8 ms·

I have this wacky idea that maybe, just maybe we should reconsider the point at which opiates would be appropriate for treating depression. I mean maybe make th

by md224 11y ago

I have this wacky idea that maybe, just maybe we should reconsider the point at which opiates would be appropriate for treating depression. I mean maybe make them a 2nd or 3rd line treatment... right now I'm pretty sure they'd only give you opiates once that whole "induce a controlled seizure" thing fails. Sure, they're addictive, but the "opium cure" was used up until the 1950's[1] and it's not like society was overrun by addicts. (I admit it's possible that the circumstances have changed, but I'd need to hear an argument for that.) Plus the fact that both Buprenorphine and Heroin-Assisted Treatment have been successful... opiates can be given as controlled medicine, and I feel like many people could benefit from them. Over 40,000 Americans die by their own hand every year.[2] I would much rather have 40,000 opioid-dependent living people if it helped them bear the weight. [1] https://www.ncbi.nlm.nih.gov/pubmed/18956529 https://www.ncbi.nlm.nih.gov/pubmed/18956529 [2] http://afsp.org/about-suicide/suicide-statistics/ http://afsp.org/about-suicide/suicide-statistics/

Fordrus 11y ago
Rofl! These are interesting points, and honestly, cause for deep thought. If these premises are sound, one might argue that a large part of the rise of clinical depression as the problem is presently constituted coincided with the phasing out of the so-called 'opium cure.' XD (I'm so not willing to commit to that position, but I mean, just looking at only those facts you've popped in right there, it sure looks like a possibility, no real harm in admitting the possibility of any given conclusion! :) ) I'd rather have opioid dependent folk than suicides, as well, mostly because I strongly trend towards any outcome where there continues to be choice and opportunity for betterment. Certainly worth exploring, at least in thought! :)
- deleted 11y ago
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- md224 11y ago
  If you're interested in studying the closest thing to it, look at the rise in popularity of Kratom, a Southeast Asian plant containing opioid alkaloids. It's commonly used by opiate addicts as a replacement therapy, and also by others as self-medication for anxiety, depression, and pain. I'm not recommending anyone try it... nobody's entirely sure if it's safe, or if it could function as a gateway drug to harder opiates. But it's worth considering the good it may be doing for some people.
  - goldfeld 11y ago
    About three years ago I tried kratom and a few hours into it I decided to start an exercise habit and I haven't stopped. I should try kratom again some day.
  - fucking_tragedy 11y ago
    > Kratom.. self-medication for anxiety, depression, and pain. > But it's worth considering the good it may be doing for some people. The only the good it's doing these people is turing them into opioid addicts with a new problem that has a good chance of eclipsing the original and a certainty of exacerbating it severely in the long-run.
anon4this1 11y ago
each year 19,000 americans die from prescription opioid overdoses and another 10,000 die from heroin overdoses which often start with prescription opioid use. In my experience (as an anaesthesiologist), people who use opioids as a response to non-pain problems are some of the most miserable people there are. It might work for a couple of weeks, but soon you're tolerant, addicted, intermittently withdrawing and your life becomes a wreck. "The prevalence of suicide attempts among opioid addicts is reported to lie between 8% and 17%, with some studies reporting an even higher rate among special groups of addicts. " http://www.ncbi.nlm.nih.gov/pubmed/9018906 http://www.ncbi.nlm.nih.gov/pubmed/9018906 Using MDMA might be useful as it is non-addictive, but again habitual use leads to decreasing benefits and increasing problems.
- dools 11y ago
  Saying that prescription opioid use is a cause of heroin overdoses ignores the fact that the reason people move to heroin is because of the paranoia about addiction which causes their prescriptions to be cut off in the first place. In the same vein (no pun intended) I've been looking for stats but not being able to find anything about what percentage of prescription opioid overdoses occur while the patient is being actively prescribed, versus those which occur when the patient is obtaining the drugs illegally once their prescription has been cut off because doctors are afraid they'll become addicted.
  - fucking_tragedy 11y ago
    > afraid they'll become addicted. Someone who isn't addicted to highly addictive substances doesn't engage in risky behavior, disregarding consequences and their well-being, by seeking out undosed, more potent and potentially adulterated highly addictive street drugs. Maybe their doctor has a valid concern. Opioids are rarely an effective treatment for non-cancer and chronic pain if taken regularly for a variety of reasons. Ideally, if a doctor is going to stop refilling a prescription of an opioid addicted patient, they should be referred to appropriate services. Detoxification, pain management and mental health specialists should be all be involved for the patient's well-being. The patient should never be cut off cold-turkey like that.
DanBC 11y ago
There's some research happening recently arpund the use of ketamine as a short term measure to stop suicidal thinking or to get people out of deep treatment resistant depression. So there's some possibility.
marincounty 11y ago
I don't think prescribing opiates to the right patient is a bad idea, or just make them legal--which will never happen. That said, you, or anyone else are not going to get opiates from any doctor in the United States. The federal government is comming down hard on doctors who prescribe opiates. The FDA just sent out prescribing recommendations to all doctors. It is stern. It's basically telling doctors just don't prescribe them--period! Or, only to cancer, and for palliative care. It will go down like this; patent will go to that rediculious office visit to discuss their pain(a lot of that pain is real. Opoids make you feel better, so the pain is bearable. There are people who stay on their original doses.) Doctor will just say--no. Patient will detox, and might die, if old, or has underlying health problems. Just like the way Jerry Garcia died out in Woodacre, CA. Or, patient will go to herion? If they live in the right area, and they are willing to break the law? Whatever--getting any opiates will be very difficult. The average patient will be in pain. I really don't like the way the government is telling doctors how to prescribe. (Bupenorpine shouldn't be thrown in the opiate mix. I have never seen anyone abuse it--period. I know it's opoid like, but so different. I don't even think it possible to OD on this drug.)
NoGravitas 11y ago
The way I've heard it put is that opiates are an extremely effective treatment for anxiety and depression, with the common and serious side effect of ruining your life. But I hear they're working on eliminating the side effects: http://mentalhealthdaily.com/2014/12/20/ly-2456302-for-depression-kappa-opioid-receptor-kor-antagonist/ http://mentalhealthdaily.com/2014/12/20/ly-2456302-for-depre...
- md224 11y ago
  That does seem to be the conventional wisdom. But it's a bit contradictory, don't you think? I mean, crippling depression already ruins your life, and suicide... well, that's the ultimate life-ruiner. Opioid replacement therapy seems to work, so I'm just not convinced that all opiates inevitably lead to doom... it feels more like FUD rather than anything backed by scientific evidence.
- deleted 11y ago
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by md224 11y ago

Fordrus 11y ago

Rofl! These are interesting points, and honestly, cause for deep thought. If these premises are sound, one might argue that a large part of the rise of clinical depression as the problem is presently constituted coincided with the phasing out of the so-called 'opium cure.' XD (I'm so not willing to commit to that position, but I mean, just looking at only those facts you've popped in right there, it sure looks like a possibility, no real harm in admitting the possibility of any given conclusion! :) ) I'd rather have opioid dependent folk than suicides, as well, mostly because I strongly trend towards any outcome where there continues to be choice and opportunity for betterment. Certainly worth exploring, at least in thought! :)

deleted 11y ago
[deleted]
md224 11y ago
If you're interested in studying the closest thing to it, look at the rise in popularity of Kratom, a Southeast Asian plant containing opioid alkaloids. It's commonly used by opiate addicts as a replacement therapy, and also by others as self-medication for anxiety, depression, and pain. I'm not recommending anyone try it... nobody's entirely sure if it's safe, or if it could function as a gateway drug to harder opiates. But it's worth considering the good it may be doing for some people.
- goldfeld 11y ago
  About three years ago I tried kratom and a few hours into it I decided to start an exercise habit and I haven't stopped. I should try kratom again some day.
- fucking_tragedy 11y ago
  > Kratom.. self-medication for anxiety, depression, and pain. > But it's worth considering the good it may be doing for some people. The only the good it's doing these people is turing them into opioid addicts with a new problem that has a good chance of eclipsing the original and a certainty of exacerbating it severely in the long-run.

anon4this1 11y ago

each year 19,000 americans die from prescription opioid overdoses and another 10,000 die from heroin overdoses which often start with prescription opioid use. In my experience (as an anaesthesiologist), people who use opioids as a response to non-pain problems are some of the most miserable people there are. It might work for a couple of weeks, but soon you're tolerant, addicted, intermittently withdrawing and your life becomes a wreck. "The prevalence of suicide attempts among opioid addicts is reported to lie between 8% and 17%, with some studies reporting an even higher rate among special groups of addicts. " http://www.ncbi.nlm.nih.gov/pubmed/9018906 http://www.ncbi.nlm.nih.gov/pubmed/9018906 Using MDMA might be useful as it is non-addictive, but again habitual use leads to decreasing benefits and increasing problems.

dools 11y ago
Saying that prescription opioid use is a cause of heroin overdoses ignores the fact that the reason people move to heroin is because of the paranoia about addiction which causes their prescriptions to be cut off in the first place. In the same vein (no pun intended) I've been looking for stats but not being able to find anything about what percentage of prescription opioid overdoses occur while the patient is being actively prescribed, versus those which occur when the patient is obtaining the drugs illegally once their prescription has been cut off because doctors are afraid they'll become addicted.
- fucking_tragedy 11y ago
  > afraid they'll become addicted. Someone who isn't addicted to highly addictive substances doesn't engage in risky behavior, disregarding consequences and their well-being, by seeking out undosed, more potent and potentially adulterated highly addictive street drugs. Maybe their doctor has a valid concern. Opioids are rarely an effective treatment for non-cancer and chronic pain if taken regularly for a variety of reasons. Ideally, if a doctor is going to stop refilling a prescription of an opioid addicted patient, they should be referred to appropriate services. Detoxification, pain management and mental health specialists should be all be involved for the patient's well-being. The patient should never be cut off cold-turkey like that.

DanBC 11y ago

There's some research happening recently arpund the use of ketamine as a short term measure to stop suicidal thinking or to get people out of deep treatment resistant depression. So there's some possibility.

marincounty 11y ago

I don't think prescribing opiates to the right patient is a bad idea, or just make them legal--which will never happen. That said, you, or anyone else are not going to get opiates from any doctor in the United States. The federal government is comming down hard on doctors who prescribe opiates. The FDA just sent out prescribing recommendations to all doctors. It is stern. It's basically telling doctors just don't prescribe them--period! Or, only to cancer, and for palliative care. It will go down like this; patent will go to that rediculious office visit to discuss their pain(a lot of that pain is real. Opoids make you feel better, so the pain is bearable. There are people who stay on their original doses.) Doctor will just say--no. Patient will detox, and might die, if old, or has underlying health problems. Just like the way Jerry Garcia died out in Woodacre, CA. Or, patient will go to herion? If they live in the right area, and they are willing to break the law? Whatever--getting any opiates will be very difficult. The average patient will be in pain. I really don't like the way the government is telling doctors how to prescribe. (Bupenorpine shouldn't be thrown in the opiate mix. I have never seen anyone abuse it--period. I know it's opoid like, but so different. I don't even think it possible to OD on this drug.)

NoGravitas 11y ago

The way I've heard it put is that opiates are an extremely effective treatment for anxiety and depression, with the common and serious side effect of ruining your life. But I hear they're working on eliminating the side effects: http://mentalhealthdaily.com/2014/12/20/ly-2456302-for-depression-kappa-opioid-receptor-kor-antagonist/ http://mentalhealthdaily.com/2014/12/20/ly-2456302-for-depre...

md224 11y ago
That does seem to be the conventional wisdom. But it's a bit contradictory, don't you think? I mean, crippling depression already ruins your life, and suicide... well, that's the ultimate life-ruiner. Opioid replacement therapy seems to work, so I'm just not convinced that all opiates inevitably lead to doom... it feels more like FUD rather than anything backed by scientific evidence.
deleted 11y ago
[deleted]