PAIN and painkillers

[MrsGamp]

I hope mod will be ok with me posting this here - at first glance it's a research-related thing, but then again, this is the "dark side" forum and of course pain and painkillers can be really dark indeed ...h

i was wondering how many people with a prescription opioid dependency got addicted through "legitimate use" ...?

also was curious to how controlled opioid painkillers are in other countries, including codeine, and what is currently "drug of choice" in hospitals for pain relief (for example in Australia right now you get either bupenorphine or Tramadol - OxyContin occasionally ... for very big post operative pain you'd get either a fentanyl or hyromorphone drip - the latter, lately, is always combined with ketamine ... details like that about how pain is treated in other "first world" hospitals in US/UK/Europe would be good ...

also if people who

finally was wondering if anyone has had a bad experience with doctor imposed "cold turkey" style withdrawal

 

[dopamimetic]

finally was wondering if anyone has had a bad experience with doctor imposed "cold turkey" style withdrawal

With benzodiazepines and other psychopharms yes, and I can easily imagine that it's a big problem with opioid painkillers because even people who resisted the temptation to take more than prescribed or didn't get that, at the point of cold turkey it's obvious that you're physically addicted to them and docs will then label them as addicts, or some just go out and buy whatever dope they can get.

Doctors should stop to fuel preconceptions and do their homework, that is to use NMDA antagonists alongside opioids and taper properly. No need to avoid opioids any more than e.g. benzos (indeed I feel it should be the other way round, we have very limited aid for month long benzo w/d but as long as you never had full blown opioid w/d, it is readily manageable).

 

[MrsGamp]

Was interested in both replies ... but am confused: by "cross tolerance" do you mean that people with benzodiazepine tolerance will automatically have opioid tolerance and vice-versa?
I've heard people use "cross tolerance" to connote benzoes and booze sort of boosting tolerance in each other but am sceptical- I've been trying to wean off Valium for years, and at present can manage on 5mg per day, but I have never found that drinking will ameliorate Valium withdrawal, although of course Valium WILL ameliorate severe alcohol W/D, eg DTs. Luckily have never been so booze dependent that I got DTs, but from a brief stay in a mental hospital 11 years ago I know the chronic alkies had to be on Valium to avoid DTs and seizures....

 

[dopamimetic]

Was interested in both replies ... but am confused: by "cross tolerance" do you mean that people with benzodiazepine tolerance will automatically have opioid tolerance and vice-versa?
I've heard people use "cross tolerance" to connote benzoes and booze sort of boosting tolerance in each other but am sceptical- I've been trying to wean off Valium for years, and at present can manage on 5mg per day, but I have never found that drinking will ameliorate Valium withdrawal, although of course Valium WILL ameliorate severe alcohol W/D, eg DTs. Luckily have never been so booze dependent that I got DTs, but from a brief stay in a mental hospital 11 years ago I know the chronic alkies had to be on Valium to avoid DTs and seizures....

No, benzos and opioids aren't relevantly cross tolerant. During withdrawal of either you might be less sensitive to any downers but it's because of increased excitation.

Booze is half a gabaergic (actually not a benzo-like positive modulator but an agonist afaik) and half a glutamate / nmda antagonist. As glutamate and gaba oppose each other, you might need pretty much valium but at some dosage you would just sleep it off. There's a drug called acamprosate which is used for alcohol withdrawal and effects both systems but it had no effects whatsoever in me and this was without ethanol tolerance.

NMDA antagonists & alcohol are cross tolerant too.