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Research Paper: Opiate potentiation using OTC medicines

shadowhigh

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Research into opiate potentiation using OTC medicines

Came across this a while ago. I honestly don't know how legit this study is because many of the interactions listed here have never come up in my searches. Wondered if any pharmacologists out there could provide any input?

I didn't want to put this in the research section as it could well be total bunk.
 
It's about the quality of an undergrad literature search compiled into a paper. Big picture ideas are generally all there, but the fine details seem a bit confused (unimportant things are highlighted, and important things are omitted).
 
Best OTC meds for potentiating opiates are paracetamol and NSAIDs, if increase pain relief and lower dose is what you’re looking for. As for recreational effects, that’s another thing and rarely and OTC increases effects in as good way as simply higher dose or weed.
 
Best OTC meds for potentiating opiates are paracetamol and NSAIDs, if increase pain relief and lower dose is what you’re looking for. As for recreational effects, that’s another thing and rarely and OTC increases effects in as good way as simply higher dose or weed.
exactly and what kills me is how many ppl on Reddit think that adding tumeric/black pepper/grapefruit juice potentiates kratom…if anything it makes it weaker.

Placebo is a strong effect!
 
Placebo is a strong effect!

We need to introduce an SI unit for the placebo effect.

I don't know why cyclizine potentiates methadone but in studies, the MAJORITY of people were mixing them. In the UK people were/are selling cyclizine for £1 a pill specifically to methadone users. That said, some people given access to cyclizine will abuse it alone, so I presume it has SOME effect.
 
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Best OTC meds for potentiating opiates are paracetamol and NSAIDs, if increase pain relief and lower dose is what you’re looking for. As for recreational effects, that’s another thing and rarely and OTC increases effects in as good way as simply higher dose or weed.

Do paracetamol and NSAIDS also potentiate the recreational aspect of opioids or just the analgesic effects?

I know for sure that Naproxen potentiates opioids, but don't think any of the other NSAIDs do.
 
Naproxen seems to interact with many classes of medicine. Of course, naproxen isn't exactly safe itself. For certain conditions it's ideal, but like so many medicines, it's use has drifted somewhat.
 
Do paracetamol and NSAIDS also potentiate the recreational aspect of opioids or just the analgesic effects?

If you suffer from pain, it can be hard to separate pain-relief and recreational effects cuz it’s hard to get proper pain-relief (when it’s moderate to strong) without any signs of recreational effects or for some, simply, side-effects. That’s kind of how opiods work.

But if there’s any increase in recreational effects from that combo, at least for me, it’s minimalal. Still for someone suffering from pain I would recommend that combo instead of higher dose because of less addiction and tolerance than from simply increasing dose of opiod (to some extent tolerance develops to pain-relief properties of opiods not only recreational).
 
Best potentiators are imho dissociatives like DXM. They also help with keeping tolerance down but will also modify the high. Never used DXM together with opioids but memantine and deschloroketamine both worked together with morphine. Certainly more than you'd get out of NSAIDs and the stomach thanks too. Nice to see that the paper doesn't limit to conservative approaches.
 
I tried opiates + disso combo just a few times in my life as I’m a type of person that still gets quite a bit from opiates alone after just a short pause and on the other hand, when I have dissos I’m more than content by them alone or rather combined them with psychedelics. When I tried combo of heroin and K, it blew me away. I didn’t expect exponential potentation and such a good synergy. Even I did like 1/5 amount of H and also a lot less of K I got so high I was focusing on my breath as it felt if I don’t I’m just gona stop breathing. Other than that it was great, it was genuine hybrid of ketamine dissociation, body feeling and slight mindfuck paired with euphoria and warmth of heroin.

Were worrying effects purely psychological? Or is there some truth in certain peoples claims that combos like that can be dangerous?

Is it even possible to take combo of dissos and opiates purely for pain relief? From my few experiences, if you don’t have tolerance to both, not really. And I think that’s also the reason there ain’t no disso + opiates formulations available, at least that I know of. I think when reaching almost enough dose of opiates and than potentiating it with even a minimal amount of disso it’ll more than likely result in recreational effects far stronger than from a bit more opiate, and another way around too.
 
Best OTC meds for potentiating opiates are paracetamol and NSAIDs, if increase pain relief and lower dose is what you’re looking for. As for recreational effects, that’s another thing and rarely and OTC increases effects in as good way as simply higher dose or weed.
Unfortunately, I have crohn's (among other things). NSAIDs are an absolute no-no for all Crohn's patients as for some reason they trigger off flare ups. Annoying when I also have a severe muscular skeletal condition (ehlers danlos) and NSAIDS would be jolly helpful.

Which is why I'm constantly scouring the net, or poking around in here, looking for anything to help with pain relief. Tried unwashed poppy seeds to make poppy seed tea but, so far, success has eluded me on that front. I'll have to keep searching because that's the only option that seems to be available.

Im 42. Have spent my adult life in pain. Things are downhill fast from here in terms of quality of life and I feel as though Ive got very little time left to have some decent experiences before life just gets too painful. And yet, the doctors care more about limiting opiates to hit arbitrary targets, 'coz addiction', than they do about managing pain. I'm angry that I don't get to make an informed decision about MY life and be given the option to give informed consent stating that yup, I know, "painkillers=terrible and bad and evil" but I want them anyway. My body. life. 😑
 
I’m surprised you don’t get issues with seed tea. If it was pure morphine yeah, but like this I would aspect it doesn’t mix well with crhon’s.

I know how it’s to be in pain most of the time, and just now as I write this. I popped strong NSAID and it helps a bit but not nearly enough to totally keep it out of my mind. I sometimes get grumpy cuz of mine pain, I’m sure many do but being on opiods or other strong + mind-alerting stuff is a double edge sword.

There’s a lot of what I can do concerning my pain but it’s not an easy task. Anxiety is in the way of some of it. When I was on loads of drugs, life was great and pain-free, but it all came with a price so now I’m looking for a lot more balanced approach.

I’m don’t know a lot about it but cold you use anti-inflammatory psychedelics even you have chrons?
 
Hey. I've decide to try microdosing. I have the relevant materials, so I will let you know how it goes. I'll be self growing and will be sure to do the relevant research before attempting this. I not in this to get high - I just want to live a fuller and more productive life, and make the most of my relative youth whilst I can.

In other news, I've unfortunately found myself in the grip of a sodding Loperamide addiction. Not only is it costing me a shit ton of money, but it brings back horrific memories of coming off absurdly high daily amounts of upto Dihydrocodine. So am in the process of tapering off.

I know that I have to take personal responsibility for ending up here (again) but I do feel that had the medical community
a) diagnosed me sooner so that my condition could gave been managed sooner instead of assuming munchausens (speculation on my part,but...) and
b) Would take the pain more seriously
Then I'd not have to seek alternatives.

For anyone still reading this, or coming across this post - before you even consider going to see a doctor and confessing your addiction issues AND you have a legitimate long term diagnosis of a condition causing long term chronic pain, then think very carefully first.

Because, it's highly likely that, when you have developed a tolerance to your pain meds or the pain gets worse, your doctor will just say 'lolz drug seeker' and you're fucked. You'll be under suspicion for the rest of your life. You may find that every interaction with any doctor will be tainted. Forever. Doctors may associate your history with addiction as a moral failing, and a party lifestyle.

You may find that, if you're still on pain medication then every other year out of the out of the blue you'll experience a push to reduce or get you off painkillers entirely. You may be told about 'research showing that opiates actually cause pain due to a paradoxical effect in the brain.

If you're on opiates, and have a history of addiction, when asked about your pain you may end up in a catch 22 situation, since, stating that your pain isn't under control will just lead to a doctor saying 'yeah, coz opiates don't work - so best not prescribe them to you anymore'...and, of course, if you say 'yes, my pain is under control' when it isn't then they'll probably just say 'great! Let's reduce them a bit.' Once you've admitted to having an opiate addiction, despite the fact that the medical system got you hooked on the first place, and/or despite the fact that you're taking them because you're generally in pain, there's no going back and doctors may hone in on that for the rest of your life, and you'll never ever be trusted ever again. Even in situations where you're simply reporting that your condition has got worse but you AREN'T asking for painkillers, there's a good chance that even that will be viewed with suspicion, and it will just be viewed as a long term ruse to get painkillers in the future.

Basically, there is a huge risk that, for the rest of your life, doctors will be constantly suspicious and your prior report of addiction will always be the over-riding factor for any and all treatment. Ultimately, you may find that doctors prioritising 'managing your addiction' over manging your pain - ultimately meaning that they'll me more focused on that than ensuring that you have a decent quality of life.

Asking for help is often deemed, patronisingly as 'so so brave;' framed as the 'right thing to do' and 'praiseworthy.' But, whilst addiction is supposedly for life and a 'disease' itself, then so is the the stigma associated with it, which will affect you for the rest of your life, perhaps making it worse. You're a statistic, and getting you off the evil drugs is a measure of success.

I'll caveat this by saying that, for some people in some situation, asking for help may s the lesser of two evils. I'm talking from the perspective of someone with several chronic health conditions that cause severe widespread pain.

If your addiction is so severe that it has put your life at serious risk - once is enough - then get help.

I do not want to be responsible for someone else being out in harms way.

I told doctors about it literally about 6 months before the opioid epidemic became big news, so this didn't help.

But if you're going to ask for help from your doctor, just make sure you're making an informed choice. I never thought it would be like this, and my honesty and decision to do the right thing has had very negative ramifications.

Ironically, the 'help' I received was so terrible (including them drug testing me and getting a false positive, which obviously made me more distrusted - and yes, they admitted they'd made a mistake)that I ended up leaving the programme and sorting it myself. Which was hellish, but had I remained under the so called treatment programme I'd have probably deliberately killed myself.

This was 9ish years ago. So you can bet your life I'm not going to my doctor about my loperamide habit.

Peace out.
 
For some reason, cyclizine specifically increases the subjective effects of methadone. In the UK in the 1980s (and indeed in pockets up to the 2000s) cyclazine abuse was a serious problem.

People discovered that shooting Diconal had spectacular effects even though dipipanone is only half as potent as morphine. But 2 or 3 x 10mg pills injected would produce truly crazy effects.

When Diconal was unavailable, it was discovered that crushing and mixing Physeptone and cyclizine would produce an almost identical effect. When only oral methadone was avilable, people continued to shoot the cyclizine tablets on top of it. Cyclizine hydrochloride isn't very water-soluble... which was like the cherry on the cake when it came to the harm caused.
 
This paper gives solubilities of:
Cyclizine base: 1 in 6 of ether, 1 in 6 of ethanol, 1 in 0.9 of chloroform, insoluble in water.
Cyclizine HCl: 1 in 115 of water (= about 8.7mg/mL), 1 in 115 of ethanol, 1 in 75 of ether (= 13.3 mg/mL, somehow?!), insol. in chloroform.

Another ref says the HCl is soluble in "DMSO, methanol, chloroform, alcohol, and water (slightly).", which in my opinion, is pretty useless without even rough amounts.'

However, even better, some maniacs apparently went looking to make an intranasal cyclizine formulation (wonder why) and found that cyclizine lactate could be trivially made (dissolve the HCl in methanol, add ammonium hydroxide, the base precipitates out (probably due to ammonium hydroxide containing a significant amount of water as well)
Cyclizine MW 266.4
HCl 36.5
Lactic acid 90.1
so 302.9 g of HCl yields 266.4g base plus 90.1g lactic acid = 356.5g lactate
1.00g HCl = 0.879g base + 0.297g lactic acid = 1.176g lactate
Their math:
1.512g HCl = 1.319g base actually 1.329g but the paper notes 10mg was removed for NMR added to 0.365 mL (@ 1.209 g/mL) = 0.441g lactic acid (based on ideal eq: 0.449g) to yield 1.76g lactate (based on ideal 1.778g)
TL;DR These guys actually did the math and it makes sense.
They claim at pH 4, solubilities of:
Cyc.HCl: 3.85 mg/mL
Cyc.Lactate: 87.35 mg/mL
and pH 6.8:
Cyc.HCl: 2.77 mg/mL
Cyc.Lactate: 32.15 mg/mL.

And even better the monograph claims it has been used as injection before too. IV cyclizine abuse will see daylight again...
 
Oh - cyclazine lactate is injectable. But these made people were crushing multiple 50mg tablets into HUGE (5mL) barrels and banging it up HOT.
 
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