N&PD Moderators: Skorpio
Are opiates really a long term solution to psychiatric maladies?
AlphaOdure
Bluelighter
Well he never said he was "prescribed" this full amount of methadone. And many clinics (at least in the US) will readily go over 200mg; especially the privately owned ones.. although it depends on the clinic. & prolonged QT intervals is a general effect of all opiates/opioids. But, as long as tolerance is present, potentially harmful side effects like prolonged QT intervals will be generally negligible (at typical doses).
negrogesic
Bluelight Crew
In a sense I was prescribed it (methadone), I was a patient in an expensive private clinic where (to a degree) dose was dictated by dollar. I do not suffer from chronic pain, but my gradual discontinuation of methadone was surprisingly easy (if not for the issue of availability, I would recommend it over buprenorphine in ORT). Oddly enough, despite having discontinued methadone years ago, any recent attempts to abuse various opioids are generally met with disappointment, and as strange as it may sound, I now find oral methadone to be more enjoyable than IV morphine.
Back on topic:
Opioid therapy in the treatment of depression is not a viable approach using available drugs. In some cases, I would consider the introduction of an opioid for such treatment in an opioid naive patient to be potential malpractice (or the least - poor standard).
Opioids can be used in a number of creative ways when a patient facing terminal illness. In hospice patients, morphine is often prescribed for a seemingly unusual indication: shortness of breath.
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AlphaOdure
Bluelighter
Have you gotten your liver enzymes checked out lately? & make sure everything is in order?
Again, i'm not an expert in pharmacokinetics.. but, i'd assume liver atrophy, dysfunction, and/or disease would affect the efficacy of CYP450 enzymes; perhaps in certain circumstances having an effect such as your own. Unless you're on other non-opioidergic drugs that may be afflicting your opiate appetite? I found baclofen to reduce my bupe intake by 50% in 7-10 days, w/o any withdrawal (for example).
I remember a while back you were meddling with IV buprenorphine--much to your liking--I assume you're no longer doing this anymore?
Anyway, IV'ing pills & dope is better for your health anyway... so that is a plus!
AlphaOdure
Bluelighter
...And yes, back to topic: umm, drugs selective for 5-HT & dopaminergic receptors are much more effective for depression (w/ less intense of a withdrawal syndrome than opiates/opioids upon cessation).
Not to mention, the original title of this thread is "Are opiates really a long term solution to psychiatric maladies?" ...I'd say the case for long term opiate/opioid use for other psychiatric issues such as the various clusters of personality disorders; or even worse- bipolar, schizophrenia, ADD/ADHD, & OCD (for example) would even be WORSE candidates for long term opiate use.
The only psychiatric condition long term opiate use is useful for is for treating addiction (which is a psychiatric disorder, at least according to the DSM-IV)- such as buprenorphine & methadone for maintenance.
AlphaOdure
Bluelighter
(and by the manner of discussion of this thread- i don't know why its in ADD???)
sekio
Bluelight Crew
Where do you propose it should go?
ADD is sort of the "dumping ground" for posts on the theoretical aspects of drugs and treatment programs, generally Other Drugs and the focus forums pick up on practical aspects of using drugs. And I prefer to keep comparatively nice threads like this away from the wash of "help how do I bang roxy 30s iv".
AlphaOdure
Bluelighter
Just thought it was more appropriate for OD; but keeping it away from "how do i bang [such and such drug]" is a valid point though. I suppose not nearly as many helpful or theoretical posts would be here otherwise. I do prefer ADD for this specific reason... except for the advanced chemistry stuff, which I can't grasp. There was a time back in the mid 2000s when OD was more akin to this sort of discussion, but I suppose things change. Anyway, I digress...
Most opiate don't really prolong it too bad. Methadone is worst than most opioids, and propoxyphene is bad. LAAM the worst, propoxyphene is bad too when it comes to QT prolongation. QT prolongation usually occurs around 200mg, sometimes much less. AFAIK tolerance doesn't really have much of an effect. Although some don't get this and use higher doses.
AlphaOdure said:
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ebola?
Bluelight Crew
EA said:
I disagree, at least working from aggregated anecdotes from those who use NMDA-antagonists to combat depression. The most effective dosing schedules seem to involve ingestion of the compound over a short period (either at threshold doses for a few days or at recreational doses once or twice), with the goal of inducing downstream neural changes that exert anti-depressive effects for a couple of weeks to a couple of months. Opioids appear effective as anti-depressants due to their immediate effects.
ebola
ebola?
Bluelight Crew
negro said:
=^0.o^=
Lulz.
tyrael
Bluelighter
To begin, in general I am usually quite a fan of usage in research of drugs which may not initially be suspected as a possible pathway (irrespective of the drug in question).
No doubt re both, however you've suggested a causation where one doesn't exist! AD's themselves, although having said effects (which no one would disagree this), in no way does it cause the affected to begin your mentioned lifestyle changed, eating healthy, etc. Pt's (just as often) take AD's and don't experience those other essential life improvement.
To you. As an example, in Australia before AD's are contemplated, generally indicated benzo are tried and for a percentage of people, this is enough! Now clearly benzo's are not AD's, same as opiates aren't (technically classed) AD's. This alone cannot and should not an excuse for an off-label use which has (albeit not as strongly as some may wish) been shown to help in said situations.
Firstly, your first sentence is to my point 
However, with your latter statement of course there ("using opiates to treat AD") will be negative side-effect/results/potential issues but name a drug which doesn't! All have under-go a form of cost-benefit analyses to asses the risks associate with, essentially, any drug be it issue with any AD, the use of a benzo or opiates!
In terms of the kinetics of why/how (it wouldn't be the first drug to come to market without extensive knowledge of it's pharmacology) irrespective of anyone's opinion (we can all voice an opinion but it won't effect whether a drug is efficacious or not) the option most definitely should be explored. If the decision was made to not even try to explore the possibilities, it immediately prevents any further advancements in those professions. It essentially comes to an exploration! If one doesn't even attempt to explore, one wont seek/find the possible rewards.
Clearly anyone who does/has worked in health has an understand of the possible variability between individuals. To disregard the thread topic, even with current AD's (and many pharmaceuticals) on the market, one may work better/worse/at all for one individual than another.
AlphaOdure
Bluelighter
Propoxyphene is rough on the cardiovascular system & heart in general, but not b/c of its opioidergic action... b/c of its effects as a local anesthetic & a sodium channel blocker, it affects QRS intervals (and subsequent QT intervals). And this particular action isn't shared by methadone or levacetylmethadol to my knowledge, & i've read a lot on both of these drugs over the years... But feel free to correct me w/ sources if they're sodium channel blockers. And relative to other full agonists, methadone & levacetylmethadol, aren't shown to have that much of a difference on the cardiovascular system. My theory is a social mania as a result of those strings of deaths supposedly related to methadone use here in the US (surprise surprise! Quite often other drugs in the system, specifically benzodiazepines, aren't mentioned. B/c painkillers = baaad! ...BUT... benzos? mother's little helper! But god forbid someone uses a bit over the prescribed opiate/opioid dose, then they're an addict! its bad! bad person! Morally weak! 
)
And yes, tolerance has a lot to do with this effect (well, w/ QT interval prolongation that is) in opioids in general. Its related to respiratory depression, at least to some extent.
Anyway.. we are way off topic from the thread's original proposition. So.. I digress.....
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Quite often other drugs in the system, specifically benzodiazepines, aren't mentioned. B/c painkillers = baaad! ...BUT... benzos? mother's little helper! But god forbid someone uses a bit over the prescribed opiate/opioid dose, then they're an addict! its bad! bad person! Morally weak!
)
And yes, tolerance has a lot to do with this effect (well, w/ QT interval prolongation that is) in opioids in general. Its related to respiratory depression, at least to some extent.
Anyway.. we are way off topic from the thread's original proposition. So.. I digress.....
Actually part of what you say here is quite on topic. People do demonize opiate use for other than pain at specific doses--literally, for no other reason than citing its addictive potential. I really don't think people, even on blue light, can appreciate just how much of a fallacy it is to not even consider opiates for use in psychiatry because of their reputation--which, I admit, is somewhat earned, but which shouldn't automatically lead to throwing away this extraordinarily effective drug class down the drain in the face of people who could achieve a net benefit.
As I understand it opiates were officially in use for psychiatric purposes in the United States in the 1950s. Does anyone know what specifically they were used for, when they were phased out, and what the exact stated reason was? I talked to a very well-known psychiatrist in my town who cited abuse potential; I could honestly see the fire behind his eyes when I brought up the prospect of opiates being prescribed for a psychiatric illness--and, get this, he not only was practicing psychiatry in the 1950s (so almost definitely prescribed opiates for psychiatric purposes) but is generally very open about prescribing scheduled medicine. when I brought up benzodiazepines as collaterally dangerous in a similar manner, he claimed that the dangers of benzodiazepines are vastly overrated. How about that? Any agreements? If so, then benzos might be a decent replacement for opiates in the anxiety department.
AlphaOdure
Bluelighter
^^^Opiates were generally (and initially) phased out by the Harrison Act (1914), although progressive restrictions ensued, culminating in Nixon's bullshit creation of the DEA. Opiates & opioids were sometimes used as "mood enhancers", alternatives to alcohol, anti-epileptics (rare), treatment for cocaine addiction, & as a treatment for alcoholism & alcohol withdrawal. Remember, depressive disorders were not widely recognized as "disorders" back then; & also, their pain relief affinity was also widely known & this was their main puprpose (mainly morphine & diacetylmorphine- remember, morphine was in use in the the Civil War, here in the US that is)
...And lots of things were in use for psychiatric conditions in the 50s, heh... LSD for alcoholism; even atropine for addiction.. you get the idea (not saying LSD wouldn't be totally ineffective for treating alcoholism like the other tryptamine ibogaine... however, unlike ibogaine, LSD does not resolve withdrawal symptoms. LSD & general psychedelic therapy would probably be more effective after abstinence symptoms have resolved themselves....)
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tyrael
Bluelighter
Funny you say that since literally last night a friend and I spoke about (basically you're entire post .... lol ....creepy). And to a degree I really do feel like laughing what I hear those kinds (a drug being demonise, having a specific reputation, etc) and admittedly by the lay but those comments.
No drug has any form of positive nor negative "traits" (for the lack of a better word atm). Drug which are "bad" or "good" just simply don't exist! (without turning this into a psych discussion. Essentially what people are doing there are anthropomorphism something(s) which do not obtain these traits!
Again, I do agree with your post. For someone (company/research/uni's/etc) to essentially limit, or in the least limit the rate of (any) science progression due to "arguments" (and I used that term very lightly) such as, opiates do indeed exhibit highly addictive qualities (with this alone imo fuel rumours and much of it's negative stigma)
Regardless, the reasons given why opiates (as an off-label used, research, etc) - such as any perceived/real stigma/reputation aren't legitimate excuses at all tbh! One would hope that specially everyone posting here! (all of whom should be highly educated enough to know how far "off-label"-use prescriptions can be taken, have general understandings of drug processes (re: research, trials, funding, blah blah), associated laws. etc. Surely, being an educated person that if they truly believe that opiate modalities for depression honestly will not work, there should be no arguments/worries since they believe they already know the results!
To use another recent yet similar situations going re medicinal marijuana. Again, it seems the biggest problem is people's (incorrect) assumption of what "weed" is! I would literally place bets on, if marijuana(/extracted and purification process) was discovered today, and was immediately considered to have medicinal uses and was utilised as such, no one would think twice about taking a cannabinoid pills when prescribed by a professional (obviously as per indicated).
An entirely new though as this one could be created to discuses what you've mentioned about tbh! However (and I admit I'm no expert) after the first benzo - initially synthetically (accidentally!) created in an attempt to create better (around the '50 afaik)- was discovery initially as a in an attempt to create better tranquilizers. As with most of those "intermediate","accident-resulted" drugs, it was documented and neatly filed away for quite a number of years. Until another chemist comes along, dusts the book of and - out of curiosity maybe? lol - chose that to study further, rat assay, the usual (this was in the '70 i reckon) and pretty much it became high demand.
The real (well I believe it ) reason it went like crazy and before this, the closet alternatives were barbiturate and they were often (afaik) reluctantly prescribed (for a multitude of reasons). If not (reluctantly prescribed then) more toward the end of their time (late 1880's to 1950 give or take) . At which point, given an option between a bard v benzo, the benzo will always(99% ) win out especially now days! The variants possible for barbituates do still have their place and indication, however due to many, many reasons, benzo's are used
Opioids are not worse than they crap they give psychiatric patients, on the contrary. SSRI withdrawal is FAR WORSE than opiate withdrawal. Also, you can COMPLETELY PREVENT opioid tolerance with several methods (co-administration with proglumide, low-dose naltrexone or memantine).
Don't be fooled, this is just another result of the war on drugs. Opioid tolerance exists because it dose-escalation is economically interesting to the big pharmas, because it can be completely prevented and even reversed.
tyrael
Bluelighter
I do agree to a point however one must realise that BL users are such a diverse type of people and more-so, extremely different knowledge levels!
For instance, I can guarantee that quite a number actually of extremely well trained, great knowledge and in fact as their profession work in health care positions - from doctors, GP's, specialist, to RN/EN, to aged-care, addiction/needle exchange/etc companies and of course to those with a (sometimes extremely) high degree level of knowledge and yet have had no formal training yet still know their stuff and of course to the Greenlighers!
I personally wouldn't use that term "collaterally damage" - in which sense?! Obviously benzos have done/do/and continue to cause problems for a certain sub-set of the populous however (and please don't interrupt this as diminish any damages caused by benzos) and every drug has harmful effects. As technology and techniques increase this also help. Anyway, (and I'm confident majority if not all) Governments have appointed officials to determine if a drug should be allow into the country.
My personal opinion is I really do hope not a drug like benzo may not be available at some point. Not for recreational uses, yet I honestly believe benzos in general are, when use/checked/help put in place/etc, one of the "best" drugs available (for known indications of course). Now having said that, I have definitely seen an increase/awareness of (and no surprise with a huge focus on negatives) things such as greater restrictions, fear-mongering and in cases extreme out right distortion of fact.
tyrael
Bluelighter
I like your post Alpha, but probably not for reasons you'll enjoy - 
no offence is intended here....
I think the way you have worded this shows exactly what some people are trying to get across in terms.
To begin with, Nixon's "war" against drugs had absolutely no positive effects - for all/any affected! And agreed regard recognition of any form of mental disorders. This wasn't limited to the US, well I know for a fact Aust went through the same thing, there would have been others. And it's really is quite that even today in parts of the word "mental illness doesn't exist"
Haha, now to get to my actual point, you (I guess rightly-so) used certain terms such as "mood enhances", "anti-epileptics" and have seen these descriptor words use often elsewhere also. I wouldn't really call it an issue of mine cos it's doesn't cause large amounts of problems yet however it can be seen that by using non-specific word to explain/describe a drug may lead to deleterious results....
I'm give example; there exist a number of noted, world excepted indications for oxycodone - with the obviously most prominent one being as an analgesic (for which most - general public - know) which of course aren't the only indications. However by marketing/pushing one use which essentially creates a stigma/judgements/opinions (which are basically not ones own due to all influences) where in the best scenario the GP informs the pt and they become educated and lose any issue they may have about having to use it for another purpose. And at the other end, the opinion of "oxycodone == analgesia" and they wont sway anyway may lead to possibly (said previous) pt not being offered/obtaining a modality which may in fact work! ![:\](https://bluelight.org/xf/BL_Images/Orig_Emoji/wrygrin.gif "wry grin :\")
Fresco
Bluelighter
No, opiates are not a long-term answer.
Kratom on the other hand some people can use for years and successfully treat their depression
tyrael
Bluelighter
Hmm, oh my, I need to reply to this! I'll take it sentence by sentence....
By anyone who works in/about drug/alcohol services (plus the obvious GPs, nurses etc) understand that one person's symptoms/reactions/person experiences with having to go through WD and basically in no way be comparable with another's. No one person can say their experiences was any worse then another's!
From my knowledge and experiences I've dealt with, opiate WD - and more so depending which specific one - are one of worse. Yet, as I said before, you're experience may indeed be different.
There actually is no complete method to prevent tolerance build - it will happen! There are clearly thing one can to do starve off and delay (as you've mentioned! ) however simply by the nature of human biology/anatomy and certain drugs, it unfortunately happens! >_<
Unfortunately mate this is where Ive kind of lost ya! Many countries do/are employing a "war on drugs" mentality, when you say "this is just another result", sorry I don't quite understand. Now the physiological and anatomical changes which occur in the body while tolerance builds has nothing to do with the second half of that sentence.
Now if I'm understanding correctly, what you really mean is the fact the there exists the ability for a tolerance build, which ultimately lead to "dose-escalation" which I think you're trying to say is with more tolerance, you're required to purchase larger doses and hence it costing more. And finally, this is an interest to BigPharma as they get richer?
Am I interrupting right here?
Unfortunately, although it's quite possible to come to these conclusions there's a few thing you need to think about more here....
1. Tolerance build will occur to majority of people and obviously dependant on the drug!
2. The fact that it happen - and one of the results is you've got to spend more money - has no correlation to BigPharma (or those like). Obviously they would benefit by having increased sales, but that's just pure, chance, luck!
3. It is possible to reduce a tolerance already there ...... it comes down to stop using the drug! There isn't anything on the market (legal or otherwise) one would use to completely prevent the build initially nor help once ya got it unfortunately!