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PostPosted: Wed Oct 19, 2011 3:53 pm 
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This is my first time ever posting anything online except ebay so I hope i'm doing this in right place. I just need advice and nowhere better than online. I'm gonna try to keep this short but a little detailed so I don't get advice that's unhelpful. I've been taking opiates, whatever available, Vi's, oc's, tramadol, methadone, etc. etc. for 10 years or so. The thing is i'm not or never have been "addicted". I get them when I can and have money to pay. Never had access to become addicted. But like everyone else says, yes I feel so much better on opiates. Quick med history: been diagnosed with depression/anxiety and yes, like everyone else i've tried the ssri's, a couple antipsychotics, effexor. etc. with no help. Opiates do. I know about tolerance, which is why even when I do get say 10 vicodins i'll take 2 and know i'll b fine for 8 or so hours, then i'll have to wait at least 2 or 3 days before 2nd dose effect equals first. Like I said i've been doing this for 10 years so please don't lecture me about addiction because like I said I don't have access or money for that. But will b first to say that if I happened to get long prescription for opiates I know I would become quickly addicted, wouldn't need to worry about being so frugal. I've read online articles about "endorphin defiency syndrome" but not really a proven "medical" condition, seems like mostly theory. So awhile back I wanted to find something that I could take that WOULD help that wasn't "street pills", I had read a few things about low dose naltrexone, but not enough to become convinced. Some say it helped, some didn't, seemed mostly for MS, cancer, HIV, not alot of info about possible endorphin defiencies. Then I read about suboxone and found a local dr who prescribed it so made appt. I basically told him what i've shared here, that i'm not psychically dependent, that yes I do abuse it when I can and that I feel better taking it. He decided that while I was really psychically dependent that I still have a problem and he would go ahead with treatment. I was hopeful that the medication would be better than any of the drugs prescribed for my mood. But then he said we'll see you back in 2 weeks and see if your ready to cease treatment. What? I thought. How the hells that gonna help? I'll just b taking Vic's again in 2 weeks. Anyway I figured it would give me an idea if helpful or not. I took the suboxone there in his office. Nasty taste made me so sick. I don't know if he gave me too much or because I wasn't in a withdraw, but I felt sick as a dog. Horrible. Just laid on couch nauseated and sweaty. Was too scared to take again cause afraid I would get sick again, and never went back to dr cause figured what's the point. He was gonna take me off soon anyway. So I continued to use opiates when available. When not, which was the case majority of the time, I was just existing, miserable, like Eeyore from Winnie the Pooh. Flash coward about 5 years to now. Still using opiates whenever available, still no addiction, still just letting days pass in a miserable existence, bored and apathetic. I don't want to be like this forever, to feel like this, there's gotta b something. I recently decided to give suboxone another try because I noticed the VA has a program. My appt. is tomorrow, wonder how that will go. either way I realize it would only be a limited run but what do I have to lose. I feel alone here with this problem. Most people on these threads or posts are either trying to get help with true psychical addiction. I just want to feel good, normal, happy, not wasting my life away feeling uninspired and useless. What is the answer here? Maybe trying to get prescribed suboxone for long-term use somehow, maybe it's getting naltrexone prescribed then making it into a low dose solution and trying that, or just continue getting whatever opiates I can and letting time just pass between my vetoed bouts of livability. Please help.


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PostPosted: Wed Oct 19, 2011 4:38 pm 
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Hi and I am sorry you are having such a difficult time. There are currently studies being done on low dose buprenorphine (the active ingredient in suboxone) done to treat depression in non-opiate tolerant people. Since you are not physically dependenon opiates it is very likely your Dr gave you too high of a dose. If I remember correctly they were using .3mg or .6mg to treat non-dependent people. I believe the link to the study is posted in the links forum and the dose they were using is there. Sub is very strong so for you it would not take much.

Now I know you said you do not want any judgement and I am not judging you but I just wanted to talk about opiate use. Just because you are not dependent on opiates does not mean you do not have a problem. I am not going to tell you that you are an addict, that is for you to decide. You are buying drugs illegally and self medicating to feel better. You may not have pawned your stuff to get drugs and have been able to keep it somewhat under control but this control most likely will not last forever. There are all different levels of addiction and I would urge you to think a bit more about your drug use and how it affects your life. All that being said I do agree with your 1st Dr and do believe you have a problem and could benefit from sub treatment. You will need a much lower dose than most people. Suboxone comes in 2mg strips (the strips are easier to cut into smaller doses) and I would try no more than .5mg on your first dose which is a1/4 of the strip. Your doctor should go over all this with you but some Drs are not very informed on sub so you may need to push for a small dose. Also if you find sub maintenance is working for you then there is no reason you should be forced off. If your Dr insists you stop sub treatment and you are not ready and your Dr forces you off then you need to find a new Dr that believes in long term maintenance. It is my belief your side effects were caused by too high of a side but if you are getting nauseous on a small dose then it could be the naloxone. Spitting after the sub dissolved will help you to not ingest the naloxone.

I really hope the sub works for you. It has helped me tremendously. Please keep us posted on your induction, good luck!


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PostPosted: Thu Oct 20, 2011 5:53 am 
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Hi hendrickj82 and welcome to the forum. Although your situation as presented to us isn't exactly typical, I do agree that you could benefit from sub treatment. You would need to be on a lower dose, I agree with that, too. However, if I'm recalling Dr. Junig's writings correctly, you'd still need to be maintained around or above the ceiling - 4 mg to keep the opiate receptors completely saturated. It will take a few days to adjust, but it should not take any longer than that (again, per Junig). But don't worry to much about dosing at this time.

For now you can give sub a try, see how you do on it, then re-assess. Good luck and do let us know about your appointment.

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PostPosted: Thu Oct 20, 2011 9:04 pm 
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Well just got back from hour long drive back from the VA. I didn't see the doctor just a social worker, she asked all the typical questions and I explained my situation. She said she felt it was more of a depression issue, so frustrating. While I sorta agree the point I have is that opiates help and feel that there going to end up not giving the suboxone a try, she asked me what I thought of therapy, I told her I've been there and his a headache because most I've talked to don't understand or want to put me on the newestantidepressant that isn't on my list of failed drugs. Im glad I posted here, feel so much better now that I got that out and the advice is priceless, thank you. Im still gonna go to the doctors appt. even though I don't have much confidence that they will go ahead with the treatment. If not I will try to find private doc once I get insurance. Just gonna b a pain trying to find doctor willing. They did say that they prescribe naltrexone too. Is there any research out there about LENDike I said before I have seen a couple posts about it. I guess worth a try if VA denies the suboxone. Just gonna b persistent and try to stay positive.


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PostPosted: Fri Oct 21, 2011 3:32 pm 
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Hi and I am sorry you are having such a difficult time. There are currently studies being done on low dose buprenorphine (the active ingredient in suboxone) done to treat depression in non-opiate tolerant people. Since you are not physically dependenon opiates it is very likely your Dr gave you too high of a dose. If I remember correctly they were using .3mg or .6mg to treat non-dependent people. I believe the link to the study is posted in the links forum and the dose they were using is there. Sub is very strong so for you it would not take much.

Now I know you said you do not want any judgement and I am not judging you but I just wanted to talk about opiate use. Just because you are not dependent on opiates does not mean you do not have a problem. I am not going to tell you that you are an addict, that is for you to decide. You are buying drugs illegally and self medicating to feel better. You may not have pawned your stuff to get drugs and have been able to keep it somewhat under control but this control most likely will not last forever. There are all different levels of addiction and I would urge you to think a bit more about your drug use and how it affects your life. All that being said I do agree with your 1st Dr and do believe you have a problem and could benefit from sub treatment. You will need a much lower dose than most people. Suboxone comes in 2mg strips (the strips are easier to cut into smaller doses) and I would try no more than .5mg on your first dose which is a1/4 of the strip. Your doctor should go over all this with you but some Drs are not very informed on sub so you may need to push for a small dose. Also if you find sub maintenance is working for you then there is no reason you should be forced off. If your Dr insists you stop sub treatment and you are not ready and your Dr forces you off then you need to find a new Dr that believes in long term maintenance. It is my belief your side effects were caused by too high of a side but if you are getting nauseous on a small dose then it could be the naloxone. Spitting after the sub dissolved will help you to not ingest the naloxone.

I really hope the sub works for you. It has helped me tremendously. Please keep us posted on your induction, good luck!


This is very good advice.

Stop the train before it crashes, but don't replace one problem with another. Buprenorphine for depression is for individuals for whom other treatments have failed. Exhaust the non-addictive options before you try this, but it may really help you. You also MUST be 100% ready to stop using opiates recreationally, or it will be a waste of time.


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PostPosted: Thu Nov 03, 2011 8:01 pm 
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Well I met with "case manager" at the VA about suboxone and she seemed empathic. Though she made it clear that there are going to b a bunch of "hoops" I have to go through to get suboxone and she also said I would have to be seen every two weeks and attend NA or some sort of counseling, get random drug tests, etc, etc. Such a pain. Had appt with her, now have 2 more appts. I have to attend in two weeks from now, then I have to recontact her once completed to set up dr consult for possible referral to outsourced clinic! Are you kidding me! Talk about hoop. So yeah hopefully in another month I can get help. And the real kicker is she said the clinic has a 2 month cut-off, if not "cured" then oh well I guess. Unreal. So much for possible treatment of refractory depression. Well at least I will have a good idea if it is helpful in low doses. And mayb it will last me long cause I will be taking smaller amount. Gees when I went to private doctor before it was just 2 appts total, 3 days apart, had it on 3rd day. But till I have insurance im at mercy of the VA. When I do get insurance though is there a way to see or ask if a doctor will prescribe for long term "maintenance" without having to switch doctors, searching or a doctor that is willing. Setting and sitting through multiple visits?


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PostPosted: Thu Nov 03, 2011 8:47 pm 
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There is a Dr finder at the top of this page, it will give you a list of drs that prescribe sub in your area. You need to just start calling Drs and ask if they believe in long term sub maintenance. I would start calling because some drs can have long waiting lists. Although there is still a long way to go sub is becoming more understood and I think you should be able to find a Dr that would keep you on sub maintenance. Let us know how it turns out.


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PostPosted: Fri Nov 04, 2011 12:19 am 
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Hey Hendrick. I hear so much stuff you said, the looking for answers, the depression.

You are definitely psychologically hooked to opiates. Anyone who thinks opiates are the cure for their depression has some psychological addiction. This isn't true. Opiates only make your depression worse. Sure they might give you a false sense of relief, but in the long run, they'll feed your depression. And I say that from experience, as I have bipolar and used opiates for so many years! because I thought they were the only thing that helped.

Pain + Opiates = More Pain ... and the feelings in between are irrelevant. When opiates tell you that they're the "cure" to any of your problems, and you believe it, you're addicted in some way!

I'm personally against people being prescribed Suboxone who are not already physically dependent on opiates. I once saw a guy who was abusing Nurofen+codeine. He'd take a few Nurofen+ every couple of days for a mild codeine buzz. He went to see his doctor, and was put on 30mg methadone. He was real sick for a couple of weeks, but built up a tolerance. Last time I saw him he was on 110mg methadone! If you don't know, that is a large dose, and he's taking thousand times the amount of opiates he was taking in the first place. That is a complete disaster of treatment in my book, but I'm not a doctor, ya know. It's a lot harder to get off 110mg methadone than 90mg codeine every couple of days.

The point I'm trying to make is, occasionally doctors do these disproportionate responses to people's problems. I have no doubt you are psychologically hooked to opiates, but (in my non-medical opinion) Suboxone can do more damage than good in people who don't have an opiate "habit".

It sounds to me that you had a buprenorphine overdose. Because of buprenorphine's ceiling effect, these are rarely fatal (as long as you don't take other depressants). But they are really painful! I've seen people go all pastey pale, constantly running to the toilet for ... at least 24 hours! They couldn't go to work. All because their tolerance was too low for the buprenorphine ... I actually gave them ... And I only gave them half a 2mg tablet! 1mg! Just goes to show what tolerance means.

Good luck to you dude, and drop me a pm if you ever wanna talk about the depression / opiate conundrum. There are better ways to deal with the depression!

Oh and low dose naltrexone? I did high-dose naltrexone once (50mg a day?), and it didn't do nothing. People raved about low-dose-naltrexone a few years back for addiction. If it worked, people would be on it. That's the only way I can put it.


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PostPosted: Fri Nov 04, 2011 4:59 am 
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Ok, I'm gonna go out on a limb, here -

While I'm physically addicted to opioids, I've found buprenorphine's benefits in the field of treatment-refractory depression far more exciting than it's temporary use as a replacement drug in chemical dependency. Of course, I don't want to disqualify the drug as a very, very efficient aid for opioid dependence - particularly when it comes to reducing craving and bringing back a sense of normalcy. But, as per results of a very small and early clinical trial (the already mentioned current trial, sponsored by RB, is due for publication in either 2012 or 2013) and patient testimony, the potential for buprenorphine as a valid anti-depressant can't be discounted. Not for EVERY depressed patient, but a subset.

Even if the treatment is off-label or even "last resort," it's still a treatment.

However, it's almost impossible to get even the world's most progressive doc to prescribe buprenorphine, a drug that causes dependency, for strictly mood-related reasons. Though quite a few non-scheduled psychiatric drugs cause wicked dependence and withdrawal, in my opinion, it all depends on clinical language and a government stamp.

And, in my experience, how much you can pay.

I fully expect to get slammed for this post, by the way. As a new poster, I do apologize if this discussion has been rehashed to death.

Out of curiosity, hendrick, two questions: 1.) How many on-label treatments for depression have you tried? and 2.) How would you describe the anti-depressant effect of the opioids you've tried? Do they bring the traditional feeling of relaxation or more of a motivated, get-out-of bed feeling?


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PostPosted: Fri Nov 04, 2011 8:07 am 
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nomoremommyfood wrote:
Ok, I'm gonna go out on a limb, here - While I'm physically addicted to opioids, I've found buprenorphine's benefits in the field of treatment-refractory depression far more exciting than it's temporary use as a replacement drug in chemical dependency. Of course, I don't want to disqualify the drug as a very, very efficient aid for opioid dependence - particularly when it comes to reducing craving and bringing back a sense of normalcy. But, as per results of a very small and early clinical trial (the already mentioned current trial, sponsored by RB, is due for publication in either 2012 or 2013) and patient testimony, the potential for buprenorphine as a valid anti-depressant can't be discounted. Not for EVERY depressed patient, but a subset.


Prescribing buprenorphine for depression is incredibly exciting. People who have treatment resistant depression, who haven't used opiates previously, of course will find the relief of being introduced to opiates so profound. The people in these studies are all opioid naive, and as such will only need tiny amounts of buprenorphine to get an effect. These people will likely be being introduced for the first time to the "opioid stone" we all feel when introduced to opiates, even a partial-agonist. This is the absolute relief a person feels when they have their depression dissolve in front of their eyes.

I have one question though. How long did these studies go for? Did they measure the potential life long consequences of creating opioid dependence in people who were otherwise opiate-naive? Most studies of new indications for medications don't exceed 6 months in length. Is this really long enough to monitor the negative effects of being introduced to opiate dependence?

In my personal opinion, there is a difference between dependence on anti-depressants (SNRI / SSRI's) and dependence on opiates. I have been dependent on both the drugs. Pristiq / Effexor were particularly nasty to get off. However, once I had endured through their withdrawal, I had zero desire or craving or compulsion to get back on them. Opiates on the other hand have been proven to induce cravings in previously dependent people, months and years after their detox. Even the times I jumped off Suboxone, for weeks after I actually had cravings for Suboxone. I ended up relapsing on the illegal opiates, as they were easier to get. There is a reason I ended up back on Suboxone eventually, yet I have no desire to take those anti-depressants.

If being prescribed buprenorphine for depression was the difference between life and death, and all other treatments have been exhausted including ECT, then being dependent on opiates is obviously a lesser evil to death. As someone who has been through opioid dependence, depression treatment and Suboxone / methadone treatment, I believe that buprenorphine may play a role in treating depression, but should not be treated lightly when prescribed to the opiate-naive.


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PostPosted: Fri Nov 04, 2011 12:48 pm 
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I tend to agree with Tear about the long term effect of using opiates for depression. The main reason being that most people do feel better early in there opiate treatment but based on my experience and others eventually opiates will turn on you and increase your depression. If this were to occur then what? Now you are opiate dependant and dealing with more problems than with which you started.

However I can understand how horrible depression is and why someone would want to try sub if all else has failed. I think before sub is an accepted medication for treatment resistant depression there needs to be some long term data. The downside to this is if it does work it would be a while before it can be prescribed for depression.

So I guess what I am saying is that I understand the want and desire to be cured but what happens if the treatment that is helping you makes it all worse a year or two down the road?


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PostPosted: Fri Nov 11, 2011 5:58 am 
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My apologies if this response comes off as hurried (I'm in bed with a cold) - I'd actually written a more coherent reply a few days and, apparently, it got lost somewhere in the world between the "back" button and the "preview" button.

The fact that my missing response contained a series of links referencing specific research - the original, tiny study in the mid-nineties and the current research conducted at the University of Pittsburgh - that I'm now too headachy to re-post probably won't win me any points, either.

Not to mention the fact that my missing post contained exact statistics stating mental illness as a central factor in approximately 90% of successful suicide attempts, backing up an argument that buprenorphine-based treatment for mental illness should not be completely ruled out. As for the lack of long-term data, I don't really have an answer - the drug is still very, very new and very, very controversial.

(Though it doesn't relate to mental illness, recently published results of a Harvard study - Adjunctive Counseling During Brief and Extended Buprenorphine-Naloxone Treatment for Prescription Opioid Dependence
- may prove interesting).

Also, not every person who takes opioids responds in the expected manner. While the majority experience a typical nodding off, relaxing effect, others find respite from depression in an unexpected burst of motivation - albeit with attached euphoria - and become addicted to the energetic feeling. This is where buprenorphine MAY fall in as acceptable treatment. While a bevy of medications are designed to deplete the "down" portion of a depressive episode (helping to cease the negative emotions), it's difficult to find medication to add an "up" factor (helping elicit positive emotions).

Buprenorphine, in some people's experience, has the essential motivating factor. Not only to bring a depressed patient out of lying in bed position, but help them seek purpose to stand up.

Yes, buprenorphine causes dependence and withdrawal. As do many, many mood-stabilizers, anti-depressant and anti-psychotics. Seroquel, if not tapered correctly, can cause insomnia for up to a month. Risperdal, if ceased abruptly, can cause crippling anxiety attacks. This form of dependence and withdrawal, in my opinion, is just as scary as potential buprenorphine dependency...particularly because the patient [i]does not expect to be sick.



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