Day: 02/17/2015

Vivitrol (now for opioid addiction)

Heroin-Plagued County Looks To New Medication To Aid Addiction (NY)

http://www.huffingtonpost.com/2015/02/17/vivitrol-heroin_n_6700738.html

Last month, Suffolk County officials announced a program to incorporate Vivitrol at all levels of the criminal justice system. Officials from the drug courts, the probation office, and the sheriff’s department are developing procedures to recommend Vivitrol to addicts, when appropriate, and have been meeting with pharmaceutical representatives from the drug’s manufacturer, Alkermes.

Opiate addiction has hit Suffolk County hard; nearly 700 people have died from painkillers and heroin between 2012 and 2014, many of them young adults and teenagers. Others often end up in handcuffs, in front of judges, and later, in jails and prisons. Meanwhile, Vivitrol programs have launched in at least 26 states and will soon be permitted in places — including Suffolk County’s jails — where other medical treatments for heroin addiction have long been banned…

https://painkills2.wordpress.com/2015/01/26/what-are-the-long-term-effects-of-narcannaloxone/

https://en.wikipedia.org/wiki/Naltrexone

Naltrexone (INN, BAN, USAN) is an opioid antagonist used primarily in the management of alcohol dependence and opioid dependence.[1] It is marketed in generic form as its hydrochloride salt, naltrexone hydrochloride, and marketed under the trade names Revia and Depade. In some countries including the United States, a once-monthly extended-release injectable formulation is marketed under the trade name Vivitrol. Also in the United States, Methylnaltrexone Bromide, a closely related drug, is marketed as Relistor, for the treatment of opioid induced constipation.

Naltrexone should not be confused with naloxone nor nalorphine, which are used in emergency cases of opioid overdose…

Naltrexone helps patients overcome opioid addiction by blocking the drugs’ euphoric effects. Unlike when used for alcohol dependence (discussed above), naltrexone has little effect on opioid cravings.[8] Naltrexone has in general been better studied for alcohol dependence than in treating opioid dependence. It is also more frequently used for alcohol, despite originally being approved by the FDA in 1984 for opioid addiction.[9]

A 2011 review of studies suggested that naltrexone was not significantly superior to placebo or to no pharmacological intervention, nor was naltrexone superior to benzodiazepine or buprenorphine. Because of the poor quality of the reviewed studies, the authors concluded that there was insufficient evidence to support naltrexone therapy for opioid dependence.[10] While some patients do well with the oral formulation, there is a drawback in that it must be taken daily, and a patient whose cravings become overwhelming can obtain opioid intoxication simply by skipping a dose before resuming opioid use. Due to this issue, the usefulness of oral naltrexone in opioid dependence is limited by the low retention in treatment. Oral naltrexone remains an ideal treatment only for a small part of the opioid-dependent population, usually the ones with an unusually stable social situation and motivation (e.g., opioid-dependent health care professionals).

Can you become addicted to mania and hypomania?

I don’t drink coffee and I’ve never taken cocaine.  I don’t suffer from ADHD, bipolar disorder, or severe depression.  I’ve been in pain for most of my life, and although I know caffeine is used in combination with pain relievers, I’ve always believed that taking powerful stimulants would only… stimulate my pain.  And my pain is stimulated enough on its own, thank you very much.

So I have no idea what it feels like to be manic or hypomanic.  And after reading a little bit about these conditions, I can pretty much conclude that they’re experiences I’ve never had and probably won’t ever have.  (Or have I?)

Mania sounds pretty painful to me — and it reminds me of a time, decades ago, when I (sometimes) had access to prescription medications.  My pain levels were still manageable back then, but the drugs were the only thing that lifted the pain. And when the pain was lifted, I was much more physically active than my body was used to (as someone who was in constant pain). In other words, I pushed myself while I was “high,” and then suffered the resulting added pain afterwards.  (Were these manic episodes?)

But I can sure understand the lure of being manic, especially the bursts of creativity… Every American longs to be an artist or a writer, mostly because they think it’s easy money. Of course that’s not true… being creative is hard work.  You have to use a part of your brain that few people have access to, a part of your brain that can be dangerous.  A part of your brain that knows both the depths of despair and the joys of… flight.  And once you find that creativity, it’s hard to turn your back on it, even if it kills you.  (Thinking of you, Philip Seymour Hoffman.)

And for pain patients, especially those who are forced to work, the bursts of energy that come from a manic episode sound like a really good thing.  One has to wonder if such states can be habit-forming, just like the drugs that can artificially cause them.  Cocaine is an addictive drug, although it’s not one of the most highly-addictive.  So if mania feels like taking cocaine, if that’s what it feels like in your brain, then it’s just logical that these manic states are also addictive. Especially when you consider the pit that you fall into once the manic episode is over.

Man, if you’re bipolar, you should learn to love roller-coasters.  (I hate roller-coasters, they make me nauseated.  Perhaps if I had more willpower, I could overcome that…)

Do you recognize your addictions, Part 3

Here’s Part 2:  https://kbailey373.wordpress.com/2015/02/17/my-jesus-addiction/

I really appreciate the response from kbailey to my post entitled “Do you recognize your addictions?” My response is directed to her, but it’s also for others that suffer from addiction and chronic pain.

Just as kbailey bristled at some of the things I wrote, I have a few questions about her words too…

I haven’t really felt the same attraction to narcotics, however, because most often they will trigger a hypomanic episode.

It’s my understanding that hypomanic episodes caused by medications are rare, especially for narcotics.  (As is hyperalgesia.)  I hope you’ll write a future post about these incidents, like which drugs caused these side effects, and if you took any drugs to treat the hypomanic episode.

PAIN AND PRIDE

I say, hopefully without pride, that I only take Tylenol®, and occasionally Ibuprofen, for relief of pain in my neck.

I wonder, do you get any relief from Tylenol?  Because with your pain levels, I would be surprised if you do.  In fact, I would guess that whatever benefit you get from Tylenol is more a placebo effect than actual pain relief.  Not that there’s anything wrong with the placebo effect… religion and prayer can work as placebos, too.  It’s just that you’re damaging your liver and kidneys for an effect that you might be able to get safely elsewhere.

But I’m confused about your mention of pride when it comes to which pain relievers you use. What does pride have to do with treating pain?  Is it your pride that determines how much suffering you think you can take?  Is your pride the same thing as your willpower? Why do you take so much pride in how much suffering you can withstand?  Is your suffering supposed to prove your worth to Jesus, and is it a requirement to enter heaven?

As long as you’re not suffering from the kind of pain that Jesus did when he was nailed to a cross, you can take pride in being able to handle it (without stronger drugs)?  Is that your benchmark for pain before you allow yourself to take pain medication? Do you think it’s a sin to take drugs that alter your thought processes?  (Sorry, I don’t expect you to answer all these questions, it’s just that I’m curious.)

I think it’s your pride and your fear, kbailey, that forced you to have poison injected into your body to help you manage the pain, turning your back on options that could stabilize your pain and keep it from escalating in the future.  And opioids can provide preventative benefits — I don’t think you can say the same about Botox.  I don’t know why you would take pride in choosing these types of treatments, but I believe that every pain patient must design their own treatment program.  So if these are the kinds of treatments you prefer, then more power to you.

However… If a pain patient needs prescription-strength drugs to manage their pain (unlike you, at this time), should they feel ashamed (the opposite of pride)?  I think patients who understand the long-term effects of over-the-counter medications can take pride in choosing drugs that are less harmful, like cannabis. And seriously, if all you’re taking is Tylenol for chronic pain, you might as well just stop taking it — it’s probably doing more harm than good.

Because of my relationship with Jesus, I essentially attend church daily. I have even experienced withdrawal symptoms, so to speak, when I have backed off from practicing my faith for short periods of time.

It’s okay to be addicted to Jesus and support tax-free religions.  It’s okay to be an adrenaline junky and jump out of airplanes or race cars. It’s legal to be addicted to cigarettes, gambling, sugar, and the internet. And we’re all addicted to oil and gas (and destroying our environment). This is the drug war, where it’s more about what society thinks than what the science says.

“I haven’t really felt the same attraction to narcotics, however, because most often they will trigger a hypomanic episode. Weird, huh? And so, I use Tylenol®, even post-op. Even after dental work. Even after my C-section…”

This sounds like boasting — about how much pain and suffering you’re able to handle without any help.  (Well, except for Jesus, Tylenol, and sometimes iburprofen, Xanax, and Botox.)

You know, some women can deliver a baby without any anesthesia at all. Some women can give themselves an orgasm with just their thoughts.  Some people can be hypnotized to the point where they don’t feel pain.  It’s true, our brains our wondrous and mysterious.

Some historical religious figures were so infatuated with, and tortured by, their religion that they experienced stigmata.  And if that’s religion, I’m not for it.  I’ve always found that religion is more about sin, shame, and fear, than about acceptance, caring, and hope. Sad, but true.

As long as we’re boasting… I was given Demerol during my 36-hour labor, how about you? Do you know if you were given any pain medications right before or during your C-section?  Or did you forego anesthesia and stay awake the whole time?  That sounds like torture…

And if you were put under for the surgery, did you know that anesthesia is just another very strong pain medication? Research has shown that the best way to manage severe pain is to keep it from spiking out of control.  So surgeons have learned to give patients pain medication before they go under the knife; sometimes it’s given during surgery; and it’s almost always given after surgery.

So, did you suffer from hypomania after your C-section?  Did you have alcohol cravings?

Surgery is a fairly new development in our evolution as a species, and it’s very traumatic to the body — to the heart and other internal organs, and to the neurons that send pain signals to and from your brain.  It seems like surgery is just a part of normal healthcare these days, but it shouldn’t be.  And it probably won’t be for long.

ADDICTION

I was told early in my recovery that if I began to use tranquilizers and narcotics, I would likely become addicted to them, in the same way that I had been addicted to alcohol.

It’s very sad that those who suffer from addiction are fed half-truths and out-and-out lies like this during treatment. AA doesn’t need to put the fear of its god into members, they just make you fear yourself — your addiction.

But addiction is a medical condition, an illness, that can be managed just like diabetes or epilepsy — just like cancer.  All this fear and shame surrounding addiction is partly the fault of the religious community, using sin and the fear of what happens after we die to shame people into doing what they say.  To believe and do what they say so we can all end up in heaven (which must be really crowded by now). And while we’re all free to have our own beliefs, when religious beliefs infringe upon science and healthcare, we all suffer.  (Although it appears some of us actually want to suffer.)

Alcohol is a drug that belongs in a very special category. It is a poison, more like Botox than opioids or marijuana.  Since I have alcoholism in my family, I’ve always wondered why I never had that problem. Maybe it’s because I don’t need alcohol to make me feel better about myself, although I have used it as a social lubricant.  Or maybe it’s because alcohol doesn’t help with the kind of pain I suffer from.

My physical pain began when I was a teenager after a 5-year gymnastics career.  I didn’t suffer from depression or other mental conditions before the pain began, although anxiety was always a part of competition.  I’m learning about conditions like bipolar and schizophrenia, but my knowledge is limited without actual experience.

But I do know a thing or two about addiction…

If you suffer from addiction, you shouldn’t be afraid to treat acute and severe pain with adequate medication.  Refusing pain medication after dental work seems a little masochistic to me, but okay, that’s your choice.  If your fear of addiction is stronger than your dental pain, that should work for you. But refusing pain medication after major surgery?  Well, I just don’t know what to think about that.

THE ANSWER IS JESUS

What I personally took from kbailey’s post was that all of my “pain management struggles” would be over if I just found Jesus; and presumably, a church to spend a lot of time in. But it has to be the right church and the right god (for instance, it appears Catholicism has fallen out of favor for kbailey).  So, let’s talk about why that’s not true…

JESUS AND RELIGION

I don’t know if Jesus was a real person or not, but let’s look back at that time period and try to guess what men like him might have been thinking…

Men didn’t really think a lot about women back then — it was a man’s world, like it is now, just a whole lot worse.  Women were slaves — sold into marriage (or worse), raped, beaten, murdered, and stoned, with no one caring one way or the other.  Women had absolutely no value during that time period.  Heck, people back then didn’t even know how babies were made.

In fact, Rev. Lindsay Hardin Freeman counted the number of times women were allowed to speak in the bible:

http://www.huffingtonpost.com/2015/02/04/bible-women-words_n_6608282.html

There are 93 women who speak in the Bible, 49 of whom are named. These women speak a total of 14,056 words collectively — roughly 1.1 percent of the total words in the holy book…

When Jesus was alive, there was no medicine or science; no aspirin or antibiotics.  Infant mortality was very high, and those who survived didn’t live very long.  No one wondered if the Earth was flat, and no one worried about over-population. (It really was a small world.) Jesus didn’t live like a caveman, but if one of us was transported back to that time period, his life would look very similar.

All this to say that if we use words and ideas that were written back then to make decisions for our healthcare right now, well, that wouldn’t make much sense.

Worship:  1. the feeling or expression of reverence and adoration for a deity.

Worshiping Jesus is like worshiping slaveholder Abraham Lincoln (or maybe like Santa Claus, more of an idea than a person).  If Jesus existed, he was just a man — he wasn’t born from a virgin and he didn’t walk on water. People back then believed stories like that because they didn’t know any better.  Who knows, maybe all of Jesus’ followers were schizophrenics, unable to tell the truth from fiction.

In fact, the term “worship” could almost be defined as an addiction, as I’ve read plenty of stories where drug addicts worship their drug of choice.  Some people worship the almighty dollar and some the Constitution.  A lot of people in America worship their guns.  And some people worship religion and the mystical stories they’re based on.  But when you look at the sheer size and ornateness of a Catholic or Mormon church, you have to really wonder what they’re worshiping inside of it.

“Recovery from alcoholism was hard enough.”

I was raised in the Catholic religion, but I didn’t spend much time wondering if there was a god or not.  When I was old enough to wonder about a supreme being, I figured, who can really know? Especially since you have to die to find out. I think I went from agnostic to atheist when I stopped taking prescription drugs, during my forced, cold-turkey detox.  Yeah, I’ve been to hell — no one can scare me with that shit now, not that they ever could.

For kbailey, the tragedies in her life and her bout with alcoholism and recovery steered her toward religion (while mine pointed me in the other direction).  To the point where she attends church every day and even describes herself as addicted to Jesus.  And damn proud of it, too. Funny, I’m just as proud to be an atheist, but I don’t feel addicted to that lack of belief in any way.

As much as you love Jesus, kbailey, I don’t understand why you choose any medical treatments at all — why not rely on prayer and faith alone?  Jesus didn’t take Tylenol or Xanax.  He didn’t have dental work done either.  (And he was probably gay.)

I can’t believe you read this whole post… 🙂