree that even if it's permissible, it should be regarded as pretty much a last resort. (I noted in another thread that I personally still consider ECT to be the last resort -- that is something that really scares me, whereas I've clearly demonstrated the ability to use opioids responsibly, so there is little danger of becoming addicted, or for that matter of anything else.)
Again, I'm highly dubious whenever I hear of a patient suing a doctor for something (particularly a psych patient). Doctors who prescribe opioids for chronic use should *always* make sure the patient signs an informed consent form stating that the patient agrees to use the drug only as directed.
> Secondly, it honestly sounds like if absolutely nothing else can help them, which is bogus.. then they need a new doctor. They need to check themselves into a hospital and get help is what they need.
Been there, done that. In fact, I was in a hospital when buprenorphine came up (the *second* time it was suggested to me, BTW) as a serious option. Almost a year after I stopped it the first time (due to very annoying side effects -- *very* bad constipation, itchies, dry mouth, irregular periods, etc., and the hope that I could figure out a way to get on high dose Parnate which would presumably solve all my problems), I was started on it again when I ended up back in the hospital, about a year later. (And this was a relatively provincial hospital (I was visiting my parents at the time), not the Harvard teaching hospital where Dr. Bodkin works. They read up on it a little bit, spoke to my doctor in Boston, and decided it would be fine. Furthermore, when they saw the effect it had on me, they decided I was ready to be discharged -- they didn't label me a drug addict at all.
If you really believe that there's *always* something else that can help, please refer to my 5/12/01 response to SalArmy4me (title was "Re: Oy Vey: Opiates » SalArmy4me" -- original thread title was "Whats the best opiate for depression?" dated 5/6/01).
> If there depression is so serious that it warrants this kind of drug use, then that would be a logical sign. They'll end up there anyway.. from addiction.
There's a definite risk of that in people who have "reward deficit syndrome." This is a form of depression with significant anhedonia which is hypothesised to result from a dysfunction in the opioidergic system (since opioids are effective, it's unlikely to be due to the same morphological changes -- decreases in receptor-effector coupling -- that occur in opioid addicts). This is, IMHO, all the more reason to provide these people with appropriate medical treatment. The effects of addiction can be devastating -- particularly in countries like the US that have draconian anti-drug laws and cultural attitudes, and that choose to spend their money on law enforcement rather than on harm reduction and medical treatment.
-elizabeth
poster:Elizabeth
thread:17065
URL: http://www.dr-bob.org/babble/20010515/msgs/63056.html