Posted by Deus_Abscondis on September 4, 2007, at 21:22:04
In reply to Re: Opioids,TRD,Oxycodones stimulant effects + ADHD, posted by rina on September 4, 2007, at 15:41:14
Thanks for the reply,
>After 4 short months of using it.
The length of time is one factor but importantly is the size of the dose.
Post trauma/surgery analgesia is very important in avoiding chronic pain conditions that can set in and cripple ones life. Sudden neck injury seems to have the potential of taking on a life of its own.
>I went through withdrawals that will never be >forgotten. i.e needles being poked in my eye
What - you stopped abruptly!? Did you discuss discontinuation with your doctor? I'm very conservative with taper rates and would expect if I used opioids that I'd need to reduce usage very very slowly and use other analgesics if pain flared during tapering off and be prepared to plateau for a while. Large dose opioid taper off could also benefit from a partial agonist/antagonist such as buprenorphine.
What taper off rate did you use? As the body has to repopulate receptors and learn to re-regulate it is going to take some time - again dose and duration of treatment dependent.
>then later sued the doctor that prescribed the >drugs to me for not letting me know the side >effects.
Doctors sure do have a duty of care to manage medication but I also believe I have some liability (if capable of making a choice). I ask doctors about medications and read the consumer information and do my homework (usually lots) - some doctors respond well when you show interest, most don't - it's cheaper to be an aware consumer than enter into litigation. I think there are some cultural differences between the US and Australia - we don't hold lawyers in such high regard - maybe a step up from used car salespeople - some tongue in cheek :-)
I think there must be cultural differences in insurance as well. In Australia we more frequently have medical insurance separate from work contracts and there is confidentiality. In any case, medical detox - a drug complication, should carry no stigma whatsoever - if your employer has the right to know the details of your medical condition then they should also be responsible enough to know the difference between abuse related detox and medical detox. Why bother having salary packaged insurance if differences like this aren't understood? Interestingly some studies show chronic pain persists longer when there is litigation involved (stress, payment driven outcomes, suggestion from legal?).>Now are you really sure this is the drug you want >to use for your illness? If so, make sure it's >really worth it for you.
I expect that the doses in our cases would be very different. Chronic pain is a different process to acute pain (although acute pain can transform into chronic pain). I have very good acute pain tolerance.
At the moment I don't think I could work with the pain levels and variability in levels I have. When I was on Oxy I worked in a casual job with quite a degree of physical work included. The drug was enabling and improved the quality of my life. I have done a pain education program. During bad periods I need one hour of yoga, one hour of aerobic exercise and at least half a hour under a hot shower and 3/4 - 1hr meditation. Mornings are the worst - at least 2hrs to 'get going' including some of the 'therapies' mentioned.
I'm only going from first impressions.
What I am saying is that Oxycodone seems to have some properties that I haven't experienced in other opioids - namely stimulation and clarity and mood brightening/anti-depressant - no anti-depressant has produced an anti-depressant effect in me. If anything the emotional blunting has contributed to workplace and personal relationship failure.If Oxy produced the same effect as codeine I wouldn't consider it.
The hepatotoxicity of acetaminophen is a real problem. I'd know if I accidentally double dosed on Oxycodone - you can perceive the difference and a double dose at the levels I'm talking about would be insignificant With acetaminophen the difference between a therapeutic dose and a harmful dose is small. Acetaminophen toxicity is insidious unless you have your liver enzymes tested frequently. From the wiki entry:
>Paracetamol overdose results in more calls to >poison control centers in the US than any other >pharmacological substance, accounting for more >than 100,000 calls, as well as 56,000 emergency >room visits, 2,600 hospitalizations, and 458 >deaths due to acute liver failure per year.[12] A >recent study of cases of acute liver failure >between November 2000 and October 2004 by the >Centers for Disease Control and Prevention (US) >found that paracetamol was the cause of 41% of >all cases in adults, and 25% of cases in >children.[13]
and
>In fact, the human toll of acetaminophen, in >terms of both fatal overdoses and chronic liver >toxicity to habitual abusers of pain medication, >likely far exceeds the damage caused by the >opioids themselves.Further, the mode of action of paracetamol is not as well established as one would think for a drug that has been available for such a long time.
Given that it is not routine to test a patients hepatic metabolic genetics and given that SSRIs are commonly prescribed for depression and co-morbid pain I don't understand why my GPs haven't required frequent liver testing.
The assumed wisdom of the medical profession doesn't stack up well against evidence but try telling them that :-) Where is the objectivity? In the limited time available for a consultation you can only be so diplomatic and then some assume diplomacy is being devious. You just can't win.
Many doctors just can't be bothered applying themselves to a treatment regime that requires some ongoing effort and/or learning - yet my mothers local doctor wanted to see he every week for an injection (this had been going on for a decade) where there was an equally effective tablet alternative.
In Australia it would seem the fastest way to trial buprenorphine for combined anagesia/depression would be to present as a heroin user - I know this is a generalisation but I don't 'look the part' (no tatoo's, all of my veins intact, good dentition and not smart enough to be streetwise).
I'm sorry to hear about your injuries rina.
P.S I would have made an insurance claim over a case of workplace bullying if it wasn't for the fact that I had a psych-history that would have complicated matters and lead to more stress. An acute injury is more evident. I really feel like I'm at the bottom of the pile - indeed I am. It seems that the worse off you are the more you are _expected_ to perform the most herculean feats of self-recovery.D
poster:Deus_Abscondis
thread:780553
URL: http://www.dr-bob.org/babble/20070831/msgs/780872.html