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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by SLS on October 27, 2005, at 10:08:39
Heroin withdrawal and abstinence.
Does anyone have any comments regarding the minimization of withdrawal symptoms from heroin and the use of methadone or buprenorphine to control cravings after detoxification?
- Scott
Posted by Declan on October 27, 2005, at 15:47:22
In reply to Heroin withdrawal and abstinence, posted by SLS on October 27, 2005, at 10:08:39
Hi Scott
I think methadone in particular is best avoided. Most heroin users have nothing like the habit they will get once they go on methadone and keep using as they do often, mainly to alleviate the depression caused by methadone. It's too hard to get off, too depressing, and too toxic. I've never taken bupe but it is supposed to be less depressing and easier to get off. Around opiates though beggars can't be choosers.
Declan
Posted by alexandra_k on October 27, 2005, at 16:30:36
In reply to Heroin withdrawal and abstinence, posted by SLS on October 27, 2005, at 10:08:39
chew poppy seeds. yeah, i think methadone is best avoided too...
Posted by SLS on October 28, 2005, at 19:08:04
In reply to Re: Heroin withdrawal and abstinence, posted by alexandra_k on October 27, 2005, at 16:30:36
> chew poppy seeds.
:-)
> yeah, i think methadone is best avoided too...
I think this person is leaning towards using buprenorphine if cravings become a problem.
Any thoughts on Ibogaine?
- Scott
Posted by Declan on October 28, 2005, at 20:22:03
In reply to Re: Heroin withdrawal and abstinence - Ibogaine?, posted by SLS on October 28, 2005, at 19:08:04
I've taken it, but before using heroin. Never understood the way it was supposed to help. It's a hallucinogen from west Africa, isn't it? It had me thinking of withdoctors. Things flying around the room.
Declan
Posted by alexandra_k on October 29, 2005, at 0:32:47
In reply to Re: Heroin withdrawal and abstinence - Ibogaine?, posted by SLS on October 28, 2005, at 19:08:04
> > chew poppy seeds.
> :-)i've heard of that... being recomended to people who are on the wait list to get onto the methadone program. i dunno how many of those suckers you need to chew. but it is supposed to help with the cravings a little. you can get them from bulk bins (you might want a fair few of them)
> > yeah, i think methadone is best avoided too...I hurt my legs a while back... I didn't know how much morphene they were giving me for that until... they said they were concerned about how much morphene i was using to deal with the pain and they wanted me to consider going on the methodone program to manage the pain / cut back. But the trouble with methodone is that it has 2X the life of other opiates. so that means... your body takes 2X as long to withdraw. I think the real problem... Was that I was going to be discharged and they didn't want an outpatient to be getting morphene tablets... I managed to taper back the morphene tablets though... Switched to codene and tramol (tramadol? something like that) and it wasn't really so much of a problem to stop...
> I think this person is leaning towards using buprenorphine if cravings become a problem.
> Any thoughts on Ibogaine?I haven't heard of either of those.
What are they?
Posted by alexandra_k on October 29, 2005, at 0:34:38
In reply to Re: Heroin withdrawal and abstinence - Ibogaine? » SLS, posted by alexandra_k on October 29, 2005, at 0:32:47
dare i say...
what i do know about heroin / opiate withdrawal...
is that physically it is no worse than a bad case of the flu.
(don't get me wrong, the flu can be pretty bad)
the trouble is...
the psychological thing...
the knowledge you have that just a little hit and not only will the physical symptoms go away but you will feel WONDERFUL.
that knowledge... is the hardest thing...
Posted by ed_uk on October 29, 2005, at 1:27:05
In reply to Heroin withdrawal and abstinence, posted by SLS on October 27, 2005, at 10:06:43
For a proportion of heroin users, controlled-release oral morphine may be preferable to methadone. Unfortunately, morphine is expensive whereas methadone is dirt cheap.
~Ed
Posted by SLS on October 29, 2005, at 1:27:05
In reply to Re: Heroin withdrawal and abstinence » SLS, posted by ed_uk on October 28, 2005, at 15:56:29
> For a proportion of heroin users, controlled-release oral morphine may be preferable to methadone. Unfortunately, morphine is expensive whereas methadone is dirt cheap.
>
> ~Ed
Hi Ed.What are your thoughts on Ibogaine?
Thanks.
- Scott
Posted by alexandra_k on October 29, 2005, at 16:50:38
In reply to Re: Heroin withdrawal and abstinence » SLS, posted by ed_uk on October 28, 2005, at 15:56:29
> For a proportion of heroin users, controlled-release oral morphine may be preferable to methadone.
uh, why?
because you can make homebake out of it?
lol
Posted by ed_uk on October 30, 2005, at 12:26:32
In reply to Re: Heroin withdrawal and abstinence » ed_uk, posted by alexandra_k on October 29, 2005, at 16:50:38
Addiction. 2004 Aug;99(8):940-5.
Slow-release oral morphine versus methadone: a crossover comparison of patient outcomes and acceptability as maintenance pharmacotherapies for opioid dependence.Mitchell TB, White JM, Somogyi AA, Bochner F.
Department of Clinical and Experimental Pharmacology, University of Adelaide, Adelaide, South Australia, 5005, Australia. t.mitchell@iop.kcl.ac.uk
AIMS: To evaluate slow-release oral morphine (SROM) as an alternative maintenance pharmacotherapy to methadone for treatment of opioid dependence. DESIGN: Open-label crossover study. SETTING: Out-patient methadone maintenance programme. PARTICIPANTS: Eighteen methadone maintenance patients. Intervention Participants were transferred from methadone to SROM (once-daily Kapanol trade mark ) for approximately 6 weeks before resuming methadone maintenance. MEASUREMENTS: Patient outcomes were assessed (1) during the transition between medications (dose requirements, withdrawal severity) and (2) after at least 4 weeks on a stable dose of each drug (treatment preference, patient ratings of treatment efficacy and acceptability, drug use, health, depression and sleep). FINDINGS: Transfer from methadone to SROM was associated with relatively mild withdrawal for the first 5 days; the final mean SROM : methadone dose ratio was 4.6 : 1. Compared to methadone, SROM was associated with improved social functioning, weight loss, fewer and less troublesome side-effects, greater drug liking, reduced heroin craving, an enhanced sense of feeling 'normal' and similar outcomes for unsanctioned drug use, depression and health. The majority of subjects preferred SROM (78%) over methadone (22%). CONCLUSIONS: These findings provide justification for further evaluation of SROM as a maintenance pharmacotherapy for opioid dependence.
Posted by ed_uk on October 30, 2005, at 12:27:13
In reply to Re: Heroin withdrawal and abstinence » ed_uk, posted by SLS on October 28, 2005, at 19:14:55
Hi Scott
>What are your thoughts on Ibogaine?
Gotta say, I'm not convinced.
Ed
Posted by maddawgz on November 4, 2005, at 19:01:28
In reply to Re: Heroin withdrawal and abstinence » SLS, posted by ed_uk on October 30, 2005, at 12:27:13
Ive been on methadone for 10yrs rubbish it does wonder's better then H !!
Posted by alexandra_k on November 5, 2005, at 6:57:09
In reply to Re: Heroin withdrawal and abstinence, posted by maddawgz on November 4, 2005, at 19:01:28
> Ive been on methadone for 10yrs rubbish it does wonder's better then H !!
Uh, better in what way?
Posted by SLS on November 5, 2005, at 7:49:18
In reply to Re: Heroin withdrawal and abstinence » maddawgz, posted by alexandra_k on November 5, 2005, at 6:57:09
Hi.
A friend of mine made it a week into heroin withdrawal cold turkey. He seems very motivated to stay clean. He has been looking for a rehab program and is on the waiting list at several of them. He will probably choose a county program.
Unfortunately, his drive to use got the better of him. At first, pot seemed to be enough of an intoxication to "fill in the holes" temporarily. Now, he is lacing his pot with heroin. His girlfriend has been tolerant of this behavior because she believes this will keep him from shooting up. We don't know how long it will be before he begins the rehab program. Does anyone have any suggestions on what he can do in the interim?
Thanks.
Heroin can certainly be a demon. It didn't take but a few weeks for him to get to this point. He was probably hooked after his very first hit.
- Scott
Posted by Declan on November 5, 2005, at 17:36:23
In reply to Re: Heroin withdrawal and abstinence, posted by SLS on November 5, 2005, at 7:49:18
Hi Scott, here's my 2 bob's worth on what you said.
My problem with heroin was the instability of the effect, always going up or down, too much or (more often) not enough, and methadone deals with that nicely when substituted for it.
Injecting heroin means more spikes and troughs, and therefore more needs to be taken, over and above anything else.
Most people who inject heroin do so because of economic factors, at least that's how I think it should be.
I don't mean to quibble, but I don't think a motivation to stay clean amounts to much. You have to have had a gutfull of it and to lose interest. OTOH if he was only shooting up for a couple of weeks and is determined, the withdrawal is minimal compared to a methadone+heroin withdrawal after decades of use.
People on methadone continue using heroin for rational reasons. They think 'if I have to take this terrible stuff, at least it will stabalize my smack habit. If I don't take smack, why take methadone?', if you can follow the drift.
I would strongly reccommend bupe over methadone.
Declan
Posted by SLS on November 6, 2005, at 10:15:54
In reply to Re: Heroin withdrawal and abstinence » SLS, posted by Declan on November 5, 2005, at 17:36:23
Hi Declan.
> I would strongly reccommend bupe over methadone.
Thanks for the affirmation. This seems to be the direction that things are headed.
- Scott
Posted by maddawgz on November 23, 2005, at 2:52:07
In reply to Re: Heroin withdrawal and abstinence » Declan, posted by SLS on November 6, 2005, at 10:15:54
I think methadone still But were all different Bup made me sick
Posted by Declan on November 23, 2005, at 14:16:58
In reply to Re: Heroin withdrawal and abstinence, posted by maddawgz on November 23, 2005, at 2:52:07
Hi MD
How did it make you sick? Were you transferring to bupe from something else, I imagine you were. The only thing remotely like bupe I've tried is pentazocine (Fortral) and it was better than codeine and that's about all.
I've heard horror stories about long term methadone people trying to transfer to bupe. Ending up in hospital, asthma attacks. From heroin to bupe seems easier.
Declan
Posted by SLS on November 25, 2005, at 8:24:22
In reply to Re: Heroin withdrawal and abstinence » maddawgz, posted by Declan on November 23, 2005, at 14:16:58
So far, so good.
My friend has made the transfer from heroin to buprenorphine with little negative effects. He feels that his cravings have all but disappeared and has not experienced any significant withdrawal syndrome. Still, he wants to be free of all opioids, and the rehab center he is going to has a schedule by which they attempt to withdraw the buprenorphine.
I find it remarkable that the transfer to buprenorphine from methadone should be so much harder than it is from heroin.
Great information.
Thanks guys.
- Scott
Posted by Declan on November 25, 2005, at 17:04:52
In reply to Re: Heroin withdrawal and abstinence, posted by SLS on November 25, 2005, at 8:24:22
Hi Scott
In the clinics they say you can transfer from 30mg methadone to the appropriate dose of bupe. Two people I know who tried this ended up very sick in hospital and with asthma attacks as well. Another who tried it on 17.5mg felt sick for a week but managed it.
Methadone might be more difficult to transfer from because of the stable blood level. On heroin you are always having some withdrawal (uneven blood levels) and maybe therefore tolerance is lessened.
Methadone is different though. Nausea (not just nausea!) in people who try methadone (before other opiates) is severe.
Your friend might have saved himself a decade or two on methadone.
Declan
Posted by Shay Sweet on December 15, 2005, at 7:53:12
In reply to Re: Heroin withdrawal and abstinence, posted by Declan on October 27, 2005, at 15:47:22
" Around opiates though beggars can't be choosers."
> DeclanUnless, of course, one is begging to differ; which I am. It sounds like you 'know some people who have heard..." but have not actually had experience with Methadone yourself.
Yes, there are users who go to the clinic and remain on the lowest possible dose so they can still get high. Those people aren't really serious about getting off dope (not yet anyway).
Then there are those who are serious about it, but they become disdained by others who have a "this sucks" attitude and are usually unavoidable at a clinic where you have to wait in line to dose.However, if you are serious and have tried to kick cold turkey, my advise would be this:
Don't hang with the same crowd, and perhaps even more importantly, do not make friends at the clinic with other patients; it's very easy to adopt the negative attitude or meet people who are into other stuff.
Be honest with your counselor, yourself, and eventually your non using friends/family.
As you can easily discover for yourself by visiting the NAMA sponsored web site, We Speak Methadone, there is so much info and support there that you can at least make a well informed decion..
Posted by Declan on December 17, 2005, at 16:48:10
In reply to Re: Heroin withdrawal and abstinence, posted by Shay Sweet on December 15, 2005, at 7:53:12
Hi Shay Sweet
I've had all the experience with methadone I want, about 20 years all up, give or take 5. I'm currently on 0.25mg or something like that. (Not a typo, I'm on 0.25mg/d.) I don't think methadone is the worst possible option by a long shot, but it's reassuring that bupe is being used more. Still, it's part of the modern world, methadone I mean, so I'll just have to accept that now is when I live.
See ya
Declan
Posted by Shay Sweet on January 6, 2006, at 23:23:18
In reply to Re: Heroin withdrawal and abstinence » Shay Sweet, posted by Declan on December 17, 2005, at 16:48:10
Hey Declan,
I actually posted a response--a pretty long one--the day after your post. Not surprisingly, it was destroyed when I fell asleep at the keyboard. I have a three-year-old little girl (going on thirteen) who keeps me pretty busy, stays up until after 10:00pm and wakes up at around sixish. It's a wonder I ever needed a .25 Xanax and an OTC sleeping pill just to catch a night's sleep!
This is the end of the thread.
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