Harm Reduction Questions for an MD?

[djsim]

What are the health risks of injecting benzyl alcohol? What would be considered a safe daily dosageA?

Do doctors ever prepare their own sterile ampoules/ solutions for injection (from scratch) if so what procedure do they follow? Do you have any references/books on the subject?

Im familiar with BA for IM preps. Steroids are generally 3% BA which is a balance between the muscular pain caused by IM ROA and bacteriosidal properties.
BA is very safe. For IV preps I'd be careful not to go above 3-5% BA.

 

[djsim]

Not sure if this is area of an MD but..

When can we except to be able to medically manipulate the reward circuit somehow? Like curing psychological addiction to different substances using medicines. Is this just a fantasy at this point?

This is my area of interest. From what we know, genes are transcribed (CREB) which alter the DAergic pathway. Success has been noted using mirtazapine, NMDA antagonists (eg memantine) and selective glutamate receptor agonists.

The DAergic pathway is intrinsic to living due to rewards and conditioning. My hunch is the only way to reverse damage (albeit slightly) is through abstinence in conjunction with adjuvants like mirtazapine.

Impossible? I doubt it, but the outcome we want is likely to be quite different to allowing full-blow psychological addiction.

 

[djsim]

What is your opinion on Olneys lesions in humans?

A likely effect of disociative abuse?

Possible but unlikely?

Doesn't happen.

Something else? (please describe)

Thanks

Olney's lesions correlate as well as lung cancer in light to moderate smokers. But that's not to say NMDA antagonists are certainly to blame.
These lesions may have been underlying genetic issues exacerbated by the nmda antagonists.
A clear correlation would be evident with PCP abuse allowing 30+ yrs to prove conclusively cause and effect.

Use dissociates in moderation.

 

[djsim]

Isn't this a tad unethical?

Not saying I don't think you should do it, I do. I think it could be an incredibly useful resource. I'm just wondering if you've considered all of the ethical and moral implications of such a thread.

What happens if, for example, you give wrong advice and someone ends up dead? A bit of hyperbole but not outside the realm of possibilities considering what takes place here on BL.

See my case studies thread... It's all about tough love
Anything requiring medical treatment will be clearly stated. I'm here to answer general issues and to refer where applicable. I do appreciate your concern though.

 

[djsim]

In your personal opinion djism, if a patient wants to go on a benzodiazepine long term for anxiety related problems because nothing else has worked for him, do you think it would be a good idea ? And also is it something that I can upright ask my doctor ? I plan to talk to my doctor about going back on xanax Tuesday and also as a more long term medication.

My anxiety is crippling in social situations. I get lots of depersonalization (where I just feel extremely off and feel like I looked manic, crazy or sketchy to people in public) randomly and always feel like people are watching what I'm doing and commenting about it. This effects my school work and my ability to pay attention in my college classes. I'm constantly readjusting myself and feel uncomfortable sitting in a chair for extended periods of time. It's extremely annoying to say the least. I also sometimes randomly experience panic attack like symptoms while just sitting at home, including random stabbing chest pains and a general feeling of pressure on my chest. This goes away by readjusting how I'm laying or sitting, or usually stretching. It will usually come back randomly though until I move again. (I ALWAYS experience this specific anxiety problem when I smoke weed, so I rarely smoke anymore). They worry me though and make me paranoid something is wrong with my heart or at any moment I'm going to experience a heart attack. I know it's anxiety though since fidgeting makes the uncomfortable feelings subside. Of course I take stimulants regularly, like every couple weeks, sometimes more, and I know those definitely don't help my anxiety as comedowns can be filled with a heart beat that shakes my shirt and random palpitations, but even without them my anxiety remains the same. I haven't seen the doctor in around 6 months or so. The last time I had a refill for xanax was around then. It was fantastic to have around for my anxiety. I was supposed to take it as needed, up to 3x daily. I was however prescribed the lowest dosage, 0.25mg, and it wasn't very affective at that dosage. I found myself taking upwards of 1mg to really get any anxiolytic effects when experience high anxiety and my prescription would always run out much to fast. I didn't always take it daily either.

So there's really two things I'm going to discuss with my doctor on Tuesday. Making xanax a more long term dosage so I know I have refills, and also upping to dosage because what was prescribed was effective, but only above my suggested dosage.

Become addicted to benzos and your life will deteriorate considerably.
I don't condone long term Xanax usage because its just masking he underlying issue.
My recommendation (meeting you halfway here)....
1. Mirtazapine - the only antidepressant with no sexual sideffects and it reduces anxiety and promotes routine sleeping times
2. Psychologist - get to the of your anxiety
3. Xanax - use it sparingly, and before sessions so you're more open to share our issues with the psych.

Chech back in mate,good luck!

 

[djsim]

T. calderone


Just to respond to this in the meantime before you have an actual doctor to over this with you. I'm not a doctor but am a second year medical student. Your liver enzymes are def elevated and certainly need to be further explored, but just know that liver enzymes are VERY sensitive. I've many times seen enzymes 20 to 30X above the reference range. So while yours are elevated, they aren't relatively that high. I must stress again though, you should have follow ups as they are certainly above the normal reference range.




The concern the doctor had was elevated liver enzymes. The ammonia test came up 56 (reference range 9-33) A few numbers came up a bit high but the ones that trouble me are under general chemistries and I need help interpreting how bad it really is. One is ALT - SGPT: 239 (reference range 9-52 units) The other is AST - SGOT: 188 (reference range 14-36 units) I'm just reading the lab results and medical reports. It's just a reference note that these numbers are in the high range. The doctor didn't really tell me anything upon being released. I have no insurance to see a regular physician but this is nagging at me. Maybe I'm getting worked up over nothing. Can you help determine if this is severe? If it was, wouldn't they tell me?

[/QUOTE]

Are you a heavy drinker?
I'm thinking chirrosis - either recovering or ongoing.
Perhaps the doctors know your past and assume your liver has taken a beating.

Fill me in on your meds, drinking habits, why you got liver enzyme checkup

 

[djsim]

I am not an MD. Well, not yet anyways. I've been a practicing paramedic for many years, and intend to attend medical school as soon as i can. Anyways, to answer your questions.

I would hope your hepatitis b came back negative since you should of received vaccines for this as a child in a 3 part booster series. Unless you meant, hep c, in which case good. Although it can take up to a year to show on tests and after the date of exposure..

-Viral

I wonder about hep c myself. That's why I need background

 

[djsim]

hi there - i'd love to ask you a couple of questions regarding patients coming in if you wouldn't mind?

have you encountered many drug-seeking individuals and how do you deal with them? what is the most commonly searched for and seeked out drug in the doctors room? is it for adhd medication or is it the good old opiates..?

Oxycodone.
A patient will show up from out of town and request a repeat as the time the visit their dr cannot be reached. Other patients seeking oxy can be rooted out be offering a buperenorphne patch.
Dex amphetamine gets a few seekers; they often he refered to a psych for diagnosis. As do pain patients repeatedly requesting opioids. Benzos are extremely common too. Xanax is a big no no. That's what all the seekers look for.

 

[djsim]

I have "adult add", (diagnosed when I was 32 - I could have been a brain surgeon if it was treated when I was a kid), I was prescribed Ritalin.
Ritalin is the only medication for ADD/ADHD available in my country, thats it, no Adderall, dexedrine, etc. At that stage of my life I was using crystal methamphetamine recreationally/self medicating (orally), and Ritalin be damned.
Obviously the crystal got out of hand after a few YEARS, and I stopped using it due to financial reasons.
I stopped about 3½ years ago.

Before the ADD diagnoses I went through (in this order - sertraline, fluoxetine, venlafaxine, paroxetine and citalopram), they did nothing, and the effexor was terrible.
Then the ADD diagnoses, Ritalin, and the Meth (which was the only thing I could feel working - so I gave up on the Ritalin).
When I quit Meth I wasn't keen on taking Ritalin as it just strung me out or didn't work at all.

So a new Dr thought he would try Dothiepin - and I really didn't want to go through the whole A/D thing again.
Obviously Desoxyn would be the right treatment, but not in this part of the world.
After 2 years I feel like I am in the exact same state mentally, financially and socially as when I started the tricyclic. I tell my Dr that I don't feel it working and as a last resort maybe I could try mirtazapine as I have heard positive reports about it.
He said that the "weight gain" side-effect wasn't worth it and that I am doing fine on the Dothiepin.
I know that weight gain from mirtazapine is a very common side effect.

So my question finally is ....... would mirtazapine be out of the question because of weight gain (I don't have weight issues) and if that is my final option - or do you have the answer or advice to point me in the right direction? (Which, in my mind, would be to move to the USA and get my F'ing dexosyn and start living my life again?).

Purely from a medication point of view, would trying mirtazapine be that bad?

Mirtazapine is the best antidepressant on the market. No sexual side effects, allows routine sleep, and weight gain is not metabolic, it is just caused by increased appetite. So watch what you eat and eat only at meal times.
It's not stimulating per se, in fact, it's taken at night for the opposite reason.
If you have a meth habit steer clear of Ritalin... It may be legal, but that means dick when uppers are your DOC.

 

[hatrix]

Become addicted to benzos and your life will deteriorate considerably.
I don't condone long term Xanax usage because its just masking he underlying issue.
My recommendation (meeting you halfway here)....
1. Mirtazapine - the only antidepressant with no sexual sideffects and it reduces anxiety and promotes routine sleeping times
2. Psychologist - get to the of your anxiety
3. Xanax - use it sparingly, and before sessions so you're more open to share our issues with the psych.

Chech back in mate,good luck!

Thanks for the info man. Went to the doctors today as scheduled and talked to her about my problems and what I wanted to do. She said xanax isn't good long term (as I knew she would say) if I'm going to be taking it daily.

I said I wouldn't take it daily, but needed an increase in dosage from my last prescription and she agreed to do so. I was prescribed 0.5mg x60, taken as needed. As long as I keep taking it only as needed, I believe she is willing to refill it long term, just not to the point of bad addiction. I was also given a sample of an SNRI, Pristiq (desvenlafaxine) but I'm debating on whether I really want to take it. I obviously take drugs recreationally occasionally or more and don't really want any possibly dangerous interactions. Besides that, no anti depressant has done anything for my anxiety. They have usually exasperated it and given me other weird side effects.

 

[uno22]

A lot of people on this board talk about the dangers of mixing opiates and benzodiazepines. I understand that it's a potentially dangerous combo, but I also know that doctors do prescribe both at the same time as well.

My question is, would it be safe for an opiate tolerant person to take .25-.5 mg of Xanax on top of their daily opiates. It's a small dose but I want to know if its absolutely safe

Thanks

 

[tentram]

yes, it's pretty safe to assume generally with small doses like that. but, what opioid are you on and what dose?

 

[uno22]

yes, it's pretty safe to assume generally with small doses like that. but, what opioid are you on and what dose?

Oxycodone, usually take 60mg every 4 hours and if I take a benzo it will be like .25-.5mg one time dose

Been on the oxy daily for years but it isn't for pain per say

 

[Pegasus]

djsim, can you please tell us more about mirtazepine? How did you decide upon mirtazepine as your antidepressant of choice?

 

[tentram]

Oxycodone, usually take 60mg every 4 hours and if I take a benzo it will be like .25-.5mg one time dose

Been on the oxy daily for years but it isn't for pain per say

you'll be fine just hide the rest of the xanax (somewhere you'll remember) so you don't go digging into more, possibly getting into a little trouble - like passing out for eg.

 

[ijustlovewikidrs]

Hey, great to have you around! Okay I'm a IV heroin user, I was wondering what the common health problems would befor an addict. For example shot immune system or low blood pressure when in withdrawal. Basically I want to know how to separate common problems an addict will have from other health problems..

Intravenous heroin use will exacerbate any and all of your health issues. Just wikipedia Opioid health effects and don't waste Dj s time.

 

[djsim]

Thanks for the info man. Went to the doctors today as scheduled and talked to her about my problems and what I wanted to do. She said xanax isn't good long term (as I knew she would say) if I'm going to be taking it daily.

I said I wouldn't take it daily, but needed an increase in dosage from my last prescription and she agreed to do so. I was prescribed 0.5mg x60, taken as needed. As long as I keep taking it only as needed, I believe she is willing to refill it long term, just not to the point of bad addiction. I was also given a sample of an SNRI, Pristiq (desvenlafaxine) but I'm debating on whether I really want to take it. I obviously take drugs recreationally occasionally or more and don't really want any possibly dangerous interactions. Besides that, no anti depressant has done anything for my anxiety. They have usually exasperated it and given me other weird side effects.

If you're going for an antidepressant mirtazapine is my recommendation as side effects are minimal except you need o keep appetite in check. Pristiq is terrible to try and get off, just like its cousin Effexor.

 

[djsim]

djsim, can you please tell us more about mirtazepine? How did you decide upon mirtazepine as your antidepressant of choice?

Personal experience, patient feedback, combined with the fact that it reduces anxiety through serotonergic channels and alpha 2 agonism, just like clonidine, which effectively lowers the body's anxiety caused by sympathetic systems. Also, it's sedating qualities and short-ish Half life allow for proper restful sleep w/o suppression of REM as caused by benzos. It also acts to reduce pain like amitryptaline according to some patients. But the best part is no sexual side effects as is the issue with ALL SSRIs etc. the only downside is appetite is increased, but his can be controlled.... It's not a metabolic issue as is the case with olanzapine (Zyprexa) and other atypical antipsychotics. many studies show mirtazapine is beneficial in addiction to boot!

 

[djsim]

Oxycodone, usually take 60mg every 4 hours and if I take a benzo it will be like .25-.5mg one time dose

Been on the oxy daily for years but it isn't for pain per say

Big doses of oxy there. Make sure the Xanax dose is low and other depressants arent in play. A short half life benzo like Xanax is safer than Valium of course, just don't redose as another poster said

 

[HeadphonesandLSD]

Thanks for the replies doc hope you get to my question about concussions/tbi soon.

I have another one but will hold off on posting more questions until you sort through all the ones already posted.

Thanks again.