![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by sdb on April 29, 2005, at 19:32:37
Hi!
Tramadol, Oxycontin, codeine, buprenorphine...
Any personal experience? -is there a long term success story? Drug combos?
Thanks for every response
Posted by BIGDaddyachmed69 on April 30, 2005, at 1:51:34
In reply to Best Opioids for social fear? - Experiences, posted by sdb on April 29, 2005, at 19:32:37
> Hi!
>
> Tramadol, Oxycontin, codeine, buprenorphine...
>
> Any personal experience? -is there a long term success story? Drug combos?
>
>
> Thanks for every responseCodeine put me to sleep...maybe it was too high of a dose...four times the recommended dose...yeah, that was too high. It reminded me of Xanax though, the feel of it, as it was putting me to sleep. If you find Xanax helpful for social fear, as I do, then I would consider trying codeine. Good luck finding a psychiatrist who will actually prescribe an opiate.
Posted by pro_social_soon on April 30, 2005, at 7:29:23
In reply to Best Opioids for social fear? - Experiences, posted by sdb on April 29, 2005, at 19:32:37
> Hi!
>
> Tramadol, Oxycontin, codeine, buprenorphine...
>
> Any personal experience? -is there a long term success story? Drug combos?
Tramadol - one of the best things Ive tried for social fear + pro-sociability, unfortunately I have to use it from time to time because if I use everyday-it loses its effect.Codeine- tried once, 300mg, just put me to sleep+drowsiness etc. Not at all pro-social.
Heroin - no way this could be useful for social-fear. It just numbs you and you dont care about anything.
Oxycontin - Ive heard its a good social lubricant, never tried it, but probably you would have to also use it from time to time.
Posted by reefer on April 30, 2005, at 10:07:00
In reply to Best Opioids for social fear? - Experiences, posted by sdb on April 29, 2005, at 19:32:37
I can't really answer your question since i'm not socially anxious. But i've been on buprenorphine since November last year. I take between 0.5 and 1.0 mg per day intranasally. This would equal to about 30 - 60 mg Per Oral morphine per day. This drug seems to self regulate in me. I just notice that sometimes a 8 mg Subutex lasts me 1 week and sometimes it lasts me 2 weeks. It seems impossible for me to build up a tolerance for this drug even long term. So i would recommend you try it, it seems to be a very safe opiod. Very mild withdrawal when getting off it completly.
Posted by Declan on April 30, 2005, at 19:56:35
In reply to Re: Best Opioids for social fear? - Experiences, posted by reefer on April 30, 2005, at 10:07:00
The ones that would be best for me are those that are least confusing (if I can put it like that). Oxycodone, methadone, pentazocine are all a little blurry like that. Hydrocodone was good. And Dilaudid.
Declan
Posted by Paulbwell on May 1, 2005, at 16:44:08
In reply to Re: Best Opioids for social fear? - Experiences, posted by Declan on April 30, 2005, at 19:56:35
> The ones that would be best for me are those that are least confusing (if I can put it like that). Oxycodone, methadone, pentazocine are all a little blurry like that. Hydrocodone was good. And Dilaudid.
> Declan
Hi,OMG, Dilaudid for social anxiety?, will a Doc actually script This Med for social anxiety? at what dose?
Cheers
Posted by Chairman_MAO on May 2, 2005, at 9:48:24
In reply to Best Opioids for social fear? - Experiences, posted by sdb on April 29, 2005, at 19:32:37
Oh, my, buprenorphine, definitely! I feel energized yet calm and centered most everywhere I go, and I have never stood up taller than I do now that I am on it. This drug is one of the best things that has every happened to me. Seriously, I try to pray to God every morning in thanks for my daily 16mg of Suboxone--and I'm not even religious! It also works within 1-3 days for many people; no waiting several weeks.
IMHO, it should be FIRST-LINE for many depressive and anxiety disorders. Try it; you won't go wrong.
Posted by Chairman_MAO on May 2, 2005, at 9:51:58
In reply to Re: Best Opioids for social fear? - Experiences, posted by reefer on April 30, 2005, at 10:07:00
The dose equivalence is 0.3mg IV/IM is equal to 10mg parenteral morphine. The ceiling is typically taken to be the equivalent of 30mg of morphine. This works out to 4mg of sublingual buprenorphine producing the maximal effect; beyond that you probably don't get much additional mu stimulation; beyond 24-32mg/day, it probably starts acting more as an antagonist.
Posted by ed_uk on May 2, 2005, at 10:58:53
In reply to Re: Best Opioids for social fear? - Experiences » sdb, posted by Chairman_MAO on May 2, 2005, at 9:48:24
Hi,
>Try it; you won't go wrong.
But........
Get an anti-emetic for the first few days of treatment, buprenorphine often makes people throw up..............tolerance to this effect usually develops quite fast. Some cyclizine might do the trick.
Ed.
Posted by EERRIICC on May 3, 2005, at 0:28:02
In reply to Re: Best Opioids for social fear? - Experiences » sdb, posted by Chairman_MAO on May 2, 2005, at 9:48:24
Following the results of the "Bodkin study" I tried lower doses of buprenorphine, 0.2-0.8 mg of temgesic, with little effect, should I assume that a higher dose will work better? What is the target dose range for treating depression?
Eric
Posted by sdb on May 3, 2005, at 16:48:22
In reply to Re: Best Opioids for social fear? - Experiences » Chairman_MAO, posted by EERRIICC on May 3, 2005, at 0:28:02
Hi chairman_MAO!
Unfortunately buprenorphine/Temgesic/Trancylpromine/Phenelzine is not available in our country. Whats your chemical broker -> xxx
Kind regards
sdb
Posted by Chairman_MAO on May 3, 2005, at 19:42:59
In reply to Re: Best Opioids for social fear? - Experiences » Chairman_MAO, posted by EERRIICC on May 3, 2005, at 0:28:02
I really think this is a highly individualized thing. I know for me that those dosages would've done virtually nothing. The only other thing I can think of is maybe you aren't taking the tablet right, but if you're leaving it under your tongue for 10+ minutes and minimizing swallowing, you're doing fine ...
Of course, I am less sensitive to opioids than most people are, I think. Perhaps that has something to do with why they're so helpful for my psych. problems.
Posted by Chairman_MAO on May 3, 2005, at 19:52:23
In reply to Re: Best Opioids for social fear? - Experiences » sdb, posted by pro_social_soon on April 30, 2005, at 7:29:23
There is little reason to assume that heroin would be of "no use". Rather, I think what you're saying is that _at the doses commonly used for pain/euphoria_ iit wouldn't help. Some people exist in a natural state where they feel numb and don't care about anything UNLESS they take potent opioids like heroin. Everyone's different.I think buprenorphine is best to start with for many reasons, including:
1) Less (or no) tolerance develops to the effect
2) impossible to OD on it without adding other CNS depressants
3) Milder side effects for me at least
4) Kappa antagonist, which could be anxiolytic/antipsychotic in its own right.
Posted by scatterbrained on May 3, 2005, at 20:20:15
In reply to Re: Best Opioids for social fear? - Experiences » pro_social_soon, posted by Chairman_MAO on May 3, 2005, at 19:52:23
So from your experience tolerance doesn't develop? Have you tried stims and found them to wear off?
Posted by jerrympls on May 3, 2005, at 22:40:08
In reply to Best Opioids for social fear? - Experiences, posted by sdb on April 29, 2005, at 19:32:37
I'm on hydrocodone for depression. yes, I have a pdoc who finally prescribed it for me. However, I'm wondering if buprenorphine would work better???? Any literature anyone can point me to?
Thanks
Jerry
Posted by Dr. Bob on May 3, 2005, at 23:20:36
In reply to Re: Best Opioids for social fear? / Chairman_MAO, posted by sdb on May 3, 2005, at 16:48:22
> Whats your chemical broker -> xxx
Please don't use this site to exchange information that could be used to import into the US prescription medication without a prescription. This came up before, so I'm going to block you from posting for a week.
If you or others have questions about this or about posting policies in general, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#illegal
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration. Thanks,
Bob
Posted by Chairman_MAO on May 5, 2005, at 20:09:52
In reply to Re: Best Opioids for social fear? - Experiences » Chairman_MAO, posted by scatterbrained on May 3, 2005, at 20:20:15
I've only noticed a tolerance to feeling "high" and nodding off while sitting down. I sure don't mind that going away, as it's not too conducive to being social!
But otherwise, yes, no tolerance to the pro-social effect. Indeed I have tried stimulants and found them to wear off. All in all I've had less than optimal results with amphetamine with everything I tried it for. No one will prescribe it for me now because I go to a public clinic, but honestly I think I get better relief from residual inattentive ADD-like symptomology (I think what I have is more properly termed dysthymia and/or a "reward deficiency syndrome") from pramiracetam than I did from stimulants.
Posted by Chairman_MAO on May 6, 2005, at 9:53:57
In reply to Re: Best Opioids for social fear? - Experiences, posted by jerrympls on May 3, 2005, at 22:40:08
I would definitely go with buprenorphine for depression first. You see, buprenorphine is a kappa antagonist; dynorphin stimulation of the kappa receptor can induce depression and dysphoria via inhibition of DA release in the VTA (the picture I'm sure is more complicated than my understanding of it). That is the opposite effect of the mu-1 receptor, stimulation of which releases more DA in the VTA (sounds like a rap lyric, doesn't it?)I'm not positive, but hydrocodone I think has kappa agonist activity. Buprenorphine is also a mu partial agonist, which means that it can stimulate the mu (euphoriant/mood boosting/analgesic) receptor to a point past which it does little more, and then in higher doses still, acts as an antagonist. Thus, it has virtually no abuse potential except in opioid-naive users, who will build a tolerance to the "nod", etc. within 3-5 days and will not be able to escalate the dose any higher as they could with traditional opioids (although the "ceiling" dose is equivalent to 30mg IV morphine, so it's not as if it is THAT weak, heh). Buprenorphine's mechanism of action is extraordinarily complex and a full account is somewhat beyond my understanding of the subject and way beyond the scope of psychobabble.
I tend to think of buprenorphine as an "opioid system stabilizer" first and an analgesic second. That is, it does have activity that's like traditional opiates/opioids, but it also has a pharmacological profile that allows it to provide a limited yet sustainable mood boost while minimizing the risks, such as dependence and respiratory depression. It's really phenomenal stuff for psychiatric problems.
You can always switch to something "stronger", but I'll bet you'd find buprenorphine more effective in the long run. You'd probably also experience fewer side effects. After being at the ceiling dose for 2 weeks (been on it for about 5 weeks now), I barely even have any constipation or any S/E from it at all.
I believe it also is devoid of the endocrinological side effects common with many other opioid drugs, such as methadone, but you'll hvae to double check on that one.
> I'm on hydrocodone for depression. yes, I have a pdoc who finally prescribed it for me. However, I'm wondering if buprenorphine would work better???? Any literature anyone can point me to?
>
> Thanks
> Jerry
Posted by Declan on May 7, 2005, at 1:55:54
In reply to Re: Best Opioids for social fear? - Experiences » jerrympls, posted by Chairman_MAO on May 6, 2005, at 9:53:57
Hi everyone
What do you see as the difference, in the way it feels as well as the pharmacology, between buprenorphine and low dose methadone? I've spent *years* getting down to 1.25mg methadone/day. (Taper your way out of that!)
Declan
Posted by reefer on May 7, 2005, at 9:46:28
In reply to Re: Best Opioids for social fear? - Experiences » reefer, posted by Chairman_MAO on May 2, 2005, at 9:51:58
Would it be ok to use a non-benzodiazepine hypnotic while using bupe? Like Zopiclone?
Posted by Chairman_MAO on May 7, 2005, at 12:42:04
In reply to Re: Best Opioids for social fear? - Experiences, posted by Declan on May 7, 2005, at 1:55:54
Methadone is a full mu (and I believe delta and kappa, too) agonist. Buprenorphine is a partial mu agonist and a kappa antagonist. Kappa stimulation can cause dysphoria other undesirable effects.
Honestly, at 1.25mg methadone, you really should just bite the bullet and try to switch to buprenorphine. 16-24mg/day of buprenorphine, IIRC, has been shown to be just as effective (not necessarily equipotent, but because of bupe's action and consequent longer-term effect on the receptors, I'm not sure you can make such an absolute potency comparison casually) as 90mg of methadone as keeping addicts in treatment ...
The main difference is methadone "feels" like an opioid--you get that "warmth", etc. Buprenorphine, after a while, feels like I'm taking nothing, except for the profound relief from dysthymia I Experience, heh.
Notwithdstanding the fact that such "treatment" is really just a government-sanctioned recapitulation of the drug dealer on the corner schema ...OK, I'll try to get off the soapbox before I start, but the fact that it is easier to cop heroin than get buprenorphine gets me really irate. I was initially refused a Suboxone prescription because I didn't test positive for opioids. It was only after I gave the doctor my signed treatment history and an affadavit from my girlfriend stating I have had addiction problems and psychiatric problems that the doc I get my bupe from was willing to prescribe. My shrink's supervisor at the clinic I go to actually is licensed to Rx bupe, but he had reached the government's arbitrary 30 patient prescribing limit, so I had to go to a methadone clinic to get it! I have to play it off like the reason I want to stay on "maintenance" is due to cravings/not wanting to "use", but honestly the main reason is that it treats my dysthymia and thus I don't have cravings or want to hurt myself!
It's like they truly want to keep the people that need opioids as miserable as possible. I am done complaining about the clinic, though, because spiritually I am so grateful to have this medication I don't care what I have to do to get it. At least I have it.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.