Archive for the ‘Addiction’ Category

Suboxone FAQ / Subutex FAQ

Monday, December 21st, 2009
DISCLAIMER: The information detailed in this article is not medical advice, nor written by medical professionals. Before making any medical decisions, it is imperative to confer with a licensed medical professional. If you have comments, suggestions, or find an error, please feel free to leave feedback using the comments section at the bottom of this page.

TABLE OF CONTENTS

  1. What is Suboxone/Subutex?
  2. How long do I have to wait before taking Suboxone or Subutex?
  3. How is Suboxone taken?
  4. What are some possible side effects of Suboxone and Subutex?
  5. What is precipitated withdrawal?
  6. What are the different stages of Suboxone treatment?
  7. Which is a better treatment for opioid addiction, Suboxone or methadone?
  8. Can a patient on methadone safely switch to Suboxone?
  9. How do I find a doctor that can prescribe Suboxone?
  10. What is the maximum number of patients a doctor may have at any one time?
  11. Is Suboxone addictive?
  12. How long after stopping Suboxone does one have to wait before narcotic painkillers become effective?
  13. Sources
  14. Comments

Terms to Know

  • affinity — the strength with which a drug binds to its receptor
  • intrinsic activity — the degree to which a drug activates its receptors
  • rate of dissociation — measure of disengagement or uncoupling of the drug from the receptor

What is Suboxone/Subutex?

Suboxone®, manufactured by Reckitt Benckiser, is the first opioid substitution treatment available without the hassle involved with going to a methadone clinic everyday or even weekly. The two active ingredients in Suboxone® are buprenorphine hydrochloride, and naloxone hydrochloride dihydrate. Subutex® has only buprenorphine as an active ingredient. Suboxone® and Subutex® are available in the following formulations:

BUPRENORPHINE
NALOXONE
IMPRINT
COLOR / SHAPE
PICTURE
Suboxone®
2 mg
0.5 mg
N2
Orange / Hexagonal
8 mg
2 mg
N8
Orange / Hexagonal
Subutex®
2 mg
B2
White / Oval
8 mg
B8
White / Oval

In a study involving 220 patients, 16-32 mg of Suboxone proved to be just as effective as high-dose methadone, and more effective than low dose methadone as treatment for opioid dependency. Typical starting dosages range from 8 mg to 32 mg per day; however, some patients believe that it is better to start as low as 2 mg. Buprenorphine is only a partial agonist at the opioid receptors, thereby lowering abuse potential. While a small amount of euphoria may be experienced in some patients, buprenorphine will never provide the same degree of intensity as a full opioid agonist (e.g. heroin, oxycodone, morphine). Because buprenorphine possess the quality of being a partial agonist, it shows a ceiling effect. This means there is a point at which buprenorphine will not increase in effectiveness, despite taking more.

How long do I have to wait before taking Suboxone or Subutex?

If Suboxone is procured legally through a doctor, the prescribing physician will almost always ask that the patient be in mild-to-moderate withdrawal during induction. For short-acting opioids, like heroin and oxycodone, withdrawal takes anywhere from 24-36 hours to kick in. When switching from a longer-acting opioid like methadone, the situation becomes a bit more complicated. The typical scenario goes something like this: (1) taper down to 30 mg methadone per day, (2) wait three days before being inducted. Transferring from methadone to Suboxone is something that has to be discussed with a doctor because it is very easy to precipiate withdrawal if the transfer is not done correctly.

“Why does the patient have to be in withdrawal when he/she comes in?”

If there are high levels of another opioid in the body, Suboxone will, in a sense, compete with the other opioid molecules, and knock them off the receptors. This occurs because buprenorphine has an extremely high binding affinity for the opioid receptors. If this happens, the patient will be thrown into precipitated withdrawal, which is extremely unpleasant, and can last a significant period of time.

“Wait, the opioid molecules that are being replaced are being replaced with another opioid, buprenorphine, so shouldn’t that still quell withdrawal symptoms?”

Buprenorphine is only a partial opioid agonist, therefore, it has less opioid effects than those of a full agonist (e.g. morphine, heroin, oxycodone). If the patient is already in withdrawal when the first dose is taken, he/she will feel better not worse.

How is Suboxone taken?

Sublingual tablets are absorbed through veins under the tongue. Before taking Suboxone, it is a good idea to drink a little water to moisten the mouth, which helps the tablets dissolve easier, and faster. If the doctor prescribes two tablets, put one on the left side under the tongue, and put the other on the right side under the tongue. If more than two are prescribed, Reckitt Benckiser, the makers of Suboxone, recommends waiting until after the first two dissolve to take the rest. It generally takes about 10 minutes for a tablet to dissolve, though it can range anywhere from 5-20 minutes. Some patients have reported holding the “juices” in their mouth for as long as 45 minutes can increase effectiveness. Try not to talk while taking Suboxone, as this can interfere with how well it is absorbed. It is important that Suboxone be taken correctly for it to work, and if a patient does not follow directions he/she may end up feeling sick. The following is a list of ways NOT to take Suboxone:

  • Never swallow the tablet — the reason Suboxone is prescribed as a sublingual tablet is because barely any buprenorphine is absorbed orally. Swallowing the tablet will render Suboxone ineffective.
  • Never suck on the tablet — for the same reason a patient does not swallow the tablet, the patient does not suck on the tablet.
  • Never snort a tablet — although intranasal buprenorphine may work, this method does not work as well as taking the tablet sublingually. Snorting anything is counter-productive to recovery, and only reinforces bad habits. Also, snorting any pill can cause severe damage to the lungs, which most people forget about.
  • Never shoot a tablet — in opioid-dependent individuals, shooting a tablet can cause precipitated withdrawal. Most doctors do not like prescribing Subutex because of the fear that people will try to inject them. The naloxone is present in Suboxone as a deterrent. Shooting any pharmaceutical not specifically prepared for injection can cause serious complications, including death. Don’t do it.

What are some possible side effects of Suboxone and Subutex?

The most common reported side effects of Subutex and Suboxone are:[2]

  • cold or flu-like symptoms
  • headaches
  • sweating
  • sleeping difficulties
  • nausea
  • mood swings

Those side effects do not sound too inviting, do they? I think these are primarily experienced during the induction period, as the body becomes accustomed to buprenorphine, rather than a full agonist. From what I have seen, most people who have become stabilized on Suboxone report very little to no side effects, and those that do report adverse reactions usually only experience trouble sleeping, sweating, and headaches. Other side effects include respiratory depression (as with all opioids), constipation, anxiety, depression, pain, and dizziness. For a full list of side effects, please refer to the prescribing information [PDF] or package insert.

What is precipitated withdrawal?

Precipitated withdrawal can occur when a person who is physically dependent on opioids is administered an opioid antagonist or a partial agonist. In those not physically dependent on opioids, an antagonist typically produces no effects, while a partial agonist would. Depending on the half-life of the antagonist or partial agonist used, the qualitative effects of precipitated withdrawal, when compared with the experience of a typical withdrawal syndrome, are often shorter lived but with a faster onset. It is quite easy to imagine why an antagonist would cause precipitated withdrawal. The antagonist has a very high binding affinity for the opioid receptors, so it displaces any full agonist opioids already present and blocks any molecules from binding for a given period of time (depending on the half-life of the antagonist). Because antagonists block the effects of opioid receptors instead of activating them, there is a drastic reduction in the previous agonist effect, resulting in agonizing withdrawal.

Partial agonists can cause precipitated withdrawal, but the concept is a little more complicated than that of an antagonist causing precipitated withdrawal. If an individual who is physically dependent upon opioids receives a dose of a partial agonist too soon after his or her last dose of a full opioid agonist, precipiated withdrawal occurs. Buprenorphine has a high binding affinity for the mu-opioid receptor, but because of its partial agonist properties, it has low intrinsic activity at that receptor (less opioid-like effects and ceiling effect). If there are full opioid agonist molecules still attached to the opioid receptors at the time of administration, the buprenorphine will displace the full agonist. Though partial agonists do activate opioid receptors, the overall effect is much less than that of a full agonist. This decrease in agonist effect can cause precipitated withdrawal. For this reason, buprenorphine is typically only given when the person physically dependent on opioids is in full-fledged withdrawal.

What are the different stages of Suboxone treatment?

Suboxone treatment should never be used by itself. It is not a cure, but rather a treatment. When used concurrently with some sort of therapy, the success rate is much higher. Suboxone treatment really beings with a phone call called the pretreatment screening; this consists of a brief interview to qualify the person, and a date may be set for intake and induction. Intake is the gathering of medical records to measure suitability for office-based treatment. If the physician feels it is necessary, he or she may perform a physical exam. At this point, the advantages and disadvantages of treatment are discussed, and any questions the patient has are answered. The next step after intake is induction. The goal of induction is to find a dose of Suboxone at which the patient feels comfortable, and withdrawal is suppressed.[3]

Once the patient becomes accustomed to their daily dose of Suboxone, he/she enters the stage of stabilization. At this point, the patient is not feeling any withdrawal symptoms or side effects, has no uncontrollable cravings for opioids, and is not using any additional opioids. During the maintenance phase, which can last anywhere from a few weeks to a few years, the patient is monitored less often, withdrawal symptoms are prevented, cravings are still suppressed, and the need to self-administer opioids is lowered greatly. The next stage is a medically-supervised withdrawal where the patient is slowly tapered off of Suboxone. Only mild withdrawal is felt if the drug is tapered correctly. Either way, the patient should be prepared to have some symptoms of withdrawal, which may include fatigue, reduced appetite, insomnia, and irritability.[3]

Which is a better treatment for opioid addiction, Suboxone or methadone?

Each person differs in what he/she requires as far as treatment in concerned because varying factors such as body chemistry, size of habit, duration of addiction, finances, etc. To help addicts find the right treatment plan, TPC! has put together a side-by-side comparison of Suboxone and methadone. Remember, Suboxone or methadone by themselves should not be considered complete treatment plans, but instead part of a comprehensive plan which leaves no aspect of opioid addiction untended. A link is provided below:

Suboxone vs. Methadone

Can a patient on methadone safely switch to Suboxone?

It is possible for a patient on methadone to switch to Suboxone; however, the difference between the two drugs may cause the former methadone-treated patient to feel unsatisfied, though there have been many successful cases noted. Methadone, being a full-opioid agonist, is more similar to heroin and oxycodone than buprenorphine. Buprenorphine is a partial-opioid agonist, which means it does not provide the same intense release of painkilling chemicals that full agonists provide. As a full agonist, methadone is also more likely to give a patient euphoria.

Because of methadone’s long half-life, it is required that the patient being inducted into Suboxone treatment be at least 72 hours without methadone. If Suboxone is taken prematurely it could cause precipitated withdrawal, a very unpleasant experience. It is important that the patient also be down to 20-30 mg of methadone before making the switch to buprenorphine. A switch should not be attempted with anyone taking over 30 mg of methadone. It is probable that the patient will experience discomfort during the first 3-5 days while his or her body becomes accustomed to buprenorphine, though it is typically fairly mild.

How do I find a doctor that can prescribe Suboxone?

Not all doctors can prescribe Suboxone because it requires special certification. If a doctor wants to be able to prescribe Suboxone, he/she must (1) send a letter of intent to the Substance Abuse and Mental Health Administration, (2) be qualified, and (3) take a special course to learn about Suboxone. Many patients believe their doctors are largely uneducated on the subject. Although every doctor must meet certain criteria, many doctors do not seem to understand addiction or how Suboxone can be used effectively. The qualifications, as taken from SUBOXONE.COM, are listed below:

According to DATA 2000, licensed physicians (MDs or DOs) are considered qualified to prescribe SUBOXONE, if at least 1 of the following criteria has been met:

  • Holds an addiction psychiatry subspecialty board certification from the American Board of Medical Specialties
  • Holds an addiction medicine certification from the American Society of Addiction Medicine (ASAM)
  • Holds an addiction medicine subspecialty board certification from the American Osteopathic Association (AOA)
  • Completion of not less than 8 hours of authorized training on the treatment or management of opioid-dependent patients
  • Organizations currently authorized to provide training: American Academy of Addiction Psychiatry, American Medical Association, AOA (through the American Osteopathic Academy of Addiction Medicine), American Psychiatric Association, and ASAM
  • Participation as an investigator in 1 or more clinical trials leading to the approval of SUBOXONE
  • Training or other such experience as determined by the physician’s state medical licensing board
  • Training or other such experience as determined by the United States Secretary of Health and Human Services

In addition, physicians must satisfy BOTH of the following criteria:

  • Have the capacity to provide or to refer patients for necessary ancillary services, such as psychosocial therapy
  • Agree to treat no more than 30 patients at any one time in an individual or group practice

Finding the right doctor can be a bit hard sometimes. It is very important that the patient be comfortable, and compatible with the doctor. Some of the doctors listed at the site below will not prescribe Suboxone to anyone, or are part of pain management or a clinic, so it may take some looking before the right one is found. The Buprenorphine Physician and Treatment Program Locator is very easy to use, and has an interactive map of the United States to help anyone looking find a doctor. Also, anyone can put their name on a waiting list if a doctor is at full capacity, so that when a spot frees up, he/she gets an e-mail; however, this is largely unnecessary because the patient limit was recently increased from 30 to 100. It should be fairly easy to find a doctor. Below is a link:

The Buprenorphine Physician and Treatment Program Locator

What is the maximum number of patients a doctor may have at any one time?

In December 2006, DATA 2000 was amended, giving Suboxone-certified doctors the ability to treat up to 100 patients; however, for the first year a doctor can only treat 30 patients at any one time. One year after the original letter of intention to treat patients using buprenorphine was submitted, the physician may submit a second notification of the need and intent to treat up to 100 patients.[4]

Is Suboxone addictive?

Yes. The active ingredient in Suboxone that keeps withdrawal at bay is buprenorphine, a partial opioid agonist. Buprenorphine has an extremely high binding affinity to opioid receptors in the brain, but because it is only a partial agonist, full effects, as produced by full agonists (e.g. oxycodone, heroin), are not present. Many people are grossly misinformed about the addictive nature of buprenorphine, and claim that there is no withdrawal syndrome, which is incorrect; however, because of its long half-life and partial agonist properties, the withdrawal is longer, but milder than that of full agonists. Some people have horror stories of their attempts to get off of Suboxone, but most of them come from people who did not taper properly. The bottom line is Suboxone is addictive, and eventually some withdrawal has to be dealt with. Suboxone will soften the fall, and withdrawal from it is certainly not as bad as withdrawal from oxycodone or heroin.

How long after stopping Suboxone does one have to wait before narcotic painkillers become effective?

Suboxone can block opioids for three days, and for individuals on high doses (>16 mg) it may be longer. An individual taking 24 mg for a few days indicated it took 5-6 days before he felt the full effects of the full agonist, oxycodone. It takes 37 hours for half of the buprenorphine in the body to be eliminated. Because of the long half-life of buprenorphine, the drug builds up in the body each day, which is part of the reason it could take a bit more than a day or two for other opioid anagesics to be effective. In summary, the factors that determine the effectiveness of opioids are dosage, frequency of use, length of time using, and individual body chemistry and metabolism.

After doing a bit of research and talking to drug users who have been in this situation, 72 hours seems to be the general consensus. Some people indicated feeling the effects after just 24-36 hours, and others said they felt a fraction of the full effects. Please understand, after taking Suboxone for a given period of time, tolerance may be significantly lower, so do not overdo it. Also, it is important to remember that even though the effects not be felt after 24 hours, it is very possible to overdose. It is impossible to monitor how the body is handling the mixture of buprenorphine and another opioid when it can barely be felt. Always consult a doctor before switching medications.

Sources

[1] Johnson, R.E., et al. A comparison of levomethadyl acetate, buprenorphine, and methadone for opioid dependence. New England Journal of Medicine 343(18):1290-1297, 2000. [Abstract]

[2] Subutex and Suboxone: Questions and Answers. FDA/Center for Drug Evaluation and Research. October 8, 2002. [link]

[3] SUBOXONE Treatment Walk-through. Subxone.com. Reckitt Benckiser. 2007. Accessed: April 23, 2007 [link]

[4] Buprenorphine-Frequently Asked Questions. Substance Abuse & Mental Health Services Administration. US Dept. of Health and Human Services. 2007. Accessed: April 25, 2007 [link]

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Vitamin B6

Friday, December 18th, 2009

DISCLAIMER: I am not a doctor, and the following is NOT medical advice. It is merely a list of things that have helped others during opiate withdrawal. Before starting any regiment including any medicine, it is imperative that the patient discusses it with a licensed physician. Some of the medicine listed can react badly with certain foods and other medicines.

CAUTIONS: “Scientific studies have shown that B6 can be dangerous in very high doses. One study suggested that long term use of doses of 500 times the recommended daily level may cause damage to the nervous system. A second study found adverse effects in humans from ingesting a dose as low as 50mg a day, although there are question marks over the methods used in this investigation. The government plans to limit the sale of over-the-counter B6 to 10mg doses, with a doctor’s prescription needed for larger amounts.” -BBC NEWS[2]

USEFUL FOR: Depression, anxiety, insomnia, sex drive

DESCRIPTION: Vitamin B6 is a water-soluble vitamin. It is found in foods such as nuts, fish, chicken, bananas, and green beans. Deficiencies of vitamin B6 can cause depression, anxiety, lowered sex drive, insomnia, water retention, weight gain/loss, and inability to process glucose.[1] Vitamin B6 also increases the levels of serotonin, a neurotransmitter thought to be involved in mood regulation, and GABA (GABA receptors are thought to be responsible for the effects of benzodiazepines) in the blood.[3] During opiate withdrawal, it is important we treat our bodies with the utmost respect because a lot of people neglect their personal health during active addiction. Vitamin B6 can help with mood, and insomnia, while helping keep our bodies balanced healthily. It is available for purchase below from a variety of reputable sources.

WHERE CAN I BUY IT?

ADDITIONAL RESOURCES:

[1] Wikipedia – Vitamin B6
[2] BBC News | Health | Medical notes | Vitamin B6
[3] MayoClinic.com – Vitamin B6

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Melatonin

Friday, December 18th, 2009

DISCLAIMER: I am not a doctor, and the following is NOT medical advice. It is merely a list of things that have helped others during opiate withdrawal. Before starting any regiment including any medicine, it is imperative that the patient discusses it with a licensed physician. Some of the medicine listed can react badly with certain foods and other medicines.

CAUTIONS:

If taken for inducing sleep – Melatonin should not be taken if eyes are exposed to bright sunlight, and melatonin should be avoided if operating any vehicle. If attempting sleep shifts of more than 1 hour, light therapy should also be used. Do not use melatonin for more than two weeks at a time.[2]

Nighttime awakenings and early morning insomnia – If you need to get up in the morning within 2-3 hours, Take regular instead of time release melatonin. Time release melatonin may last into the waking hours, causing confusion and mood problems. Do not take melatonin if you awaken less than one hour before you need to get up.[2]

USEFUL FOR: Insomnia, jet-lag, mood

DESCRIPTION: Melatonin is a neurotransmitter released by the pineal gland, which is a small gland located in the brain. The structure of the neurotransmitter is very similar to serotonin. It acts as a sort of regulator for the human “biological clock.” During the daytime hours, melatonin is at its lowest, whereas at night it is higher, peaking around 2 A.M. for healthy people, and 3 A.M. for the elderly.[1] Information received via the eye (light/darkness) travels to the area of the brain that regulates circadian rhythm, and from there signals are sent to the pineal gland which subsequently releases melatonin into the bloodstream. Typically, darkness activates nerves in the brain that stimulate release of melatonin. Melatonin is thought to be involved in the regulation of sleep, eating, and reproduction.

When the flow of melatonin is disrupted, which can happen due to jet-lag, aging, or stress, the body is negatively affected on both a mental and physiological level. Studies of jet lag have shown that melatonin, when taken at the normal bedtime hour at the new destination, can relieve symptoms of jet lag, and create a normal sleep pattern. Melatonin will not help people sleep longer, or fall asleep faster when taken at bedtime; however, taking melatonin very late in the afternoon has helped people fall asleep faster. Melatonin will help people get to sleep though. During opiate withdrawal, hormones are sent into a frenzy, and are all out-of-whack. Melatonin, which can be found at the local GNC or below, can act as a sleep-aid, and help regulate sleep cycles. Toxicity tests have proven melatonin to be very safe, but there are no conclusive tests proving its long-term effectiveness as a sleep aid; however, it’ll help do the trick for the time being!

WHERE CAN I BUY IT?

ADDITIONAL RESOURCES:

[1] Erowid Melatonin Vault : Info. #1
[2] talk about sleep – How to Use Melatonin Correctly
[3] Melatonin.com

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L-Tyrosine

Friday, December 18th, 2009

DISCLAIMER: I am not a doctor, and the following is NOT medical advice. It is merely a list of things that have helped others during opiate withdrawal. Before starting any regiment including any medicine, it is imperative that the patient discusses it with a licensed physician. Some of the medicine listed can react badly with certain foods and other medicines.

CAUTIONS: L-tyrosine has not been reported to have any serious side effects; however, long-term use of high doses (1000 mg+) should be monitored by a physician, as there are no studies of long-term use of high doses of L-tyrosine.

USEFUL FOR: Energy, depression, alcohol withdrawal support, phenylketonuria deficiency, Parkinson’s Disease

DESCRIPTION: L-tyrosine is a nonessential amino acid that the body synthesizes from another amino acid, phenylalanine. It is the precursor of several neurotransmitters, including L-dopa, dopamine, norepinephrine, and epinephrine. Supply of norepinephrine and epinephrine, two of the bodies most important “stress” hormones, are often depleted as a result of stress. Because L-tyrosine acts as a precursor to norepinephrine and epinephrine, it may help reduce the adverse effects of stress (environmental, psychosocial, and physical).

When taking opiates, the body becomes accustomed to an obscene amount of dopamine, a chemical involved in the feeling of pleasure, and when opiate intake is stopped withdrawal is felt. Withdrawal often involves anhedonia, the loss of the ability to experience pleasure. L-tyrosine may help correct the imbalance caused by opiate addiction. Food that are rich in L-tyrosine include animal meat, wheat products, oatmeal and seafood. Overall, L-tyrosine can help increase feelings of well-being, heighten mental alterness, and offset stress-induced physical/mental fatigue.

WHERE CAN I BUY IT?

ADDITIONAL RESOURCES:

[1] PDRHealth – L-tyrosine
[2] Wikipedia – L-tyrosine
[3] Erowid Experience Vaults – Totally Underrated (L-tyrosine)

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Kava Kava

Friday, December 18th, 2009

DISCLAIMER: I am not a doctor, and the following is NOT medical advice. It is merely a list of things that have helped others during opiate withdrawal. Before starting any regiment including any medicine, it is imperative that the patient discusses it with a licensed physician. Some of the medicine listed can react badly with certain foods and other medicines.

CAUTION: Excessive use may cause liver damage. Milk thistle can help prevent liver damage. Kava kava must not be taken with any benzodiazepine (Xanax, Klonopin, Valium).

USEFUL FOR: Anxiety, pain, depression, insomnia, stress relief

DESCRIPTION: Kava kava, a member of the pepper family, is an herb that can ease anxiety without the cloudiness of the mind presented with traditional anxiety medications. Kava was the prime choice of drink for royalty in the South Pacific, and is believed to have originated in Melanesia. Studies prove kava is effective for relieving anxiety and panic.

Dosages for specific ailments as recommended by WholeHealthMD.com

  • Anxiety – 250 – 500 mg (2-3 times a day)
  • Insomnia – 250 – 500 mg (30 minutes to an hour before bedtime)
  • Pain – 250 – 350 mg (2-3 times a day)

WHERE CAN I BUY IT?

ADDITIONAL RESOURCES:

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Ibuprofen

Friday, December 18th, 2009

DISCLAIMER: I am not a doctor, and the following is NOT medical advice. It is merely a list of things that have helped others during opiate withdrawal. Before starting any regiment including any medicine, it is imperative that the patient discusses it with a licensed physician. Some of the medicine listed can react badly with certain foods and other medicines.

CAUTION: Prolonged use can cause stomach bleeding and ulceration, kidney dysfunction, and liver inflammation.

“Consult your doctor if you are taking antihypertensives, steroids, anticoagulants, antibiotics, itraconazole or ketoconazole, plicamycin, penicillamine, valproic acid, phenytoin, cyclosporine, digitalis drugs, lithium, methotrexate, probenecid, triamterene, or zidovudine.

Consult your doctor if you have any of the following: bleeding problems, inflammation or ulcers of the stomach and intestines, diabetes mellitus, systemic lupus erythematosus (SLE, lupus), anemia, asthma, epilepsy, Parkinson’s disease, kidney stones, or a history of heart disease or alcohol abuse. Use of ibuprofen may cause complications in patients with liver or kidney disease, since these organs work together to remove the medication from the body.”

-WholeHealthMD

USEFUL FOR: Muscle aches, pains, headache

DESCRIPTION: Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), can help relieve some of the aches and pains experienced during withdrawal. Prescription strength ibuprofen is 800 mg; it is not recommended anyone go over this dosage in one sitting. For some, as little as 400 mg, the recommended dose for adults, will be enough to ease some of the pain. A popular brand of ibuprofen is Advil, but generics work just as well and are cheaper.

WHERE CAN I BUY IT?

ADDITIONAL RESOURCES:

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DLPA

Friday, December 18th, 2009

DISCLAIMER: I am not a doctor, and the following is NOT medical advice. It is merely a list of things that have helped others during opiate withdrawal. Before starting any regiment including any medicine, it is imperative that the patient discusses it with a licensed physician. Some of the medicine listed can react badly with certain foods and other medicines.

CAUTION: Those with the genetic disorder, phenylketonuria (PKU), should not take this supplement. It can lead to brain damage, and progressive mental retardation if left untreated. The disorder is typically diagnosed shortly after birth. This is the same warning found on packs of gum which contain the artificial sweetener, aspartame. Aspartame is broken down into phenylalanine in the body.

If taking baclofen, levodopa, an anti-depressant, or an MAOI, consult a doctor before taking this supplement.

USEFUL FOR: Analgesic, anti-depressant, dopamine restoration

DESCRIPTION: L-phenylalanine can be converted into L-tyrosine, a protein forming amino acid. L-tyrosine is converted into L-DOPA, which is further converted into dopamine, norepinephrine, and epinephrine. D-phenylalanine prevents enkephalin degradation, which is thought to be the mechanism providing the analgesic effects. The antidepressant effects are thought to be a result of the elevated levels of norepinephrine and dopamine in the brain.

When quitting opiates, dopamine levels plummet causing dysphoria and loss of pleasure. DL-phenylalanine can help restore dopamine levels. Opiate cessation also causes a reduction in endorphins, which is part of the reason withdrawal occurs. D-phenylalanine helps prevent the breakdown of enkephalins, one of the endogenous opioids. As a result of the stated pharmacological actions, dl-phenylalanine may help ease some opiate withdrawal symptoms.

WHERE CAN I BUY IT?

ADDITIONAL RESOURCES:

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Diphenhydramine

Friday, December 18th, 2009

DISCLAIMER: I am not a doctor, and the following is NOT medical advice. It is merely a list of things that have helped others during opiate withdrawal. Before starting any regiment including any medicine, it is imperative that the patient discusses it with a licensed physician. Some of the medicine listed can react badly with certain foods and other medicines.

CAUTION: Consult a physician before taking diphenhydramine if taking any central nervous system depressant. CNS depressants include opiates/opioids, benzodiazepines (Valium, Klonopin, Xanax, etc.), barbituates, and alcohol.

USEFUL FOR: Insomnia

DESCRIPTION: Diphenhydramine has a variety of applications as an over-the-counter medicine. It is used to relieve allergies, motion sickness, and occasional insomnia. During withdrawal, it can help ease the insomnia that never seems to end. A common dose for the treatment of insomnia is 50 mg.

Finding the best price. Certain varieties of diphenhydramine can be very expensive, therefore, it is important to know how to identify products containing this as the active ingredient. Certain kinds of Benadryl and the sleep-aid Sominex may contain the exact same amount of the active ingredient, but differ in price. To be on the safe side, the only product which is applicable in this sort of situation is one which has ONE ACTIVE INGREDIENT, diphenhydramine. Brands which only contain diphenhydramine as the active ingredient include Sominex, Unisom, and Benadryl.

WHERE CAN I BUY IT?

ADDITIONAL RESOURCES:

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5-HTP

Friday, December 18th, 2009

DISCLAIMER: I am not a doctor, and the following is NOT medical advice. It is merely a list of things that have helped others during opiate withdrawal. Before starting any regiment including any medicine, it is imperative that the patient discusses it with a licensed physician. Some of the medicine listed can react badly with certain foods and other medicines.

CAUTION: 5-HTP must not be taken with any anti-depressant (Prozac, Zoloft, Paxil, etc.) due to an increased risk of a possibly fatal condition called serotonin syndrome. 5-HTP may exacerbate anxiety and depression in some individuals.

USEFUL FOR: Depression, anxiety, mood swings, insomnia

DESCRIPTION: 5-HTP works by naturally increasing serotonin levels. In the brain, 5-HTP is converted into serotonin, which is then converted into melatonin. Melatonin has proven to be an effective sleep-aid. Increasing serotonin levels may also create some relief from depression and anxiety. In some individuals, 5-HTP may be more effective than prescription anti-depressants.

WHERE CAN I BUY IT?

ADDITIONAL RESOURCES:

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Drug Rehabilitation

Friday, December 18th, 2009
  1. Introduction
  2. Ingredients of Effective Drug/Alcohol Treatment
  3. Overview of Different Types/Stages of Treatment
  4. Wikipedia: Drug Rehabilitation

I. Introduction

Detoxification and rehabilitation from drugs is considered by some people to be the single hardest thing one will ever encounter in life. Many people will try detoxifying from drugs at home, and equipped with a hefty stash of over-the-counter “comfort” medicine, as well as some benzodiazepines, a valid attempt is made. Some may last a day or two, others will succeed, but the majority will need some sort of outside help. Unfortunately, many people will say, “I can’t go into a drug rehab! I need to work!” Drug abuse negatively affects every aspect of the addicts life, as well as those around him or her. Pretty soon, that addict may find himself without a job. Thankfully, there are ways of getting help for drug addiction, even if completely broke.

“Ensuring Solutions to Alcohol Problems, a research-based project at George Washington University Medical Center, reviewed research literature and consulted with professionals in the treatment and rehabilitation industry to identify 13 active ingredients of effective alcohol treatment,” said About.com about the Ingredients of Effective Alcohol Treatment. The following, though it talks about alcohol treatment, applies to opioid depedency treatment as well, and is a good starting point in judging whether or not a facility is effective.

II. Ingredients of Effective Alcohol Treatment

  • Early detection, including screening and brief interventions (for non-dependent problem drinkers). The earlier the treatment for drinking problems begins, the better the chance for success.
  • Comprehensive assessment and individualized treatment plan. Treatment for alcoholism and drug abuse is not a one-size-fits-all proposition. Not all patients require the “acute care” approach.
  • Care management. Treatment programs need to be carefully managed every step of the way, sometimes involving family members and friends, from the initial assessment through continued follow-up after the intervention program ends.
  • Individually delivered, proven professional interventions. Several interventions, based on different treatment philosophies, can be effective in reducing alcohol consumption depending on the patient’s gender, severity of dependence and motivation to change. Effective treatment programs will offer more than one approach.
  • Contracting with patients. Also called contingency management or behavior contracting, contracting with patients to reward good behavior and to punish bad behavior can improve treatment outcomes.
  • Social skills training. The basis for cognitive behavioral therapy, people with alcohol problems can be taught to recognize stressful situations, in which their drinking has been a problem in the past, and skills to help them cope with those situations.
  • Medications. Medical treatments cannot “cure” drinking problems, but they can be combined with other interventions and therapies to produce treatment that is even more effective.
  • Specialized services for medical, psychiatric, employment or family problems. Treatment programs need to be targeted at the individual needs of the patient through “problem-to-service matching.”
  • Continuing care. Most who enter treatment have at least one relapse. Follow-up contact, as well as participation in support groups, have both been shown to improve long-term treatment outcomes.
  • Strong bond with therapist or counselor. Research shows that counselors and therapists who bond with patients through empathy, rather than confrontation, are powerful motivating influences in alcohol treatment.
  • Longer duration (for alcohol dependent drinkers). How long a patient stays in treatment matters more in most cases than if a patient is treated in an inpatient or outpatient setting. Studies indicate that outpatient treatment lasting less than 90 days results in poorer outcomes.
  • Participation in support groups. Project MATCH and other studies in the 1990s definitively proved that participation in support groups, such as Alcoholics Anonymous, can be an active ingredient of treatment– both during a professional intervention and after.
  • Strong patient motivation. All approaches to alcoholism recovery depend on the desire of the person to get and remain sober. Effective treatment programs enhance this motivation with intervention and therapy.

Source: Ensuring Solutions to Alcohol Problems, The George Washington University Medical Center. The Active Ingredients of Effective Alcohol Treatment (PDF). June 2003.

III. Overview of Different Types/Stages of Treatment

  • Detoxification (i.e. detox) – This is the first step toward a better life. At a detox, the patient will rid themselves of the drug in a safe, clean medical environment. Often comfort medications are provided to make the transition a little easier. Some places may use methadone or buprenorphine for a few days to help ease withdrawal symptoms. At the end of this phase, the patient may be on some sort of maintenance therapy, but will be clean of their drug of choice with, hopefully, few lingering physical symptoms.
  • Inpatient drug rehab – Treatment for the behavioral, social, and psychological problems associated with drug use will be taken care of at this stage. This is a very hard period, many times marked by intense, frequent cravings, lingering withdrawal symptoms, and a complete reprogramming. Drug addicts often lose all coping mechanisms, to the point where if a problem arises, he or she compulsively turns to drugs to fix the problem, which only worsens things. At this stage, the patient is learning how to live again, without drugs. Some places are very strict as far as male-female contact, what time to get up in the morning, keeping the room clean, making the bed, etc. The support groups at residential drug rehabs are very helpful, and it is important to attend all of them. Don’t worry! It’s not as bad as it sounds!
  • Extended care – Extended care includes any programs attended after leaving the inpatient (residential) facility. Most programs include attending a few support groups a week, seeing a therapist, and/or a psychiatrist. This usually continues anywhere from three months to a year depending on circumstances.
  • Faith-based groups – Alcoholics Anonymous (AA), and Narcotics Anonymous are included in this group. Many opioid addicts actually prefer AA over NA because it’s easier to find a meeting, and there are usually more people with more clean time. For some people, the idea of submitting to a “higher power” is not conceivable, so alternative groups are used. SMART Recovery is probably the best one out there. (http://www.smartrecovery.org)
  • Halfway houses / sober houses – Halfway houses are more restrictive than sober houses, but both promote a sober lifestyle. The good thing about something like this is that the recovering addict is surrounded by people in the same situation, so there is a degree of empathy, and understanding. The bad side is that there are rules, and they must be followed. TRUTH – this part of treatment has saved many lives!

IV. Wikipedia: Drug Rehabilitation (written by external sources)

Drug rehabilitation (often drug rehab or just rehab) is an umbrella term for the processes of medical and/or psychotherapeutic treatment, for dependency on psychoactive substances such as alcohol, prescription drugs, and so-called street drugs such as cocaine, heroin or amphetamines. The general intent is to enable the patient to cease substance abuse, in order to avoid the psychological, legal, financial, social, and physical consequences that can be caused, especially by extreme abuse.

Drug rehabilitation tends to address a stated two-fold nature of drug dependency: physical and psychological dependency. Physical dependency involves a detoxification process to cope with withdrawal symptoms from regular use of a drug. With regular use of many drugs, legal or otherwise, the brain gradually adapts to the presence of the drug so that normal functioning can occur. This is how physical tolerance develops to drugs such as heroin, amphetamines, cocaine, nicotine or alcohol. It also explains why more of the drug is needed to get the same effect with regular use. The abrupt cessation of taking a drug can lead to withdrawal symptoms where the body may take weeks or months (depending on the drug involved) to return to normal.

Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach the patient new methods of interacting in a drug-free environment. In particular, patients are generally encouraged or required not to associate with friends who still use the addictive substance. Twelve-step programs encourage addicts not only to stop using alcohol or other drugs, but to examine and change habits related to their addictions. Many programs emphasize that recovery is a permanent process without culmination. For legal drugs such as alcohol, complete abstention–rather than attempts at moderation, which may lead to relapse–is also emphasized (“One drink is too many; one hundred drinks is not enough.”) Whether moderation is achievable by those with a history of abuse remains a controversial point but is generally considered unsustainable.

Various types of programs offer help in drug rehabilitation, including: residential treatment (in-patient), out-patient, local support groups, extended care centres, and sober houses.

Pharmacotherapies to a greater or lesser extent have come to play a part in drug rehabilitation. Certain opioid medications such as methadone and more recently buprenorphine are widely used and show significant efficacy in the treatment of dependence on other opioids such as heroin, morphine or oxycodone. Methadone and buprenorphine are maintenance therapies used with an intent of stabilizing an abnormal opioid system and used for long durations of time though both may be used to withdraw patients from narcotics over short term periods as well. Ibogaine is an experimental medication proposed to interrupt both physical dependence and psychological craving to a broad range or drugs including narcotics, stimulants, alcohol and nicotine. Some antidepressants also show use in moderating drug use, particularly to nicotine, and it has become common for researchers to re-examine already approved drugs for new uses in drug rehabilitation.

Drug rehabilitation is sometimes part of the criminal justice system. People convicted of minor drug offences may be sentenced to rehabilitation instead of prison, and those convicted of driving while intoxicated are sometimes required to attend Alcoholics Anonymous meetings. There have been lawsuits filed, and won, regarding the requirement of attending Alcoholics Anonymous and other twelve-step meetings as being inconsistent with the United States’ Constitutional mandate of separation of church and state, although there is no such provision in the Constitution itself. Opponents cite a personal letter from President Thomas Jefferson, and attribute it to the First Amendment right. (source: http://www.usconstitution.net/jeffwall.html) (source: http://www.loc.gov/loc/lcib/9806/danpre.html)

Some psychotherapists question the validity of the “diseased person” model used within the drug rehabilitation environment. Instead, they state that the individual person is entirely capable of rejecting previous behaviours. Further, they contend that the use of the disease model of addiction simply perpetuates the addicts’ feelings of worthlessness, powerlessness, and inevitably causes inner conflicts that would be easily resolved if the addict were to approach addiction as simply behaviour that is no longer productive, the same as childhood tantrums. Drug rehabilitation does not utilize any of these ideas, inasmuch as they intrinsically contradict the assumption that the addict is a sick person in need of help.

Traditional addiction treatment is based primarily on counselling. However, recent discoveries have shown that those suffering from addiction often have chemical imbalances that make the recovery process more difficult. Often times, these imbalances may be corrected through improved diet, nutritional supplements and leading a healthy lifestyle. Some of the more innovative treatment centres are now offering a “Biochemical Restoration” process to supplement the counselling portion of treatment.

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