Posted by Elizabeth on February 26, 2002, at 23:45:58
In reply to Re: Addiction » Elizabeth, posted by shelliR on February 25, 2002, at 10:31:20
> The question of addiction is a very complicated one, I think.
No question about that!
> I probably had a normal reaction to oxycontin, but what is normal versus pathological, anyway?
I'm afraid that we only have DSM-IV to help us identify what's "pathological." The diagnostic criteria for "substance dependence" (i.e., addiction) appear to take into account that there is some relationship between addiction and "physical dependence" (tolerance, withdrawal symptoms), but physical dependence is neither necessary nor sufficient to define addiction. Some addicts aren't physically dependent; some people are physically dependent on a drug but are not addicted. I'm sure that this was the intent of the DSM-IV committee that came up with this criteria set.
The other criteria, of course, are fuzzy (like most DSM-IV diagnostic criteria). They obviously wanted the criteria to be strictly behavioral (to create an illusion of objectivity, I guess). I think that the subjective phenomenon that is central to drug addiction is drug craving (not just the desire to relieve withdrawal symptoms). A frequent consequence of these cravings is "drug seeking behavior": going to different doctors and pharmacies to get multiple prescriptions for the same drug, going to the other side of town early each morning to buy drugs, committing crimes to get the money to pay for the drugs, etc.
Another consequence is that it's very hard to stop taking the drug or limit one's use of it (for example, resolving that "this will be my last hit" on numerous occasions).
"Impairment" (a common DSM buzzword) is another aspect of addiction. Impairment related to drug addiction can lead to things like losing one's job, getting in auto accidents, nodding off with a lit cigarette in one's hand, etc.> I increased my dose x5 in a five month period. Still, I suppose, that doesn't clearly proof that I was addicted, but I certainly became habituated easily to that drug.
Yes, and whether or not you were addicted, I imagine that being "habituated" (good word, BTW) was hard enough. Having to keep raising the dose has to be difficult (how do you know how much to raise it and how often?), and I'm all too familiar with the fear of not being able to get needed medication.
> If you are pharmacologically dependent, and the medication is taken away from you, you probably would probably feel and do things that you otherwise would not. You might become obsessed about getting the drug.
I don't know for sure, but I have a hunch that the obsession has to do with how difficult it is to get oxycodone (or anything that would serve as a substitute). If you have to concentrate all your energy and attention (and anxiety) on something, it's easy to get obsessed with it.
> It is hard for me to clearly identify whether my difficulty in giving up methodone had to do with the resurgence of my depression or withdrawal or both.
I can understand that. May I ask what the withdrawal symptoms were for you? Buprenorphine doesn't really cause any bad w/d symptoms besides rebound depression (which seems to be a general withdrawal symptom with ADs, for me anyway).
> I am not really disagreeing with you, just saying that I don't think there is a clear distinction between addiction and being pharmacologically dependent.
Sometimes there is. I have a friend whose kid takes Adderall and clonidine for ADD. That six-year-old boy sure isn't an addict. My dad isn't addicted to his cardiovascular medications. I know a yoman who takes oral steroids for asthma; she's not addicted either. But you've got a good point that sometimes it's not too clear.
Something that might be interesting to you: when patients are taking morphine et al. for pain, they don't have much trouble tapering off it when the pain goes away. It's comparable to going off benzos: abrupt stoppage is a no-no, but if you taper off gradually (preferrably with a doctor's assistance), it's not too tough. (I was talking about this stuff with my mom earlier today. She's a biomedical ethist, and we like talking about end-of-life issues, patients' rights, and other medical ethics issues -- and of course drugs.)
> My experience with oxycontin has given me quite a scare.
I have a friend who was an addict when he was younger. He does feel like there have been long lasting changes. He has a high tolerance to opioids, higher than he had when he first started taking them. There are some other kind of weird things about him that make me wonder.
> even though I was off all opiates for six weeks, it has taken a higher dose of vicodin (than pre oxycontin) to relieve my depression, since I have resumed taking the drug in the last few days.
So now you're on Vicodin again? Are you taking it regularly, or as-needed?
> I don't think I would take opiates if they did not take away my depression. But I do like opiates, and if I had a recreational drug, it would be my drug of choice.
I don't seem to get high on them, although it's been pointed out to me that I might not be taking enough to know.
> I have ordered temgesic (sublingual bupe) from the internet and do feel a bit safer taking that because it cannot (so I read) make you high.
Depends how you define high. Personally, *I've* never been high on it. But then, I've never been high on any of 'em. What I've heard from people who have more experience with opioids than I do is that buprenorphine is qualitatively different -- full agonists can make you feel euphoric, bupe just makes you feel content. I think it will still be fine for depression.
> Also, there is no guarantee that habituation will not occur. Maybe less likely than with full opiates, but not out of the question.
I haven't had the problem, and I hope that you won't, either.
> By the way, sublingual buprenorphine is up before the FDA and should be approved soon. (Of course they have been saying that for almost two years.)
YUP!
> Also, I spoke to several of the researchers at McLean re that version of bupe, and neither thought is was less stable than the injectable bupe.
Less "stable?"
> I have been through ect, unsuccessfully, but at least it seems not to have killed too many of my brain cells. And I am exploring hormonal and other physical causes of my depression (see below post).
Eh, it's all physical.
> I think if I didn't know that opiates were an option, I could not continue to live with this pain. So whatever the risk, opiates are giving me some relief and some hope.
>
> What else are you taking with the bupe?So far it's
Effexor XR 150 mg bid
Buprenex 0.3 mg tid
Trileptal 600 mg bid
Ambien 20 mg qhs
Colace 300 mg qd
Xanax 1-2 mg prn
promethazine 25 mg prn
propranolol 20 mg prn
bethanechol 25-50 mg prnShould be enough, shouldn't it?
-elizabeth
poster:Elizabeth
thread:93100
URL: http://www.dr-bob.org/babble/20020222/msgs/95656.html