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Here's a cross post from the addiction and recovery thread:The_Book_Of_Harry posted:After years of active addiction, 3x28-day rehab (2008, 2011, 2014), a couple outpatient programs, hundreds of *A meetings, hundreds of hours reading, writing, studying and reflecting, I finally embarked on a winning strategy that is working for me. I was raised in a great home by loving parents, in the good suburbs. I went to prep school and an Ivy, but depression and addiction were stronger than the will to be a citizen. I turned to coke and alcohol in college, continuing and diversifying my vices when I moved back home. Soon enough, plentiful and cheap oxycodone and oxymorphone were my obsession. Eventually, heroin became cheaper and more accessible, so it was a no-brainier  to make the switch.Ugh.... ------------------ Legalize. Heavily regulate. Treat.
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Feb 29, 2016 21:44
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Beaters posted:I used to work with lots of docs and medical researchers. This gem came from some random doc several years ago. Lol. I also have a copy of that pen, acquired when I worked for a pharmacy. ------- Re: suboxone/methadone and impairment I take 60mg methadone qd, and I feel exactly the same 24/7 There is no high/buzz whatsoever at a maintenance dose for me. If you offer an addict a choice of a needle full of either dope or buprenorphine/methadone, 997/1000 will choose the dope. I've injected 32mg of bupe in an hour and felt nothing other than "not in withdrawal" back when I was prescribed 3.5 of the 8mg tablets qd. When I was opioid-naive, I took a partial bupe tablet and became embarrassingly impaired. ..... The opioid-maintained addiction patient is similar to the well-maintained psychiatric patient. Sure, we NEED our medicine, but that minor inconvenience literally saves our lives and livelihoods, with a community net benefit.
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Feb 29, 2016 22:01
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Cugel the Clever posted:Watching the Frontline episode on the Opiode epidemic and it's reaffirmed my As a former junky, I can absolutely say that I would have signed-up for something like that. An overdose of opioids/benzos can be manufactured for next to nothing, and it would save communities tons of money. I don't see assisted suicide as being politically feasible, though. And most hardline junkies don't really want to die, they just want to find a way to stay high constantly. Protip: it's nearly impossible. Dope always costs exactly as much as you have. That said, there are huge swaths of addicts who will be nothing but a burden on the system til they die. And treating people who can't or won't change (even when they really want to) gets really expensive. Even putting everyone on blockers like methadone or bupe only works when people make other lifestyle changes...like attending therapy, shifting to new people, routines, spaces, etc. The only real answer seems to be legalization and regulation, with easily accessible treatment (I prefer medication and science-based treatments moreso than 12-step/spiritual methods, but they can co-exist). Jail is expensive and doesn't help. Legal drugs lower prices and reduce external harm. Suicide booths are always an option, I guess. But there should be a psychiatrist and a methadone clinic right next door...
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Mar 1, 2016 02:33
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More like MarkR It's a lot like craigslist, but with more drugs and risk!
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Mar 8, 2016 15:04
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KingFisher posted:Sorry I just don't get it. If just getting through withdrawal led to cleanliness, jails might be useful. If it were simple, rehabs would post better than the 90% failure rates that are currently common. The best explanation I've seen is in a film called "Pleasure Unwoven" which makes a very convincing argument that "addiction is a disease OF choice." This is to say that the addict does not make choices like other people, because their brains are hijacked and reprogrammed through the drug dependence. I see where you might think what you do, but it's a very naive viewpoint.
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Mar 18, 2016 04:49
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Today in group at the methadone clinic, I pitched the idea of government-sponsored suicide booths for junkies. Votes were 12/12 against.
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Mar 28, 2016 16:11
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Your Dunkle Sans posted:Does that pay the rent? If you can afford a spot with a yard (as a recovering addict), you probably will have a commute that requires a well-maintained, insured, registered vehicle. Which means you need a steady job with decent pay. There are more than a couple companies willing to take the risk of hiring employees "in recovery." Understandably, though, many of these companies want the applicant to have achieved years of stability. This puts people in the sort of situation where I am...grinding at a low-wage job that barely makes ends meet. Eventually, I might be able to save for reinstating my license, buy a car/etc, but it's going to rely on my patience, thrift and health...not all of which is solely under my control. Many of my peers can do everything I am, still never escaping abject poverty. Far too many people get where I am and say, "my situation is arguably worse than when I was strung out! I'm still overworked, stressed and broke...without my dope! I might as well go back to the needle...one last time...gently caress it!" And just that easily, the downward spiral returns. Without some sort of HOPE or serious mindfulness practice, abstinence-alone is not enough to create meaning and value in people's lives.
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Mar 28, 2016 19:13
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Your Dunkle Sans posted:I agree and sympathize with your situation. Although I am not an addict, I am stuck with two dead end menial jobs and I'm working on escaping that poverty trap. I'm still young(ish), but plenty of my peers have a decade+ on me, in addition to a kid or more. Good fuckin' luck, ya know?
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Mar 28, 2016 20:26
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PT6A posted:That's not good. Fentanyl is pretty much the perfect way to execute the "what if we just let addicts off themselves?" plan from a while back. Around here, they're saying that a lot of fentanyl is being produced by Chinese superlabs, but I don't know how accurate that is. Very few junkies do fentanyl only. Not only is it far less euphoric than other opioids, it's far more scarce in the market. I've done it maybe a dozen times, and I greatly preferred regular dope. ---- It is a great way to beef your china, though, so I'm never surprised to see it as a cut/additive. -------- Also, the study of effectiveness of treating eating disorders has a great deal of cross-application to other addictions/afflictions...IMO
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Apr 2, 2016 00:53
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I was a model student from a solid family and I didn't get into drugs until college. I wanted to "expand my consciousness" like Huxley, and do ALL THE DRUGS like the beats, and especially like Burroughs. I was desperate to try H. I couldn't find it at my school (in a small city in upstate NY) except once, but I absolutely loved it. I did become rapidly enamored of cocaine and alcohol, though, as the central pillars of my identity began to crumble and morph. 1) I lost the young woman I assumed I'd marry 2)I lost faith in all gods, and I didn't get grasp the joyous liberation possible within existentialism 3) Econ, Organizational Development, and Labor History convinced me that my dream of fighting for the unions was a lost cause. One thing that never failed me, however, was getting wasted with my friends. The depression got worse as I never took time for anything but class, work, and partying. As the semesters and years went on, my usage increased and my participation decreased. Eventually, it was either kill myself, take a year off, or fail 4/5 classes. So at this point, I'm 21 or 22, depressed as hell and I have a drug problem. But you couldn't tell me that. I had a 'money' problem, the drugs 'didn't affect my work or my life.' So I just worked and did drugs until I'd get fired and eventually run out of money, causing more depression and self-loathing. Eventually I got access to obscene amounts of painkillers and didn't have to worry much about money. But you know how that goes...eventually money became a problem again, and dope (heroin) was suddenly affordable and consistent, with sober dealers who ran on time. That was 6-7 years ago, and I don't need to tell you the rest about my using. It's all depressing. Just know the my 3 trips through inpatient rehab, the outpatient treatments, zillions of AA/NA meetings, both half-way houses, all the psych ward trips, my jail time....none of that was ever enough to keep me off drugs/booze one month in the real world. But my current methadone-assisted treatment, including group and individual counseling, combined with my separate psychiatric doctor and counselor, along with dramatic life/health improvements, has been spectacularly successful. I finally made it a month off dope/booze...more than 6 months ago, and I'm still sober tonight.
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Apr 3, 2016 07:03
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pangstrom posted:I can envision a treatment with a high chance of success (outside of the people where it's REALLY progressed, I guess) if you could limit the inpatients to people who have decided they really want to get better and are willing to change/let go. But yeah that's sort of like saying I can cook a delicious dinner as long as the guests are starving. It's going to be a 2 way thing for the foreseeable future; there isn't a FO4 addictol on the horizon. I have a friend who "really wants to get clean" but doesn't understand the difference between "wanting" something and taking real action. We go to the same program, but she does nothing but the barest minimum and acts surprised that she's still miserable. And we have the same teary-eyed conversation every couple days. And nothing changes except how loud she is about how hard she's wishing her problems away. I've known plenty iterations of that personality type, especially within recovery groups and inpatient treatment, Personally, I was on fire for sobriety after my 2nd completed inpatient rehab, but I relapsed with in a month (with guys in my halfway house). I limped along for another few months, doing things like moving into a stable environment and reconnecting with my sober [then]partner, working long hours, and (detrimentally) trying to pretend my addiction never happened. As it were, I didn't understand what I was doing, and I was strung-out soon enough. And this story is anything but rare. Recovery is absolutely a daily process, replete with intricacies. But too many people are like inept bodybuilders...we get all buff and fit over the course of a couple months, and then we get lazy....soon enough regressing into a blubbering mess. Recent studies indicate long-term participation in a recovery community correlates strongly with long-term sobriety. Seems simple and obvious, but I attribute much of my past failures to an inability to grasp that concept. These days, I train my "recovery muscles" consistently. Group/counseling is nearly a daily activity, meditation is daily, my mindfulness practice demands persistence, I think about everything I eat, and so on. Recovery is absolutely possible. How to convince addicts to "buy-in" to the best, individualized treatment modality is quite another.
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Apr 6, 2016 03:30
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My Imaginary GF posted:I think it's a question of resources. By the time someone is an addict, treating them will cost enough that you will have failed to prevent others becoming addicts. If an addict does not buy-in to treatment, spending any resources on attempts to produce buy-in is an absolute waste. Half of what you said makes sense. Putting people who don't want help into treatment is generally pointless. We agree on that. -------- I'm not really sure what you mean by spending money on preventing people from becoming addicted. Everyone knows drugs are addictive and unhealthy. Actual prevention is arresting the cycle of substance use, and getting the substance abuser to continue with sobriety (and long-term treatment) before they exact any (more) costs upon society and themselves.
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Apr 6, 2016 23:20
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Guavanaut posted:But not everyone who uses them becomes an addict. And plenty of people develop destructive addictions to things that are not chemical. So perhaps a better pathway would be looking for underlying causation rather than additional prohibition and anti-whatever messages. Well, if we're talking resource allocation, good luck with all that. Causes for addiction are as varied as causes for all form of discomfort from minor aches to full blown suicidal ideation. We would have to fix inequality, mental illness, cure boredom, fix families, improve social structures.........................and so on. And then people will still do drugs, if only because they can be loads of fun. The only real answer is found in the 3-part model of legalization, regulation and treatment. And it could pay for itself.
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Apr 7, 2016 12:30
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ToxicSlurpee posted:Most people who do drugs don't get addicted. Generally speaking relatively few recreational drug users turn into addicts. Heroin is kind of an exception but even things you associate with very high levels of addiction don't have them that high. Even cocaine users tend to not get addicted. Sure, this was never a point on which I disagreed. I've been in more than a few groups where a counselor/leader posed the question, "how many of you (by a show of hands) set out to become addicted?" I have yet to see a person raise her hand.
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Apr 7, 2016 15:43
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Grundulum posted:This seems like a pretty concise analogy. I'll file it away for later use if I need it. The methadone/Suboxone clinics/docs are fond of that analogy. And of course long-term opioid users are dependent (or addicted). They just aren't always drug abusers/junkies.
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Apr 9, 2016 04:04
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CoolCab posted:The physiological effects of severe opiate withdrawl very rarely kills the sufferer directly, sure. But said effects also include "agonizing pain, hellish emotional distress/mental health trauma and a (physiological) borderline-biological imperative to get more opiates in your system right loving now to the point it overrides your capacity to reason". This combination can be pretty loving fatal (!), particularly if you're not being given adequate support and treatment to get through it (often due to poverty). And (as often noted) the week or so of acute withdrawal is just part 1. I've gotten through sickness 30 times, only to jump right back in the deep end. If withdrawal from opioids could ensure long-term abstinence, jails might actually be useful.
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Apr 9, 2016 20:25
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Albino Squirrel posted:I should preface this by saying that I'm a doctor in an inner-city clinic in Western Canada. Although I'm a family doctor by training, the nature of my clientele means that I spend about half my time dealing with either addiction, chronic pain, or both. We have an explicit harm-reduction focus, and run opioid maintenance programs in addition to a needle exchange. I am currently succeeding in methadone-assisted treatment, and I have used both bupe and methadone extensively. Methadone succeeded where bupe failed, not because of the actual drug, but because of the forced compliance. I have to show-up every day to take my methadone, whereas my suboxone prescription simply handed me 105 pills and said, "see ya next month!" My methadone clinic stresses participation in both individual and group therapy, and I see an outside psychiatrist. On bupe, I sometimes went to see a psych doctor, and I never attended any groups. Many people will sell a portion of their bupe to buy dope for a few days every month...if they can even manage that much self-control. On methadone, I am subject to a minimum of one drug-screen every month, and testing positive eliminates take-home medication. Methadone is also slightly less street-sellable. Exceedingly few people take it for any other reason than avoiding sickness. Bupe's blockade effect is very easy to shoot-through, as well. Oxymorphone and hydromorphone can be injected effectively with little diminished effect. In contrast, I've wasted a good chunk of money and time trying to get acceptably high while on methadone...to no avail. --------- I think bupe is a perfectly acceptable medication, and I would likely be equally successful if my clinic dosed me with bupe instead of methadone (an option they offer). I've also considered switching to bupe once I'm at a point in my recovery where I'm no longer benefiting from doing 20+ groups a month. Or when I need more freedom of schedule. Who knows...I may just quit the stuff one day...but I'm in no hurry right now.
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Apr 11, 2016 03:08
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Albino Squirrel posted:There's a distinction between 'safe injection sites' and 'opioid-assisted treatment'. A safe injection site (at least as structured in Canada) only implies a location where you get clean needles and a nurse observing you while you shoot up. It does not involve freely provided drugs; Insite is a BYOB model. This reduces the harm from injection - you're less likely to get cellulitis if you have clean tips and alcohol swabs - but since you're still injecting gently caress knows what there's still a risk from the drugs themselves. Typically I would do between 8-12mg when I would shoot through it. Only certain drugs, though. Sub seems to do a fine job of blocking dope and oxycodone. I'm currently at 60mg/qd of methadone, and even banging a hydromorphone 8mg barely produces a tingle, much less a rush, and certainly no legs. I either can't feel dope/oxycodone or I just fall asleep if I jack-up the dosage. ----- Sidenote: The sub strips are extremely popular among the prison population, due to the ease of smuggling them. ----- People like to complain about the hassle of seeing the office for doses every day/week, but simply being forced to get out in public every morning does wonders in itself. Especially so when the patient takes a moment for therapy/recovery at the same time. Being a junky is a full-time job; quitting requires that same sort of dedication, for most of us, anyhow. ----- I like the cut of your jib.
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Apr 12, 2016 22:50
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PT6A posted:Police and media are currently busy freaking out about something called W-18 here. It is legit in that large heroin distribution networks are always looking to cut costs/boost profits. Salesfolk want users on the edge of death, yearning for more...not dropping out of the market. Take from that statement what you will about the prevalence of analogues. My dealers always wanted me happily high; not dead.
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Apr 23, 2016 05:42
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Albino Squirrel posted:Fun thing about street value: Tylenol #3s go for a couple of dollars a pill up here. Generic acetaminophen/codeine pills of the same strength go for about a dollar. And codeine 30s go for about 50 cents. Where the gently caress do you live? Can't GIVE away those fuckers in my hood.
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Apr 28, 2016 12:35
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BrandorKP posted:Just had an inlaw die of a methadone, ambien, xanax drug interaction. He had gone the prescription opiates to heroin route over a little less than a decade and was finally seeming to get his poo poo together. Apparently it is a stop breathing in one's sleep sort of a thing. Sorry for your loss. Goddamn it, kids. Don't mix benzos and opioids...no matter how good it may feel. And despite the lifesaving potential of methadone, if you take it with too many bars, you will flop. Some people (like my ex) do it all day, every day. A startling number of others simply die.
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Apr 29, 2016 04:43
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Albino Squirrel posted:My professional, medical opinion is that that is a loving retarded dose for wisdom teeth. No kidding. I was under the impression that codeine/related meds were generally ineffective wrt teeth pain. A handful of meperidine/promethazine is normal, yeah?
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May 30, 2016 17:59
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Beaters posted:Yes, it was connected to alcohol prohibition, and the entire progressive era food and drug reform movement. The original federal drug enforcement bureaucracy was part of the Bureau of Prohibition. The Harrison Act was passed just before WW1, but only clamped down on hard after alcohol prohibition kicked in. After alcohol prohibition got going, a lot of people turned to other ways to get high and organized crime stepped right up to fill the expanding market. I suggest Johann Hari's recent book, Chasing the Scream as a decent introduction to how the mess got rolling. This is an excellent read, and the book includes an intriguing depiction of Joe McCarthy at the end...
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Jun 6, 2016 05:27
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Lyrica and neurontin are worthless in the junky community. You can't give that poo poo away, and they certainly never did anything for me... pangstrom posted:I guess at least the opiate ODs are yielding a lot of organs. Still way too many old sick people for them to go around, though. Silver linings!
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Oct 19, 2016 21:23
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big cock Salaryman posted:oh come on harry they are not, if loperamide is worth something then gabapentin has to be For real... Pain clinic (in my area anyhow) would distribute hundreds of gabapentin tabs along with piles of Roxies/oxymorphone...and god knows we bought a lot of scripts...and we had to buy the loving neurontin, too, else the Rx wouldn't fill for us. Serious pain in the rear end
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Oct 19, 2016 23:41
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Note: I did know a child in highschool who took neurontin til it gave him seizures Maybe those outliers are why folks think it has a value. E:he switched to rock and is Guavanaut posted:It's big in Northern Ireland for some reason. Yeah..."big" and "killed a couple idiot children" are not synonymous Note the "freely available" quotation in your article. The_Book_Of_Harry fucked around with this message at 23:49 on Oct 19, 2016 |
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Oct 19, 2016 23:43
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jabby posted:Taking long term opioids without developing tolerance or physiological addiction? Literally impossible. Anecdotal, but: I take 70mg/methadone daily, and have been addicted to large quantities of opioids for a decade+) and I'd argue that I receive little to no analgesic effect at this point. Unless I'm horribly, horribly afflicted...but there is no reason for a person in my condition to experience any real pain.
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Oct 20, 2016 03:48
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Thankfully, heroin is still available, clean and inexpensive! God bless the Afghan invasion! e: $3/g for fentanyl analogs...it's amazing only a couple thousand people died (in the US) from them this past year. gently caress me running The_Book_Of_Harry fucked around with this message at 05:03 on Dec 13, 2016 |
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Dec 13, 2016 05:01
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pangstrom posted:That (along with a similar compound) is the stuff the Russians pumped into the theater to resolve a hostage situation in 2002 This was a fascinating read, and I thank you for posting/reminding me of it. Albino Squirrel posted:Carfentanyl apparently has even stronger binding affinity to the opioid receptor than naloxone. You can reverse the carfentanyl OD, but you need, like, a LOT of Narcan. According to the warning signs posted at my methadone clinic, narcan can (sometimes) pull a person out of immediate withdrawal, but it wears off pretty quickly. Therefore, narcan will wear off before the carfentanyl has been sufficiently metabolized by the patient. You are likely going to need to hit them with narcan more than once, over (very roughly) an hour/two period. People have thought their lives had been saved, only to soon drop into that final nod.
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Dec 18, 2016 21:20
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OhFunny posted:The full breakdown of 2015 deaths from the CDC has been released: Goodbye, friends. We miss you all.
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Dec 18, 2016 21:25
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For sure. Even a stout shot of regular dope may take a couple rounds of narcan.
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Dec 19, 2016 03:39
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pangstrom posted:Putting straightforward suicide attempts aside, what proportion of users-mixing-opiates-with-depressants-who-OD knew they were playing with fire, do you guys think? Seems like it would be high. Feels semi-suicidal, at least the "gently caress it" sense. My buddy tried so drat hard to kill himself with dope+Xanax He really thought he'd done enough one afternoon. Because "I would understand," he thought he could die in my house. He always said, "I know mixing these is gonna kill me...eventually." This time, he made me swear not to revive him before he threw a boulder in the spoon, already slurring from my vodka and his pills. But when he slammed to the floor at freefall, I turned him so he could breathe. I sat and made sure he'd live for a couple hours. He never did die. This summer, friends reported he kept doing larger and larger...really impossible shots...and yet he lived Until he took a beautiful walk at dawn, on one of Nashville's most scenic hills, and shotgunned himself into permanent memory ---- Many people want to die, and many of them are junkies. I agree with OP
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Jan 5, 2017 01:02
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Eej posted:Most of the time it's just like "oh right, drat, ok, give x instead thanks" but there are the occasional curmudgeonly old dudes who get all offended that we questioned their years of experience and judgement. Young doctors can vary from being super on the ball with their pharmacological choices to putting you awkwardly on the spot to pick a drug for the patient (I don't know what their case file looks like, man) but that usually only happens for antibiotics so that's pretty straightforward. I currently take trazodone (50mg QHS) and lexapro (10mg QAM) and methadone (80mg QAM). It's the first time in 10 years on/off psych medications that I've ever felt real improvement. I spent several hours on PubMed the other night, reading everything I could that seemed to address potential risks of the combination. Negative reactions seem dramatic but rare, and the combination is widely prescribed throughout the US. I was considering trying to add bupropion to my regimen (for smoking cessation) until I read this paper Are Pharmacotherapies Ineffective in Opioid-Dependent Smokers? Reflections on the Scientific Literature and Future Directions. Now I'm not sure the slim benefit justifies the risk of wrecking something that seems to work well.
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Jan 24, 2017 18:12
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Hydromorphone as replacement therapy is undesirable, due to its short half-life, in this methadone-maintained ex-junky's opinion. Sure, dillies offer a fantastic rush, but it lasts about as long as crack. ---- Also, iatrogenic addiction truly is a minor part of the opioid crisis. Certainly, doctors write for too many pills, but most of our addicts had a pre-existing disposition toward addiction, in my experience. This is facilitated by doctors, but it isn't the root issue. Like MIGF says, it's a moral failing. Just kidding. It's a combination of genetics, behavior and circumstance.
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Jan 29, 2017 05:22
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KingEup posted:Why can't you have both at the same time? Huh? That article doesn't mention methadone, and hydromorphone isn't diamorphine. I'm fine with heroin replacement therapy as a tool for reducing harm, but alternatives like bupe and methadone are desirable for a person like me due to their lengthy half-lives. I can miss a clinic day without any fear of experiencing withdrawal symptoms...symptoms I'm likely to treat with street dope.
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Jan 29, 2017 20:35
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Fair enough, the video shows that she does take a small amount of methadone, too. Im confused about how her dosing works, though. The article says she receives about half a gram of heroin daily, but the video shows her receiving 1/3 of that, alongside 10mg methadone (most maintenance prescriptions are between 60-100mg QD). One of the links has a doctor talking about twice daily dosing of heroin, but perhaps she goes three times a day? For someone like me, that's too great a time commitment, compared to methadone's minimal constraints. But to answer the question, why not both? A clinically-effective dose of methadone blunts the pleasurable effects of heroin (through cross-tolerance), and taking enough dope to override the methadone carries significant risk of overdose. Certainly, many people still use heroin while maintained on methadone, but most will acknowledge that "[they] only get sort-of high." Therefore, I'm choosing the methadone-only approach. Others do what they will.
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Jan 29, 2017 21:11
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Ytlaya posted:This is only tangentially related to your post, but one issue I had on suboxone that I always thought was strange is that one dose a day would not work well for me, and I had to split the dose and take half in the morning and half in the evening. I would begin to experience noticeable withdrawal symptoms by the evening if I took a dose in the morning (not terrible, but enough that I felt too bad to enjoy doing anything and wouldn't be able to sleep by that night). My doctor wouldn't believe me about this. I tried to convince myself it was psychological, but after trying to force myself to just take it once in the morning I realized it definitely wasn't. Some people need split dosing, and my clinic accommodates those people, so long as their "peak and trough" test confirms abnormal rates of metabolization. Also $500 for opioid replacement is a bargain. If your habit is less than $20/day, you need detox, not maintenance.
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Jan 30, 2017 02:57
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Opioid habit...it's only a problem if/when you run out! And how can one be an addict if they've never tried or wanted to quit?! Riddle me that, will ya?
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Jan 31, 2017 06:25
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[quote="Megasabin" post=""469259925"] If you shake off your tunnel vision for a second, you will see there are thousands of other articles and textbooks that are outside your viewpoint. Please read them. [/quote] Thank you for a saving the thread from a less-thorough post by me. Also, thanks for saving me an hour or so.
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Feb 10, 2017 07:08
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| # ¿ Apr 30, 2024 06:56 |
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Are novel opioids the next generation of anti-depressants? Opiates as antidepressants.
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Feb 27, 2017 06:32
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