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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by 4WD on September 4, 2004, at 22:04:16
I had the first appointment with my new doc on Thursday. In the course of talking with him I told him I occasionally (once a month or so)took hydrocodone (which I get legitimately because of herniated disks).I told him that was the only time I actually felt "normal" - had an interest in doing things like working in my garden, could enjoy working a crossword puzzle, etc. I was completely honest and told him that when I have it, I take more than prescribed, recreationally. He didn't say much at the time, but later asked if I had ever taken naltrexone. I said, no, why? He said, well, it's an opiate antagonist and would bind with opiate receptors. Since you seem to have a good response to opioids (!), maybe the naltrexone would help your depression. I'd never heard of this and it sounds counter-intuitive, doesn't it?
Then, when I was about to leave, he asked me if I'd ever been on... and he names off a list of three or four drugs, one of which was nortriptyline and one of which, I think, was buprenorphine. I said no. I'd never heard of buprenorphine but in looking up naltrexone and depression, I came across buprenorphine. I read some of the posts here and read some PubMed articles.
My question is this: For someone with a weakness for opioids, well - only hydrocodone actually - would this be a good idea? Could I develop dependence? Is buprenorphine actually a good legitimate antidepressant? Would it take away my desire to take opioids to feel better?
I'd appreciate any insight.
Marsha
Posted by 4WD on September 6, 2004, at 17:45:29
In reply to Questions about naltrexone; buprenorphine, posted by 4WD on September 4, 2004, at 22:04:16
Posted by michael on September 6, 2004, at 21:11:54
In reply to Questions about naltrexone; buprenorphine, posted by 4WD on September 4, 2004, at 22:04:16
>... My question is this: For someone with a weakness for opioids, well - only hydrocodone actually - would this be a good idea? Could I develop dependence? Is buprenorphine actually a good legitimate antidepressant? Would it take away my desire to take opioids to feel better?
>
> I'd appreciate any insight.
>
> MarshaHi -
First of all, Bup is an opioid.
Second - It could be a good idea - there was someone here a while back who used it. If you search for buprenorphine & Elizabeth, you'll find a number of her posts, & probably learn a lot - she knows her stuff quite well.
Third - be thankful that you have a pdoc who is open-minded enough to consider things like this, much less bring it up himself (as opposed to you asking about it). Really thankful. Seems like many are afraid to prescribe stimulants, much less opioids... even if it doesn't work, at least he's got an open mind, & is trying to find something that'll help.
Lastly, regarding dependence - who cares? We all take our drugs (anti-depressants) every day... we're all dependent on them.
Developing a tolerance, and requiring increasingly higher doses is another matter...
However, if "X" mg of buprenorphine, bid or tid works, w/o building up a tolerance (or, poop-out?) - then consider yourself lucky to find something that works for you. (of course, that's all "IF").
Just my 2+ cents... hope it makes some sense, as well.
Good luck.
michael
Posted by 4WD on September 7, 2004, at 13:55:04
In reply to Re: Questions about naltrexone; buprenorphine » 4WD, posted by michael on September 6, 2004, at 21:11:54
> >... My question is this: For someone with a weakness for opioids, well - only hydrocodone actually - would this be a good idea? Could I develop dependence? Is buprenorphine actually a good legitimate antidepressant? Would it take away my desire to take opioids to feel better?
> >
> > I'd appreciate any insight.
> >
> > Marsha
>
> Hi -
>
> First of all, Bup is an opioid.
>
> Second - It could be a good idea - there was someone here a while back who used it. If you search for buprenorphine & Elizabeth, you'll find a number of her posts, & probably learn a lot - she knows her stuff quite well.
>thanks for the tip. I'll look it up.
> Third - be thankful that you have a pdoc who is open-minded enough to consider things like this, much less bring it up himself (as opposed to you asking about it). Really thankful. Seems like many are afraid to prescribe stimulants, much less opioids... even if it doesn't work, at least he's got an open mind, & is trying to find something that'll help.
Yeah, I was surprised. This was on my first visit to him. Of course when he asked me what I did for "fun" I started crying and couldn't stop.
> Lastly, regarding dependence - who cares? We all take our drugs (anti-depressants) every day... we're all dependent on them.
>
> Developing a tolerance, and requiring increasingly higher doses is another matter...
>
> However, if "X" mg of buprenorphine, bid or tid works, w/o building up a tolerance (or, poop-out?) - then consider yourself lucky to find something that works for you. (of course, that's all "IF").I guess that's the info I'm looking for - whether that's likely to happen.
Thanks again for responding.Marsha
Posted by michael on September 7, 2004, at 14:02:16
In reply to Re: Questions about naltrexone; buprenorphine » michael, posted by 4WD on September 7, 2004, at 13:55:04
Hi again,
Feel free to decline to answer this question, but I was wondering if you might be willing to mention what city (region?) you live in... just in case it's anywhere near me - sounds like you may have found a good pdoc, & that's not always an easy thing to do...
If you prefer not to post that info on the board, you can e-mail me at mplsmtl@uscorp.net .
Good luck, either way -
michael
Posted by 4WD on September 7, 2004, at 14:31:07
In reply to Re: Questions about naltrexone; buprenorphine » 4WD, posted by michael on September 7, 2004, at 14:02:16
> Hi again,
>
> Feel free to decline to answer this question, but I was wondering if you might be willing to mention what city (region?) you live in... just in case it's anywhere near me - sounds like you may have found a good pdoc, & that's not always an easy thing to do...
>
> If you prefer not to post that info on the board, you can e-mail me at mplsmtl@uscorp.net .
>
> Good luck, either way -
>
> michael
I live on the Alabama Gulf Coast - between Mobile, AL and Pensacola, FL.I'm not sure one of the drugs this guy mentioned was buprenorphine. I know he mentioned Naltrexone. Then when I was looking up naltrexone and depression I started finding articles on buprenorphine and the name sounded familiar. I just think it might be one of the drugs he mentioned.
Posted by michael on September 7, 2004, at 14:39:02
In reply to Re: Questions about naltrexone; buprenorphine » michael, posted by 4WD on September 7, 2004, at 14:31:07
> > Hi again,
> >
> > Feel free to decline to answer this question, but I was wondering if you might be willing to mention what city (region?) you live in... just in case it's anywhere near me - sounds like you may have found a good pdoc, & that's not always an easy thing to do...
> >
> > If you prefer not to post that info on the board, you can e-mail me at mplsmtl@uscorp.net .
> >
> > Good luck, either way -
> >
> > michael
>
>
> I live on the Alabama Gulf Coast - between Mobile, AL and Pensacola, FL.
>
> I'm not sure one of the drugs this guy mentioned was buprenorphine. I know he mentioned Naltrexone. Then when I was looking up naltrexone and depression I started finding articles on buprenorphine and the name sounded familiar. I just think it might be one of the drugs he mentioned.
>Thanks for the reply. Unfortunately for me, I'm in the twin cities region, so I guess I won't need to ask you for the doc's name, etc.
If you happen to think of it the next time that you talk to him... maybe you could see if he has any suggestions that he might refer someone to in the Minneapois/St. Paul area? Don't go out of your way... Just an idea...
Thanks again for the replies.
michael
Posted by steveb on September 7, 2004, at 15:12:13
In reply to Re: Questions about naltrexone; buprenorphine » 4WD, posted by michael on September 7, 2004, at 14:39:02
As per my post above, I've tried buprenorphine several times, and despite the fact that it was the only drug that ever offered me full remission from depression and GAD, I would STRONGLY recommend you stay away from it. It is a powerful opioid with all it's problems: side-effects, dependence, tolerance, withdrawal. I've lived through these enough times not to want to try again, despite the great feeling you get while on the drug.
All the best
> > > Hi again,
> > >
> > > Feel free to decline to answer this question, but I was wondering if you might be willing to mention what city (region?) you live in... just in case it's anywhere near me - sounds like you may have found a good pdoc, & that's not always an easy thing to do...
> > >
> > > If you prefer not to post that info on the board, you can e-mail me at mplsmtl@uscorp.net .
> > >
> > > Good luck, either way -
> > >
> > > michael
> >
> >
> > I live on the Alabama Gulf Coast - between Mobile, AL and Pensacola, FL.
> >
> > I'm not sure one of the drugs this guy mentioned was buprenorphine. I know he mentioned Naltrexone. Then when I was looking up naltrexone and depression I started finding articles on buprenorphine and the name sounded familiar. I just think it might be one of the drugs he mentioned.
> >
>
> Thanks for the reply. Unfortunately for me, I'm in the twin cities region, so I guess I won't need to ask you for the doc's name, etc.
>
> If you happen to think of it the next time that you talk to him... maybe you could see if he has any suggestions that he might refer someone to in the Minneapois/St. Paul area? Don't go out of your way... Just an idea...
>
> Thanks again for the replies.
>
> michael
Posted by michael on September 7, 2004, at 17:13:47
In reply to Re: Questions about naltrexone; buprenorphine, posted by steveb on September 7, 2004, at 15:12:13
Hi -
I admit my knowledge on this subject/med is fairly limited - probably comes mostly from Elizabeth, who used to post here, and was pretty well educated/informed... and was on Bup for a period of time. Fwiw, I thought it was supposed to be a less "powerful" opioid, and was sometimes used to wean people from other stronger ones - of course, I may be Entirely wrong on that.
My only other thought/comment is the standard ymmv - different people react differently to the same drug... Amphetamines have a bad reputation, but I take them almost daily - same dose for a few years now, and sometimes abstain for a few days at a time (w/o any withdrawal/craving/etc.).
Others have had major problems getting off of effexor, which I was able to get off of easily & quickly - within a week, two at the most...
In any case, I'm not advocating bup's use, & neither do I mean to discount your experience with it. Just trying to learn, myself... and saying that while your experience is probably more typical, others might find Bup to be just the med they need.
michael
> As per my post above, I've tried buprenorphine several times, and despite the fact that it was the only drug that ever offered me full remission from depression and GAD, I would STRONGLY recommend you stay away from it. It is a powerful opioid with all it's problems: side-effects, dependence, tolerance, withdrawal. I've lived through these enough times not to want to try again, despite the great feeling you get while on the drug.
>
> All the best
>
Posted by 4WD on September 7, 2004, at 17:58:38
In reply to Re: Questions about naltrexone; buprenorphine, posted by steveb on September 7, 2004, at 15:12:13
Thanks. I think it's too scary for me to consider. I'd probably end up abusing it. I have enough problems without developing dependence on opioids.
Marsha
Posted by steveb on September 8, 2004, at 6:50:02
In reply to Re: Questions about naltrexone; buprenorphine » steveb, posted by michael on September 7, 2004, at 17:13:47
Hi there,
I live in Switzerland and Subutex (buprenorphine) has been used here for many years to wean folks off heroin. It's preferred over other replacement therapies because of its long half-life (approx 24 hrs, so one dose a day) and because it can't be (ab)used intra-venously - pill turns granular when you try to melt it.
Subutex is used in 2 ways: 1) Withdrawal therapy: for folks getting off heroin, Subutex is administered in decreasing amounts over 2 weeks or so to alleviate heroin withdrawal symptoms; 2-3 weeks is pretty much the max before the body gets accustomed to the bup; and 2) Replacement therapy: continuous use over several weeks/months/years for long-term addicts. Here one illegal, expensive and "dirty" opiate is replaced by a cleaner and legal opioid, with full dependence & tolerance being passed from one drug to the other.
Although buprenorphine is classed as a "partial-agonist" - which means you don't quite get the same rush & "nodding-off" effect you'd get on most opiates, it is still a very powerful opioid, thus highly psychologically and physically addictive.
I agree that the "mileage migh vary" adage applies to most psycho-active drugs, particularly anti-dep or anti-anxiety drugs. But it's difficult to suggest that everyone's experience might be different on an opiate/opioid like Subutex. It's like saying everyone's experience may be different on heroin, oxycontin or morphine. Physical addiction is inevitable with all these drugs, as anyone who has ever used them can attest, and from my experience, withdrawal from Subutex is in NO WAY easier than withdrawal from any opiates - heroin, morphine, etc.
I hate knocking something as potentially useful as buprenorphine, and maybe opiate/opioid therapy is indeed the only solution for a small class of depressed folks. But if you go down this route do so with the knowledge that physical dependence will be your companion.
That is why my remaining Subutex is still in the bathroom closet, untouched now for over 12 months, and counting...
Be safe.
> Hi -
>
> I admit my knowledge on this subject/med is fairly limited - probably comes mostly from Elizabeth, who used to post here, and was pretty well educated/informed... and was on Bup for a period of time. Fwiw, I thought it was supposed to be a less "powerful" opioid, and was sometimes used to wean people from other stronger ones - of course, I may be Entirely wrong on that.
>
> My only other thought/comment is the standard ymmv - different people react differently to the same drug... Amphetamines have a bad reputation, but I take them almost daily - same dose for a few years now, and sometimes abstain for a few days at a time (w/o any withdrawal/craving/etc.).
>
> Others have had major problems getting off of effexor, which I was able to get off of easily & quickly - within a week, two at the most...
>
> In any case, I'm not advocating bup's use, & neither do I mean to discount your experience with it. Just trying to learn, myself... and saying that while your experience is probably more typical, others might find Bup to be just the med they need.
>
> michael
>
>
> > As per my post above, I've tried buprenorphine several times, and despite the fact that it was the only drug that ever offered me full remission from depression and GAD, I would STRONGLY recommend you stay away from it. It is a powerful opioid with all it's problems: side-effects, dependence, tolerance, withdrawal. I've lived through these enough times not to want to try again, despite the great feeling you get while on the drug.
> >
> > All the best
> >
>
Posted by 4WD on September 8, 2004, at 14:22:13
In reply to Subutex / buprenorphine, posted by steveb on September 8, 2004, at 6:50:02
Steve,
Thank you for your post. That was exactly what I was trying to find out. I don't think feeling good for a few weeks/months is worth the horror of coming off opiates. I know how badly I react sometimes after taking just a few pain pills over a 12 hour period - several days of severely increased depression. What's weird is that it doesn't always happen. Just maybe once in five times. But when it does, wow, it's horrible. Anyway, thanks.
Marsha
Posted by MindReseacher on September 8, 2004, at 22:23:03
In reply to Re: Subutex / buprenorphine » steveb, posted by 4WD on September 8, 2004, at 14:22:13
Hi, i just came across your post. I have been on suboxone for 8 months. To give you a brief past, i was using oxycontins and Heroin, nasally, for about 8 months, every day, up to 5-6 bags on average or 5-6 oxy 40mgs. It was total full bloan addiction, i could not stop, even after a rehab for 10 days, which i walked out of. Now i have not been on opiates that long, but the addiction to oxys and heroin ( in my opinion, are basically the same, oxys actually are worse to come off, for me. I tried, detoxing with vicodin ect, with no luck, except for eating all of them.
Now my addiction is funny. I drank alcohol for 10 yrs, but moderately, maybe 5 beers a few nights a week, and one night alot. But never felt i had a problem. I then started using ghb, which after a few months, i was using it 24/7 for 3 yrs. I thought id never stop, until i ended up in a long term rehab. I was clean of all drugs for 9 months, then for some unlucky, (very very lucky i thought at the time), a guy was giving me like 30 oxy 40mgs every 3 weeks for basically nothing. Well one 40mg turned into 2, then up to 6 or more daily, nasally. After a few months, i could not get oxys anymore, i switched To heroin nasally. Basically felt the same, except did not itch as much as oxy, H hit me quicker and did not last as long. BOTH, killed my bank account. Just in like 2 months!!
Well, in january, a friend of mine introduced me to suboxone, who was also on H. He told me how to contact a list of doctors, i found a doctor about 1 hr away from me, made an appointmet. By mid jan , or so, I got my first appointment and was perscribed 8mg's 3x daily. Which is the top dose. I worked like a dream for withdrawls, but for some people, like me, it did not elimnate all cravings and i was still missing something, feeling bored, unmotivated, not much energy or "zest for life".
I did relapse on suboxone, but dont, i repeat dont let this make you think subxone wont work for long term. Some people love em, some dont respond well. I just basically did not want to stay clean, plus I didnt know i had severe ADD.
After 2 months, my doc diagnosed me with ADD, after that test, and was persribed adderall 20mg 2x daily. Let me tell you, that hit nail on the head. I felt 80 percent better, motivated, more focus, mental function, less cravings, and seems to work "synergystically" with suboxone and a small dose of Klonopin., .5mg -1mg as needed.
THese 3 meds, along with 10mg of lexapro, kept me above water, i did not use, even though yes i did have cravings, but not as much as subxone alone, let alone without suboxone, I would probably be in rehab for another 6 months.
I believe Suboxone (IMO) is a great drug, with less abuse potential than methadone, due to the partial agonist of Mu opiate receptor, And antagonist of Kappa receptor. Some opiate "nieve" users do get "semi high" if they take 2-3 8mgs of suboxone. But an opiate tolerant person, will just become unsick, or feel normal. But with the addition of Adderall and some Klonopin, i felt so much better, all around, being depression, anxiety, social phobia, ADD, drug cravings, and life seems much much better.Now some "aa/na" members, which i must say i do attend, would say im just using another drug. Well, I can state alot of opinons and facts about drug addiction. I dont believe that just because a person is an opiate addict, will abuse every drug. I would never snort cocaine, do acid, smoke pot, drink more than 6 beers, overtake or abuse klonopin, or speed. I dont intend to nor have any craving to. So, i believe the PROPER medication to help both drug craving and Mental disorders, is at the top of the anti-drug list. Yes, Na/aa also help alot, along with family support, theorapy, and proper nutrition.
Back to suboxone. Another opinion i have. THis is due in comparison to methadone. I would say if an addict had failed several times at drug treatment, tried and failed on suboxone, also uses the drugs I.V. , well i would say Methadone would help them, keep from using Heroin oxys, etc, and would prevent such person from doing illegal drug like acts, Risk Disease via Needle usage, Keep the addict stable on methadone, just so they are not craving or wanting to use, after various other attempts. But methadone in itself is very addictive, yet is controlled, so you have to go to the clinic every day and get your dose. You cant abuse it, unless say you hide the pill, not swallowing it, or better yet, give him or her the Liquid Methadone. ETC ETC.
But for an addict, like myself, who hasnt been using opiates for very long, does not use needles, Did remain clean after 2 rehabs but relapsed, and does not do "anything" for a hit, such as committing numerous crimes , etc, suboxone can be a great option. (note this is my opinion). I have read persons who were flat out 15-20 bags i.v daily heroin addicts who quit using suboxone, and in retrospect, had persons try suboxone and puked or just got sick, and they harldy used. I seem to fall in the middle, moresoe, my ADD, and depression , seem to be a big part of the addiction puzzle.
My doctor works with me, unlike some doctors who you tell honestly you have a problem with say oxycontin, and will not even give you ambien for sleep. Well, imo, you just waisted 100 dollars, give or take, unless you have insurance, which you still may waist 15.00 plus medication costs.
I dont see how straterra would be benificial for ADD, esp severe cases. Or Welbutrin, but alot of doctors will not write you any amphetamines, or Ritalin, so you end up on Welbutrin or Straterra. Then you are persribed adarax, which is basically just antihistamine, instead of some xanax for anxiety. On top of this, you may not even get more than 8mg of suboxone. Coming off more than 5 bags or oxys, you need at least 16mgs , i would imagine from what i have researched. Then anxiety, a benzo is a must, and a good antidepressant which will cause the least side effects and work faily quickly. I do great on lexapro, at a low 10mg dose, i have no side effects and im not depressed. Zoloft also helped me with depression.To sum this up, access your problem. Get a good doctor, one who is certified to perscribe suboxone, subutex. Have a diagnoses if you suffer from any mental disorders, or dual diagnoses, work out alot, and take nutritional supplements. IF you do, say have good results with Suboxone, 8-16mg dose is a good maintenance dose ( Now i can get away with 8mgs daily), If you are depressed, get on a good antidepressant, a months worth of xanax or Klonopin for axiety would be nice, something to help sleep, like remeron, or Ambien, and if your the 80% of addictive persons who suffer from ADD, and there are 6 types, Id would say Adderall or dexadrine. If your honest, and you find your abusing adderall, or dex, tell your doc, maybe you will do ok on welbutrin or Straterra.
My regiment is currently (5 months clean)
Lexapro 10mg
Suboxone 16mg 2x daily
Adderall 30mg 2x daily (although need a 3rd dose)
Klonopin .5mg 3x daily, or 1-2 mg at bedtime.Note, the reason i mentioned the 3rd dose is because adderall for me wears off in 5-6 hrs, so i get maybe 11-12 hrs tops of adderall effects. That leaves me with another 6 hrs due tothe fact i only sleep for 6-7 hrs. But I have to talk this over with my doctor, or swith to ADDERALL XR if my insurance will pick it up.
MindReseacher
Posted by 4WD on September 9, 2004, at 21:28:00
In reply to Re: Subutex / buprenorphine, posted by MindReseacher on September 8, 2004, at 22:23:03
Thanks for all the info. I am afraid to try the buprenorphine; I'm afraid 1. I'd become dependent and then just have to suffer withdrawal 2. I'd like it too much and end up trying to abuse it.
Marsha
This is the end of the thread.
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