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  • BDD Moderators: Keif’ Richards

Opiates/Opiods as a pyschiatric Medicine?

Salvinorin A

Bluelighter
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May 2, 2013
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As you all know these are a two very powerful classes of drugs however, they posses strong anxioylic and strong anti-depressant effects. They do come with unwanted risks like depedence, but so do benzos and so do ssris. So why arent these drugs used as a medicine for mental illness. I understand they have a high abuse potential and i can see them worried about more drugs getting onto the street, but i feel some people may have a genuine use for these drugs when other options do not work. Im not saying it should be the first resort nor am i condoning the use of these drugs, but wouldnt some studies in this area prove helpful? Either way people will use drugs despite laws and all the efforts to stop it and a lot of drug abuse issues stem from mental illness. What we are doing now clearly isnt working, its time to change.

What do you guys think on this? Does anybody have any experience with this?
 
Tolerance, a short half-life, and prohibition making them not easily attainable make them an unrealistic option for depression, even though, they are extremely effective. The only viable options would be the currently available maintenance drugs (buprenorphine, methadone) which are, in some cases, prescribed for psychiatric illness (off-label).

http://www.ncbi.nlm.nih.gov/pubmed/7714228
http://www.ncbi.nlm.nih.gov/pubmed/6959168
 
I would rather them adjust MDMA to schedule 2 for this.. for therapy sessions at low doses apparently it was a very powerful tool.

I know they are testing it now for PTSD.. who knows.. in the next couple years could we start seeing some pharmaceutical MDMA??

As far as opiates go for mental health.. like Baooozs said.. Bupe and Methadone have been used in the past and are used off label for Mental reasons sometimes.. but I think most opiates are just too high risk.. especially since the physical dependence on them is so over the top compared to other drugs.
 
I noticed codeine helps me when Im anxious... it helps as the benzos does..... at least for me...
 
Lol opiods for depression would be like putting a band aid on a large open laceration.

Why isn't the same logic applied to benzodiazepines though? I think it's more of a stigma that's attached to opioids rather than them being a riskier option than other available drugs.

It seems like everyone these days has a benzodiazepine RX. Is the anxiety they have debilitating enough to warrant the use of a class of drugs that are more dangerous in withdrawal? I think it's up to each physician and user to assess the risk to benefit ratio. Opioids are no more dangerous than benzodiazepines. Even SSRI's and anti-convulsants have issues of their own in dependance and withdrawal, with an array of unwanted side-effects.
 
Why isn't the same logic applied to benzodiazepines though? I think it's more of a stigma that's attached to opioids rather than them being a riskier option than other available drugs.

It seems like everyone these days has a benzodiazepine RX. Is the anxiety they have debilitating enough to warrant the use of a class of drugs that are more dangerous in withdrawal? I think it's up to each physician and user to assess the risk to benefit ratio. Opioids are no more dangerous than benzodiazepines. Even SSRI's and anti-convulsants have issues of their own in dependance and withdrawal, with an array of unwanted side-effects.

What about danger in an overdose? Benzo overdose is no drama at all, opioids and opiates, a whole different story.
Add in addiction, potential for recreational use.. That's why they are controlled
 
What about danger in an overdose?

Good point. You can overdose on tricyclic antidepressants as well. They're still prescribed. It falls under the risk category. The point I'm trying to illustrate is that most other psychiatric drugs pose the same risk of dependance, addiction, and withdrawal. With some of them, such as benzodiazepines being worst in that respect. Therefore, people shouldn't be so quick to dismiss the use of opioids for psychiatric illness, unless they're willing to do the same for a host of other drugs.

Let's draw up this scenario. A user of buprenorphine for 10 years and a user of alprazolam for 10 years. Who has a better, or shall we say easier chance of quitting? Certainly the opioid user. Without the proper care the benzodiazepine user will fall into psychosis, suffer seizures, autonomic disturbances, brain and nerve damage through excitotoxicity and apoptosis.

What does the opioid user suffer during withdrawal that could be lethal or that causes permanent physiological damage? Nothing...except in very very rare cases.

I'd trade my benzodiazepine dependance for an opioid dependance any day of the week.
 
I've got bipolar 1 and I've had all different types of antidepressant's all resulted in either mania or increased anxiety.
I've only got limited experience with opioids/opiates, but, I can say that Kratom defo gives me both a lift and relaxes me at the same time, codeine from CWE makes me feel really good, but, I honestly think if I was prescribed an opiate that I would abuse it to get high.
I am prescribed clonazepam, cos the shrink that prescribed it me in the first instance felt it was a benzo I would be less likely to abuse than diazepam. For the most part she was right, I tried to get high on it when first prescribed but fast realised it just didn't give me the euphoria that diazepam does at high doses.
I do still abuse it though in the sense I use it as a comedown/sleep aid when I've overdone stims, but my use is such I've not yet ran out of a script before it's due in the last 3 years.
Nor do I take it to the extent that I suffer WD's when I take a break from it for tolerance sake - if it was diazepam I would certainly of abused it.
Anyway, sorry, my point is that were I prescribed opiates for my mental health issues, I'm pretty certain I'd abuse them to get high, they're not my DOC but if it was there, I'd hammer it.
I think there's probably a fair few people with mental health problems that would abuse drugs with the potential to get high - not saying EVERYONE would, but I'm sure I'm not the only one, and I think this is probably one of the reasons why opiates wouldn't be considered, too high risk of abuse by the patient.
I mean, my partner holds my meds for me, but I ain't proud to say that I'll bullshit him and sweet talk him into letting me have extra if I've overdone the stims :-(
 
Good point. You can overdose on tricyclic antidepressants as well. They're still prescribed. It falls under the risk category. The point I'm trying to illustrate is that most other psychiatric drugs pose the same risk of dependance, addiction, and withdrawal. With some of them, such as benzodiazepines being worst in that respect. Therefore, people shouldn't be so quick to dismiss the use of opioids for psychiatric illness, unless they're willing to do the same for a host of other drugs.

Let's draw up this scenario. A user of buprenorphine for 10 years and a user of alprazolam for 10 years. Who has a better, or shall we say easier chance of quitting? Certainly the opioid user. Without the proper care the benzodiazepine user will fall into psychosis, suffer seizures, autonomic disturbances, brain and nerve damage through excitotoxicity and apoptosis.

What does the opioid user suffer during withdrawal that could be lethal or that causes permanent physiological damage? Nothing...except in very very rare cases.

I'd trade my benzodiazepine dependance for an opioid dependance any day of the week.

You can fatally overdose on a wide range of unrestricted psych drugs. The difference with Opiates/opioids is that because you can get high on them, it is more likely that people will take big doses recreationally and accidently OD.

I get prescribed stims for ADHD and it is a daily battle use them properly. Something highly re-enforcing like opiates.... Its actually the reason why I drew the line at opiates. I can see the potential for addiction inside me.

That said, I don't object to the idea in principle, I just think it would cause more problems than it would solve.

I think if opiates/opioids were prescribed for mental health reasons, there would have to be close supervision.
 
You can fatally overdose on a wide range of unrestricted psych drugs. The difference with Opiates/opioids is that because you can get high on them, it is more likely that people will take big doses recreationally and accidently OD.

I get prescribed stims for ADHD and it is a daily battle use them properly. Something highly re-enforcing like opiates.... Its actually the reason why I drew the line at opiates. I can see the potential for addiction inside me.

That said, I don't object to the idea in principle, I just think it would cause more problems than it would solve.

I think if opiates/opioids were prescribed for mental health reasons, there would have to be close supervision.
Jesus man, that must be horrific trying not to abuse prescribed stims - I wouldn't be able to not abuse them, you are stronger person than me mate!
I agree that if they were ever prescribed for mental illness it would have to be closely supervised - if the patient had history of substance abuse I think an inpatient setting would be necessary.
 
Dexamphetamine has owned my life for long periods of time. Ritalin is moreish, but manageable.

Atypical opioids like tramadol and Bupe may have some potential, I trialed the latter for my my own issues..didn't really help.
 
There are very good reason opiates aren't used in modern psychiatry. For one thing, they are very addictive; an addiction to opiates will compound any psychiatric conditions. In fact, becoming an addict can change a persons personality, and IME it's never for the better. I'm an opiate addict myself, and before I began my opiate "career", I was an outgoing and perfectly normal kid; a decade later, and I'm like another person: I have depression, insomnia, a distrust of people in general, asocial tendencies, anxiety, and paranoia. opiates will work only too well at completely suppressing a wide range of mental conditions; when your high as a kite on opiates, you'll feel no anxiety, no fear, no depression - you're in a kind of blissed out euphoric bubble, feeling neither life's highs or lows; it's an emotional plateau, in effect. This may sound perfect, but in reality it's a very bad thing, as the whole point of engaging in psychiatry is to treat the underlying causes of the problems; the symptoms can be alleviated with medication, and that's obviously widely used in our medicated society, but the real goal of psychiatry is to treat, and hopefully cure, these conditions permanently. This has to be done in the right frame of mind, and it involves tackling them through therapy and serious self-work. If you're on an opiate "cloud nine", this approach is unlikely to work in my personal experience. I saw a psychiatrist in my heroin days; I was too high to engage, and merely smiled, nodded, and portrayed myself in a positive a light as possible - I manipulated the shrink, because I wanted to be somewhere else.

It's for this reason that in the UK, people who suffer from conditions which have been medicated with benzodiazepines in the past, are more likely to be referred to CBT therapy or counselling; they know the drugs are great for eliminating anxiety in the short-term, but will not help the patient in the long run. it's a far more difficult approach, for sure, but it stands a better chance at really helping them.

Btw I completely agree with the fact suboxone has improved the lives of many people. It's worked very well for me, too. Not so much as an antidepressant, but I haven't used a true opiate for almost a decade, and I have no craving for opiates whatsoever - a miracle for me. It doesn't blunt the feelings at all; you're thinking "straight", and have to learn to deal with life again. So yeah as others have pointed out, there is a lot of potential in suboxone, at least for opiate addicts. It's no magic bullet or wonder drug, but when people describe it as a lifesaver, I tend to agree.
 
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This is a topic I have always pondered. I have heard about psychiatrists prescribing their patients low doses of codeine as an anti-diarrhea medication for symptoms caused by IBS which are primarily psychiatric reasons (rarely physical). Also Tramadol has been used as an anti-depressant. As far as anxiety goes, let me just say that after being on klonopin and xanax for a couple years I would rather be physically addicted to opiates. I've experienced w/d's from both and opiates can at least be managed. All you can do with benzos after awhile is just keep increasing the dosage for the rest of time. It could prove worthwhile for a decent scientific study into practicing psychiatry with opiates/opiods. I've never experienced a panic attack on solely pain killers.

-MF4M
 
This is along the lines of giving amphetamines for depression.

It works yes, but it is a very unstable practice.

Sub therapeutic doses are a good starting point, but I would highly agree with agonist-antagonist support in particular.

I would think the objective is to find a stable point rather than one being high...

Tramadol is also a good starting point... I feel it has more to offer in this practice than it does as a painkiller.

Full agonist would most likely lead to compulsion. I find methadone is definitely not suitable...
 
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