Posted by Caleb462 on December 17, 2003, at 0:26:39
In reply to Re: More Questions for Caleb ...... bupe, posted by maryhelen on December 16, 2003, at 19:24:29
> Hi Caleb:
>
> I cannot thank you enough for taking the time and having the patience to answer my very long post. You have helped me greatly, as I am feeling very hopeless about ever not being depression or conquering the opiate addiction and when I saw your initial post, I felt the first glimmer of hope for the first time in a long time. I really appreciate it, but I still have some questions following some of your comments and I hope you don't mind hanging in with me and anwering a few more questions:
>
> 1) > In the doctor's office I took my first dose in 4mg increments...... Question: Does this mean that you stayed in the office for a certain length of time after starting with a much smaller dose? What length of time between each increment? I gather the dose can be raised fairly quickly.
>I was in the office for a few hours signing papers and then experimenting with dose. I started at 4 mg. The effects came on within about 5-7 minutes. After about 30 minutes, it was obvious I was going to need to go up. Thus I was given another 4 mg, for a total of 8 mg. The effects increased quite a bit - and for the first time I felt the grip of addiction lessening. After another hour or so, I was given an additional 4 mg, for a total of 12 mg. About 5 minutes after taking this last dose, it was like a lightbulb clicked on.. and boom! My cravings dissapeared. I felt free from addiction for the first time since in several months.
> 2) > You will go back to feeling normal, the way you felt before you ever got hooked (and that is a wonderful feeling). Question: I do not believe that I have ever felt normal.
I meant normal in that you will not feel like you did when you were an addict. The pain and craving of constantly needing opiates to function will be gone.
Indeed, I eventually realized that the opiates I took for my migraines, were also having a positive effect on the depression. I, therefore, believe I had the depression before I progressed into the opiate addiction. Do you think this will make a difference?No, I too was depressed before I became an addict, or before I ever began using pain pills.
I musn't forget that I still have hope that the Nardil will begin to work.
Yes, don't give up hope on that. Of course, with the bupe it may not even matter.
>
> 3) > But anyway, bupe has antagonist properties meaning its effects stabilize and eventually bupe has the ability to block its own effects. Question: Caleb, I do not understand what this means.It is hard to explain. Buprenorphine is not a typical opioid agonist. Let's take for example, oxycodone, which is a typical agonist. Oxycodone binds to and activates the mu-opioid receptors in your brain quite well. As the dose is raised, it continues to bind to more and more receptors and continues to activate them, causing increased effects.
Buprenorphine is also an agonist. However, it is what is known as a partial agonist, or a mixed agonist/antagonist, which ever term you prefer. Like oxycodone (or morphine, hydrocodone, etc.), it binds to your mu-receptors and activates them. However, buprenorphine does not fit into the receptors as well as a normal opioid. Because of this, it DOES activate receptors, but it will prevent other opioids from activating receptors because of its unique binding affinity. This is good, because if you for some reason do get some breakthrough cravings and decide to use, the effects of whatever you use will be lessened greatly.
Anyway, another thing happens because of the way bupe acts at receptors. It causes continued effects as the dose is raised, but only to a certain extent, and to a much lesser degree than a typical opioid. This is because it actually begins to block ITSELF, even as more activation increases. Eventually, at very high doses, the blocking effects will win out completely, and it will turn into an opioid antagonist with no noticeable agonist effects at all. I hope I explained this well enough for you to understand. I know it can be confusing. But anyway, you can go up to a dose of 32 mg and bupe will still posess signifigant action as an agonist. It is useless to go past this dose, however, since the effects will not increase, and eventually the effects will completely stop as bupe becomes an antagonist and actually send you into withdrawal.
>
> 4) > You should know though, that I was not completely PHYSICALLY addicted, and was primarily psychologically addicted. Meaning I was not going through intense physical withdrawals ... Caleb: I also do not go through physical withdrawal when I am out of the pills. My is also psychological, and my withdrawal involves, yes some rebound headache, but worsening of depressive symptoms.
>
> 5) > As for your doctor prescribing it, I'm a little wary on this. Caleb ..... I live in Canada. My psychiatrist works for the Centre for Addiction and Mental Health in Toronto, previously four different centres .... The Clarke Institute, a world renowned Centre for treatment of mental illness and research, The Donwood Institute, a well known substance abuse facility, the Addiction Research Foundation (ARF), and the very old Queen Street Mental Health Facility. The four are coming together in one facility and should offer one of the best in the treatment of mental illness and addiction, in Canada and possibly may become world renowned. The reason I mention this, is because I met my current psychiatrist while in the Donwood, the substance abuse facility, but he also works at the Clarke Institute. It was he who mentioned the possiblity of using bupe, so he would be able to prescribe it. He is going to set me up with an appointment with the best Mood Disorder Speicalist in Ontario. However, he also knows I come here to Dr. Bob's and is very receptive to the information I have come to him with in the past when talking about medications. He also believes, and is open to the fact, that it is those of us who experience first hand the medications and would have better knowledge of the drug's reactions and side effects, more so than he would looking at his textbooks. I have gone way off topic, but thought that it may be helpful to others to know the Centre exists, who are within reasonable travelling of it. Yet, I really do not want to go the Specialist, as I feel at this time I would rather tell my pdoc I would like too try the bupe with the Nardil first, as I meet all of the criteria for it. I think I may call him tomorrow and talk to him about it.
Alright, sounds good. Let me know what happens.>
> Caleb, even if the bupe does not work tremendously for the pain, I would much rather get help with the depression and certainly need to stop taking the opiates.I understand, but you can count on getting atleast some signifigant degree of pain relief, and who knows? Bupe may provide enough pain relief as well.
I really don't know how much longer I can stand this depression, and missing out on and being robbed of life. What really is the point of living, mostly in bed, using opiates just to be at social situations, such as Christmas. After 51 years of living I don't see the point, except being forced to live because others would be upset if I died. I don't know Caleb. I guess I am just rambling.Not rambling at all. I understand how you feel.
I have a daughter and 4 grandchildren, but, as pathetic as this may sound, I get resentful toward them, because it is for my daughter that I really do have to live.
>
> Again, thank you for your time and I am so happy for you that you have found something that is helping you with both opiate addiction and depression.
>
> maryhelenThank you again, and I'm glad that you may finally find a way out of your depression. You sound like a great person, who is unfortunately having to go through some horrible things. I wish you all the luck in the world! Bupe is really a great drug, trust me.
Keep me updated.
poster:Caleb462
thread:289561
URL: http://www.dr-bob.org/babble/20031213/msgs/290806.html