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Dr. Bob is Robert Hsiung, MD,
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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
Posted by FredPotter on August 20, 2007, at 15:50:14
In reply to Panadeine Plus » FredPotter, posted by Paulbwell on August 20, 2007, at 1:47:50
Thanks Paul how's it going? I got some Nurofen Plus and took it with ordinary Panadeine but didn't notice anything. Partly I want to alleviate painful muscles but they don't seem to respond. I'm pretty undepressed at the moment so perhaps that's why I had no AD response Fred
Posted by Paulbwell on August 21, 2007, at 4:08:03
In reply to Re: Panadeine Plus, posted by FredPotter on August 20, 2007, at 15:50:14
> Thanks Paul how's it going? I got some Nurofen Plus and took it with ordinary Panadeine but didn't notice anything. Partly I want to alleviate painful muscles but they don't seem to respond. I'm pretty undepressed at the moment so perhaps that's why I had no AD response Fred
Hi,
Looking good, feeling good thanks. I hope you find a satisfactory remedy for your muscles, i wonder what treatments you have tried. Good to hear your feeling well-keep it up!
Cheers
Posted by FredPotter on August 21, 2007, at 15:20:37
In reply to Re: Panadeine Plus » FredPotter, posted by Paulbwell on August 21, 2007, at 4:08:03
Thanks Paul. I'm glad to hear you're well. Where in NZ are you? Nice weather we're having
Posted by Larry Hoover on August 27, 2007, at 20:52:19
In reply to Re: Getting Doctors to prescribe opiates, posted by confuzyq on August 16, 2007, at 20:59:38
I don't know where else to put this, but I need to vent.
My son, 15, has the sad luck of having chronic ingrown toenails. I cannot understand how he can even wear shoes. The swelling. The bleeding. The infections.
He's had doctors take the nails off three times already, so I have some idea of his pain tolerance. He handles pain better than I do. I doubt I'd be able to wear shoes with those toes.
For some reason known only to the doctors, they've refused up until now to permanently block the regrowth of the offending nails. Finally, we got a doctor to do this for him. (Their argument: "He's so young!" Uhhh....so?)
They send him home with 18 Tylenol 3s. It soon became apparent that he's got his dad's 2D6 capacity. Your liver uses 2D6 to convert some codeine to morphine, and he's getting no relief. My son was screaming through the night, banging his head on the wall to block his sensation of the pain. He chewed a hole through his blankets, clenching them in his teeth. The doctors would not prescribe anything for his pain. They didn't want to make him into an addict!
What is wrong with these doctors? 1 out of every 10 Caucasians gets no (or limited) analgesia from codeine. Asking for something else is not drug seeking. You can't get better when you're in that kind of pain.
I drove 2 hours to bring him some Percocets, and within 20 minutes his face relaxed. Another 10 and he was asleep. When he awoke a couple hours later, I had my son back.
Lar
Posted by Paulbwell on August 27, 2007, at 21:30:53
In reply to Re: Getting Doctors to prescribe opiates, posted by Larry Hoover on August 27, 2007, at 20:52:19
> I don't know where else to put this, but I need to vent.
>
> My son, 15, has the sad luck of having chronic ingrown toenails. I cannot understand how he can even wear shoes. The swelling. The bleeding. The infections.
>
> He's had doctors take the nails off three times already, so I have some idea of his pain tolerance. He handles pain better than I do. I doubt I'd be able to wear shoes with those toes.
>
> For some reason known only to the doctors, they've refused up until now to permanently block the regrowth of the offending nails. Finally, we got a doctor to do this for him. (Their argument: "He's so young!" Uhhh....so?)
>
> They send him home with 18 Tylenol 3s. It soon became apparent that he's got his dad's 2D6 capacity. Your liver uses 2D6 to convert some codeine to morphine, and he's getting no relief. My son was screaming through the night, banging his head on the wall to block his sensation of the pain. He chewed a hole through his blankets, clenching them in his teeth. The doctors would not prescribe anything for his pain. They didn't want to make him into an addict!
>
> What is wrong with these doctors?I'm sorry for your son-and he was in real physical pain! imagine the nightmare TRD patients go through when they have only found pain meds to help to work.
It's because authorities will bar an MD to practice if they discover they have scripted/more of, a pain med than the law deems acceptable, whether they're doing well or not, the laws the law, it's not medicine. It's this threat that causes Docs to withhold pain meds-even to thoes with chronic pain, the Doc is simply too scared to script them.
> I drove 2 hours to bring him some Percocets, and within 20 minutes his face relaxed. Another 10 and he was asleep. When he awoke a couple hours later, I had my son back.
>
> LarGood you were able to help him out, interesting that you were able to aquire something effective for him when he wasn't.
Cheers
Posted by Phillipa on August 27, 2007, at 21:37:00
In reply to Re: Getting Doctors to prescribe opiates, posted by Larry Hoover on August 27, 2007, at 20:52:19
Lar one of the first things they teach in nursing is that you will get written up in a hospital if you withold pain meds from a patient. This is gross and horrible for your son. I wouldn't worry about addiction as he heals his need for the pain meds will diminish. Phillipa
Posted by Quintal on August 27, 2007, at 22:06:28
In reply to Re: Getting Doctors to prescribe opiates, posted by Larry Hoover on August 27, 2007, at 20:52:19
I'm sorry to hear about your son Lar. I had a similar experience when I had cellulitis - the codeine I was given had no effect, then I figured out that might be because of the SSRI I was taking. I was given tramadol and that worked a charm, not sure if that uses 2D6 but it worked anyway.
Q
Posted by FredPotter on August 27, 2007, at 23:44:30
In reply to Re: Getting Doctors to prescribe opiates » Larry Hoover, posted by Paulbwell on August 27, 2007, at 21:30:53
I've got a friend who's a brilliant sax player who's also an amputee. They keep chopping extra bits off at the knee. He drinks to help take his mind off the pain because they won't prescribe him any pain control (oh take some paracetamol etc). And when he drinks he can can get a bit nasty. They presumably know he drinks so assume he'll abuse painkillers. Actually recently they prescribed tramadol and he seems much happier and doesn't need drink
Posted by Larry Hoover on August 28, 2007, at 19:01:19
In reply to Re: Getting Doctors to prescribe opiates » Larry Hoover, posted by Paulbwell on August 27, 2007, at 21:30:53
> Good you were able to help him out, interesting that you were able to aquire something effective for him when he wasn't.
>
> CheersI've got a good supply of oxycodone. I've got causalgia a.k.a. reflex sympathetic dystrophy a.k.a. complex regional pain syndrome. He accidentally grabbed my pill bottle by mistake, I believe.
The war on drugs mentality should not pervade in the realm of acute pain relief. E.g. my friend's mom, dying of bone cancer, denied opiates because of their addictive potential. It was near unbearable to be near her, towards the end. But what else could you do?
Lar
Posted by Larry Hoover on August 28, 2007, at 19:03:14
In reply to Re: Getting Doctors to prescribe opiates » Larry Hoover, posted by Phillipa on August 27, 2007, at 21:37:00
> Lar one of the first things they teach in nursing is that you will get written up in a hospital if you withold pain meds from a patient. This is gross and horrible for your son. I wouldn't worry about addiction as he heals his need for the pain meds will diminish. Phillipa
Oh, I'm not worried about addiction. He's just like me. He barfs if he takes too much. That was the excuse the doctor's office gave for not providing 3 day's worth of pain relief. Unbelievable.
Lar
Posted by Larry Hoover on August 28, 2007, at 19:04:55
In reply to Re: Getting Doctors to prescribe opiates » Larry Hoover, posted by Quintal on August 27, 2007, at 22:06:28
> I'm sorry to hear about your son Lar. I had a similar experience when I had cellulitis - the codeine I was given had no effect, then I figured out that might be because of the SSRI I was taking. I was given tramadol and that worked a charm, not sure if that uses 2D6 but it worked anyway.
>
> QThanks, Q. You're right, some SSRIs can inhibit 2D6. Kind of an iatrogenic (doctor-caused) form of what I have, genetically. Same outcome, though.
Lar
Posted by Larry Hoover on August 28, 2007, at 19:07:18
In reply to Re: Getting Doctors to prescribe opiates, posted by FredPotter on August 27, 2007, at 23:44:30
> I've got a friend who's a brilliant sax player who's also an amputee. They keep chopping extra bits off at the knee. He drinks to help take his mind off the pain because they won't prescribe him any pain control (oh take some paracetamol etc). And when he drinks he can can get a bit nasty. They presumably know he drinks so assume he'll abuse painkillers. Actually recently they prescribed tramadol and he seems much happier and doesn't need drink
Just what I'm talking about.....they refuse to adequately address pain, and turn someone towards self-medication.....then blame him for self-medicating, in the void they've created.
I hope your friend is luckier than most. Tramadol doesn't have a history of prolonged action. It's pretty well known for poop-out.
Lar
Posted by Cecilia on August 28, 2007, at 21:19:54
In reply to Re: Getting Doctors to prescribe opiates, posted by Larry Hoover on August 27, 2007, at 20:52:19
Larry, is hydrocodone metabolized by the same enzymes as codeine? I was prescribed Vicodin for pain but one does nothing except make me itch and two made me sick as a dog. (I find it impossible to believe that people actually take these drugs for pleasure). Anyway, if I happened to be the one in 10 who gets no relief from codeine would hydrocodone be the the same? Cecilia
Posted by Larry Hoover on August 28, 2007, at 21:41:20
In reply to Re: Getting Doctors to prescribe opiates » Larry Hoover, posted by Cecilia on August 28, 2007, at 21:19:54
> Larry, is hydrocodone metabolized by the same enzymes as codeine?
Yes, it is. Hydrocodone metabolizes to hydromorphone, using the 2D6 enzyme. That's Dilaudid.
> I was prescribed Vicodin for pain but one does nothing except make me itch and two made me sick as a dog. (I find it impossible to believe that people actually take these drugs for pleasure). Anyway, if I happened to be the one in 10 who gets no relief from codeine would hydrocodone be the the same? Cecilia
Yes, you got it right. All the side effects, but none of the good stuff.
Lar
Posted by Cecilia on August 29, 2007, at 2:34:37
In reply to Re: Getting Doctors to prescribe opiates » Cecilia, posted by Larry Hoover on August 28, 2007, at 21:41:20
Thanks Larry. Is there a blood test to determine if I'm one of the people who don't metabolize the 2D6 enzyme properly and what pain meds (and other meds, i.e. antidepressants) don't use this enzyme? (Not, of course, that I'm likely to get my HMO to order the test even it is exists, they already know I'm anxious, and are likely to just laugh at the neurotic woman bringing in info from the internet. Do you have a link to some authoritive type source I could bring in on this topic?)
Posted by Cecilia on August 31, 2007, at 2:06:45
In reply to Re: Getting Doctors to prescribe opiates » Larry Hoover, posted by Cecilia on August 29, 2007, at 2:34:37
I've been trying to find more info on this CYP2D6 enzyme, and it seems like pretty much all the pain meds and most antidepressants are metabolized by it. Which may explain why I've had no depression relief from any of the many many antidepressants I've tried and bad side effects from most. Interestingly the two that had no side effects (though no benefits either) one, celexa, doesn't appear to use CYP2D6, the other trazodone, does. The ADs with the worst side effects for me were Effexor, Cymbalta, various tricyclics and all the MAO's, Effexor, Cymbalta and tricyclics all use CYP2D6, couldn't find any info on the MAO's. As for pain meds, oxycodone, also appears to use CYP2D6, but you say it still works for people with a deficiency in this enzyme? I'm confused. I guess the 1st thing is to see if I can convince my doctor to figure out if I really am deficient in this enzyme, though it sure sounds like it from my reaction to Vicodin. I've given up hope of ever finding anything that would work for depression, but it sure would be nice to be in less pain from my severe arthritis. Cecilia
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