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PostPosted: Wed Mar 18, 2009 3:54 pm 
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I just contacted a local Boston shrink who came highly recommended by a colleague (for depression, not opiate use), and by coincidence, his name came up under naabt.org in response to my query.

My issue is that I'm not addicted to typical opiates, but have been self-medicating for 12+ months (as a result of hip dysplasia/DJD) with nalbuphine, which as you know is not a DEA-scheduled opiate, but an agonist/antagonist (though IMHO, at lower doses it has a lot of "mu" activity). (Total hip replacement happened in late July 07 and was spectacularly successful.) But, after 12 months of being on the stuff (interspersed with periods of legit-prescribed Percocets, for which I used the nalbuphine to "extend" the prescribed opiates, I find that I still have a terrible craving for nalbuphine. I always limited myself to 30mg SC TID which was a "sweet spot". (10mg of nalbuphine is roughly equipotent to 10 mg IM/SC morphine.) Stopping suddenly would cause severe sneezing and rhinorrhea, which would eventually end after a week or so, but was quite annoying and never ended the compunction to reorder the stuff. Both 40 mg of Oxycontin (chewed) or 30-60mg IM of Pentazocine (via India) would also halt the symptoms and craving, but naturally, only temporarily.

Anyway, I saw this shrink, explained more or less what I've repeated here, and he's legitimately treating me for a a recent sudden 10-week onset of depression due to job loss and dealing with a severely Alzheimer's-addled mother in mid-late disease who has taken a turn for the worse. To a certain extent, this is what I expected (if not hoped), but the impression I left with was that he discounted my Nalbuphine use as irresponsible, financially discretionary (as long as I was employed), and in any event, simply a matter of lack of self-control and poor impulse control to auto-initiate reduction from 30mg TID to 20 TID to 10 TID and so on until I was drug-free. Easier said than done! I do not think (as yet) that he would consider me as a candidate for buprenorphine treatment, even at the lowest dose, though I don't disagree that treating the immediate depression is a wise choice.

In the meantime, I feel like a recent ex-smoker (never smoked personally, but I think I know what it feels like now!) who has no $$$ for either cigarettes or nicotine gum/patches.

I was so hoping for just a pill that would help (with other support systems) to block the psychological (if not some residual physical) cravings for the drug, but I admittedly realize that he's in in uncharted territory when it comes to nalbuphine. If I had all the access to my mother's Oxycontin (which I don't, not would I put her thru that), and take that regularly, I feel like I'd be getting a better chance of bupe treatment and a blunting of this continual craving for the nalbuphine which I still feel.

I was wondering whether in your professional opinion whether you felt that buprenorphine could be useful in treating my situation. Your informed, insightful writings which I've only recently come across last week have been an inspiration.

Regards,

FooBear


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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