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N&PD Moderators: Skorpio | thegreenhand
opiates as antidepressants?
- Thread starter iloveoxycontin
- Start date
![:\](https://bluelight.org/xf/BL_Images/Orig_Emoji/wrygrin.gif "wry grin :\")
I've been using buprenorphine as an antidepressant for 13 months now, and the more conventional poppy-derivatives for at least a year before that.
I haven't been willing to let my doctors dismiss my complaints of pain, anhedonia and bedtime insomnia (and weird 36-48 hour sleep cycles) by prescribing the SSRI of the month, or Effexor, although I've had doctors insist upon both to try to hurry me out of their office (and by prescribing another drug, they get to bill the 5 minute visit as a "high-complexity office visit - $200").
My quality of life definately improved dramatically during this period, initially (2.5 years ago) my sleep improved, and my recreational alcohol, weed and meth intake stopped, both of which I attribute to my self-medicational use of opioids.
Not everybody can safely self-medicate with opioids, in fact I would strongly advise against it, because it is FAR too easy to fall into the trap of falling in love with "the nod", or placing the drugs on a pedestal as infallable cures for all that ails you. I believe there were 3 factors which helped me control my usage above all others...
#1 I found a passion in learning all that I could about opioids, and knowing everything there is to know about its pharmacology and chemistry (and history and sociological factors) BEFORE ever using them.
#2 I STRONG belief that moderation is EXTREMELY important in using ANY drug, and a love for the principles of harm-reduction. I've always limited my consumption essentially only to what I NEED (or more specifically, the dose which would provide me the most benefits with the least harms), and didn't do recklessly large amounts, and always strived to ration out my supply to last as long as possible (which helped me both financially and with my tolerance)
#3 I have always taken great care to opioids in easily measurable forms, primarily pharmaceutical quality pills, and I've always used a milligram scale and a measuring syringe whenever appropriate to assure that the dosage I injested was always predictable and reasonable.
Believe me, if you take great care to NOT do 40mg lines of Oxy every time you feel like it, you'll be MUCH better off one day in the future when you break some toes and decide to eat an OC10, and you experience 12 hours of blissful RELIEF.
To anybody who NEEDS an opioid in their life, either long term or short term, for one reason or another (pain, depression, dependance, addiction), I strongly recommend considering Buprenorphine, as it has made my life easier and more bearable for more than a year now, and my tolerance has not increased at all... I still experience pain-relief from it, though it never produced unwanted sedation, nausea, apathy, or cognitive issues. I've been using right around 2mg for the last 13 months, in 2-4 divided doses per day either orally or nasally (depending on whether I'll need to talk to anybody for 15 minutes or so).
To those who suffer the primary side effect of the opioids, remember FIBER and MAGNESIUM are enough to return you to your pre-opioid function. IF those aren't enough, look into "Polyethylene Glycol 3350 powder", its a lifesaver!
If somebody in this thread is looking for some references for further reading, look no further than:
http://hive.dopers.org/bupe_for_depression.txt
http://hive.dopers.org/buprenorphine.txt
http://opioids.com/buprenorphine/buprefdep.html
http://www.dr-bob.org/babble/20041211/msgs/428827.html
I know this isn't a research paper or anything (I do plan to write one on this subject someday - tonight is NOT the night, I've got a trip to pack for), but I feel my personal experience answers the original question just as well as any study could (while I acknowledge that my sample size here is 2 - the other party wishes to remain nameless).
I haven't been willing to let my doctors dismiss my complaints of pain, anhedonia and bedtime insomnia (and weird 36-48 hour sleep cycles) by prescribing the SSRI of the month, or Effexor, although I've had doctors insist upon both to try to hurry me out of their office (and by prescribing another drug, they get to bill the 5 minute visit as a "high-complexity office visit - $200").
My quality of life definately improved dramatically during this period, initially (2.5 years ago) my sleep improved, and my recreational alcohol, weed and meth intake stopped, both of which I attribute to my self-medicational use of opioids.
Not everybody can safely self-medicate with opioids, in fact I would strongly advise against it, because it is FAR too easy to fall into the trap of falling in love with "the nod", or placing the drugs on a pedestal as infallable cures for all that ails you. I believe there were 3 factors which helped me control my usage above all others...
#1 I found a passion in learning all that I could about opioids, and knowing everything there is to know about its pharmacology and chemistry (and history and sociological factors) BEFORE ever using them.
#2 I STRONG belief that moderation is EXTREMELY important in using ANY drug, and a love for the principles of harm-reduction. I've always limited my consumption essentially only to what I NEED (or more specifically, the dose which would provide me the most benefits with the least harms), and didn't do recklessly large amounts, and always strived to ration out my supply to last as long as possible (which helped me both financially and with my tolerance)
#3 I have always taken great care to opioids in easily measurable forms, primarily pharmaceutical quality pills, and I've always used a milligram scale and a measuring syringe whenever appropriate to assure that the dosage I injested was always predictable and reasonable.
Believe me, if you take great care to NOT do 40mg lines of Oxy every time you feel like it, you'll be MUCH better off one day in the future when you break some toes and decide to eat an OC10, and you experience 12 hours of blissful RELIEF.
To anybody who NEEDS an opioid in their life, either long term or short term, for one reason or another (pain, depression, dependance, addiction), I strongly recommend considering Buprenorphine, as it has made my life easier and more bearable for more than a year now, and my tolerance has not increased at all... I still experience pain-relief from it, though it never produced unwanted sedation, nausea, apathy, or cognitive issues. I've been using right around 2mg for the last 13 months, in 2-4 divided doses per day either orally or nasally (depending on whether I'll need to talk to anybody for 15 minutes or so).
To those who suffer the primary side effect of the opioids, remember FIBER and MAGNESIUM are enough to return you to your pre-opioid function. IF those aren't enough, look into "Polyethylene Glycol 3350 powder", its a lifesaver!
If somebody in this thread is looking for some references for further reading, look no further than:
http://hive.dopers.org/bupe_for_depression.txt
http://hive.dopers.org/buprenorphine.txt
http://opioids.com/buprenorphine/buprefdep.html
http://www.dr-bob.org/babble/20041211/msgs/428827.html
I know this isn't a research paper or anything (I do plan to write one on this subject someday - tonight is NOT the night, I've got a trip to pack for), but I feel my personal experience answers the original question just as well as any study could (while I acknowledge that my sample size here is 2 - the other party wishes to remain nameless).
ratrenkamp
Bluelighter
- Joined
- Jan 4, 2005
- Messages
- 31
so, why then do you chose a synthetic opiate over the real thing, i mean, if your gonna do it do it right!
PhorIndicator
Bluelighter
- Joined
- Aug 7, 2004
- Messages
- 728
Mirtazapine is a great anti-depressant, especially when it is combined with another strong SSRI or SSRI/NI like Effexor. It caused me to gain 65 pounds while on it though, and I eventually becoming 10 times more depressed because of my weight gain and self-esteem than I ever had been before taking remeron.
As far as an opiate anti-depressant, I am surprised no one has mentioned Tramadol yet. I find it to be have a very good anti-depressant effect, almost identical to Effexor, actually, but of course with that extra "opioid" boost from its actions on the MU receptor. Also, ultram is not as physically addictive as other opiates and has a stimulating effect to it, which is more condusive to someone taking an anti-depressant at the beginning of the day.
As far as an opiate anti-depressant, I am surprised no one has mentioned Tramadol yet. I find it to be have a very good anti-depressant effect, almost identical to Effexor, actually, but of course with that extra "opioid" boost from its actions on the MU receptor. Also, ultram is not as physically addictive as other opiates and has a stimulating effect to it, which is more condusive to someone taking an anti-depressant at the beginning of the day.
Nuke_Africa
Bluelighter
- Joined
- Dec 8, 2004
- Messages
- 19
"If we could sniff or swallow something that would, for five or six hours each day, abolish our solitude as individuals, atone us with our fellows in a glowing exaltation of affection and make life in all its aspects seem not only worth living, but divinely beautiful and significant, and if this heavenly, world-transfiguring drug were of such a kind that we could wake up next morning with a clear head and an undamaged constitution-then, it seems to me, all our problems (and not merely the one small problem of discovering a novel pleasure) would be wholly solved and earth would become paradise."
ALDOUS HUXLEY
ALDOUS HUXLEY
If you're talking to me, I chose buprenorphine over heroin or opium because:
#1 - Buprenorphine has a 24-48 hour half-life, allowing me to sleep-in late in the morning, and go through an entire day at work, without fiending for a fix...
#2 - Buprenorphine is LEGAL for me to obtain and possess. All I need to do is visit my doctor once a month, and tell him that I'm doing well, and not pee dirty for opiates (they pee test me for everything, but I sometimes fail for benzos or weed, but he doesn't care too much). If I get pulled over, like recently for expired registration, I have NOTHING to worry about because I am NOT BREAKING ANY LAWS... the highway patrol can search my car (not that I'm going to let them), find my opiates, and then GIVE THEM BACK TO ME AND LET ME GO. This 1 fact definately lowers my overall anxiety level, and further improves my sleep at night, both of which reduce my NEED to do opiates to mask these 2 negative stimuli (anxiety and insomnia).
#3 - My INSURANCE pays for it. While I realise not everybody is currently working a full time job at a company with good medical benefits (especially not in the world-capital of medical greed, the USA), but knowing that my medication which happens to be an opioid is only costing me $30 a month, definately reduces my anxiety over figuring out how to pay for it. I empathize with those of you who need to spend next week's paycheck to stand on a street-corner and score some dope - I only wish the best for you and hope that you can find a financially feasible way to obtain the most appropriate medication you need.
#4 - Buprenorphine has a CEILING effect, and it is provided in pharmaceutical-grade pre-measured pills, meaning I never have to worry about over- (or under-) dosage as long as I'm on bupe. Knowing just how many opiate users out there occasionally misjudge their doses, or are using something mis-represented as a given dose, and wind up either not breathing and suffering a naloxone shot, or dying, or not getting any opiates at all (due to fake shit), I am glad to have found a consistant, stable supply.
#5 - Buprenorphine, when used as directed, will NOT cause one's tolerance to opioids to increase. I've heard countless stories of people who have jacked up their opioid tolerance to the point where they MUST have 80mg of oxy or 1/4 gram of heroin every couple hours, or else they get violently ill.
#6 - Convenient method of administration. I very much appreciate that administering suboxone (buprenorphine) to myself only requires that I have the pill bottle to crush it, a piece of paper to scrape it, and a tube (straw or dollar bill) to snort it. Even simpler still is that I can just put one under my tounge and not talk to anybody for 10 minutes. Both of these choices are dramatically simpler than obtaining and maintaining (sterilizing) IV injection works, and the work needed to find a private, sterile environment to inject. These are also easier than finding foil, a lighter and a private place to smoke something. I bet those poppy-tea users who spend over an hour each day cooking, straining and drinking their pods wish that sublingual administration was an option.
thursday
Bluelighter
- Joined
- Mar 19, 2004
- Messages
- 2,262
personally, i think a partial opiate like buprenorphine is perfect as an anti-depressant if you can suppress the urge to abuse it or get high off of it all the time. i've been using buprenorphine instead of prozac/lexapro for about 4 months now and it's worked much better than those SSRI's did. It's also a helluva lot cheaper. Lexapro cost me $200 a month, Buprenorphine costs me $10. I've been using roughly the same dosage the entire time too.
I think people seem to forget that anti-depressants might actually work because they work on the opiate system. Of course this is not completely clear.
http://biopsychiatry.com/fluoxopi.htm
http://biopsychiatry.com/opanti.htm
http://biopsychiatry.com/imipramine-deltaopioid.htm
http://biopsychiatry.com/paroxetine-opioid.htm
can't find the study that shows anti depressant activity was lost in an animal study when naltrexone whas given. Although on the dr. bob website i read about a psychiatrist using natrexon as an add on to anti depressants. Maybe the animal model for depression is actually a better model for pain relief...
http://biopsychiatry.com/fluoxopi.htm
http://biopsychiatry.com/opanti.htm
http://biopsychiatry.com/imipramine-deltaopioid.htm
http://biopsychiatry.com/paroxetine-opioid.htm
can't find the study that shows anti depressant activity was lost in an animal study when naltrexone whas given. Although on the dr. bob website i read about a psychiatrist using natrexon as an add on to anti depressants. Maybe the animal model for depression is actually a better model for pain relief...
PuppyUpper
Bluelighter
- Joined
- Mar 10, 2005
- Messages
- 12
I have been on straight Bup Inj for 2 years....
Please let me share my admiration for Buprenex Injections as a pain killer AND anti-depressant. I have been on Bup inj (IM or SubQ works equally) for two years following a MVH Ax with complicated injuries to my entire cervical spine and T-1 and 2 of my thoracic spine.
I checked into rehab in 2001 for Vicodin abuse. Mostly running from WD's rather than getting high because after two years of daily use it took too much, but abuse and sobriety followed after rehab nonetheless and without any relapse.
I got in the car accident about 8 months later, and to make a long story short, surgery would not happen for several years and with the amount of pain i experienced on a daily basis I cringed at the thought of the amount of pain pills I would be eating and probably end up abusing....you get the scenario.
I came across a forum online with many people on straight Bup w/o naloxone before Subutex or the others were approved. They all had medical needs for it and raved about it for reasons that were very attractive to me such as abuse potential due to antagonist properties, WD, etc. I approached my doctor with this as an alternative to heading down a road of addiction I didnt want to return to agin and she was happy to do it. The only drawback is that I have to stick myself because there is no pill form approved for pain (at least at that time) and patches were and still are available only in England (I think).
I dont want to make this as long as I could so i will get straight to the facts I have experienced with this drug:
1. I started out at 1 ampule (.324) TID and in two years with no increase OR decrease in pain i have only had to increase my dosage to 1.5amps TID. Only 1 and a half amps a day increase in two years.
2. When you initially start it you do get pretty heavy doses of euphoria but in my case only for a couple of weeks until my body adjusted. To give you an idea of my opiod tolerance it is where I could wear a 75mcg Duragesic patch and have a little drowsiness as the only side effect, probably due still to my prior abuseof opiates.
3.If you increase the time between doses by a good amount you may get a good hit of euphoria too, for example, if I usually took shots at 9, 3 and 9 but on any given day I skipped my three o'clock dose, then when I take the third dose of the day I would get a pretty big hit of euphoria. BUT if I take the three doses regularly on schedule I DO NOT experience euphoria no matter with or without food. This is a huge factor I am sure as to why I have had great success without abuse with Bup.
4. Someone posted above some ungodly amount he thought was the "ceiling effect" and I am sure he is knowledgeable but I would be dead of an overdose before I would ever get close to it. Each amp is .324 per mL of Buprenex in each amp. So I take less than a Mg and he mentioned i think something over 50mg? You see my point - I guess Suboxone (sp) may be different because of the additional antagonist?
5. There are definate mood elevating properties, they difference isn;t severe but very much noticeable when I have been off of it for at least several days. If you Google you can find a study done at a US University on straight Bup as a mood elevator. They didnt use the term antidepressant - mood elevator is what I believe they said. It may have been University of Iowa and if I can find it I will post after this.
6. WD's....aaahhhhh here is the beauty of this opiate in my opinion. I have been to opiate WD hell, unable to move out of my own pool of sweat and I have a post in the Dark Side forum about it under the Opiate WD thread. For brevity here, i will tell you it was one of the worst WD's of the posts in that thread. That said, I needed to be off the Injections for a week to have a minor surgery and obviously the antagonist conflict with anesthesia. Here is how I tapered VERY simply and successfully; I took ONE amp at 24 hours each day (exactly 24 hours apart) for five days and then stopped cold turkey. Knowing what can come from opiate Wd i was SHOCKED when the only WD symptom I had AT ALL was a runny nose! That's it! You talk about one happy camper - Bup came through for me because that is the main reason I took it - ease of getting off it. It also reinforces the reasons we are seeing this in place of Methadone which I hear is a hell of a bitch to get off even with tapering - uncomfortable at best. I became not only a Bup customer - but a active ADVOCATE for this drug to be used in place of these hellacious short acting opiods in chronic and long term pain patients.
7. I have strongly advocated anyone I run into that is on short acting opies to get this and have successfully converted a few who met the circumstances this drug is so benficial for, mainoly chronics as I said above. HERE IS THE CATCH: I have had the majority come back to me horrified by the reaction of their various MD's when they requested this drug and met with arrogance and inflexibility even when the patients gave them thorough explanations for their request. As you know, Bup Inj is not a commonly used drug for pain in the US in the whole scheme of things used for pain. The common thread I heard over and over was that upon referencing their pocket drug PDR's and such, that seemed to be when the shock hit and in fact some felt the MD's turn on them as if they were seeking heroin - a couple were even turned away and dropped as patients because the MD's felt it was drug seeking behavior!!
Now WAIT A MINUTE..........these unempathtic MD's are reading something in these PDR's and the like and I can't put my finger on what exactly it is or if there are that many stupid MD's that arent calculating dosages in their head or whatever - i heard something like several PDR's mentioned equianalgesia and morphine and that's when the doc freaked. Well sure - tell me if I am wrong Pharmers - if you use Bup Inj at doses that are about 5 to 10mgs higher than I am using it is a omnipotent opiate. My pocket drug PDR doesnt give a equianalgesic conversion, but I suspect either there is an exaggeration or maybe just confusion on their part about where a dosage would start on a patient such as myself in moderate pain and a low dose.......I dont know - maybe you guys can tell me - but this is a terrible misconception about this drug - one doctor saying it was comparable to legal heroin - and it kills me to see the brain damage going on and the struggle with breakthru pain and even addictions and agonizing physical dependence in these patients when they could be SO much more happy and getting adequate pain management with this drug.
I know i am a nut about this but I have been through Opiate hell as you have heard me say and that is what drives me to get these doctors to wake up and take a chance and try something different instead of fearing their licences because they are arrogant and misinformed - certainly not because there is any legitimate reasons to fear anything let alone to deny these patients the best thing they can give them.
And....... I'm spent........is anyone out there getting my frustrations and if all my facts are right....isnt this a viable alternive with a very nice side effect of mood elevators? READ: NOT euphoria, NOT fucked up on opiates, BUT an intangible but very noticabldifference after a couple weeks use of the drug. I know you'll have to take my word on some of this but seeing my motivations for advocating this I can only hope you see my intentions are genuine but very determined, too.
Thanks for listening and I hope I have contributed something useful!
Melissa
The following are excerpts from an editorial in the June 15th, 1996 issue of the journal Biological Psychiatry. The editorial outlines the (irrational) reasons buprenorphine is not used more often in cases of clinical depression that has not responded to every other available treatment.
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>
>
>
> Buprenorphine for Depression: The Un-adoptable Orphan
>
> Buprenorphine [BPN] in low (circa 0.3 mg qid) transmucosally (under the tongue or by nose drops) can be dramatically effective in cases of treatment for refractory depression. Its safety and efficacy are not secrets, yet it has received little study and currently receives little clinical use.
>
> Early in BPN's history, Emrich et al (1982) found it a potent antidepressant in drug-refractory depressives. Sporadic supporting reports have appeared in the literature from time to time since then. Most recently, Bodkin et al (1995) reviewed the literature and reported an open trial of 10 cases to further document BPN's value as an antidepressant. When the drug works, it works quickly. Bodkin et al say they see results within several days. We have found that most patients experience benefits of an adequate dose within three hours. The only intolerable side effects are nausea and dysphoria. The effects are seen in 10% to 20% of patients and are quickly obvious....
>
> We have personally treated five patients with BPN in whom the results were impressive. Three were more or less typical cases of depression who had failed adequate trials with various treatments, including, in one case, a thorough course of ECT. Of the two less typical patients, one was a case of panic disorder with onset in childhood and what could better be called dysthymia rather than typical depression.... All five patients were followed for several years while good results were maintained.
>
> Given BPN's availability and demonstrated efficacy, why is it so rarely used in treating depression? Therein hangs a tale. Reckitt and Colman Pharmaceuticals, Inc. [R&C] received their NDA to market BPN as a parenteral analgesic more than a decade ago. It appears that their grand strategy was to get BPN approved as an over-the-counter analgesic. It does indeed have a remarkable safety profile. At high doses, it produces less respiratory depression and cognitive obtunding than morphine, perhaps due to its antagonist action....
>
> Addiction and tolerance are not serious problems. Patients who abruptly stop the drug complain of fatigue, dysphoria, upset stomach, and sometimes piloerection. This pallid imitation of narcotic withdrawal is generally not associated with craving, and indeed patients do not usually associate their symptoms with having stopped the drug until they experience the relief occasioned by restarting their treatment. There are reports of the drug being abused, but then some substace abusers will abuse almost anything. We were told that San Quentin stopped using white scouring powder because substance-abusing inmates were injecting it into themselves!
>
> One handicap BPN has had as an antidepressant was the absence of any interest in that application on the part of the manufacturer. The idea of selling BPN as an OTC analgesic was not an unreasonable one, but it did not lead R&C to pursue work on the psychotropic properties of their drug.
>
> It appears tha BPN can be used much as methadone is used in maintaining opiate addicts. While doses of up to 32mg have been used, doses in the order of 6 to 12mg seem best. Compare this to the 0.15mg to 0.3mg doses that are effective in depression. Several studies have reported that BPN is indeed effective in treating opiate dependence, although less so than methadone (Kosten et al 1993 and Strain et al 1994). However, BPN's use in treating addicts, plus the ominous "-norphine" suffix in its name, have been even more of a deterrent to BPN's exploitation as an antidepressant than has R&C's narrow focus on its analgesic applications.
>
> Comparing BPN with classic mu agonist opiates is unfair. BPN is a derivative of thebaine, which has partial mu agonist and kappa antagonist activities. As a partial agonist, it seems to act as a mu antagonist at higher doses, and this provides some protection against it being used in escalating doses by substance abusers. In addition, in low doses it produces minimal or no euphoria. We have a little packet of reprints to send out to pharmacists who call accusingly and question why we are prescribing such a "dangerous narcotic."...
>
> We have continually been frustrated by the resounding lack of interest our colleagues have shown in BPN as an antidepressant. In spite of some promising pilot work, Veterans Administration workers treating post-traumatic stress disorder have declined to study BPN because so many of their clients are substance abusers, and BPN is "narcotic-like."
>
> We discovered that someone had contracted with Cygnus, Inc. to develop a BPN patch. That was accomplished, but the contracting company dropped the project. The developed BPN patch now sits on their shelf. However, after a few cordial lunches, Cygnus indicated they would need a million dollars up front to reactivate production of the patch for a clinical trial. Small business grants are limited to $100,000 to start, so that would not get Cygnus back into the BPN patch business. Also, treatment-refractory depression does not sound like an appealing market to business types. We are not sure the market is so small, and it has been suggested that as many as 20-30% of depressed patients may be treatment-refractory. But certainly, for a single physician, patient accrual is slow. While the patent on BPN has run out, orphan drug status might allow a company to be protected against competition while it recoups its investment and more. But so far there is little interest from industry.
>
> Academia has been similarly uninterested, but with better reason. It's too bad that substance abuse takes a hight priority than depression in congress, but then what is one to expect. And our wildest fantasy does not have the National Institutes of Mental Health approving the trial of such an oddball drug for treatment-refractory depression. In our mind's eye we can see the pink sheet: Reviewer No. 1 says: "We already know that BPN works in depression, so why do it again?", while reviewer No. 2 says: "It's too much of a long shot in these times of short money."...
>
> Research is the art of the possible, and none of us these days can afford to espouse lost causes. But your local pharmacist can dispense BPN without a triplicate, and even supply a syringe and needle so the patient can withdraw the drug form the vial and squirt it under the tongue. You will find it in the Physician's Desk Reference under the trade name "Buprenex" injectable, 0.3mg/ml. So even if the orphan remains un-adoptable, you might want to try BPN on an occasional drug-refractory depressive, and so keep it alive, at least in the lore of those who do tertiary psychopharmacology.
>
>
> Enoch Callaway
> University of California-San Francisco
> Tiburon, CA
>
>
> References:
>
> Bodkin JL, Zornberg GL, Lucas SE, Cole JO. (1995): Buprenorphine treatment of refractory depression. Journal of Clinical Psychopharmacology, 16:49-57.
> Emrich HM, Vogt P, Herz. (1982): Possible antidepressive effects of opioids: action of buprenorphine. Annals of the New York Academy of Sciences, 398:108-112.
> Kosten TR, Schottenfeld R, Ziedonis D, Falcioni J. (1993): Buprenorphine versus methadone maintenance in opioid dependence. J Nerv Mental Dis 181:358-364.
> Strain EC, Stitzer ML, Liebson IA, Bigelow GE. (1994): Buprenorphine vs. methadone in the treatment of opioid-dependent cocaine users. Psychopharmacology 116:401-406.
Please let me share my admiration for Buprenex Injections as a pain killer AND anti-depressant. I have been on Bup inj (IM or SubQ works equally) for two years following a MVH Ax with complicated injuries to my entire cervical spine and T-1 and 2 of my thoracic spine.
I checked into rehab in 2001 for Vicodin abuse. Mostly running from WD's rather than getting high because after two years of daily use it took too much, but abuse and sobriety followed after rehab nonetheless and without any relapse.
I got in the car accident about 8 months later, and to make a long story short, surgery would not happen for several years and with the amount of pain i experienced on a daily basis I cringed at the thought of the amount of pain pills I would be eating and probably end up abusing....you get the scenario.
I came across a forum online with many people on straight Bup w/o naloxone before Subutex or the others were approved. They all had medical needs for it and raved about it for reasons that were very attractive to me such as abuse potential due to antagonist properties, WD, etc. I approached my doctor with this as an alternative to heading down a road of addiction I didnt want to return to agin and she was happy to do it. The only drawback is that I have to stick myself because there is no pill form approved for pain (at least at that time) and patches were and still are available only in England (I think).
I dont want to make this as long as I could so i will get straight to the facts I have experienced with this drug:
1. I started out at 1 ampule (.324) TID and in two years with no increase OR decrease in pain i have only had to increase my dosage to 1.5amps TID. Only 1 and a half amps a day increase in two years.
2. When you initially start it you do get pretty heavy doses of euphoria but in my case only for a couple of weeks until my body adjusted. To give you an idea of my opiod tolerance it is where I could wear a 75mcg Duragesic patch and have a little drowsiness as the only side effect, probably due still to my prior abuseof opiates.
3.If you increase the time between doses by a good amount you may get a good hit of euphoria too, for example, if I usually took shots at 9, 3 and 9 but on any given day I skipped my three o'clock dose, then when I take the third dose of the day I would get a pretty big hit of euphoria. BUT if I take the three doses regularly on schedule I DO NOT experience euphoria no matter with or without food. This is a huge factor I am sure as to why I have had great success without abuse with Bup.
4. Someone posted above some ungodly amount he thought was the "ceiling effect" and I am sure he is knowledgeable but I would be dead of an overdose before I would ever get close to it. Each amp is .324 per mL of Buprenex in each amp. So I take less than a Mg and he mentioned i think something over 50mg? You see my point - I guess Suboxone (sp) may be different because of the additional antagonist?
5. There are definate mood elevating properties, they difference isn;t severe but very much noticeable when I have been off of it for at least several days. If you Google you can find a study done at a US University on straight Bup as a mood elevator. They didnt use the term antidepressant - mood elevator is what I believe they said. It may have been University of Iowa and if I can find it I will post after this.
6. WD's....aaahhhhh here is the beauty of this opiate in my opinion. I have been to opiate WD hell, unable to move out of my own pool of sweat and I have a post in the Dark Side forum about it under the Opiate WD thread. For brevity here, i will tell you it was one of the worst WD's of the posts in that thread. That said, I needed to be off the Injections for a week to have a minor surgery and obviously the antagonist conflict with anesthesia. Here is how I tapered VERY simply and successfully; I took ONE amp at 24 hours each day (exactly 24 hours apart) for five days and then stopped cold turkey. Knowing what can come from opiate Wd i was SHOCKED when the only WD symptom I had AT ALL was a runny nose! That's it! You talk about one happy camper - Bup came through for me because that is the main reason I took it - ease of getting off it. It also reinforces the reasons we are seeing this in place of Methadone which I hear is a hell of a bitch to get off even with tapering - uncomfortable at best. I became not only a Bup customer - but a active ADVOCATE for this drug to be used in place of these hellacious short acting opiods in chronic and long term pain patients.
7. I have strongly advocated anyone I run into that is on short acting opies to get this and have successfully converted a few who met the circumstances this drug is so benficial for, mainoly chronics as I said above. HERE IS THE CATCH: I have had the majority come back to me horrified by the reaction of their various MD's when they requested this drug and met with arrogance and inflexibility even when the patients gave them thorough explanations for their request. As you know, Bup Inj is not a commonly used drug for pain in the US in the whole scheme of things used for pain. The common thread I heard over and over was that upon referencing their pocket drug PDR's and such, that seemed to be when the shock hit and in fact some felt the MD's turn on them as if they were seeking heroin - a couple were even turned away and dropped as patients because the MD's felt it was drug seeking behavior!!
Now WAIT A MINUTE..........these unempathtic MD's are reading something in these PDR's and the like and I can't put my finger on what exactly it is or if there are that many stupid MD's that arent calculating dosages in their head or whatever - i heard something like several PDR's mentioned equianalgesia and morphine and that's when the doc freaked. Well sure - tell me if I am wrong Pharmers - if you use Bup Inj at doses that are about 5 to 10mgs higher than I am using it is a omnipotent opiate. My pocket drug PDR doesnt give a equianalgesic conversion, but I suspect either there is an exaggeration or maybe just confusion on their part about where a dosage would start on a patient such as myself in moderate pain and a low dose.......I dont know - maybe you guys can tell me - but this is a terrible misconception about this drug - one doctor saying it was comparable to legal heroin - and it kills me to see the brain damage going on and the struggle with breakthru pain and even addictions and agonizing physical dependence in these patients when they could be SO much more happy and getting adequate pain management with this drug.
I know i am a nut about this but I have been through Opiate hell as you have heard me say and that is what drives me to get these doctors to wake up and take a chance and try something different instead of fearing their licences because they are arrogant and misinformed - certainly not because there is any legitimate reasons to fear anything let alone to deny these patients the best thing they can give them.
And....... I'm spent........is anyone out there getting my frustrations and if all my facts are right....isnt this a viable alternive with a very nice side effect of mood elevators? READ: NOT euphoria, NOT fucked up on opiates, BUT an intangible but very noticabldifference after a couple weeks use of the drug. I know you'll have to take my word on some of this but seeing my motivations for advocating this I can only hope you see my intentions are genuine but very determined, too.
Thanks for listening and I hope I have contributed something useful!
Melissa
The following are excerpts from an editorial in the June 15th, 1996 issue of the journal Biological Psychiatry. The editorial outlines the (irrational) reasons buprenorphine is not used more often in cases of clinical depression that has not responded to every other available treatment.
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> Buprenorphine for Depression: The Un-adoptable Orphan
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> Buprenorphine [BPN] in low (circa 0.3 mg qid) transmucosally (under the tongue or by nose drops) can be dramatically effective in cases of treatment for refractory depression. Its safety and efficacy are not secrets, yet it has received little study and currently receives little clinical use.
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> Early in BPN's history, Emrich et al (1982) found it a potent antidepressant in drug-refractory depressives. Sporadic supporting reports have appeared in the literature from time to time since then. Most recently, Bodkin et al (1995) reviewed the literature and reported an open trial of 10 cases to further document BPN's value as an antidepressant. When the drug works, it works quickly. Bodkin et al say they see results within several days. We have found that most patients experience benefits of an adequate dose within three hours. The only intolerable side effects are nausea and dysphoria. The effects are seen in 10% to 20% of patients and are quickly obvious....
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> We have personally treated five patients with BPN in whom the results were impressive. Three were more or less typical cases of depression who had failed adequate trials with various treatments, including, in one case, a thorough course of ECT. Of the two less typical patients, one was a case of panic disorder with onset in childhood and what could better be called dysthymia rather than typical depression.... All five patients were followed for several years while good results were maintained.
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> Given BPN's availability and demonstrated efficacy, why is it so rarely used in treating depression? Therein hangs a tale. Reckitt and Colman Pharmaceuticals, Inc. [R&C] received their NDA to market BPN as a parenteral analgesic more than a decade ago. It appears that their grand strategy was to get BPN approved as an over-the-counter analgesic. It does indeed have a remarkable safety profile. At high doses, it produces less respiratory depression and cognitive obtunding than morphine, perhaps due to its antagonist action....
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> Addiction and tolerance are not serious problems. Patients who abruptly stop the drug complain of fatigue, dysphoria, upset stomach, and sometimes piloerection. This pallid imitation of narcotic withdrawal is generally not associated with craving, and indeed patients do not usually associate their symptoms with having stopped the drug until they experience the relief occasioned by restarting their treatment. There are reports of the drug being abused, but then some substace abusers will abuse almost anything. We were told that San Quentin stopped using white scouring powder because substance-abusing inmates were injecting it into themselves!
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> One handicap BPN has had as an antidepressant was the absence of any interest in that application on the part of the manufacturer. The idea of selling BPN as an OTC analgesic was not an unreasonable one, but it did not lead R&C to pursue work on the psychotropic properties of their drug.
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> It appears tha BPN can be used much as methadone is used in maintaining opiate addicts. While doses of up to 32mg have been used, doses in the order of 6 to 12mg seem best. Compare this to the 0.15mg to 0.3mg doses that are effective in depression. Several studies have reported that BPN is indeed effective in treating opiate dependence, although less so than methadone (Kosten et al 1993 and Strain et al 1994). However, BPN's use in treating addicts, plus the ominous "-norphine" suffix in its name, have been even more of a deterrent to BPN's exploitation as an antidepressant than has R&C's narrow focus on its analgesic applications.
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> Comparing BPN with classic mu agonist opiates is unfair. BPN is a derivative of thebaine, which has partial mu agonist and kappa antagonist activities. As a partial agonist, it seems to act as a mu antagonist at higher doses, and this provides some protection against it being used in escalating doses by substance abusers. In addition, in low doses it produces minimal or no euphoria. We have a little packet of reprints to send out to pharmacists who call accusingly and question why we are prescribing such a "dangerous narcotic."...
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> We have continually been frustrated by the resounding lack of interest our colleagues have shown in BPN as an antidepressant. In spite of some promising pilot work, Veterans Administration workers treating post-traumatic stress disorder have declined to study BPN because so many of their clients are substance abusers, and BPN is "narcotic-like."
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> We discovered that someone had contracted with Cygnus, Inc. to develop a BPN patch. That was accomplished, but the contracting company dropped the project. The developed BPN patch now sits on their shelf. However, after a few cordial lunches, Cygnus indicated they would need a million dollars up front to reactivate production of the patch for a clinical trial. Small business grants are limited to $100,000 to start, so that would not get Cygnus back into the BPN patch business. Also, treatment-refractory depression does not sound like an appealing market to business types. We are not sure the market is so small, and it has been suggested that as many as 20-30% of depressed patients may be treatment-refractory. But certainly, for a single physician, patient accrual is slow. While the patent on BPN has run out, orphan drug status might allow a company to be protected against competition while it recoups its investment and more. But so far there is little interest from industry.
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> Academia has been similarly uninterested, but with better reason. It's too bad that substance abuse takes a hight priority than depression in congress, but then what is one to expect. And our wildest fantasy does not have the National Institutes of Mental Health approving the trial of such an oddball drug for treatment-refractory depression. In our mind's eye we can see the pink sheet: Reviewer No. 1 says: "We already know that BPN works in depression, so why do it again?", while reviewer No. 2 says: "It's too much of a long shot in these times of short money."...
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> Research is the art of the possible, and none of us these days can afford to espouse lost causes. But your local pharmacist can dispense BPN without a triplicate, and even supply a syringe and needle so the patient can withdraw the drug form the vial and squirt it under the tongue. You will find it in the Physician's Desk Reference under the trade name "Buprenex" injectable, 0.3mg/ml. So even if the orphan remains un-adoptable, you might want to try BPN on an occasional drug-refractory depressive, and so keep it alive, at least in the lore of those who do tertiary psychopharmacology.
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> Enoch Callaway
> University of California-San Francisco
> Tiburon, CA
>
>
> References:
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> Bodkin JL, Zornberg GL, Lucas SE, Cole JO. (1995): Buprenorphine treatment of refractory depression. Journal of Clinical Psychopharmacology, 16:49-57.
> Emrich HM, Vogt P, Herz. (1982): Possible antidepressive effects of opioids: action of buprenorphine. Annals of the New York Academy of Sciences, 398:108-112.
> Kosten TR, Schottenfeld R, Ziedonis D, Falcioni J. (1993): Buprenorphine versus methadone maintenance in opioid dependence. J Nerv Mental Dis 181:358-364.
> Strain EC, Stitzer ML, Liebson IA, Bigelow GE. (1994): Buprenorphine vs. methadone in the treatment of opioid-dependent cocaine users. Psychopharmacology 116:401-406.
iloveoxycontin
Bluelighter
- Joined
- Dec 11, 2004
- Messages
- 39
I keep hearing great things about buprenorphine, i'm eager to try it as a replacement for the painkillers i am taking. My doctor is hesitant about prescribing me to harder opiates (and i am too) because of my past abuse, but if this bupe is all that you say it is, i'm considering suggesting it to him as an alternative to other opiates. the only thing im worried about is my doctor taking it the wrong way, it would be horrible if i got dropped as a patient or just denied because he thought i was just trying to get stronger opiates or something. I'll give it some thought...informative post btw, thank you.
Rock on Melissa, I too believe bupe can be an excellent pain killer for those who need MODERATE pain relief... like more than ibuprofin/other NSAIDs can provide, but less than a good old multi-faceted pain-relief regimin, including a long-lasting opioid, a short-acting opioid for breakthrough, and alternative pain relief modalities/therapies, including benzos/muscle relaxants for muscular pain, or Capsaicin for oral/phantom pain, or NMDA antagonists for neuropathic pain...
My point is I find bupe helps my pain, it makes me less miserable, which is a blessing... its probably the most I could expect to get legally, considering that I'm a 23 year old middle class male in america... I know that oxy or dilaudid could kill ALL of the pain, but I'm still not sure whether that would be overkill or not, and I know that eventually there would come some day that I'm not so lucky, so its comforting to know that I'll not have HELL to pay on that day. I suppose bupe helps me feel well enough to live my life as I would like to 98% of the time, and that's what I call a pretty good medicine... for the few minor side effects, it does a damn good job of improving overall quality of life.
My other point is if an opioid isn't providing ALL of the relif one needs, there are other options that one can use in ADDITION to an opioid. DLPA works wonderfully as a supplement both for the treatment of pain and for depression. Excersize, range-of-motion stretching, and enjoying the sun can make life a lot more livable as well... (I love swimming to kill 3 birds with 1 stone)
My point is I find bupe helps my pain, it makes me less miserable, which is a blessing... its probably the most I could expect to get legally, considering that I'm a 23 year old middle class male in america... I know that oxy or dilaudid could kill ALL of the pain, but I'm still not sure whether that would be overkill or not, and I know that eventually there would come some day that I'm not so lucky, so its comforting to know that I'll not have HELL to pay on that day. I suppose bupe helps me feel well enough to live my life as I would like to 98% of the time, and that's what I call a pretty good medicine... for the few minor side effects, it does a damn good job of improving overall quality of life.
My other point is if an opioid isn't providing ALL of the relif one needs, there are other options that one can use in ADDITION to an opioid. DLPA works wonderfully as a supplement both for the treatment of pain and for depression. Excersize, range-of-motion stretching, and enjoying the sun can make life a lot more livable as well... (I love swimming to kill 3 birds with 1 stone)
What a wonderful world that would be, in which a person in pain could get GENUINE RELIEF from any of the myriad outlets which sell OTC drugs... I believe that buprenorphine is far safer overall than most other drugs on the market, including most of the well-known OTC drugs, and that it is well within the intellectual grasp of even the laziest members of society to understand the implications of using such a forgiving opioid for pain.
PuppyUpper
Bluelighter
- Joined
- Mar 10, 2005
- Messages
- 12
I second that........
Right on Who mE - the scarriest thing of this WHOLE biz related to physicians and opies (and I am sure you have figured this out as well as MEself)anyone who has either used, abused, or been addicted opies over a pretty good chunk of time knows more about *opies* -PERIOD- than the docs prescribing them. And as said above if you point something out - oh God forbid! - you get any number of condescending and/or arrogant responses from the Doc. I respect they spent a long time in school - they are better people than me as far as patience goes - but they arent getting a good education for what they are paying for. Most dont have a clue, eh?
Unfortunately for people like me that have been in MVH Ax's or whatever the injury may be - I could NOT come clean and tell my doc about my prior addiction and rehab because I know except for a VERY few docs in this country - I would be laying here in my bed writhing for years in pain. Legit injury or not. So I chose not to suffer and I researched my self.
What is wrong with an opiate not often used - such as Bup - being used for mild depression IN ADDITION to pain? I wish to God and the Heavens someone someday can get through to these people and get them to look outside of their little boxes.
Sorry - off the soapbox now - just very passionate about docs ready to shove them at you and then not empathize when you get hooked!!!
Right on Who mE - the scarriest thing of this WHOLE biz related to physicians and opies (and I am sure you have figured this out as well as MEself)anyone who has either used, abused, or been addicted opies over a pretty good chunk of time knows more about *opies* -PERIOD- than the docs prescribing them. And as said above if you point something out - oh God forbid! - you get any number of condescending and/or arrogant responses from the Doc. I respect they spent a long time in school - they are better people than me as far as patience goes - but they arent getting a good education for what they are paying for. Most dont have a clue, eh?
Unfortunately for people like me that have been in MVH Ax's or whatever the injury may be - I could NOT come clean and tell my doc about my prior addiction and rehab because I know except for a VERY few docs in this country - I would be laying here in my bed writhing for years in pain. Legit injury or not. So I chose not to suffer and I researched my self.
What is wrong with an opiate not often used - such as Bup - being used for mild depression IN ADDITION to pain? I wish to God and the Heavens someone someday can get through to these people and get them to look outside of their little boxes.
Sorry - off the soapbox now - just very passionate about docs ready to shove them at you and then not empathize when you get hooked!!!
PuppyUpper
Bluelighter
- Joined
- Mar 10, 2005
- Messages
- 12
who mE........
Onemore thing, I can't figure out what the hell is DLPA - sounds familiar - refresh me?
Are you on Bup injections too?
Onemore thing, I can't figure out what the hell is DLPA - sounds familiar - refresh me?
Are you on Bup injections too?
qwe
Bluelight Crew
- Joined
- Jul 28, 2004
- Messages
- 16,269
excerpted from www.biopsychiatry.com
The "depressant" opioids are somewhat more benign. They are effective painkillers. They can also be extremely pleasurable. In classical antiquity, Aristotle - admittedly not always the soundest authority on medical matters - classified pain as an emotion. Opium was a traditional remedy for melancholic depression; its efficacy is arguably superior to Prozac, though controlled clinical trials are lacking. In "animal models", opioids reverse the depressed behavior, learned helplessness and neuroendocrine responses associated with clinical depression. By contrast, opioid antagonists such as naloxone exacerbate them. To confuse matters further, sufferers of depression typically share an increased sensitivity to pain; and modern "antidepressants" can themselves act as "physical" painkillers. Conversely, mu-opioid receptor agonists offer both unsurpassed pain-relief and extraordinary emotional well-being; and delta-opioid agonists and enkephalinase inhibitors can function as antidepressants. There is clearly an intimate link between "physical" and "emotional" pain. In defiance of dualist metaphysics, the opioids tend to be best at banishing both.
Contemporary medical orthodoxy classifies drug-induced bliss as an "adverse side-effect" of analgesics - even in the terminally ill. Yet we could all do with having our native endorphin systems enriched. Next century and beyond, the customised site-selective successors to today's opioid drugs will play a critical role in promoting emotional superhealth.
Unfortunately, present-day opioids are flawed. Taken at fixed dosage, they lose some of their euphoriant and analgesic effect as tolerance sets in; opioid drugs are physiologically addictive. Overdoses can cause respiratory depression; by contrast, physical pain is a potent respiratory stimulant. When taken recreationally, opioids inspire a dreamily contented disengagement from the problems of the world. Their use diminishes our drive to constructive activity as consumers in today's competitive global marketplace. More insidiously, excess consumption of narcotics inhibits the release of endogenous opioids normally induced by social interaction with friends and family. By diminishing the craving for human companionship, the addict substitutes one form of opioid addiction for another. Thus junkies are usually "selfish".
The physical risks of opioid use shouldn't be exaggerated. Most of the problems that users suffer ultimately derive less from their choice of drug itself than from the illegal status of narcotics in prohibitionist society. Yet even if opioid drugs were legal and given away in cereal packets, such drugs wouldn't make a good choice of mood-booster - or at least not in their present, crudely non-specific guise. Kappa-agonists, for instance, impair dopamine function. They have dysphoric and psychotomimetic effects: one might as well drink ethyl alcohol spiced with meths. The paradise-engineers of posterity will surely weed out such adulterants from their elixirs altogether.
The "depressant" opioids are somewhat more benign. They are effective painkillers. They can also be extremely pleasurable. In classical antiquity, Aristotle - admittedly not always the soundest authority on medical matters - classified pain as an emotion. Opium was a traditional remedy for melancholic depression; its efficacy is arguably superior to Prozac, though controlled clinical trials are lacking. In "animal models", opioids reverse the depressed behavior, learned helplessness and neuroendocrine responses associated with clinical depression. By contrast, opioid antagonists such as naloxone exacerbate them. To confuse matters further, sufferers of depression typically share an increased sensitivity to pain; and modern "antidepressants" can themselves act as "physical" painkillers. Conversely, mu-opioid receptor agonists offer both unsurpassed pain-relief and extraordinary emotional well-being; and delta-opioid agonists and enkephalinase inhibitors can function as antidepressants. There is clearly an intimate link between "physical" and "emotional" pain. In defiance of dualist metaphysics, the opioids tend to be best at banishing both.
Contemporary medical orthodoxy classifies drug-induced bliss as an "adverse side-effect" of analgesics - even in the terminally ill. Yet we could all do with having our native endorphin systems enriched. Next century and beyond, the customised site-selective successors to today's opioid drugs will play a critical role in promoting emotional superhealth.
Unfortunately, present-day opioids are flawed. Taken at fixed dosage, they lose some of their euphoriant and analgesic effect as tolerance sets in; opioid drugs are physiologically addictive. Overdoses can cause respiratory depression; by contrast, physical pain is a potent respiratory stimulant. When taken recreationally, opioids inspire a dreamily contented disengagement from the problems of the world. Their use diminishes our drive to constructive activity as consumers in today's competitive global marketplace. More insidiously, excess consumption of narcotics inhibits the release of endogenous opioids normally induced by social interaction with friends and family. By diminishing the craving for human companionship, the addict substitutes one form of opioid addiction for another. Thus junkies are usually "selfish".
The physical risks of opioid use shouldn't be exaggerated. Most of the problems that users suffer ultimately derive less from their choice of drug itself than from the illegal status of narcotics in prohibitionist society. Yet even if opioid drugs were legal and given away in cereal packets, such drugs wouldn't make a good choice of mood-booster - or at least not in their present, crudely non-specific guise. Kappa-agonists, for instance, impair dopamine function. They have dysphoric and psychotomimetic effects: one might as well drink ethyl alcohol spiced with meths. The paradise-engineers of posterity will surely weed out such adulterants from their elixirs altogether.
dracosuicide
Greenlighter
- Joined
- Jul 12, 2010
- Messages
- 1
okay here we go
first off fuck you guys. thats how pissed i am..all the time. i am a diagnosed shizophrenic..im on ssi for it..ill show you the fucking razorblade scars on my wrist.(all of them pointing doen) i had 2 severed veins and a room full of blood when i was found..which was a fucking fluke. honostly? do i wish i could afford opiates? YES. would i have tried commiting suicide if i could afford opiates? NO should my opiates be covered by medicaid like they cover shitty psychotic meds that dont help my visions and just make me want to go to sleep? YES. will i commit suicide in the not very distant future(i give myself a year or 2 more of life) YES. am i only 20 years old and shouldn't die that young NO not to ME. ?WHY? because stupid fucks say opiates are addicting. IM SUPPOSED TO TAKE THE MEDS YOUR GIVING ME NOW EVERY DAY ANYWAY DUMBFUCK.so now your only argument is overtime i have to take more...I DONT CARE IF I HAVE TO TAKE 8 PILLS A DAY PEOPLE DO IT EVERY FUCKING DAY. ARE YOU TRYING TO SAVE MONEY AT THE COST OF PEOPLES LIVES NOW????because iv started a war..and yes it's come to this. i want a script i can pick out (iv been self medicating myself for years i know what fucking makes me feel good) and i dont want some asshole in a suit or a fucking cloak telling me what to take because they've never had a problem and never seen a ghost.
-your talking to a dead man.
"PAIN"
first off fuck you guys. thats how pissed i am..all the time. i am a diagnosed shizophrenic..im on ssi for it..ill show you the fucking razorblade scars on my wrist.(all of them pointing doen) i had 2 severed veins and a room full of blood when i was found..which was a fucking fluke. honostly? do i wish i could afford opiates? YES. would i have tried commiting suicide if i could afford opiates? NO should my opiates be covered by medicaid like they cover shitty psychotic meds that dont help my visions and just make me want to go to sleep? YES. will i commit suicide in the not very distant future(i give myself a year or 2 more of life) YES. am i only 20 years old and shouldn't die that young NO not to ME. ?WHY? because stupid fucks say opiates are addicting. IM SUPPOSED TO TAKE THE MEDS YOUR GIVING ME NOW EVERY DAY ANYWAY DUMBFUCK.so now your only argument is overtime i have to take more...I DONT CARE IF I HAVE TO TAKE 8 PILLS A DAY PEOPLE DO IT EVERY FUCKING DAY. ARE YOU TRYING TO SAVE MONEY AT THE COST OF PEOPLES LIVES NOW????because iv started a war..and yes it's come to this. i want a script i can pick out (iv been self medicating myself for years i know what fucking makes me feel good) and i dont want some asshole in a suit or a fucking cloak telling me what to take because they've never had a problem and never seen a ghost.
-your talking to a dead man.
"PAIN"
Wow....well I must say, quite a while ago, I had taken a few hydrocodones, and I felt very happy and at great peace, wanting to hug and kiss this very earth, then I thought....Holy Shit! These would be absolutely perfect for people suffering depression. Then I read some article about opiates being pushed to the wayside for these tri-cyclic antidepressants. I think that's a bunch of B.S. At the very least, run a long term study on the efficacy of opiates as a medication against depression.