Posted by Elizabeth on January 30, 2002, at 14:28:59
In reply to Buprenorphine or Percocet? , posted by Jet on January 26, 2002, at 22:43:59
> What troubles me is: I have been seeing him for 15 years and nothing else has worked for me and he knows it!
My guess is that he's scared to prescribe opioids. They're not "normal" for a pdoc to prescribe, and many doctors are afraid that if they prescribe the "wrong" drugs or "too many" of the controlled drugs that are labelled for psychiatric indications (like amphetamines and benzos) then the state medical board will get wind of it (perhaps through some well-meaning pharmacist). He might also be concerned that since you have ADD and perhaps bipolar disorder, you might be at risk for addiction.
> I have been depressed for most of my adult life and I have never given up trying to find a way to crawl out of my depression – so why should he give up on me?
I know how you feel. :-(
> How should I approach her?
I never know how to answer that question (although I've posted in response to some other people who asked it in the past so evidently I did come up with an answer at some point -- you might want to check the archives). I think some doctors are just too rigid to be convinced, even when it is the only right thing to do. If they're not, just telling them what you've said here might be enough, I think -- how you need opioids to feel "normal" and to function normally, how you've tried all sorts of other things with no success and now are having only limited success with Topamax, how you feel like your pdoc is "giving up" on you.
> I don't know if she will be brave enough to prescribe me Buprenorphine, but I am going to ask her anyway.
Mention its advantages compared to other opioids. The main disadvantages are the difficult formulation (people have found ways around that, and she could always show you how to give yourself an IM injection) and the fact that retail pharmacies don't normally carry it (they would have to special-order it, which they can do).
> I am going to ask her if she will call Dr. Bodkin. Do you think he will talk with her?
He seems to have been willing to talk to people's doctors about this, so I would guess yes.
> I really would appreciate your input here. I see her next Tuesday.
I'm not sure which Tuesday you mean here -- am I too late?
> Do you think that I should try the Buprenorphine or stay with the Percocet?
Percocet isn't a good choice, since it has Tylenol in it. You'd want something that has only oxycodone in it (such as OxyContin). I think it's better to try buprenorphine first; if it doesn't work or causes problems you can't manage, discontinuing it is likely to be less troublesome than discontinuing oxycodone would be.
> What is Buspar?
A serotonin type 1a receptor partial agonist. Labelled for anxiety, has a reputation for being ineffective.
> Will my doc be able to prescribe the Buprenorphine from a regular pharmacy?
Yes, although the pharmacy will have to order it (which can take a couple of days).
> Can I take Buprenorphine on a “as needed” basis?
Yes.
> What is the best dopamine agonist in your opinion?
Direct, or indirect? (If you're including indirect agonists, I'd say Dexedrine.)
> Will the Buprenorphine mix ok with Topamax and Dexedrine?
Should be fine.
I hope this helps. Let us know how it goes and what you decide.
-elizabeth
poster:Elizabeth
thread:91728
URL: http://www.dr-bob.org/babble/20020124/msgs/92212.html