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Dr. Bob is Robert Hsiung, MD,
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Posted by Quintal on August 14, 2007, at 4:48:33
In reply to Re: responce to misunderstanding, posted by linkadge on August 13, 2007, at 21:55:27
No problem link. I'll connect the two threads since what I posted to you on the opiate thread is much the same as what I'd like to say in response to your post here.
http://www.dr-bob.org/babble/20070808/msgs/776148.htmlQ
Posted by FredPotter on August 14, 2007, at 15:30:08
In reply to Re: responce to misunderstanding » linkadge, posted by Quintal on August 14, 2007, at 4:48:33
Right so how do we manage this? In this country they mix codeine and paracetomol in a cunning ploy to prevent the codeine doing anything, since paracetomol is dangerous, but codeine not particularly. I think there needs to be a shift away from the notion that the greatest harm a Dr can do is make a patient an addict. In my view there is greater harm, viz removing one's sex life, causing weight gain and even diabetes, and worst of all allowing a hypocampus-shrinking condition like depression to continue
Fred
Posted by Quintal on August 14, 2007, at 18:57:02
In reply to Getting Doctors to prescribe opiates » Quintal, posted by FredPotter on August 14, 2007, at 15:30:08
I'm not sure how you'd go about asking a doctor to prescribe you opiates for depression. I suppose you could take along one of those bupe studies if you think that would help. I think you'd need to have a pretty good relationship with your doctor for them to seriously consider something like this, obviously. I have a feeling that by far the majority would still refuse though.
In your country there is a high-strength preparation of dihydrocodeine and paracetamol called Panadeine, more info here: http://forum.opiophile.org/showthread.php?p=152432#post152432. I use a similar one called Paramol. I combine it with an ibuprofen-based codeine preparation called Nurofen Plus, I don't know if you can get it where you live. You need to use high-strength preparations because those 8mg tablets are useless for most people, though personally I can detect the effect of 16mg codeine.
You could always try for some real grown-up strength ones by developing the old bad back, or arthritis pain. Tramadol is an interesting opiate having SNRI-like action, and I prefer it to codeine.
Q
Posted by Quintal on August 14, 2007, at 19:01:21
In reply to Re: Getting Doctors to prescribe opiates » FredPotter, posted by Quintal on August 14, 2007, at 18:57:02
Sorry Fred, Panadeine actually contains codeine, not dihydrocodeine - had my wires crossed. Good news is that it contains 15mg per tablet according to this article and Wiki: http://forum.opiophile.org/showthread.php?t=7098.
Q
Posted by FredPotter on August 14, 2007, at 20:41:04
In reply to Re: Getting Doctors to prescribe opiates » FredPotter, posted by Quintal on August 14, 2007, at 18:57:02
Yes you're right we have Panadeine and Nurofen. Unfortunately I've never noticed anything when I take them. They can't even take away a headache
Posted by Quintal on August 14, 2007, at 21:01:53
In reply to Re: Getting Doctors to prescribe opiates » Quintal, posted by FredPotter on August 14, 2007, at 20:41:04
Yes, it's unfortunate you've had such a poor response to them Fred. They can take away a headache. They work for me. Have you taken them together?
Q
Posted by linkadge on August 14, 2007, at 21:56:13
In reply to Getting Doctors to prescribe opiates » Quintal, posted by FredPotter on August 14, 2007, at 15:30:08
>In my view there is greater harm, viz removing >one's sex life, causing weight gain and even >diabetes, and worst of all allowing a hypocampus->shrinking condition like depression to continue
Bingo. And who says you can't become an SSRI addict? There are certain consumer driven rating systems that rank SSRI's more difficult to quit than opiates.
For the 2 cents it is worth restating, I have gone on and off opiates before, one time upto 120mg codine a day (Wisdom teeth), and found SSRI withdrawl to be more profound.
I honestly think this is why some doctors are revisiting the idea. They may be thinking that all thing considered, its worth a shot.
There is a lot more history devoted to the use of opiates for depression than there is SSRI's.
It took us 100's of years to conlcude the opiates were habbit forming, but only 20 years to conlcude the same about SSRI's.
Linkadge
Posted by linkadge on August 14, 2007, at 21:58:18
In reply to Re: Getting Doctors to prescribe opiates » FredPotter, posted by Quintal on August 14, 2007, at 18:57:02
It is not hard possable to separate the codiene from the ASA or tylenol.
I cannot say more as I am not sure about board pollicies on such issues.
Linkadge
Posted by FredPotter on August 14, 2007, at 23:04:07
In reply to Getting Doctors to prescribe opiates » Quintal, posted by FredPotter on August 14, 2007, at 15:30:08
Sorry of course I meant "hippocampus". In "Against Depression" Peter Kramer devotes a large part of his writing to describing the physical changes in depression eg hippocampal shrinkage and decrease in glia cells in the pre-frontal cortex. Perhaps if a Dr can appreciate the physical harm correlated with depression, s/he might be more impressed than by the usual depressed persons' complaining and see opiates as a viable alternative. I'm not clear if the physical effects cause the depression, are caused by it, or are merely associated or if they have a functional relationship (a two-way effect) Fred
Posted by FredPotter on August 14, 2007, at 23:09:26
In reply to Re: Getting Doctors to prescribe opiates » Quintal, posted by Quintal on August 14, 2007, at 19:01:21
ah I'm been taking a generic with only 8mg
Posted by Quintal on August 15, 2007, at 1:09:49
In reply to Re: Getting Doctors to prescribe opiates » Quintal, posted by FredPotter on August 14, 2007, at 23:09:26
The Paramol + Nurofen Plus combo contains the equivalent of ~50mg codeine in total. Because codeine needs to be metabolized in vivo there's a ceiling effect to the amount that can be processed as a single dose, and 60mg is usually given as that amount. So we're getting pretty close to that using my combo, and if you can metabolize codeine properly (some people lack the enzyme) then you should feel some effect at that dose. If you can't, then you may be deficient in the liver enzyme CYP2D6, which according to Wiki, is the one that does all the donkey work in converting codeine into morphine.
Q
Posted by Quintal on August 15, 2007, at 1:29:22
In reply to Re: Getting Doctors to prescribe opiates, posted by linkadge on August 14, 2007, at 21:56:13
>It took us 100's of years to conlcude the opiates were habbit forming, but only 20 years to conlcude the same about SSRI's.
I'm not aware of any research that concludes SSRIs are habit forming. It's been known since time immemorial that opium is habit forming. There were some spurious claims about lack of addiction potential of morphine when it was first isolated, but that was disputed fairly quickly. It's been a pattern repeated with cocaine, barbs, amphetamines and benzos.
>For the 2 cents it is worth restating, I have gone on and off opiates before, one time upto 120mg codine a day (Wisdom teeth), and found SSRI withdrawl to be more profound.
Some questions link. How long were you taking codeine for? How long were you taking SSRIs for? How did you withdraw from each? This feels like a recurring theme.
>I am permitted to take upto 1mg of clonazepam on a daily basis.
Incidentally, if you are permitted to take up to 1mg clonazepam as required, why did you need to go to the ER for three nights of insomnia? Did the clonazepam not work?
http://www.dr-bob.org/babble/20070604/msgs/762423.htmlQ
Posted by Jamal Spelling on August 15, 2007, at 2:26:05
In reply to Re: Getting Doctors to prescribe opiates, posted by linkadge on August 14, 2007, at 21:56:13
> It took us 100's of years to conlcude the opiates were habbit forming, but only 20 years to conlcude the same about SSRI's.
With all due respect, Linkadge, I don't think it is generally accepted that SSRIs are habit forming. At best, they are recognised to have a discontinuation syndrome associated with them, which, I admit, is just a euphemism for withdrawal.
Jamal
Posted by confuzyq on August 16, 2007, at 20:59:38
In reply to Re: Getting Doctors to prescribe opiates » FredPotter, posted by Quintal on August 14, 2007, at 18:57:02
> I'm not sure how you'd go about asking a doctor to prescribe you opiates for depression. I suppose you could take along one of those bupe studies if you think that would help.
Yup, that's how it's done, it can work, did for me (tramadol). But actually there are quite a few seeds of earlier tramadol studies to be found at reliable sources; involving reputable researchers; whose findings were going in encouraging directions, to bring along also. Chances of succeeding are much better at someplace like a teaching hospital/research center also.
This may be a stretch but I even read once that chances can be better if you not only go someplace like the above, but to a pdoc there who specializes in addiction. Since, they may feel more in control, more capable of being able to spot any signs of trouble at any point. I get the logic of that, but don't know how well it translates in reality.
Aside from being able to show a "highly evolved" pdoc at least a decent amount of credible evidence, someone like that will probably also understand and factor in that a big part of why tramadol (for depression and/or OCD and more) research stopped going anywhere wasn't because early indications weren't encouraging, but because no one was willing to pay for it anymore. Since, little money could have been made from it either way anymore, as it was already out in generic form.
But yes, true that "by far the majority would still refuse though." And I'd imagine, almost definitely if it was anything besides tram or bup.
Posted by jhj on August 18, 2007, at 4:06:55
In reply to Re: Getting Doctors to prescribe opiates, posted by confuzyq on August 16, 2007, at 20:59:38
If i were to ask my Pdoctor to give me Opiates and somebody informs the Police about our conversation,both of us would be find ourselves behind the bar.
Posted by confuzyq on August 18, 2007, at 12:11:11
In reply to Re: Getting Doctors to prescribe opiates, posted by jhj on August 18, 2007, at 4:06:55
>
> If i were to ask my Pdoctor to give me Opiates and somebody informs the Police about our conversation,both of us would be find ourselves behind the bar.Not in the U.S. It wouldn't be illegal, unless your doc was charged with and found guilty of acting as a mere drug dealer, prescribing when there was little rationale for it, or in quantity. But you, you would have a legal prescription from someone who was a licensed doc at the time.
But sure if you literally just walked in and asked a pdoc for an opiate, you may be seen as drug-seeking; and if he just gave it to you without knowing you or using much criteria for the decision, he could end up being seen as a doc who doesn't use his privilege lawfully enough.
So of course legalities can be related, such as the doc worrying what the DEA may think of a practice. While we hear occasional horror stories of docs being unfairly accused of basically acting as drug dealers, it's not that prescribing (in this case) an opiate in itself was illegal. Obviously a lot of careful judgment and moderation has to be used in the prescribing.
Posted by kingcolon on August 18, 2007, at 19:12:52
In reply to Re: Getting Doctors to prescribe opiates, posted by confuzyq on August 18, 2007, at 12:11:11
Here's an article from Elle magazine that another member referred to in a previous post. It's amazing that a Harvard psychiatrist who did a pioneering study on buprenorphine for depression would not prescribe it for this case of refractory depression because she wasn't an addict and doing so would be off-label dispensing of an opioid, which could arouse the DEA.
http://www.elle.com/featurefullstory/11334/beyond-the-valley-of-the-dolls.html
Posted by confuzyq on August 19, 2007, at 3:10:28
In reply to Re: Getting Doctors to prescribe opiates, posted by kingcolon on August 18, 2007, at 19:12:52
Fabulous article kingcolon, just fabulous. Thank you. (Read all 13 pages!) So many things I could say, but for now suffice to say... I am of the mind that it's pure insanity to consider the perils of carefully controlled opiate usage for treatment resistent depression any worse than those suffered from "approved," mainstream meds. The only other thing I will add at this time is... GRRRRR! ;-)
> Here's an article from Elle magazine that another member referred to in a previous post. It's amazing that a Harvard psychiatrist who did a pioneering study on buprenorphine for depression would not prescribe it for this case of refractory depression because she wasn't an addict and doing so would be off-label dispensing of an opioid, which could arouse the DEA.
>
> http://www.elle.com/featurefullstory/11334/beyond-the-valley-of-the-dolls.html
>
>
Posted by confuzyq on August 19, 2007, at 15:47:09
In reply to Re: Getting Doctors to prescribe opiates, posted by jhj on August 18, 2007, at 4:06:55
Ah, ok I just saw down below that you are in India. So my U.S. opiate prescribing legality post will not have been helpful obviously. :-)
>
> If i were to ask my Pdoctor to give me Opiates and somebody informs the Police about our conversation,both of us would be find ourselves behind the bar.
Posted by Paulbwell on August 20, 2007, at 1:47:50
In reply to Re: Getting Doctors to prescribe opiates » Quintal, posted by FredPotter on August 14, 2007, at 20:41:04
> Yes you're right we have Panadeine and Nurofen. Unfortunately I've never noticed anything when I take them. They can't even take away a headache.
Yes here downunder you can get OTC:
-Codeine #2 (USA), called Panadeine+ =15mgs Codeine + 500mgs Paracetamol.
-Nurofen Plus=13mgs Codeine + 200mgs Ibu. They have recently changed the formulation after health ministry requests, because too many people found out the two sides were simply stuck together, and would split them, therefore taking a large dose of Codeine only, i'm sure to the companies reluctance-and sales.
Posted by Quintal on August 20, 2007, at 2:09:25
In reply to Panadeine Plus » FredPotter, posted by Paulbwell on August 20, 2007, at 1:47:50
I've heard of this, but I could never see any dividing marks on my tablets, and I forgot which side was supposed to contain the codeine. When did they alter the formulation?
Q
Posted by Paulbwell on August 20, 2007, at 2:17:19
In reply to Re: Panadeine Plus » Paulbwell, posted by Quintal on August 20, 2007, at 2:09:25
> I've heard of this, but I could never see any dividing marks on my tablets, and I forgot which side was supposed to contain the codeine. When did they alter the formulation?
>
> QHey,
I remember hearing it on TV about 2 years ago i think, where people were being interviewed who had become dependant.
Cheers
Posted by Quintal on August 20, 2007, at 2:27:38
In reply to Re: Panadeine Plus, posted by Paulbwell on August 20, 2007, at 2:17:19
Considering the motives most people would have for isolating the pure codeine, are you sure they weren't addicted? Do you know if the company altered the formulation in the UK?
Q
Posted by Paulbwell on August 20, 2007, at 2:37:47
In reply to Re: Panadeine Plus » Paulbwell, posted by Quintal on August 20, 2007, at 2:27:38
> Considering the motives most people would have for isolating the pure codeine,
They didn't 'isolate' the Codeine so much, as in they showed someone, very quickly and easily, spliting a whole pack, then taking it.
are you sure they weren't addicted?
Well the item said so much....
Do you know if the company altered the formulation in the UK?
Don't know about UK, but aparently the company who made them there used to produce the tabs in two different half colours, white and pink, which they soon changed to all white.
Cheers
>
> Q
Posted by Quintal on August 20, 2007, at 2:38:36
In reply to Re: Panadeine Plus, posted by Paulbwell on August 20, 2007, at 2:37:47
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