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I think one aspect of this problem is that many doctors are very ignorant about opioids and addiction. It's a very common belief among doctors, for example, than the medication tramadol (trade name Ultram I think) isn't addictive. This is complete and utter nonsense and objectively false, yet it is commonly believed by doctors because doctors generally believe whatever drug reps tell them.pangstrom posted:Is there a story where for some (say, emergency) surgery the anesthetic didn't work because the patient was an opioid addict? It seems like that would happen. This kind of scares the poo poo out of me as someone on suboxone (which not only gives you a tolerance to opiates, but actively blocks other opiates). While I carry a card in my wallet that is intended to notify people of this, the amount of opiates that would be required to be effective is so huge that I imagine doctors would be hesitant to use them even if they knew about the suboxone. I just try not to think about how hosed I would be if I got in a serious car accident or something.
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Jan 26, 2016 18:37
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Hardawn posted:So I had almost 15 days clean of everything and was feeling fantastic then I see the doctor, and he recommends subs to help keep me off. What in the gently caress??? Why in the living hell would someone prescribe suboxone to someone who was already clean (and feeling fine to boot)? That makes no sense at all. Suboxone is just as difficult (if not more difficult) to quit if you do anything other than a quick taper after transitioning to it from some other opiate. pangstrom posted:How impaired are you on that stuff? I've heard very different things, some of which is dose etc. but some of it just seems to be idiosyncratic or something. Seems everyone agrees tapering and getting off it is a really difficult, though. Zero impairment in terms of ability to function or think or anything like that. I think that most people who are predisposed to becoming opiate addicts tend to not be very impaired by them unless they take huge doses (for example, I've never had some of the symptoms, like nausea, that other people mention on opiates, even before becoming addicted). But I feel zero excitement or enjoyment or anything like that on suboxone. It's like my brain doesn't produce much dopamine anymore or something. Maintenance drugs are useful in certain situations. They're generally a good idea if the addict isn't ready to quit (and quitting will invariably fail in the long term if it isn't something the addict is truly committed to), since they allow a lot more stability than using other drugs and remove the risk associated with using drugs off the street. This is mostly due to the fact that suboxone only needs to be taken once a day, compared with having to use most other opiates every few hours. And some people are able to feel totally normal on suboxone (I'm unfortunately not one of them, due to the lack of pleasure/happiness I mentioned above), so if you're one of those people it can often be a good idea to just stay on suboxone for the rest of your life, particularly if you're old. I'm not sure if I'll ever be able to get permanently clean. I can deal with acute withdrawal, but I've always experienced extremely bad PAWS. It's not the depression or anything that gets to me; it's more that I am completely incapable of resting both physically and mentally and perpetually have this feeling of physical discomfort. I can't sleep without (strong, prescribed) chemical assistance, and even when I do it doesn't feel restful. Feeling unrested and uncomfortable 24/7 with no respite ends up driving me crazy after a while. All I can think about is how much I want to be able to just feel comfortable and rest my body. It's horrible and I don't know if I'll ever be able to deal with the year+ of those symptoms that will be necessary for me to fully recover. Hardawn posted:I've given a strip (8mgs) to people with very little opiate tolerance and it'll floor them and also possibly make them vomit. Jesus, yeah, 8mg is a loving massive dose for someone with zero opiate tolerance. Even 2mg will have a huge effect on an average person. Many suboxone doctors actually prescribe doses that are too high; most addicts shouldn't require more than 8mg.
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Feb 16, 2016 21:41
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pangstrom posted:Yeah, this is a place where, from the outside, people's imaginations usually fail them. People think it's like not eating a cookie or working on a Saturday or something. Yeah, before going through all this I would have been literally incapable of imagining how terrible addiction/withdrawal is. It's the sort of feeling that a normal person wouldn't even be capable of experiencing during their lifetime; the experience can only be reproduced specifically by withdrawal itself. Describing the symptoms just makes it sound like some combination of the flu and insomnia. I once almost died of Scarlet Fever as a kid*, and that was a million times better than withdrawal. It's frustrating, because many people just think "well, you have to man up and deal with it" and compare it to stuff like quitting cigarettes, but it's just not the sort of thing a normal person can will themselves to do. The very idea of experiencing withdrawal just makes me mentally curl up into a fetal position, and putting myself in a situation where I would experience more than a few hours (much less multiple days) of withdrawal is basically equivalent to someone trying to will themselves to jump off of a building or cut off their own arm; your brain just screams at you "BAD IDEA DO NOT DO THIS". And after multiple years, it just gets harder, because you become more and more familiar with the feeling and more afraid as a result. The one "upside" to opioid abuse becoming more well-known is that hopefully attitudes towards addiction will change. Addiction is bad enough by itself, but it's even worse knowing that most people would think worse of you for it. At least people with other serious diseases know that they have most peoples' support and won't be condemned for it. *though once admitted to the ER it was cured super fast since I think Scarlet Fever just needs some antibiotics
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Feb 29, 2016 19:16
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SedanChair posted:What in the wasteful, murderous gently caress? I guess we could just improve the law and medical practice, or we could, you know, go all Aktion T4 about it. Seeing stuff like that post is honestly very hurtful. It's difficult to describe, but it just makes you feel like you're worthless and should always keep everything bottled up. I imagine it's sort of similar to the way minorities/LGBT people feel when they're exposed to bigotry (LGBT is probably a better comparison, since a black person can't hide the fact that he's black). Even though I'm an addict, I've never stolen or even done anything illegal (I don't really think the illegal part matters but maybe some people do), and the only way I've hurt anyone else with my addiction is through my parents being upset that I'm so unhappy. My using stopped being related to trying to get high after the first year or so, and afterwards was entirely just to avoid the hell of withdrawals. I could seek out something that would get me high, but I don't. My motivation is entirely a fear of withdrawal/PAWS. Generally speaking, if a large number of people have a specific problem, blaming individuals is both ineffective and dumb. People do things for a reason, and if a significant number of people behave in a certain way there is likely some reason they are doing so other than "they're just lazy/morally inferior."
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Mar 15, 2016 17:25
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Ran Mad Dog posted:I don't image for a second there aren't people so far down the path of physical addiction that the next withdrawal would literally kill them who would prefer to just end it all. If you've never been so hopelessly addicted to something then you have no idea how amazingly hosed up and painful it can be. While I think it's impossible for opiate withdrawal to kill you (unless you have heart problems or some complicating factor), I'm sure there are many addicts who become suicidal. But they (kind of obviously) always have the tools available to them to commit suicide; all they have to do is OD. I doubt society would approve of that any less than some sort of institutional euthanasia; most people are still going to think poorly of an addict, even if they chose to die. The number of people who think all addicts are human trash is stunning (I imagine the sort of anti-drug education kids receive might contribute to this perception).
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Mar 18, 2016 00:36
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Subvisual Haze posted:Gabapentin I'm prescribed a pretty high dose of Gabapentin, and I'm not sure how anyone could use it recreationally like that. It does have a noticeable potentially recreational effect the first couple times you take it (sorta like some strange mix between xanax and marijuana, but far weaker and only really affects your body), but it stops doing that after the first one or two doses and higher doses don't really have any additional effect past a point, so I don't see how it could be used regularly in that manner.
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Oct 19, 2016 18:05
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Tim Raines IRL posted:what about certain products being sold as "Kratom" or tinctures thereof, do they have recreational potential? Kratom is absolutely addictive and absolutely has opioid effects. Like, suboxone will throw you into precipitated withdrawals if you are dependent on kratom, there is no debate to really be had on this subject. It really annoys me to see people spreading the myth that kratom magically eases withdrawal symptoms without being an opioid itself (newsflash - it eases withdrawal symptoms because it's an opioid!). Even NPR reported this nonsense the other day. Part of the misconception stems from people buying lovely kratom (if it's kratom at all) from headshops and the like and noticing it has no effects (or taking very low doses - a LOT of kratom is required to have much of an effect, more than you'd usually use to make tea). There's also a perception that an herb like kratom must be more healthy because it's a natural and a plant or something silly like that. That being said, I don't really have a problem with the plant itself being legal, because there's a limit to just how addicted you can get to it (there's a peak beyond which you just feel sick, so it never really reaches the point where withdrawals are impossible to deal with), but the extracts are extremely dangerous and no different than any other strong opioid (the most common strong one can easily punch through 8+mg of suboxone). I'm not sure if there's a way to make the extracts illegal while leaving the plant itself legal, though. The plant can be useful for tapering off of stronger opioids, as long as you use it as a tool for tapering and realize that staying on it is just substituting one addiction for another. I think the plant itself is only really dangerous for people with a propensity towards opioid addiction - it takes a very long time to become dependent on, partly because it tastes really nasty which creates a barrier to frequent and heavy use. I think I used the plant for ~6 months before becoming dependent to the point that I experienced noticeable withdrawals (and at some point after that moved on to the extracts, though I forget when exactly). One thing I'm curious about is the percent of addicts who are unwilling or unable to seek out opiates illegally. I imagine the percent is pretty small, but speaking from my own experience I probably would have never become addicted if I didn't have access to legal opioids like kratom and poppy pod tea (no idea if these are still legal, I used them years ago). I don't know a single other addict in my personal life and don't remotely fit the image of what most people consider addicts to be like (though from my experience this is true of more addicts than most people would think).
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Dec 13, 2016 10:37
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PT6A posted:Now, are there lots of people who will avoid seeking illegal or semi-legal opioids once the addiction has taken hold? I'm guessing a lot fewer. Yeah, this is what I was referring to - people who wouldn't ever seek out illegal opioids. I bring this up mainly because people getting a taste for opiates from prescription painkillers is something that will always happen - you can reduce how often it happens, but doctors aren't going to stop prescribing opiate painkillers anytime soon. An important question, I think, is what percent of these people would seek out illegal opiates if/when their doctor/pharmacist discontinues their prescription. I mention my personal circumstances because I'm probably a member of that subset who would never have become seriously addicted if legal/semi-legal opioids weren't available (though this might be different if I knew a source for illicit opiates; I'm just not willing to go through the effort of seeking them out) Partly for this reason, it concerns me to see doctors potentially reacting to this crisis by going to the other extreme and suddenly forcing people into quick tapers (if they taper them at all). Tapers are more successful when done very slowly, and I'm worried that doctors (who are generally profoundly ignorant about addiction) are going to end up driving a bunch of people towards illegal opiates by giving them unrealistic taper schedules.
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Dec 14, 2016 22:01
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pangstrom posted:It's not like most people can pull of a gradual taper on their own, either. Oh, for sure. But I think that it should at least be the first thing attempted. After that you can consider other options (though they're unlikely to be effective if the patient isn't willing/able to do a slow taper), or move to something like suboxone maintenance, though that should be a last resort. One other thing I often notice doctors (and even sometimes psychologists/psychiatrists who specialize in addiction) are ignorant about is the issue of PAWS (or the knowledge that it isn't merely a psychological issue). This leads to approaches that center on discontinuation and getting past acute withdrawal, but such an approach is usually doomed to failure if the addiction was bad enough to result in severe PAWS symptoms for months (if not years) afterwards.
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Dec 14, 2016 23:28
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Tim Raines IRL posted:I really want to know how many of these involved other drugs, specifically benzodiazepines. The majority of opioid overdose deaths involve concurrent alcohol/tranquilizer use. Benzodiazepines fall under tranquilizers I believe, but alcohol is probably more common and has the same dangerous effects when combined with opioids. Generally speaking, the overwhelming majority of opiate overdose effects occur under one of the following circumstances: 1. Concurrent use with alcohol/tranquilizers/benzos 2. Using the "typical" amount after being clean for a while and no longer having the necessary tolerance 3. The drug being mixed with something, which can apparently be an issue with street drugs Opiate overdose using just the opiate and with someone current dependent on the drug is actually very uncommon (because the addict has tolerance). edit: Edited for greater accuracy Ytlaya fucked around with this message at 09:22 on Jan 4, 2017 |
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Jan 4, 2017 09:15
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ToxicSlurpee posted:Yes it's often a combination of the two. People know addiction kills people and drugs are bad. The problem is that for a lot of people real life is worse. It's also that the level of suffering that addiction creates for the addict is literally inconceivable for normal people. So before becoming an addict, he/she thinks "my life is poo poo now, so it's worth getting to feel nice for a while even if I end up addicted." But this is because they don't quite realize just how much worse things can be. At least this was the case for me. One thing that bothers me the most as an addict is that I can't communicate my situation to family/friends because they don't really have the frame of reference to understand this sort of suffering. Like, I've given up on ever being normal and healthy again, but I at least want those close to me (which isn't many people; just my parents and 2 best friends) to understand the way I feel. It's not that they aren't kind (they are), but it's just sort of lonely being incapable of communicating the way you feel to those close to you, especially when it's something that completely and utterly dominates every aspect of your life. I realize that other long-term addicts also understand, but they aren't the ones I want to understand.
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Jan 7, 2017 05:18
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ToxicSlurpee posted:But sometimes, when you've had a bad day, or you're frustrated with life, or somebody just offers you some...man, just a little taste...I had some good times then. That sure felt good, you know? It wasn't all bad. We used to use and then we'd... What I think people don't understand is that they think of it in terms of a single instance of someone thinking "should I use? sure!", when it reality it's more like 10,000 instances of someone thinking "should I use?", saying "no" the first 9,999 times and then "yes" the 10,000th. They're missing the countless invisible times that people are struggling with the decision but not using, and of course it only takes a single mistake to ruin everything.
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Jan 7, 2017 06:04
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Doctors thinking Tramadol isn't addictive has always astounded me. Like, how is it even possible to be that ignorant? It's your job to know this stuff! Do these dumb fucks just take everything drug reps tell them as gospel? (the answer is yes)
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Jan 21, 2017 20:36
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Albino Squirrel posted:Look, the naltrexone blocks the hydrocodone, which gives her withdrawal, which gives her the shits, which leads to weight loss! What's so hard to understand here buddy! Thanks God the patient didn't use the naltrexone drug; just the mere mention of precipitated withdrawal causes me to react viscerally. Regarding doctor ignorance, I think the problem isn't so much the lack of pharmaceutical training (though more couldn't hurt, since there often aren't a very large number of drugs frequently prescribed in some specialties - opiates for pain doctors being a prime example), but more the fact that many doctors seem to think they're experts in areas they aren't. It's like they think being a doctor also gives them some sort of authority in science in general, when from my experience most doctors aren't any better than a layperson when it comes to thinking scientifically, evaluating/reading research or scientific media, etc.
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Jan 22, 2017 18:02
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The_Book_Of_Harry posted: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. Yeah, the danger is just from the Trazodone and Lexapro combo, and under normal circumstances/doses there won't be a problem (and even if there was, you'd notice symptoms before it became dangerous, unless you just suddenly took some much larger dose). I experienced mild serotonin syndrome symptoms once, a long time ago back when I was mixing large doses of Tramadol with whatever antidepressant I was also on at the time, but the serotonin weirdness from an excessive dose of Tramadol far outweighs what would usually occur from a normal dose of Trazodone/Lexapro/etc.
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Jan 24, 2017 23:10
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Albino Squirrel posted:Oh, God, methadone and bupe are so much better for opioid dependence. If you really wanna get your life back on track that's the way to go. But not everyone does well on them, usually of they're not quite ready to give up the needle. (One of the inclusion criteria for NAOMI was having tried and failed methadone, for instance, which is about 50% of initial methadone scrips.) 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. Do opioids (and other drugs I guess) affect different people for different amounts of time or something? Regarding suboxone in general, I feel like it's terrible how most people can't get it for a reasonable price. I was lucky enough to have good insurnace through my job that brought the cost to just $50-75 a month (for the medication itself, the doctor was $150/month). But I can't imagine someone working for minimum wage being able to spend like $500/month on suboxone.
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Jan 30, 2017 01:42
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KingEup posted:Show me data that says iatrogenic addiction is the the norm. Does iatrogenic addiction include people who develop a "taste" for opiates through their prescribed medication and then seek them out through illegal channels later? Because I imagine many people were prescribed them for a while and that they developed a preference for opiates as a result that lead to them seeking out heroin or whatever. edit: Haha Jesus Christ he seriously advocated Suboxone for a percocet addiction? The fact that he thinks Suboxone has more "mild" opiate affects/withdrawal makes me think he doesn't have access to any information beyond what's on the official Suboxone website or something. (I mean, it does have more mild affects if you already have a huge tolerance, but it would absolutely hit someone with a mild habit like a ton of bricks.) Tangentially related to this, I find that many Suboxone doctors prescribe doses that are WAY too high. I was initially prescribed 24mg of Suboxone, and I later realized that I didn't need more then like 2-4mg (though at least tapering from 24mg to 4mg was super easy). Ytlaya fucked around with this message at 19:20 on Jan 30, 2017 |
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Jan 30, 2017 19:12
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pangstrom posted:As a total aside, I think Dr. Drew thinks doctors are responsible for the epidemic and NOT pharma for a few reasons, but one of them is because he got ID'd as taking $ from GSK for talking up Wellbutrin's lack of sexual side effects (or even positive sexual side effects), which he defends himself from by saying it was consistent with his clinical experience etc. In other words, pharma is just pharma being pharma and it's the doctor's job to do the right thing, which he claims he did. While I think he's technically correct in the case of Wellbutrin, one of the worst/dumbest things in psychiatry is psychiatrists who use their clinical experience to attribute a bunch of random characteristics to various antidepressants. I've had several psychiatrists in the past talk about how this or that SSRI/SNRI is better for energy or whatever, and it's a bunch of unscientific nonsense.
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Feb 8, 2017 19:03
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twig1919 posted:As someone who has taken stimulants for an unrelated medical condition, this feeling is simply the feeling of getting "high" on stimulants. Everyone feels that way if they take enough of an upper: that is why people smoke crack and snort cocaine. While this is true and undoubtedly results in a lot of people without ADD thinking "ah I must have ADD since I can focus so much better on Ritalin/Adderall/whatever!", for people who actually have really bad ADD there's a significant difference in the way they react. My cousin has really bad ADD, and he becomes really subdued while on Ritalin and hyper when he's off of it, which is pretty much the opposite of the way it affects people who don't have ADD. Also, you didn't mention older classes of antidepressants like MAOIs or tricyclics that I believe a more effective at helping moderate to severe depression than many more recent medications (I think the reason they're not prescribed as often is due to potential side effects and psychiatrists being told/lied to by pharma companies that newer SSRIs/SNRIs are better). edit: Honestly, when it comes to psychiatry I feel like gross ignorance among psychiatrists is at least as big of a problem as misleading pharmaceutical advertising. It's stunning how ignorant many (probably most) psychiatrists are about the medications they prescribe.
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Feb 23, 2017 21:42
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Weldon Pemberton posted:They seem so inconsistent in their effects on different people, and even the same person at different points in time. Everybody talks about Effexor/venlafaxine being a horrible drug that causes awful withdrawal and scary sounding poo poo like "brain zaps", which I've never experienced. But when I went back on it after about 9 months of not taking any medication, I had completely different side effects The problem is that "Depression" isn't really a single condition - it's just a really vague set of symptoms a person can experience. In reality there are probably many different things, both biological and psychological, that can cause the symptom of "Depression." Think of it this way - "Depression" is a symptom like "fever." Imagine that you gave a whole bunch of people with a fever some medication meant to cure a specific fever-causing illness. The medicine would genuinely work with that small subset of people, but it would do nothing for the others because their fever is caused by a completely different condition. In the same way, once you remove placebo effect from the equation, SSRIs/SNRIs probably only actually help a relatively small subset of people experiencing depression. Unfortunately, I think many actual psychiatrists don't really understand this. They assume that psychiatry is just like any other field of medicine and that you have the specific disease "Depression" if you've experienced certain symptoms and that antidepressants will cure this disease. In reality, we're basically shooting in the dark and throwing medicines at people in the vague hope that whatever is causing their depression symptoms might be alleviated. And this is certainly better than doing nothing at all and does help some people*. But I think it would be good if more people, including many psychiatrists, understood that "Depression" is not a single condition with a consistent cause. Two people with depression might actually have completely unrelated problems that just cause them to experience the (again, super vaguely defined) symptom "Depression." *With the exception of people who are prescribed medicines like Effexor that can be difficult to discontinue without informing them of those side effects. Many psychiatrists are profoundly ignorant about the medications they prescribe and do not warn patients about things like discontinuation syndrome. They just assume whatever the drug rep told them is true and that "New SSRI/SNRI _____" is a good medicine that will cure their depression. Like, I personally was prescribed the tricyclic antidepressant amitriptyline a few years ago, and it is extremely difficult to stop using. If I try to stop using it I experience severe insomnia, and accounts online have indicated that this insomnia can last as long as months. My psychiatrist never warned me of this.
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Feb 26, 2017 05:07
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The first time I got mild sexual side effects and a reduced appetite, but nothing else. The second time I got constant nausea and euphoria, and no sexual side effects. It was the same dose, release time, and manufacturer. I wasn't taking anything that would have interacted with the drug, either.
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Cranappleberry posted:This is just an abstract but 54% effectiveness for melancholic depression is pretty drat good. Other antidepressants are effective as well, obviously. Antidepressants are also effective in treating many other problems including anxiety, ticks, ADHD and the list goes on. I mean, if you want to complain about psychiatrists not informing you of side-effects okay but they are prescribing something based on the best evidence available. Their intention is to medicate you because they are medical doctors and that is what medical doctors do. Usually if you ask they will tell you about side-effects. Your pharmacist is also required by law to tell you about side-effects and you have to sign a thing saying you were informed or chose not to be informed. SSRI/SNRI antidepressants definitely help some people with depression, but keep in mind that a good portion of that 54% effectiveness is likely placebo (in the sense that there's a good chance you'd get a pretty high % of effectiveness with placebo and need to compare with that). I mean, I'm certainly in favor of continuing to prescribe antidepressants and disagree with the guy who said they're a scam. But I think it's important to realize that depression is almost certainly not a single condition and that unless you're lucky enough to have a form of depression caused by something treatable by SSRIs/SNRIs they won't be more useful than a placebo. In terms of psychiatrists, there absolutely is a big issue with many being super ignorant, like ignorant to the point where an educated layperson with access to Google would know more than them. I think this is exacerbated by the things drug reps tell them, which often leads them to assume that newer = better (generally speaking, if the first anti-depressant a psychiatrist recommends is a newer non-generic SSRI you need to get a new psychiatrist). Also, the patient shouldn't have to ask about their medication having potentially severe side effects. I'm not saying it's illegal for them to not tell you, but it's absolutely unethical. Most patients will (reasonably) assume that their doctor will inform them about any significant side effects.
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Feb 27, 2017 04:13
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The_Book_Of_Harry posted:Are novel opioids the next generation of anti-depressants? I've always wondered what role opioid receptors might have in depression with some people. This is obviously completely subjective, but the way I used to feel "depressed" was very similar to what I now recognize as weak withdrawal. I would just have this vague feeling of restlessness and lack of energy. I feel part of the problem depression research runs into is that it can be very difficult to accurately describe the things patients feel. My "depression" was always 100% a physical feeling, but since that feeling didn't include actual pain there wasn't really any way to describe it other than "low energy and restlessness" which is the same language used for most other forms of depression. So psychiatrists would see me check those boxes but not really understand the feeling (since there isn't really any way to accurately convey it without someone experiencing it themselves). Cranappleberry posted:Placebo effect is accounted for in double-blind studies. Hence the comparison of a drug to a placebo. All antidepressants are studied in this manner. So, no, your first paragraph is incorrect. Regarding the first part, I was referring to you quoting effectiveness. I looked up the study in question, and 54% had complete or partial response to the medication compared with 23% given placebo. Which is absolutely significant, but the 54% by itself doesn't tell the whole story (since you'd get about half of that with a placebo). I'm not saying most psychiatrists are ignorant, but from a lot of personal experience (and the experiences of other people) there are a hell of a lot of dumb ones out there. I can't count the number of times I've heard psychiatrists talk about how they think SSRI X is better for "energy" than SSRI Y, based only upon their own anecdotal experience with patients (I think the whole "making judgements based upon anecdotal experience" thing is a big problem and leads to a bunch of very unscientific/wrong conclusions). The issue stems from the fact that psychiatry requires more of a scientific outlook on the part of the physician than many other clinical fields. For many other medical fields, physicians can rely on the fact that a bunch of the medications they prescribe directly and concretely treat conditions or symptoms. For example, a doctor knows that antibiotic X will cure bacterial infection Y, so all they need to know is "this medicine fixes this condition." But this isn't the case for antidepressants. We don't really understand all the different things that can cause the symptom of depression (and it's important to distinguish it from a single condition here; some scientific studies make the mistake of assuming depression is a single disease rather than a symptom that can have different biological causes), and it's important that psychiatrists understand this. Interestingly, the best psychiatrist I've ever had was this guy who was going through residency IIRC. He understood that it's just a matter of trial and error and that there's no way to know which specific medication will cure a specific person's depression (aside from stuff like certain medications being better or worse depending upon severity of the depression). (I probably don't really disagree with you much, since I also think the "psychiatry is pseudiscience" people are stupid. It's absolutely a real science, but there are definitely problems in the way it's administered due in part to the very uncertain nature of the field compared with other medical fields. I think that psychiatry requires a stronger understanding of the underlying science than many other medical fields.) Ytlaya fucked around with this message at 22:21 on Feb 27, 2017 |
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Feb 27, 2017 22:14
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Danknificent posted:but she now has some health problems as a result of her chronic use that are expected to kill her within a few years. How does this work? I was under the impression opiates didn't actually cause any harm to the body outside of the respiratory depression if you take too much. People can experience side effects like malnutrition due to their addictions, but that isn't directly caused by the drug. Does it maybe mean acquiring some sort of needle-based illness, like AIDS?
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Mar 31, 2017 01:21
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pangstrom posted:Addicts generally don't lead normal lives and it's not just government policy that causes that. Yeah; even on suboxone I never felt quite the same as I did back before I had ever used. Even ignoring the psychological issues, I couldn't experience feelings like pleasure or excitement in the same way I could when clean. I know that some addicts are able to feel totally normal on suboxone, but for me it just made things tolerable and preferable to using a short-acting opioid.
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Apr 3, 2017 22:48
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deoju posted:This was news to me: Opiod addicts using massive doses of an anti-diarrhea medication for withdrawals and getting high. You know how opioids make you constipated? Imodium is just an opioid that doesn't cross the blood brain barrier (in normal therapeutic doses). So it's not as strange as the headline makes it sound, since all opioid drugs do literally the same thing as Imodium to your GI system. Even in lower doses, Imodium is part of the core OTC cocktail of drugs you should take to help alleviate opiate withdrawal symptoms. edit: Ah, the article mentions most of this. The headline is just a little misleading because it seems to imply that Imodium, as an anti-diarrhea medication, is somehow fundamentally different from other opioids. Ytlaya fucked around with this message at 01:54 on Apr 12, 2017 |
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Apr 12, 2017 01:52
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Rhandhali posted:That's a little extreme, but the stuff is dosed medically in micrograms. Look up the phenazepam threads in TCC if you want an idea of what a great idea it is to eyeball something that potent. I remember one my brief foray into attempting to use phenazepam (the context was actually me looking for something to take the edge off of opiate withdrawals). I took what should have been lower than the recommended dose and entered this extremely unpleasant and scary disassociated state for like over a week. I think it ended up taking 2 weeks before I felt completely normal again, which scared the poo poo out of me because the internet told me it should have stopped working within a day or two. Permanently scared me away from any sort of non-prescription benzos (not that I really find benzos appealing in a recreational sense to begin with).
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May 27, 2017 06:26
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pangstrom posted:Aside but: my best friend in high school became a real alcoholic and the response among ~5 mutual friends (all intelligent, reasonably informed, mostly progressive) could be pretty well summarized by "dude he needs to stop being a weak dick" even after talking about it for an hour. The willpower/character thing is very much the default position. I really hate this part. If someone is, say, LGBT, there's a large portion of society that will look down on them and treat them like poo poo, but at least it's relatively easy to predict who will treat you normally and won't be bigoted towards you. Someone who is pretty liberal/progressive politically is likely to at least not have any sort of hostility or negative reaction to you if that's the case, and certain groups can be relied upon to treat you very positively. But it is extremely difficult to predict someone's views of addiction. Progressive liberals are almost as likely as conservatives to condemn and ostracize someone for being an addict, and even if they show some degree of sympathy they'll probably still think less of you as a person. Unless someone has specifically talked about their feelings about addiction, it's always a risk. To be honest, it's hard not to feel bitter about it, and it really reveals just how skin-deep their empathy is. edit: I want to be clear that I'm certainly not saying addicts are treated worse on average than LGBT people, or comparing the two situations otherwise. I'm just referring to the fact that it's very difficult to predict how someone will treat you based off of their politics, etc. pangstrom posted:People who think it's a willpower/character monocausal thing really hate stuff like this. It reads as indulging people who are already self-indulging. And you almost need some parts of the city "lost" to homeless drug addicts (or otherwise completely vacant, or completely disenfranchised) to put the sites in so residents don't go nuts. People just don't understand. For one thing, your average person is quite literally incapable of comprehending just how terrible opiate withdrawal can be (and this also applies to a lot of people with weaker/newer opioid addictions, who like to contribute their opinions about how "yeah it's pretty bad but not so terrible it's impossible to deal with*") It's just out of the scope of what humans will normally experience, and the whole "knowingly subjecting yourself to it when you quit" angle adds an extra layer of difficulty. It is very accurate to compare the whole detox process (including PAWS for long-term/serious addicts) with someone voluntarily subjecting themselves to torture. It's sometimes possible, but it requires either a special kind of person or circumstances where someone literally can't use for whatever reason. I use the torture analogy because it breaks people out of the whole "isn't it common sense to quit if it's the only way to have a decent life?" thought process. Misunderstandings usually seem to involve people projecting their own experiences dealing with normal/"mundane" challenges and difficulties onto the experiences of the addict. * Fast forward a couple years of them continuing to use because they thought withdrawals were tolerable, until they finally reach the point where they're no longer quite so tolerable. Ytlaya fucked around with this message at 23:53 on Feb 6, 2018 |
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Feb 6, 2018 23:50
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PT6A posted:It depends how you define 'loser' too. Is it a term that carries a moral judgement, or just an observation of the facts of someone's current life situation? I'm pretty sure pretty much everyone who says that says it in a derisive way that is intended to imply moral failing. No one ever calls people with, say, cancer "losers" even if it destroys them financially or whatever.
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Feb 8, 2018 19:00
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sea of losers posted:this derail about trump is stupid, maybe instead of that we could look at how the FDA is getting more negatively vocal about kratom, something that could actually help ppl but isnt particularly profitable My feeling about kratom is that it's probably best for it to be legal (if for harm reduction reasons if nothing else - better for people to take kratom than pretty much any other opioid), but people need to be better informed about exactly what it is. It is considerably less dangerous than other opioids by virtue of having an effective cap to the amount you can take (without it just causing unpleasant symptoms like nausea), so I don't really know how someone would overdose on the raw leaf, but it is still an opioid and is still addictive. It can be a useful tool to taper off of stronger opioids, but many people are under the wrong assumption that it isn't an opioid itself, and they end up taking it and thinking "this is a miracle drug!" because it helps with their withdrawals (and ultimately end up switching one addiction with another).
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Feb 9, 2018 00:58
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PT6A posted:Or just for any opiate that someone's already addicted to. Is there any reason why heroin addicts are better off being switched to some drug they don't like, rather than a clean supply of heroin they can afford and dose properly? The main problems I see with the opiate epidemic is people overdosing, the crime involved with distribution, and people committing crimes to fund their habits. I couldn't give two fucks if someone gets high safely. Legitimate reasons could include 1. buprenorphine is safer than heroin for anyone with a strong addiction (for anyone with a high tolerance it's basically impossible to OD on by itself) and 2. it's easier to live a semi-normal life on buprenorphine due to its long half-life than it is on something like heroin. It also helps psychologically to know that taking more won't really give you a high (if you're on a higher dose, that is; if you're taking, say, 2mg you actually will notice if you take an additional 1-2mg, but if you're taking 8+ you're unlikely to notice anything from higher doses). Speaking from personal experience, it helps just to know that it's pointless to even try. If I knew taking more would have an effect, I would constantly have to be fighting against that urge. Heroin should still be available for harm prevention reasons, but I'm not sure if it really makes sense to treat it as a buprenorphine substitute unless someone just repeatedly keeps relapsing to heroin after being prescribed suboxone. Ytlaya fucked around with this message at 02:54 on Feb 9, 2018 |
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Feb 9, 2018 02:50
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Danknificent posted:Both; his take is that she should've been off the suboxone ages ago and that she's not really trying to get clean. If she's been on it three years, it's absurd to hold that against her. For many people, ending long-term addictions like that just isn't possible. Beyond initial withdrawal (which is very long for suboxone due to long half-life), there's an additional period of months (if not years for longer-term addicts) of severe insomnia (and other symptoms) that can make it very difficult for someone to continue holding down a job. The fact she's been on it three years means she's probably unlikely to relapse onto an illicit substance, and the suboxone itself won't affect her behavior in any way. Someone taking suboxone for years is effectively no different than someone taking any other drug they need for a health condition in terms of the extent to which it affects their behavior and way of life. I could also understand the whole "negative effects of living with a drug-addict parent" aspect if she had only been on the suboxone for less than a year or something, but three years is enough time that she's shown a strong commitment to living a sober life.
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Feb 9, 2018 21:17
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Danknificent posted:1) Nobody's saying it's not worth pursuing. By nobody I mean me. By all means, pursue it. I can't envision how it would work, but I would never get in anyone's way. The good thing is that we don't need to ask this question, since we already know the answer. These programs have been implemented before, and have positive results. And the issue of "street drugs" being cut with things is a very big issue. People with active addictions virtually never overdose from just using the opiate. They only overdose if either 1. they mix the opiate with something else, like alcohol or benzos, 2. they use their "old dose" after being sober for a while, or 3. their drug is cut with something far more powerful. Legal injection sites completely eliminate the third problem, greatly help to prevent the first, and will likely at least prevent death from the second (since people would be around to administer naloxone). edit: I think the third issue - opiates being cut with stronger opiates - is also the leading cause (or one of the leading causes) of opiate-related deaths in recent times.
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Feb 11, 2018 01:15
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Teriyaki Koinku posted:The way I see it, it's like asking a regular human being, "hey, you don't need food! Just choose not to be hungry!" Yeah; I would argue it's even worse, because you don't undergo hellish suffering if you forget to eat a meal. There's also a misconception that relapses are always due to the person wanting to use again for recreational reasons, and while that's certainly often the case, for longer-term addicts I would argue that PAWS symptoms are a much bigger factor. Most people (honestly pretty much everyone who isn't either a psychiatrist/doctor specializing in addiction or an addict) aren't even aware of PAWS, and many non-addicts who are aware of it don't really understand it (since all they see is the list of symptoms that kinda resemble those are clinical depression or something). Ytlaya fucked around with this message at 21:23 on Feb 14, 2018 |
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Feb 13, 2018 20:15
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^^^^ You know, articles like that really make you lose faith in the reliability of doctors. Like, how can you trust them if they can so easily be convinced to prescribe a bunch of addictive opiates (and with a "religious fervor" nonetheless)? I've had enough bad experiences that I learned to never just take a doctor/psychiatrist's word for it and always at least look up the medication's side effects online.ToxicSlurpee posted:Some people are just extremely resistant or practically immune to some things. It's part of why dosing drugs is pretty difficult; one person will get a response from 10 mg while another can take 100 mg and still feel nothing. It's why "L.D. 50" is a thing; that's the dose that will kill 50% of people. Do some Googling to see some of the absurd amounts of various substances that people have consumed and survived. What Tim Raines mentioned seems far more likely, because it's not unusual at all for (as in your example) someone with insomnia to not respond to weak over-the-counter sleep aids like benedryl, while it is very unusual for someone to not respond at all to opiates (unless there's some specific condition causing that). Benedryl (and I believe other anti-histamine sleep aids) won't do anything for certain types of insomnia, and can actually make it worse when the cause is something like restless legs. Ytlaya fucked around with this message at 19:33 on Feb 23, 2018 |
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Feb 23, 2018 19:26
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the black husserl posted:I don't respond at all to Oxy or Hydrocodone (half a dozen prescriptions and no luck) and my doctor said it was likely this issue. I get all the nausea though, fun! Hope I never encounter any actual pain or I'm screwed This is one of the downsides to being on suboxone. If I ever need to have emergency/immediate surgery I'll be in a very bad situation as far as opiate-based pain management options, since the suboxone would block them unless you increased the dose to some extremely high level (that the physician would likely be uncomfortable with unless they had experience with that specific situation). If you can postpone the surgery a few weeks it's possible to switch to a shorter-acting opiate that won't block other opiates like the suboxone, though even then you're pretty much at the mercy of the physician regarding whether or not they give the correct dose to account for existing tolerance.
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Feb 24, 2018 20:37
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tetrapyloctomy posted:The naloxone in Suboxone shouldn't be a problem, but buprenorphine's high receptor affinity is an issue. Yeah, I imagine that unless the physician in question is already familiar with dealing with opiate-dependent individuals they would balk at the incredibly high (relative to a "normal" person) doses that would be required for someone on suboxone. sea of losers posted:i was under the impression that bupe was a partial agonist and that the naloxone in suboxone was barely bioavailable orally tho? To clarify a bit more what tetrapyloctomy said, receptor affinity is a different thing than being a full/partial agonist. The latter is basically about how strong the effect is once it binds to the receptor, but not the rate at which it binds to receptors.
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Mar 5, 2018 18:22
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The_Book_Of_Harry posted:Thanks again, NA Bulletin #29 Ugh, I had this problem with trying to find meetings due to being on suboxone. I had to lie about it, which defeats the entire purpose of those meetings. It's really dumb, since people on replacement therapy have to deal with a lot of the same stuff as any other sober addicts (assuming they're using the medicine as prescribed anyways). I was able to find a meeting specifically for suboxone patients, and it was really good but also an hour+ drive away and extremely inconvenient (since it was a couple hours after work it basically tied up my entire evening). There was another meeting called (IIRC) Smart Recovery that was also objectively superior to NA in every way, but it was even more prohibitively far from where I live.
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Mar 9, 2018 17:46
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OXBALLS DOT COM posted:Yeah, a whole lot of people get given opiates at some point but only a small subset become addicts. About 10% of the population is addicted to drugs/alcohol and this is pretty consistent between races, regions, etc. and probably reflects a specific predisposition to addiction that exists in the population as a trait or brain type. You even hear about cross-activation, such as a different drug of abuse triggering relapses into the original drug. Based off my subjective personal experience, I feel like being exposed to opiates medically more frequently increases the chance of becoming an addict. I've always had a strong tendency to enjoy opiates, but the first couple times I was briefly prescribed them for stuff like surgeries the experience just sort of faded into my memory and didn't "stick" psychologically. But later on I was prescribed a significant amount of tramadol for back pain (that in retrospect really didn't need opioids or whatever pseudo-opioid thing tramadol is; gabapentin probably would have sufficed), and having that extended access for several weeks sort of ingrained the nature of the experience and how much I enjoyed the feeling in my mind and ended up leading to me seeking "grey market" opioids in the future (specifically poppy pod tea and kratom). I feel like, in the grand scheme of things, there isn't a whole lot that can be done to completely "cure" more serious/longer-term addicts, but there are at least measures that can be taken to give them a better quality of life (like in my case suboxone maintenance). And there'll be some people who, for whatever reason, are capable of becoming completely clean, and access to therapy and other support can help get them there.
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Mar 28, 2018 06:02
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OXBALLS DOT COM posted:Despite how it's marketed, gabapentin is also addictive and abusable. Not in the same way as opioids. Gabapentin doesn't really product any sort of psychotropic effect after the first couple times you take it (and even then it just makes you feel sorta floaty), and while discontinuation symptoms exist they aren't any greater than those from an SSRI or something and are completely management. Anything can be psychologically addictive, but gabapentin is probably lower risk than most things and doesn't really have any potential to escape to the point where it could cause health problems (gabapentin in particular, compared with lyrica or something, has quickly diminishing returns from higher doses). It's a good option for someone who isn't getting any help from stuff like NSAIDs but doesn't want to take opiates. PT6A posted:Yeah, I got fentanyl during a surgery, and although I didn’t feel a goddamn thing pain-wise, it made me feel awful and the side effects were terrible. My first thought was “how the gently caress is this addictive?” but then my second thought was “imagine how bad the physical addiction must be if this is preferable.” That’s what convinced me that life must be absolutely hellish for opiate addicts, where that feeling is better than the alternative. There seems to be a dramatic difference between the way certain individual react to opiates. Some people get nausea, for example, while I (and most other addicts I've met) have never remotely exhibited that side effect. I've never taken fentanyl, but presumably I would react to it similarly to literally every other opioid I've taken. If you're curious, the effect of a moderate dose of opiates for me and most other addicts I've met is virtually identical to the feeling you get after a great work-out, except of varying higher intensity depending upon the dose (which isn't surprising, given the fact the work-out feeling is created by endogenous opioids). I sometimes even refer to exercising as my "gateway drug," because in the couple years prior to using opioids I became addicted to running and exercising because of the feeling it gave me. That's part of what's so dangerous about it; the feeling doesn't involve any sort of "alteration of consciousness"* (I've never liked alcohol or marijuana for this reason), so you can function just fine while experiencing it, at least if you have the biological affinity most addicts likely have. It doesn't make us sleepy in normal doses, and actually has an opposite effect. If you've ever taken a stimulant, like adderall or ritalin, as a person without ADD, it's kinda similar to that feeling except without the "abnormal" level of energy or subsequent crash. * Unless you take such a high dose you're "nodding," which is something I never enjoyed. I've also only ever done oral opioids, so I can't speak to the "rush" you apparently get from injecting. edit: Another thing to keep in mind is that part of the reason addictions usually escalate is that it takes a while for withdrawal to become so bad it's intolerable. This means that, at first, you experience mild withdrawal and think "eh, this kinda sucks but it's not so bad, and the upsides outweigh the downsides." If you google opiate withdrawal, for example, you'll find a bunch of people recommending exercising as a way to cope with it. These people are all experiencing extremely mild opiate withdrawal, but they don't know any better because serious opiate withdrawal is basically outside the scope of normal human experience and not something you can really imagine without having experienced it. But by the time it becomes that bad, it's already too late and quitting has already becoming an almost insurmountable challenge. Ytlaya fucked around with this message at 21:09 on Mar 28, 2018 |
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Mar 28, 2018 21:01
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OXBALLS DOT COM posted:Most abusers as reported are addicts/poly-drug-abusers who take it on top of their heroin, etc., to potentiate the drugs, temporize until they get more H, and bypass some of the blockers. But if you snort big doses it reportedly does produce euphoria on its own too. Hm, I'm both an opiate addict and have been prescribed gabapentin for a long periods of time, and it does literally nothing remotely recreational after the first couple times you take it and isn't particularly difficult to stop (you just feel vaguely off for a couple days, but nothing that bad). I guess maybe snorting it could do something (since I obviously haven't tried), but given how high gabapentin doses are in milligrams it seems like that would be really difficult (unless it just has radically higher bio-availability when taken that way). It seems like it could be one of those situations where it's just taken by people desperate for some sort of high, and gabapentin's minimal-but-existent noticeable affects allow their minds to fill in the rest as a placebo. It seems like Lyrica would have more abuse potential, since I don't think Lyrica has the same diminishing effects as gabapentin and has the same effects otherwise. All of this being said, I've also never enjoyed the effects of things like alcohol or benzos, so I guess maybe someone who enjoys those might find it more appealing. My dad has had issues with alcoholism and had no problems with taking gabapentin, though. Either way, I guess the greater point is that it's definitely way preferable to opiates as a painkiller if it's sufficient for the individual in question. Some doctors will prescribe tramadol, but tramadol has effects very similar to opioids, so gabapentin is definitely a preferable alternative to that. Pretty much any substance that has literally any psychotropic effect is going to have abuse potential with some people, but I think there's a significance difference between things like gabapentin and stuff that both clearly and obviously produces a positive effect and causes severe physical dependence.
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Mar 29, 2018 03:18
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