Opioids The case of the frozen addicts

[Lorne???]

I think you mean it contains SNRI properties (it is not SSRI inhibiting, it is a reuptake inhibitor of serotonin and norepinephrine) how strong it inhibits the reuptake of serotonin would translate to how likely it is to cause serotonin syndrome. Every doctor should know this, why it would ever be used first over proven safe and natural opiates like morphine - the gold standard, I just don't understand. I know the serotonin has something to do with migraines as migraines are treated with triptans which are serotonin agonists, and people with cluster headaches (the worst crazy most fucked up migraine) have taken low doses of 5htp agonist psychedelics as a form of treatment. The risk of serotonin syndrome Vs. just giving morphine seems like a no brainer. May tramadol is a specific opioid good for migraines?

All very interesting, but headaches are still very poorly understood, some basic stuff is known, but the true cause of all headaches and solutions seems to elude us. I wonder how long the brain will hold onto it's mysteries.

When it comes to pharmacology, most doctors don't know shit. I have always hated fucking pethidine, yet a small portion of doctors still use it religiously, despite it being one of the weakest, most unreliable opioids around, with the worst potential for side effects.

Yeah, giving pethidine when you have access to morphine and dozens of other effective safe opioids without atypical side effects is stupid. Giving it to someone on tramadol should be grounds to lose your fuckibg prescription pad.

 

[Lightning-Nl]

When it comes to pharmacology, most doctors don't know shit.

This is all too true. Why are doctors given PhD's in Psychiatry when they know nothing about the drugs used to treat psychiatric disorders?! Hell! Every time I see my doctor (and don't get me wrong, he's been a great doctor to me), I tell him something about pharmacology that he knew nothing about.

 

[lolwhatzdrugs]

Really? I heard most of the parkinsonism displayed by the 'victims' could be reversed with treatment? I guess the symptoms were partially reduced but there was still organic tissue damage done.

I thought I read that Kidston recovered a lot of his dopaminergic function, but he then died of a cocaine overdose. Was he compensating/self medicating for not enough dopamine, did he have some other psychological issue initially, or was he merely a poly-drug addict organic chemist who wasn't too strict on procedure with synthing a obscure compound and dabbling with all sorts of addictive stuff?

 

[sekio]

When it comes to pharmacology, most doctors don't know shit.

The key word being most. General practitioners shouldn't be expected to know about the intricacies of the brain. They're meant to diagnose disease in the rest of the body, too. Good luck getting an anesthesiologist to diagnose a bacterial infection, read liver enzyme levels, or set broken bones.

There's a joke I'm quite fond of that applies here too. What do you call a doctor who graduates in the bottom 10% of his class? Doctor.

Was he compensating/self medicating for not enough dopamine, did he have some other psychological issue initially, or was he merely a poly-drug addict organic chemist who wasn't too strict on procedure with synthing a obscure compound and dabbling with all sorts of addictive stuff?

I imagine mostly the latter. There's probably an element of "fuck it, I have parkinsons now, anything goes!" in there too.

MPTP induced neuron destruction (Parkinson's disease?) is irreversible and is one of those situations like having HIV where we have drugs to fix most of the symptomology but we can't cure it.

 

[lolwhatzdrugs]

I agree for sure. Mother fucker flew too close to the sun and burnt his damned wings off. I got mine shored up with wire. It sure looks sturdy!

 

[Jktm]

The key word being most. General practitioners shouldn't be expected to know about the intricacies of the brain.

While I agree with this to a degree, should an internist not know that combining max dose tramadol, buspirone, and duloxetine, not know this is a very bad idea?

This happened to me and now I have a conditioned response to freak out within 3 days of starting an SSRI so I have to stick to things like amitriptyline or mirtazepine for depression.

 

[lolwhatzdrugs]

While I agree with this to a degree, should an internist not know that combining max dose tramadol, buspirone, and duloxetine, not know this is a very bad idea?

This happened to me and now I have a conditioned response to freak out within 3 days of starting an SSRI so I have to stick to things like amitriptyline or mirtazepine for depression.

If you're prescribing drugs that have the potential to cause serotonin syndrome and you don't know that, and you induce it in a patient, you should lose your license. Hell not understanding the dynamics and prescribing it, you should know enough to know that you're practicing medicine in bad faith.

As for you speaking of a conditioned response, I don't quite understand. Is this psychosomatic? Would it occur if a doctor told you you were getting a new SSRI and gave you a placebo in a double blind fashion? How is a tricyclic AD different? Not trying to knock you or anything like that if I come across that way. I'm glad you're on something that's working for you.

 

[Lorne???]

If you're prescribing drugs that have the potential to cause serotonin syndrome and you don't know that, and you induce it in a patient, you should lose your license. Hell not understanding the dynamics and prescribing it, you should know enough to know that you're practicing medicine in bad faith.

As for you speaking of a conditioned response, I don't quite understand. Is this psychosomatic? Would it occur if a doctor told you you were getting a new SSRI and gave you a placebo in a double blind fashion? How is a tricyclic AD different? Not trying to knock you or anything like that if I come across that way. I'm glad you're on something that's working for you.

To be fair, serotonin syndrome is extraordinarily rare, and up until (relatively) recently practitioners received very little education on it that I'm aware of.

Sekio's right, I mean pharmacology is just one aspect of medicine, but it still annoys me that after 8 years of school,(not to mention residency) that they know less than a civilian.

(BTW, this comes from someone who has had serotonin syndrome, and it's pretty damn hard to get, and still rarely fatal. Pretty fucking scary, though....)

(Edit: And yeah, I wondered about the conditioned response thing myself)

 

[vicapro]

When I had pancreantitis they had had me on dilaude 3g every 3 hours for 9 days then went ti a different hospital bc I was on vacating when I got it and went home to my local hosp. and this Indian doc puts me on pethidine even though me and my patents ask for the sane dilauded regime bc it worked but he said I was abusing it which what 15 yo kid getting iv dilauded at the click of a button wouldn't? And then 2 and a half weeks after all these opiods being pumped in my system he says I'm healthy enough to go home and didn't even taper or give me anything. When I got home I just thought out was an absolutely terrible cold since I never used a drug in my life before this and lone behold I got way addicted to oxy 2 years later. That Indian doctor is the definition of a doctor not knowing shit

The title of the thread is actually a documentary available on youtube. Pethidine just seems like among the most dangerous opioids, whether from impure synthesis to inducing serotonin syndrome. Never come across the stuff personally, but as mentioned, it's safe if you're not a fool.

 

[unhinged17]

In 2011, I interviewed Barry Kidston's mother, sister and housekeeper, as well as his treating physician and NIH scientists who recreated his research to get to the bottom of his accident. The family provided me with recorded interviews, lab notes, biographical information, and other personal papers that belonged to Barry. I am currently in grad school, and will be busy with this for another year, but over this summer I'll be moving forward on my Barry Kidston project. There is little information out there on Barry. Is anyone still interested in him? What would you like to see - a book? A website?

 

[blue_applesauce]

In 2011, I interviewed Barry Kidston's mother, sister and housekeeper, as well as his treating physician and NIH scientists who recreated his research to get to the bottom of his accident. The family provided me with recorded interviews, lab notes, biographical information, and other personal papers that belonged to Barry. I am currently in grad school, and will be busy with this for another year, but over this summer I'll be moving forward on my Barry Kidston project. There is little information out there on Barry. Is anyone still interested in him? What would you like to see - a book? A website?

Anything, that's fascinating!