Posted by jeffrey d roth, md on April 16, 2005, at 16:41:17
In reply to Roth : Opiates, posted by hadleigh71 on April 15, 2005, at 13:53:56
> Thank you for your time Dr.Roth and to Dr.Bob for supporting this forum.
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> I'm quite surprised with all the discussion that normally takes place here in regards to opiates that no one has chimed in with the $64,000 question.
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> I understand Dr.Bob's and the mental health communities position on the use of opiates as their addiction potential is immense and most with mental health issuses have problems with compliance. I have also read Dr.Bob's position as to why they shouldn't be used :
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> http://www.dr-bob.org/babble/20010411/msgs/59892.html
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> Let me begin by stating I am currently taking Zoloft 50 mg and Klonopin 1 mg for social anxiety and depression along with a small dose of Sam-e 200 mg and have had a good response to these medications, I also walk daily with this giving me much benefit. I happened into opiates after my Gall Bladder surgery (Vicodin) and noticed an immediate improvement in my outlook and social functioning after a weeks worth of useage and the euphoria wore off, I also have migraines and found they helped as well and have been taking two a day (1/2 4 X day) for the last two years. I haven't needed to increase doseage to keep the therapeutic effect. I am doing much better than I was before I started but still slip back into old patterns irregardless. Vicodin is by no means the silver bullet as its addition has only improved my overall response slightly. I would like to add before Vicodin I was actively suicidal and that has now been tamed and caged but has not completely left me as I know it never will.
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> My question to you is should they have a place in mental health treatment or is their addiction potential too enormous. Is there any interest in the field considering how many get such a positive response from them. I know it seems silly to ask an addiction specialist this question but you must be a special breed to be willing to come here and help up this way.
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> Thank youDear Hadleigh71,
Thanks for your confidence and trust. I hope that my response lives up to your hopes. My own belief is that the potential for abuse is much more embedded in the person(even more the person's role than the person's biology) than the pharmacologic agent. Therefore I wonder whether much of the mythology about opiates' special qualities contributes to the stigma attached to opiate addiction. I would not be surprised if controlled use of opiates is as common as controlled use of alcohol, the latter drug being much more toxic than any opiate.
All of that being said, as an addiction psychiatrist, I rarely prescribe any medication (other than for detox) except for low dose antidepressants. I do this not because other medications are ineffective; I simply prefer psychosocial interventions such as mutual help groups, group psychotherapy, and other therapies, including e-groups like this bulletin board. So I would encourage you to continue reaching out for human support, and if the medications are of use to you in the meantime, I hope you can let go of shame or secrecy about using them.
Jeffrey D. Roth, MD
poster:jeffrey d roth, md
thread:484714
URL: http://www.dr-bob.org/babble/subs/20050323/msgs/485174.html