Why are doctors so concervitive?

[EsourceR]

.....Also, how are you gonna judge how much tolerance a patient has? People with chronic pain are often put on patient activated morphine drippers, but shit like that isn't practical in an outpatient situation.

A good doctor will advise and discuss with the patient about the drugs he's giving and their potential for addiction. I find this step is often missed. Keeping in mind, we're all responsible for our own health and well being to a certain degree.

If you're asking for meds for recreational use ... you already know what you're getting yourself into most of the time. Those who legitimately need medication ... should also be under medical supervision. If a doctor is working with a patient to achieve pain control ... a lot of the dependancy issues will be dealt with along with other issues regarding abuse.

There is a highly effective method involved in evaluation of pain and tolerance. The decision making tree must be followed closely. Pain is subjective. A good doctor is a good judge.

Pumps are great as an outpatient situation ... very costly though.

 

[soundphaRm]

^ There's a difference between requiring amino acids and requiring opiates.

Our entire biochemical "machinery" requires fuel and maintanence, which is provided by sugars, proteins, vitamins and minerals. You cannot avoid eating them, because your body needs them to work, just like a car needs petrol to run.

Opiates, and other drugs are not essential to our body (just like alloy wheels aren't essential to a car). Its nice if you've got them, but you can live without them.

True. But what I think he saying is extending that idea into the realm of neuropharmacology. Neurotransmitters make us who we are (personality, in addition to the entire functioning of the nervous sytem). Just as people can have serotonin imbalances (whether from genes or environment, or both), so it stands to reason that other neurotransmitters could also be in various states of disarry, creating the many problems of personality "disorders" including the apparant "abuse" of these CNS active molecules.

I sincerely believe that it's the imbalance of certain endogenous neurotransmitters that drives people to replace/augment them, in the form of self administration of their exogenous relative...

I mean, you may have noticed that certain personality types are attracted to certain drugs, so I think that also further reinforces the above hypothesis.

 

[Enlitx]

I am sorry, but these posts that addiction has nothing to do with character are fucking silly. I think the people of the drug culture need to start taking some personal responsibility if they ever want to help others see decriminilization as a reasonable option.

Yes, certain drugs will change your brain so you will not feel the same without the drugs as you did before starting to use them. This does not mean you have no choice over the matter. It simply means your body is pushing you in a certain direction to feel a certain way that you seem to like. It is not dragging you kicking and screaming in that direction though, and your somatic capabilities are completely sufficient to ward off these urges.

Look at sex for an example. An orgasm definetely activites the pleasure centers of your brain in such a way that one would be inclined to keep doing it. It is a good feeling, and I doubt anyone would dispute that. Hormones will change the way you think and make you more susceptible to seeking sex. Does this mean that you can rape a woman or masturbate while sleeping with your nephews? Hell no, and the reason is because most people understand that one has the ability to consciously override basic desires.

In short, if you can't stop taking drugs because you prefer the "high" over your relationships or what have you (because that is what it really is) then please admit you like drugs more than your family, because it still takes conscious control to put that needle in your arm.

 

[edarrin]

What are they afraid of? They don't want methadone, they don't want to stop using heroin, why not put them on a high dose????

Ever heard of malpractice? Did said heroin addict come in with a letter from a reliable source stating that he takes x amount of H a day and is opiate tolerant? Anyone can say that. What if he gives him a good IV push and said pain in the ass OD's and because the nurses don't catch it in time said addict dies from respiratory depression? Where does the shit land. You have a lot to learn. Guess you haven't been in the profession too long.

 

[EsourceR]

^^^malpractice is a bitch for sure

most times it can be proven that malpractice has not occured. rather than malpractice has occured.
...especially if the patient was aware and knowledgable regarding his actions and potential outcomes.

IF the doctor is reliable, professional and has sufficient evidence of standard satisfactory care
... the only lawsuit to take place would be civil.
as we all know ..in civil law ...anyone can be sued by anyone for just about anything (hot mcdonalds coffee for example). that makes it a justice and the laws problem.

if they wish to keep good docs and medical professionals... they should start listening to good doctors and getting rid of the bad ones.

I don't believe in self medication. I do believe in access to medication however. The two are a fine line our governments seek to control. They try to represent something ... though i'm not sure who or what for exactly...sigh (another topic).

Only ... their solution is a type of polluted prohibition rather than education and access.

 

[lifeisforliving]

I am sorry, but these posts that addiction has nothing to do with character are fucking silly. I think the people of the drug culture need to start taking some personal responsibility if they ever want to help others see decriminilization as a reasonable option.

Yes, certain drugs will change your brain so you will not feel the same without the drugs as you did before starting to use them. This does not mean you have no choice over the matter. It simply means your body is pushing you in a certain direction to feel a certain way that you seem to like.

In the beginning, yeah, you're right - people decide to take drugs. BUT the underlying reason they start taking drugs MAY be because of an underlying mental illness.

But when you are an addict, it is just not as simple as you make it out.... which is why DRUG ADDICTION is an ILLNESS, not a "character flaw" decision every time an addict wants another high.

It is not dragging you kicking and screaming in that direction though, and your somatic capabilities are completely sufficient to ward off these urges.

Uh huh, ask a few benzo addicts or heroin addicts about that one....8)

Look at sex for an example. An orgasm definetely activites the pleasure centers of your brain in such a way that one would be inclined to keep doing it. It is a good feeling, and I doubt anyone would dispute that. Hormones will change the way you think and make you more susceptible to seeking sex. Does this mean that you can rape a woman or masturbate while sleeping with your nephews?

What the fuck does having incest have to do with drug addiction? You are talking about personally harming another person... that is clearly different from wanting to inject yourself with heroin.

Oh and YEAH, there ARE mental illnesses that affect a person's desire to sleep with little children. If you are raping women and having incestuous thoughts due to uncontrollable sexual desires, I'd say that's a mental illness.

Hell no, and the reason is because most people understand that one has the ability to consciously override basic desires.

But isn't that the crux of the matter? At what point do urges overcome conscious thought? And this isn't about free will vs. determination, it's about psychology and neurobiology.

In short, if you can't stop taking drugs because you prefer the "high" over your relationships or what have you (because that is what it really is) then please admit you like drugs more than your family, because it still takes conscious control to put that needle in your arm.

People who are severely addicted to drugs do not get extremely "high", they get "normal". If you read a little more about drug addiction, you would know this.

 

[lifeisforliving]

Ever heard of malpractice? Did said heroin addict come in with a letter from a reliable source stating that he takes x amount of H a day and is opiate tolerant? Anyone can say that. What if he gives him a good IV push and said pain in the ass OD's and because the nurses don't catch it in time said addict dies from respiratory depression?

Your country has a real problem with that. And if addiction was seen in reality as a mental illness, and TREATED, then we would all be farther along as a society.

Where does the shit land. You have a lot to learn. Guess you haven't been in the profession too long.

You're not saying that because of malpractice suits and the current way the law works that we should continue to turn away patients? The system has to change, and it will.

 

[BilZ0r]

Look, I'm not going as far as Enlitx here, addiction is real, and hard to break. But forming it in the first place is stupid. Like the guy in this thread who got all pissy because he got addicted to his meds, he was stupid. You can tell when you're getting addicted to meds. The liturature that came with the meds will say that they are habit forming. (and yes, if your meds didn't come with liturature (even though you should have asked for it) and your doctor put you on a several month course, then it isn't your fault, I was going to put a "if your tricked into take drugs" disclaimer, but I thought no one would actually raise that objection).

BUT the underlying reason they start taking drugs MAY be because of an underlying mental illness.

What? Like retardedness? The massive majority of people on this board take drugs, yet the massive minority of people are addicted, it's not about taking drugs, it's about how you take them. All of those quotes you're using to support your arguement are saying ADDICTION isn't a charachter flaw... I completely agree, it is a phsyiology rewiring.. but getting addicted is a charachter flaw. Sure, some people are either genetically, or behaviourally more likely to get addicted to a certain, or all drugs, but that's no excuse. Some people are behaviourally more likely to do a bunch of stupid shit that hurts them and others, but no one says "It's okay to hit your wife, it's not a charachter flaw, it's an illness, you were beaten when you were young, so it's only natural". Just don't fucking do it.

 

[lifeisforliving]

Look, I'm not going as far as Enlitx here, addiction is real, and hard to break. But forming it in the first place is stupid. Like the guy in this thread who got all pissy because he got addicted to his meds, he was stupid. You can tell when you're getting addicted to meds. The liturature that came with the meds will say that they are habit forming. (and yes, if your meds didn't come with liturature (even though you should have asked for it) and your doctor put you on a several month course, then it isn't your fault, I was going to put a "if your tricked into take drugs" disclaimer, but I thought no one would actually raise that objection).


What? Like retardedness? The massive majority of people on this board take drugs, yet the massive minority of people are addicted, it's not about taking drugs, it's about how you take them.

No, like brain differences that make people more suceptible to drugs such as opiots. I always hear about opiates "filling a hole" with certain people, they have a natural problem with opiates in their genes/environmental upbringing.

Just as OCD is a mental illness, so can be drug use/abuse/addiction. I believe there is an underlying mental/biological condition that makes certain people extremely suseptable to drug addiction.

The only personal experience I have with something that is close to addiction was when I did alot of cocaine, but when I wanted to stop, I stopped. For me, there was no real craving past day 1 (because I needed sleep), but I've seen other people that just can't give a drug up.

All of those quotes you're using to support your arguement are saying ADDICTION isn't a charachter flaw... I completely agree, it is a phsyiology rewiring.. but getting addicted is a charachter flaw. Sure, some people are either genetically, or behaviourally more likely to get addicted to a certain, or all drugs, but that's no excuse. Some people are behaviourally more likely to do a bunch of stupid shit that hurts them and others, but no one says "It's okay to hit your wife, it's not a charachter flaw, it's an illness, you were beaten when you were young, so it's only natural". Just don't fucking do it.

Yeah, but the asshole who beats his wife should get real therapy if you actually want him to STOP WANTING to hit a woman. Putting the wifebeater in jail will NOT make him stop his behavior. It is an underlying mental illness that needs to be addressed.

You should think about why a person has behavior that allows them to make those stupid mistakes. There are people out there that are very mentally ill, that simply do not think like you or I or many people here. THEIR drug addiction NEEDS to be seen as part of their illness, not a character flaw.

 

[BilZ0r]

I believe there is an underlying mental/biological condition that makes certain people extremely suseptable to drug addiction.

Tough tits for them. They still wouldn't get addicted if they didn't try the drugs. There is absolutely no evidence that some people are born with a strong urge to try drugs.

Yeah, but the asshole who beats his wife should get real therapy if you actually want him to STOP WANTING to hit a woman. Putting the wifebeater in jail will NOT make him stop his behavior. It is an underlying mental illness that needs to be addressed.

Fair enough, and perhaps they person who is going to get addicted should get therapy, but that doesn't mean that either of them aren't fuck heads for doing what they have urges to do.

 

[Donbon]

Many great men:
Addicted to opiates
writers, rockstars, magicians, business people
They can handle their job, just give them their dope

Im sure allot of rock, art etc. Is made on opiates and we can thank them for their great work!

Opiates releives depression, just like any ssri
some people are depressed, some people dont like ssri, but likes opiates more
shouldnt they be allowed to get it at an reasonable cost?

If you did it legal for everyone then there would be no problem

They didnt have to steal to get the money!

How about poor asian farmers with allmost no money, but being exploidet by organised crime bosses who forces them to work on the opium fields, shouldnt they be allowed to make themselves a better life by using it?

Well, some people have easy access to lots of drugs, very cheap, Opium in asia (and middleeast) weed, cocaine in south america

Drugs helps poor people survive

Great tools can also be great weapons

A knife can be tool or weapon

It all depends on use

By making it illegal its used like weapons

Some people are forced to make a living, we are not all rich, someone have to deliver the dope

 

[Delta9]

Someone mentioned that "old school thinking" is what causes doctors to be conservative with regards to drugs. I think this is untrue. It seems that in the past doctors handed out prescriptions for amphetamines, barbituates, benzos, and opiates far more than they do now. That led to a (small) percentage of those patients having full blown drug addictions which is why new doctors in med school were taught to use these drugs only when absolutely necessary.

I think the real reason doctors are now more conservative is because the whole "doctor-patient relationship" has really disappeared. Almost everybody used to have a family doctor who would be there for your whole life and know you very well on a personal level. Nowadays, most people don't know what to say when someone asks them who their family doctor is.
A doc who has known you since you were a baby is much more likely to give you whatever medication you want because they will know if you are a drug addict or not, whereas if you are just some random person coming in, they have every right to believe that you are an addict trying to score some pills. I'm sure a lot of doctors have to deal with drug seekers everyday.

It's also a problem when a lot of people go to the doctor for pain or psych. problems or whatever and just want some pills, and when the doctor suggests physical therapy or cognitive therapy the patient will completely lack interest. This shows to the doctor that people don't really want to take the steps necessary to help their problems (if they even exist), they just want the damn pills.

I'm not saying I agree with doctors being conservative with drugs. I'm somewhat of a libertarian and think all drugs should be legalized and available to anybody that wants them. But doctors do have legit reasons to suspect that anyone coming in for pain pills or benzos or whatever is an addict and so the docs are forced to be conservative so they don't get into trouble.

On a related note I don't see why docs are so worried about their patients getting addicted to their meds. If a patient gets addicted, that should just be considered a necessary but unfortunate side effect of the treatment. Like when people are put on benzos for long periods of time, addiction is unavoidable, but a good doc knows how to deal with it and taper the patient off the drugs when they want to stop using them.

 

[EsourceR]

^^the old skewl i was referring to was for pain evaluation, management, and treatment.

... good arguements in your commentary though.

 

[drplatypus]

Interesting! As a doctor myself, it saddens me every bit as much to hear generalizations about doctors as it does to hear generalizations about drug consumers. Alot depends on the area of practice you are referring to, and the generation of the doctor. And then there is the personal experience of the doctor themselves. If a doctor has been conned by a 'seeker' in the past, that can create enough resentment to effect the way they treat patients in the future. I think younger doctors are more open to negotiation of treatment regimes, but nobody is going to trust a patient who lies to them. Patients with long term addiction problems are far better off to freely state them in their medical history, so that we can factor that into any analgesic protocol. In this day and age, it is ethically inexcusable to with-hold pain relief for patients in pain, and if a dose of opiate is so low that it isn't even covering withdrawal, it needs to be increased substantially.
It is a 2 way street, mind you. I have had stand up toe-to-toe arguments with people who think it is conservative of me not to hand out benzo's for the weekend. Sure, if you are having palpitations and real signs of overdose, I'll treat you, but none of us have done 5 years of medical school and then the rest to become a dispensary for recreational users. Apart from the fact that it would be grossly illegal in any part of the world, there are just no drugs that are completely safe to take, and it would be morally irresponsible to prescribe to people just because they wanted some.

 

[BilZ0r]

Opiates releives depression, just like any ssri

Really? Is that why all heroin users are so happy? Just because a drug is euphoric doesn't make it an antidepressant

 

[VelocideX]

Opiates releives depression, just like any ssri
some people are depressed, some people dont like ssri, but likes opiates more
shouldnt they be allowed to get it at an reasonable cost?

Opiates produce euphoria, not antidepressive effects (as bilz0r said). In any event, opiates produce tolerance and then addiction. At the end of that, you're addicted to opiates and they don't provide you with depression relief OR euphoria. SSRI antidepressants are not addictive (though they do have discontinuation effects. that's not addiction), and do not produce tolerance. Their effect GROWS with time.

 

[Donbon]

VelocideX and Bilz0r i beleive you are wrong!

Opiates relieves depression, i did not say permanently!

Name ONE drug who does and isnt quite damaging!

SSRI are very much known to have both serious side effects and addiction (if you stop using, bad stuff will/can happen, often does)

Lets say, someone with depression, takes Heroin ONCE every week, dosnt get addicted, but the kick is enough to remind him how good life/drugs can be, and he dosnt need anything else, cause he knows next week he is gonna bang again

Even if you ARE addicted, then you can just up the dose a bit and the euforia returns, its all about dose, and some people loves to be hooked on opiates

Its realy not the addiction who is the problem, problem comes when supply of drugs are running out!

So with an unlimited supply of opiates then no problem!

Lets say you had a poppy field and a big one, or you buy it 10 bucks a g. That would only be possible without a blackmarked and laws against it

Opiates are dirt cheap to produce if you have the right stuff!

SSRI i think can be far more devastating and damaging than opiates!

Opiates are quite safe in the right dose

SSRI are known to make people commit murder and suicide and behave like a fucked up on psychosis without empaty or like a walking zombie with disturbed REM

I realy cant see why this knowledge is not more widespread

I think its because people are more and more using SSRI to feel happy but its a dead track in the long run.

People are not depressed only because of chemical inbalance but that inbalance is caused by something much deeper like a stressfull life and problems in general.
Meditation helps quite i bit i would say.
Its all about connetion

Cheers

 

[Enlitx]

Ok, I still think people are missing my point. I absolutely believe certain people have neurotransmitter deficencies that will predispose them to liking a certain drug more than others and make them feel normal only under the influence , but one can ALWAYS choose to not use.

I absolutely do not care how fucking addicted you are to heroin, EVEN when you are starting to get completely depressed and feel like complete shit due to a lack of endorphins, you STILL can CHOOSE not to do it. Please point me in the direction of a heroin user who is so completely out of control that he will sit in a burning house and die just so he can shoot up. You know why the heroin junkie would run out of the house? Because he has somatic capabilities to allow him to choose life over heroin. That same junkie might not see his family so he can stay home and shoot up. He prefers the high over his family, but NOT over life. Please don't tell me that was not his choice! It might have been a disease that contributed to his decision, but it was ultimately his decision.

The problem I have is when people say it was the disease that was ultimately responsible for his decision and he had no control over it. Humans always have control over it, until you can prove that a change in brain chemistry due to addiction actually COMPLETELY overrides somatic capablities, you must admit that character does have something to do with it.

 

[EsourceR]

^^I believe in ACCESS to drugs ... but giving them out ? without education or supervision? to ... ahem ...some people (who obviously wouldn't be able to manage their own care ... including those who aren't able to use common sense ... or seek education ...when they are unable to think for themselves ?

... these aren't the doctor's issues to deal with ...they're yours. And so they are regulated ...although sometimes politically and otherwise improperly.

Unlimited supplies of drugs won't solve anyone's problems.
This can lead easily to increased tolerance in abusers ... which leads to addiction and possibly overdosing
... no one knows their very own individual lethal dose. An autopsy would tell you this ... but why would you care when you're already dead?

... Kinda an uninformed, opinionated commentary IMO.

anyhow ... those of you still listening ...here's my commentary for the day

Depression is a route to mental illness. I agree that certain stressors make depression worse if not dealt with. Although with proper treatment ... the stressors are more managable.

No matter how hard you try, you can't eliminate stress. Good and bad and difficult things just happen. Some people learn to deal with it effectively ... others can't deal with stressors
... it's usually no fault of their own. Depression can result. Chemical imbalances may occur at any point in anyone's life. Don't ever say it won't be you.

Some people turn to recreational forms of drug use to TEMPORARILY turn off/on their physical/mental stressors in an effort to create a desired ... yet false ...reality.
Take drugs ... legal ones like alcohol, prescription such as xanax or otherwise ... everything from niacin to heroin.

In mental illness ... or even addiction
...therapeutic medical supervision AND patient co-operation is the basis for treatment.
This involves short acting treatments (eg. benzo) and long acting treatments (psychotherapy and prozac) or a mix... for their individual effectiveness
...this is in order to treat varied symptoms for optimal functioning and quality of life. Keep in mind certain drugs should not be mixed and this is why medical supervision is necessary. You wouldn't drink household chemicals ... yet you might dose something far more lethal if used incorrectly.

There are even drugs like Cogentin that are used to treat side effects of other drugs. Each person needs invidualized focused care to (when possible)... to try and avoid negative side effects ... and possible long term complications.

Recreational value associated with ANY drug is arguable. This is why doctors can't always see past the stereotypical abuser to implement a TREATMENT PLAN "with options".

A real (often subtle) illness that is usually treatable underlies
... especially when someone presents ...SEEKING! medical advice or treatment. Offer your patient something useful to them before they leave ... even if ...only a promise.
How often do you "promise" someone something? - hard thing to do ... but isn't it the right thing?

Drugs aren't the be all and end all to treating illness though ... there are other options ... just need to educatedly experiment with a few... to see what works.

Drugs are not the BIG problem either
.... treating ANY illness effectively is the REAL problem.
Good doctors, knowledge, research, patient co-operation and common sense all are essential to find effective, individualized, and appropriate treatment in an illness including addiction.

Treating depression and addiction are totally different subjects. I would point out the commonalities (*likes) and differences
...or you could just research them and save me some time.

As far as most people are concerned. Mental illnesses and addictions are not curable, only managable.

Addiction and side effects such as withdrawl are "acceptable consequences"... of treating an illness/creating an altered reality
... and for many ... this includes recreational or self-administrated drug use.

In most circumstances of mental illness or addiction... without treatment the person suffers either a major dent in quality of life or "the god given right" and ... ability to live pleasurably and purposefully from day to day. Seek help. It might be a life long journey.

With recreational drug use ... when it is no longer managable
(much like a mental illness) ... it can lead to another illness called addiction. Either ... constitutes medical treatment using different therapies.

This institutes the pros vs. cons of treatment options.

Recreationally *or medically supervised ...diagnosis, treatment, experimentation, evaluation and monitoring of mental illnesses *or treatments (such as drug use)... is a delicate balance

... a never-ending individual up and down saga that is hard to achieve and attain.

...just ask any drug user or person with a mental affliction.

 

[fairnymph]

SSRI antidepressants are not addictive (though they do have discontinuation effects. that's not addiction), and do not produce tolerance.

I believe it is possible to develop tolerance to SSRIs/SSNRIs. I have. But yes, it's not nearly as common or assured as opiate tolerance.