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Opioids A different thought on opioid addiction....

A lot of good responses that do make a lot of sense: there is no easy answer to these type of questions and it is good to see people with different viewpoints discussing them in a polite and meaningful manner. So often online you see people who have a difference in opinion take it personally which has not happened here.

Speed King: I agree with what you are saying on how we've decided certain substances are acceptable and others are not. I remember a college text I was reading saying "most people are addicted to something wither it is caffeine, nicotine, alcohol, opioids, etc. If you are lucky it is something legal and socially acceptable." I think a lot of the harm from drugs comes from moral judgements placed on others who don't conform to certain standards of behavior (instead of saying "so long as you aren't hurting anyone (directly; you could basically say ones actions hurt you emotionally simply because you find it disturbing- that isn't what I mean) it doesn't matter if your behavior is different than mine and I don't judge you for it" society feels everyone has to conform to a certain norm- an idea I feel may have actually been essential when we were say hunter-gatherers where we needed everyone to pitch into the group for survival; now due to advanced technology the multiplication of manpower is becoming so great I think we will have to move past the idea that everyone needs to get up everyday and go to work 40 hours a week b/c we simply won't have work for everyone). And I feel that with a less morally judgemental approach to addiction we could do a lot better job of treating addiction: in studies on HAT (heroin assisted treatment) they seem to be finding that when heroin is supplied to addicts with some safety controls and in a controlled manner these individuals seem to be healthy, happy, and functional. And I think there may be other similar treatments for other addictions (it is a little harder for me to think of what might work and what might not) but say you take alcohol: doctors most often don't want to prescribe tranquilizers to alcoholics because they just feel that, even though benzos (which do have some negatives) are far less harmful to the body/brain than alcohol, they will drink in addition to them unless it is given in a controlled environment. But what about a pill that could contain both a benzodiazepine and antabuse? Not saying that would be perfect (I don't like the idea so much of "we are giving you something that will make you violently ill if you drink" but maybe in combination with a benzo....) but it is a thought. I think if we stopped making it a moral issue the opioid problem would actually be very easy to deal with if access to bupe, methadone, and even HAT was widely and easily available for everyone. Yes, someone might still be using but they wouldn't be hurting themselves nearly as much and there are suggestions property crimes would hurt drastically.

Crzydiamond and belfort: I get exactly what you are saying- and it could be possible for someone going to go to the hospital recieve morphine and think "this is what I have been looking for." And then you have people that hate it- for example my mother is not a rec. drug user but she does like drinking (my wife has even said that she thinks she even has very low grade alcohol since my mother drinks wine (2 to probably 3 or 4 glasses a night- but she is highly functional and it isn't bothering others so I feel like we are splitting hairs over a definition in this case) yet she hates opioids- she broke her knee and just vomits her brains out when given morphine or even if she takes a single percocet (oddly, she has bad anxiety and even hated xanax when her doctor gave her a few to take for panic attacks which is odd b/c she likes alcohol). I think the differences in how people react to opioids and why some might feel like it is missing may be differences in the endorphin system (maybe people prone to opioid addiction are deficient in endorphins and maybe people prone to stimulant addiction are deficient in dopamine as said above.

Burn out- I don't know that it is one thing that causes the disease (a gene) even if there is one, that it is only genetic, nor that you can't get better. I have heard of people that at one point were alcoholics and stopped, then were able to drink socially. And as an opioid addict I actually have gotten RXs for opioids after surgery that I used as prescribed and didn't continue to use after. With a lot of diseases there are multiple causes and people do get better, maybe sometimes completely. I guess I feel like there is something underlying just because how differently we respond to substances even as addicts. I remember when I was younger and was at an AA meeting (I think there are positives and negatives- in the right group they can be good social support but some of their ideas are outdated as well) and I said to an alcoholic something about how we respond differently and I couldn't imagine drinking 24/7- he said he felt the same way about heroin, he tried it once and could not fathom (other than with the explanation we are all different) using it all the time. Maybe it is sort of like cancer which, within each type of cancer is a specific disease, but that there are different factors (genes, smoking, nutrition, environment, etc.). Even if say opioid addiction is a very specific disease that is the result of reduced levels of endorphins who is to say that would be entirely genetic? Maybe severe psychological trauma could cause it in some people. It still would be a specific illness and different than say chronic depression (but maybe chronic depression could contribute in some people). While these aren't entirely new ideas we do tend to look at hard drugs as if someone is exposed to them they have a certain risk of becoming an addict- but maybe the fact that they are seeking them out means they already are. I think this could change the way we treat it if it became known through some level of research that this is absolutely the case.

I guess my main point from the start is that there seems to be this thought, even on bluelight and I';m not saying it is wrong, that if a completely normal well person tries a certain substance there is a chance of them becoming an addict as opposed to thinking maybe they start using the substance because they are already sick. And maybe those people will NOT always be sick in the way the AA thinking goes. I have seen research saying there are cases even of heroin addicts who at one point in there life are hardcore addicts and LATER are chippers (there seems to be a drop in very addictive activity towards opioids in many users in their late 30s early 40s- which is part of why harm reduction is important, maybe as long as you keep someone alive there is actually a good chance they get better).
 
reading some of the replies i had to join in. i only take opiates for social occasions(college) i am cutting back cause i am sick of wding of the weekend so i only use (half a 25mcg fent patch chewed) mondays and thursdays. i feel like i can talk to the hottest girl in the place and not feel awkward. as a matter of fact the three serious relationships i have been in i got the courage to ask the girl of by eating a 30. oh and i believe its less than 10% of CPP become addicted. shit i just wrote a seven page paper on why opiates should be used to treat depression for english class. i feel like myself when i take these and nothing in the world has ever made me feel this way cept rolling but ya cant do that everyday.
 
pillman1224- they have talked about using opioids for depression, as I'm sure you know due to your recent research. Usually it is bupenorphine that they speak of using to do so (and supposedly the company that produces suboxone is trying to do so or the manufacturer of other agonist/antagonists- maybe you know a little more about this?) I actually think, in the US (at least the Boston area), if one didn't care about being labled an addict and has a little financial resources they can pretty easily be prescribed opioids. I think it is pretty rare people get turned away from bupe/methadone (I found methadone treated my depression, anxiety, cravings awesome- I had very few cravings and felt good most days (other than the hour or two before dosing when I would start to feel sick; I think I metabolize drugs fast) when on the clinic- but it is SO inconvienient that my family just didn't want to put up with it- now I'm on bupe and don't think it works nearly as well) treatment. Being labled an addict does have consequences though, but maybe if someone felt they absolutely could not live w/o opioid treatment....

Hopefully, if it is a relatively safe and effective treatment for depression in some cases people will have access to it soon w/o having to be at all dishonest
 
pillman1224- they have talked about using opioids for depression, as I'm sure you know due to your recent research. Usually it is bupenorphine that they speak of using to do so (and supposedly the company that produces suboxone is trying to do so or the manufacturer of other agonist/antagonists- maybe you know a little more about this?) I actually think, in the US (at least the Boston area), if one didn't care about being labled an addict and has a little financial resources they can pretty easily be prescribed opioids. I think it is pretty rare people get turned away from bupe/methadone (I found methadone treated my depression, anxiety, cravings awesome- I had very few cravings and felt good most days (other than the hour or two before dosing when I would start to feel sick; I think I metabolize drugs fast) when on the clinic- but it is SO inconvienient that my family just didn't want to put up with it- now I'm on bupe and don't think it works nearly as well) treatment. Being labled an addict does have consequences though, but maybe if someone felt they absolutely could not live w/o opioid treatment....

Hopefully, if it is a relatively safe and effective treatment for depression in some cases people will have access to it soon w/o having to be at all dishonest



the study i actually quoted in my paper used oxymorphone aka "opana" except one person who had a history of opioid dependence he was given 10mgs oxycodone q12h i believe and it truly helped him (shocker). i have heard of bupe being used for depression not methadone though i cannot and will not tough methadone.
 
Wow- oxymorphone- never tried it but heard it was a very well liked opioid and very strong (I remember one of the few people I talked to who had tried it (someone in detox years ago) said it was so strong he shot half a tablet and passed out (w/a heroin habit) there are probably a couple reasons for this though- 1) it only has a 10% bioavailability oral 2) it is usually only prescribed to people that already have an opioid tolerance such as chronic pain patients who are no longer getting adequate relief from say oxycodone; so you have a pill which in many strengths is intended for people w/o tolerance and only 10% will make it through the stomach/digestion). Everyone is different though.

I'm on bupe but have a lot of pain and anxiety and methadone helped with that. Most people don't recommend it for recreational use as the half-life lasts longer than the effects which causes people to redose until it has a toxic build-up. On the other hand I found fent's half-life to be far to short and when I was getting the pure powder last spring it gave me the worst/fastest building tolerance of any opioid I ever tried and worst withdrawals by far (I used fent for a few weeks and went from 300mcgs IV to 2-4mgs IV (and probably 1mg just to even be not sick) and had to switch to diamorphine for a few weeks to get back on bupe as bupe didn't even touch fent withdrawals). I have been itching to take some opioids and know I shouldn't but prob will... but for me personally I will stay away from fent. I really wish I could get on pain management (I actually did have a doc give me methadone even though I was an addict for pain but only gave me 30mgs (and I was being prescribed 24mgs/day bupe before) and I ended up still sick taking 10mgs every 8 hours and still using and got arrested while prescribed it and got flagged I think (I don't think the specific red flag matters as much as it used to now with the databases though- if you get prescribed bupe they already have that info and know you are an addict). If I could get my hands on any opioid it would be oxymorphone probably BUT I feel like levomorphone or methadone in the right dose would probably be the right meds b/c they help with nerve pain more than other opioids (I have a history of 4 spinal fractures, 3 deginerated-dessicated-and sliding discs). Most likely I will not be prescribed anything and will just end up self-medicating (benzos ocassionally help but I know I can't take those all the time and they don't help as much- I will probably continue to go through cycles of bupe+extreme pain then opioid abuse for the rest of my life). I do think that other factors do make it harder to stay clean when you are an addict- I always get to the point where I feel like pain is so bad I don't really value my life and then I relapse (why not use if you don't really even care about death? I am not suicidal, I won't try to make it happen so much as I don't always care if it does).
 
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