Posted by Elizabeth on October 25, 2001, at 12:37:44
In reply to Re: Buprenorphine (response), posted by Dr. Bob on October 23, 2001, at 11:11:01
> Buprenorphene has not been extensively studied and the long-term risks are, as of yet, unknown.
Why isn't the research being done?
> A fear still exists that some patients may get addicted to this opiate agonist/antagonist.
I'm surprised -- and disappointed -- to read this. Buprenorphine really does not cause a high. There is a pretty low ceiling on its effect; although 0.3 mg is supposed to be equivalent to 10 mg of morphine (IM), the effect of morphine continues to increase as the dose is increased, while buprenorphine reaches a plateau at a pretty low dose. So it's not much of a drug of abuse. I think that, for once, the FDA got it right when they placed buprenorphine in Schedule V. The only reason an addict might want it would be to relieve withdrawal symptoms during a "dry spell."
I've been taking buprenorphine (as an antidepressant) for a year or so. It was first suggested to me in 1996 when I was living in Cambridge. I continue to be impressed by its efficacy, especially after all the treatments that have failed. I haven't become tolerant to the antidepressant effects (although most of the side effects have subsided with time). The physical dependence seems to be mild: missing a dose of Nardil (when I was taking it, that is) was much more unpleasant than missing a dose of buprenorphine is. I don't experience "cravings," nor do I feel tempted to increase the dose. I don't know too many people who've taken buprenorphine or other opioids for depression, but I know that I'm not the only one who's had a positive experience with them. In addition to buprenorphine, there have been reports of successful treatment of depression with tramadol, morphine, methadone, oxycodone, and even oxymorphone (!).
Most people who take full-agonist opioids for pain (even chronic or long-term pain) do not become addicted to them. Shouldn't we treat depressed patients on an individual basis, rather than prejudging them as universally unreliable? My experience with depressives does not lead me to believe that they are less trustworthy than, say, cancer patients.
Some people abuse benzodiazepines. Certainly, many people abuse stimulants. No one (except a few voices on the fringe, maybe) is suggesting that these drugs should not be prescribed for anxiety, mood, sleep, and attention-deficit disorders. Opioids are the oldest antidepressants. I don't suggest that they should be a first-line treatment (mainly because of their side effects, which can be pretty harsh), but with the availability of safe, generally nonaddictive opioids like buprenorphine, how can we simply dismiss them as a legitimate form of treatment?
-elizabeth
poster:Elizabeth
thread:81497
URL: http://www.dr-bob.org/babble/20011025/msgs/82287.html