A
ac_claire
Guest
Yeah…I only feel “sick and tired” when I’m not taking methadone.
I just wish I could find my way out now.
- Status
I just wish I could find my way out now.
Z
zenith15
Guest
Dosing is a very individualized matter, and I really just hate to see people making judgments against others based on their doses when they are NOT physicians and do not have a full grasp of how tolerance works and how various other factors can change dosing needs–body weight; length of time addicted; heaviness of the addiction; different disease processes, particularly hepatitis C; menopause; other prescribed medications; type of work performed; metabolism; pregnancy, and many many other factors come together to determine dose need. The correct dose for the patient is whatever dose that controls their symptoms for a FULL 24 hours, without sedating them.
Or, for example, a patient may have their withdrawals controlled at a dose of, say, 60mgs, but they are continuing to use opiates. If their dose is increased to 80mgs, this will block the euphoric effects from other opiates without causing one itself, thereby making the use of opiates useless to that patient.
People are of the impression that clinics just push people to go up up up on their dose. This is actually untrue from several perspectives. Clinics have more patients than they are able to accept as it is and many places have long waiting lists, so there is no need to keep people there against their will. Also, studies show us that the longer patients remain in treatment, the better they do. For those leaving treatment however, the relapse rate is about 90% within a year.
Studies show unequivocally that higher dosed patients do better in treatment than lower dosed patients. Let’s take the UK as an example. The average dose in the UK is 30-40mgs, less than half of the low end of the average dose needed by most patients (80-120 mgs). As a result, a large number of their patients continue using opiates while in treatment and gain little benefit.
However, in the USA and in many other countries that practice adequate dosing, the results and outcomes are markedly different. It’s as if we gave a 300 lb man a dose of penicillin meant for a tiny infant, and then blamed the penicillin itself when he failed to get well, rather than the inappropriate dose.
I myself am on a dose of 240 mgs. You may read that and think “Surely no one needs a dose like that!” but how do you know this? Are you basing it just on how you, personally would feel on that dose? Because we know that the avg. dose of methadone for pain control is 5 to 10 mgs. If you gave an acute pain patient a dose of 10mgs of methadone, and then told them you take 50 mgs a day, they would be shocked and could not imagine how on earth you could be standing there before them looking normal. But, your tolerance is much greater then theirs, and in addition to other factors, you require a higher dose. I see this “dose prejudice” all the time in MMT circles–people looking down on others, or announcing that no one needs more than _______ mgs, or that, as I read in a recent book, “anyone who says they need more than 40 mgs is trying to get high”. Please, let’s not make judgments on people because their dose may seem higher than we personally need. If someone is nodding out, over sedated, etc, that is another matter.
Lastly, I did want to bring up that mention that was made of how MMT should be the last choice. This is a very common thought, even in some methadone clinic personnel, but it’s not really true.
We know for a FACT that methadone is far and away the most effective treatment available for opioid addiction–FACT. (NIDA, W.H.O., NIH, White House ONDCP).
We know that the relapse rates for those with SEVERE OPIOID ADDICTIONS going into abstinence based treatment centers is ABYSMAL–FACT.
We know that while there are a few who, as Gary mentioned I believe, after a year or two of abstinence may once again begin to “feel back to the way they did before”, there are many more who will NOT, no matter how long they wait. And there are also many who, having never had a normal production of natural endorphins to BEGIN with, would not welcome a return to feeling “normal” for them.
We know that only about 5 to 10% of severe opioid addicts (the type served by the clinics) succeed in abstinence based treatment, but about 65% succeed in methadone treatment.
And, we know that, for those who leave abstinence based treatment and relapse, the consequences are often very severe–loss of career, loss of relationships, child custody, loss of finances, loss of health, loss of freedom, loss of life. Not everyone will live–and remain free–long enough to keep plowing through treatment after treatment after treatment until someone FINALLY suggests MMT once they are judged “last resort” material.
I went through 13 different rehabs–both (name removed by moderator)atient and outpatient, short term and long term. I had every therapy you can imagine. I attended thousands of 12 step meetings, worked the steps, did all I was told. As the years went on and I began losing all the things dear to me–my career, my family, my finances, my freedom, my health, no one EVER suggested that I try something different this time–not ever, not once. If they had, I could have been spared so much agony and anguish, and so much loss. But–because they wanted to save MMT for the “worst of the worst”–I never even knew it existed. I had to be told by another addict.
Now, I am not saying that MMT should be the first thing offered to everyone with an opioid addiction. Federal Law requires that the patient be able to show they have been actively addicted for a minimum of one year. And we do have Suboxone now, which is appropriate for those with lighter habits such as someone with a 6 month Vicodin addiction. BUT, there is no reason to withhold the most effective treatment for such a deadly and severe illness until everything else has been tried and failed numerous times.
Just some thoughts to mull over.
Or, for example, a patient may have their withdrawals controlled at a dose of, say, 60mgs, but they are continuing to use opiates. If their dose is increased to 80mgs, this will block the euphoric effects from other opiates without causing one itself, thereby making the use of opiates useless to that patient.
People are of the impression that clinics just push people to go up up up on their dose. This is actually untrue from several perspectives. Clinics have more patients than they are able to accept as it is and many places have long waiting lists, so there is no need to keep people there against their will. Also, studies show us that the longer patients remain in treatment, the better they do. For those leaving treatment however, the relapse rate is about 90% within a year.
Studies show unequivocally that higher dosed patients do better in treatment than lower dosed patients. Let’s take the UK as an example. The average dose in the UK is 30-40mgs, less than half of the low end of the average dose needed by most patients (80-120 mgs). As a result, a large number of their patients continue using opiates while in treatment and gain little benefit.
However, in the USA and in many other countries that practice adequate dosing, the results and outcomes are markedly different. It’s as if we gave a 300 lb man a dose of penicillin meant for a tiny infant, and then blamed the penicillin itself when he failed to get well, rather than the inappropriate dose.
I myself am on a dose of 240 mgs. You may read that and think “Surely no one needs a dose like that!” but how do you know this? Are you basing it just on how you, personally would feel on that dose? Because we know that the avg. dose of methadone for pain control is 5 to 10 mgs. If you gave an acute pain patient a dose of 10mgs of methadone, and then told them you take 50 mgs a day, they would be shocked and could not imagine how on earth you could be standing there before them looking normal. But, your tolerance is much greater then theirs, and in addition to other factors, you require a higher dose. I see this “dose prejudice” all the time in MMT circles–people looking down on others, or announcing that no one needs more than _______ mgs, or that, as I read in a recent book, “anyone who says they need more than 40 mgs is trying to get high”. Please, let’s not make judgments on people because their dose may seem higher than we personally need. If someone is nodding out, over sedated, etc, that is another matter.
Lastly, I did want to bring up that mention that was made of how MMT should be the last choice. This is a very common thought, even in some methadone clinic personnel, but it’s not really true.
We know for a FACT that methadone is far and away the most effective treatment available for opioid addiction–FACT. (NIDA, W.H.O., NIH, White House ONDCP).
We know that the relapse rates for those with SEVERE OPIOID ADDICTIONS going into abstinence based treatment centers is ABYSMAL–FACT.
We know that while there are a few who, as Gary mentioned I believe, after a year or two of abstinence may once again begin to “feel back to the way they did before”, there are many more who will NOT, no matter how long they wait. And there are also many who, having never had a normal production of natural endorphins to BEGIN with, would not welcome a return to feeling “normal” for them.
We know that only about 5 to 10% of severe opioid addicts (the type served by the clinics) succeed in abstinence based treatment, but about 65% succeed in methadone treatment.
And, we know that, for those who leave abstinence based treatment and relapse, the consequences are often very severe–loss of career, loss of relationships, child custody, loss of finances, loss of health, loss of freedom, loss of life. Not everyone will live–and remain free–long enough to keep plowing through treatment after treatment after treatment until someone FINALLY suggests MMT once they are judged “last resort” material.
I went through 13 different rehabs–both (name removed by moderator)atient and outpatient, short term and long term. I had every therapy you can imagine. I attended thousands of 12 step meetings, worked the steps, did all I was told. As the years went on and I began losing all the things dear to me–my career, my family, my finances, my freedom, my health, no one EVER suggested that I try something different this time–not ever, not once. If they had, I could have been spared so much agony and anguish, and so much loss. But–because they wanted to save MMT for the “worst of the worst”–I never even knew it existed. I had to be told by another addict.
Now, I am not saying that MMT should be the first thing offered to everyone with an opioid addiction. Federal Law requires that the patient be able to show they have been actively addicted for a minimum of one year. And we do have Suboxone now, which is appropriate for those with lighter habits such as someone with a 6 month Vicodin addiction. BUT, there is no reason to withhold the most effective treatment for such a deadly and severe illness until everything else has been tried and failed numerous times.
Just some thoughts to mull over.
A
ac_claire
Guest
I know for a fact, from my own pretty extensive experience (and also secondhand from my dad’s experiences) that MANY clinics do push clients to go up on their doses. I’ve been to 6 clinics over the years and 3 of them did not encourage me to raise my dose. Of the ones that did, one of them was pretty hardcore and blatent about pushing the “higher is better” philosophy. I’d go in to talk with my counselor and he’d ask how I was sleeping. “well, not very well…” (I’ve been an insomniac my entire life). Every single time he encouraged a visit with the nurse and a med increase. The nurse always agreed about the increase. This was at the clinic I attended for almost 3 years (it was in Seattle) and got to my all-time high of 150 mgs, at which point I was nodding out every afternoon. To be honest, at the time I enjoyed the nodding and it DID help me sleep better so I was like…“ok, sure!” These were the “professionals” after all…surely they knew best.
And zenith, I’m sorry about the comments I made about high doses…those were not meant to be blanket statements and I should have qualified them. I didn’t know that you are at 240 mgs. and I can’t/won’t judge you for that. Only you know if it works for you. In my own experience, anything over 100 made me nod like crazy. Depending on my tolerance, even much lower doses made me nod and over-sedated me. I didn’t necessarily always notice it but my friends, family and co-workers sure did.
But this all depends on what your definition of “doing better” is. If that means not using illicit drugs, then I can see how that’s a valid point.
Welll…again, depends on your perspective. Methadone Maintenance is, in itself, an opioid addiction. So if your goal is to not be addicted to opiates, being on methadone forever isn’t really gonna be the goal you’re shooting for.
If your goal is to get off heroin (for instance) and onto a legal drug and treatment plan that will allow you to work and-- if you work the program right-- have a normal life, then methadone might be for you. Should you be on it indefnitely? I don’t know. Depends on the person and what they want and whether they’re willing to deal with the consequences of being addicted to methadone and chained to a clinic indefinitely. And again, depends on whether or not the endorphin deficiency theory is actually good science or not. I don’t know either way.
Yes, those are facts. Substance asbuse-- especially of opiates-- is a beast and most people don’t kick it all the way in the long run. Sad but true.
For me, after I got past my first couple years on methadone-- in which I dropped into the “using” mindset and didn’t really care about having a normal, clean life-- methadone did and does allow me to have a normal life. But only as long as I take the methadone and accept the consequences that go along with it. The price is progressively getting higher and higher for me (literally and figuratively speaking). But after all this time I’m just not sure if I’ll be able to function without it.
I really should never have gotten started on it in the first place…I was not an ideal candidate at all, and I didn’t even fit the requirements of the federal law you mention below. But dwelling on all that now isn’t gonna fix anything.
I didn’t know that this was a federal law. I’ve seen this law broken dozens-- maybe even hundreds-- of times durimg my years in MMT. In fact I have never heard of ANY patient seeking methadone being turned away as long as they had the money and showed up at the clinic with withdrawal symptoms.
Z
zenith15
Guest
Federal law REQUIRES the patient to show either by both current and old injection scars or by pharmaceutical/medical records, or by testimonial letters from physicians, clergy, etc that the person has been actively addicted to opiates for a minimum of one year. Clinics must make every effort to determine this to the best of their ability.
Also, I wanted to replay to your remarks here:
"*Welll…again, depends on your perspective. Methadone Maintenance is, in itself, an opioid addiction. So if your goal is to not be addicted to opiates, being on methadone forever isn’t really gonna be the goal you’re shooting for.
If your goal is to get off heroin (for instance) and onto a legal drug and treatment plan that will allow you to work and-- if you work the program right-- have a normal life, then methadone might be for you. Should you be on it indefnitely? I don’t know. Depends on the person and what they want and whether they’re willing to deal with the consequences of being addicted to methadone and chained to a clinic indefinitely. And again, depends on whether or not the endorphin deficiency theory is actually good science or not. I don’t know either way*. "
Firstly, endorphin deficiency is not a theory–it is science FACT. The only thing that remains a theory is whether or not some addicts may have been deficient in endorphins prior to becoming addicted, possibly predisposing them to an opioid addiction by causing them to have a very different reaction to opioids than most people would. This has not been proven but is a solid theory.
However, endorphin deficiency caused by opioid use is NOT a theory at all, but is factual, provable science. We know for a FACT that everyone who uses opioids for long periods of time WILL cause their brain to cease producing endorphins–that is a FACT. We know that, when opioid ingestion ceases, whether slowly or abruptly, there is a time period during which the person will still not produce endorphins and that the symptoms, while they vary from person to person in intensity, often include severe depression, anhedonia, annxiety, extreme irritability, and physical exhaustion–this is also a FACT. We know that in some people, this will reverse itself with time, while in others, it may never reverse itself–and we know that this is more likely to be permanent depending on the length of time they were addicted and other factors, though there are exceptions on both ends. A very well done German study showed that on average about 4 years was long enough to cause permanent suppression of endorphins in many addicts.
Lastly, I want to clarify one thing. I thought I had already stated this but maybe not. Methadone maintenance is NOT “in itself an opioid addiction”. This is possibly the most harmful, damaging and untrue myth associated with MMT, and the main reason people look down upon it and patients themselves often feel wracked with guilt and shame no matter how well they may be doing on treatment.
There is a large difference, scientifically and medically, between addiction and physical dependence. Addiction involves not JUST physical dependence, but also a set of behaviors, such as continued use despite harm, lying and manipulating to get more, taking more than prescribed, taking it by a route not prescribed, obsessing over the drug, etc etc.
MMT patients who are taking their medication as prescribed and who are not abusing other drugs do not meet the scientific or medical guidelines for being “addicted” to methadone, though they may be physically dependent on it.
When a person is "addicted’ to a drug, the addiction causes problems in their life–chaos, health problems, legal problems, financial problems, inability to work or care for family, a lack of interest in former hobbies or pursuits, etc. Their life is only about the drug and getting more.
However, when a person takes a medication as prescribed, for the treatment of a legitimate medical condition (in this case, endorphin deficiency), the quality of their life IMPROVES. They are once again able to be responsible, reliable, productive. They can once more take part in life and turn their attention to normal, everyday pursuits and concerns.
Are they dependent on medication for this change? Yes. But, so are millions of people the world over who take daily medications to control chronic medical or psychiatric conditions, and who would become quite ill right away if that medication were removed. DO they view themselves as “slaves to a drug”? No–in fact, they usually view the drug as having liberated them from the prison of their disease and enabled them to live their life again.
My personal feeling on this is that recovery is not about whether or not we need to take a medication to rebalance our brain chemistry. Recovery is about the fruits of our life. Are we productive, reliable, employed if able, taking care of our duties and obligations? DO we have hopes and dreams we are working towards? Do we have the respect and trust of our family and friends, our co-workers? Those are the things that constitute genuine recovery, in my book.
My life on MMT is every bit as full as I could want it to be.I visit my clinic once a month. I am able to work in a professional capacity, travel, write, volunteer my time to help others, sit on Boards, etc. It took me awhile to get past all the prejudices I had picked up in my many years in abstinence based rehabs and to begin learning things for myself and seeing things differently, and I understand it may be difficult for others to accept some of these things as well, and that’s ok. I just do what I can to share what I have learned, with the hope that I may be able to help someone else who is struggling–and often that’s not even the person I am addressing, but ends up being someone else entirely.
Gotta run, thanks for your reply–all the best to you and your family.
Also, I wanted to replay to your remarks here:
"*Welll…again, depends on your perspective. Methadone Maintenance is, in itself, an opioid addiction. So if your goal is to not be addicted to opiates, being on methadone forever isn’t really gonna be the goal you’re shooting for.
If your goal is to get off heroin (for instance) and onto a legal drug and treatment plan that will allow you to work and-- if you work the program right-- have a normal life, then methadone might be for you. Should you be on it indefnitely? I don’t know. Depends on the person and what they want and whether they’re willing to deal with the consequences of being addicted to methadone and chained to a clinic indefinitely. And again, depends on whether or not the endorphin deficiency theory is actually good science or not. I don’t know either way*. "
Firstly, endorphin deficiency is not a theory–it is science FACT. The only thing that remains a theory is whether or not some addicts may have been deficient in endorphins prior to becoming addicted, possibly predisposing them to an opioid addiction by causing them to have a very different reaction to opioids than most people would. This has not been proven but is a solid theory.
However, endorphin deficiency caused by opioid use is NOT a theory at all, but is factual, provable science. We know for a FACT that everyone who uses opioids for long periods of time WILL cause their brain to cease producing endorphins–that is a FACT. We know that, when opioid ingestion ceases, whether slowly or abruptly, there is a time period during which the person will still not produce endorphins and that the symptoms, while they vary from person to person in intensity, often include severe depression, anhedonia, annxiety, extreme irritability, and physical exhaustion–this is also a FACT. We know that in some people, this will reverse itself with time, while in others, it may never reverse itself–and we know that this is more likely to be permanent depending on the length of time they were addicted and other factors, though there are exceptions on both ends. A very well done German study showed that on average about 4 years was long enough to cause permanent suppression of endorphins in many addicts.
Lastly, I want to clarify one thing. I thought I had already stated this but maybe not. Methadone maintenance is NOT “in itself an opioid addiction”. This is possibly the most harmful, damaging and untrue myth associated with MMT, and the main reason people look down upon it and patients themselves often feel wracked with guilt and shame no matter how well they may be doing on treatment.
There is a large difference, scientifically and medically, between addiction and physical dependence. Addiction involves not JUST physical dependence, but also a set of behaviors, such as continued use despite harm, lying and manipulating to get more, taking more than prescribed, taking it by a route not prescribed, obsessing over the drug, etc etc.
MMT patients who are taking their medication as prescribed and who are not abusing other drugs do not meet the scientific or medical guidelines for being “addicted” to methadone, though they may be physically dependent on it.
When a person is "addicted’ to a drug, the addiction causes problems in their life–chaos, health problems, legal problems, financial problems, inability to work or care for family, a lack of interest in former hobbies or pursuits, etc. Their life is only about the drug and getting more.
However, when a person takes a medication as prescribed, for the treatment of a legitimate medical condition (in this case, endorphin deficiency), the quality of their life IMPROVES. They are once again able to be responsible, reliable, productive. They can once more take part in life and turn their attention to normal, everyday pursuits and concerns.
Are they dependent on medication for this change? Yes. But, so are millions of people the world over who take daily medications to control chronic medical or psychiatric conditions, and who would become quite ill right away if that medication were removed. DO they view themselves as “slaves to a drug”? No–in fact, they usually view the drug as having liberated them from the prison of their disease and enabled them to live their life again.
My personal feeling on this is that recovery is not about whether or not we need to take a medication to rebalance our brain chemistry. Recovery is about the fruits of our life. Are we productive, reliable, employed if able, taking care of our duties and obligations? DO we have hopes and dreams we are working towards? Do we have the respect and trust of our family and friends, our co-workers? Those are the things that constitute genuine recovery, in my book.
My life on MMT is every bit as full as I could want it to be.I visit my clinic once a month. I am able to work in a professional capacity, travel, write, volunteer my time to help others, sit on Boards, etc. It took me awhile to get past all the prejudices I had picked up in my many years in abstinence based rehabs and to begin learning things for myself and seeing things differently, and I understand it may be difficult for others to accept some of these things as well, and that’s ok. I just do what I can to share what I have learned, with the hope that I may be able to help someone else who is struggling–and often that’s not even the person I am addressing, but ends up being someone else entirely.
Gotta run, thanks for your reply–all the best to you and your family.
Z
zenith15
Guest
Also, ac claire, wanted to apologize to you for the choppy response–I had to edit the TAR out of it to get it to fit–seems there is a character limit per post, and I do tend to “run on”.
A
ac_claire
Guest
zenith-- I agree with your differentation between “addiction” and “dependency”…even if, personally, I link them together *in my own mind *and don’t see a conflict or have a problem saying I’m addicted to methadone, I can definitely see how the semantics there can contribute to descrimination against MMT patients. Yes, we’re physically dependent on a drug, but we have normal lives, we have jobs, we aren’t involved in addictive behaviors, etc. You laid it out very eloquently. In my experience people like you and like me seem to be in the minority…I mean, look at how many people attend any given clinic and how many of them, even after being there for years, haven’t acheived a level where they only have to come in once or twice a month. The people who get monthly carries are a definite minority. And those who don’t get the carries (that is, who aren’t entrusted with take-home doses for any length of time and have to come into the clinic daily or bi-weekly, etc. to dose) don’t get them usually because they’re still abusing other drugs and are unable to give a clean UA test or unable to keep their appointments or show proof of employment, etc. All that is only pointed out to say that in my opinion, based on my experiences, most of the people on MMT are *addicted *to methadone (using your clinical defnition of addiction) and not just “physically dependent”.
All the great things you’re saying about MMT may be true (I believe they are true, for some), but they aren’t true across the board. Many, many more people use methadone as just another drug of abuse. Even if their intentions are good, even if an addiction to methadone is better than an addiction to heroin…that’s still the reality of their situation and their relationship to methadone.
That’s one thing that bugs me so much about some of the required counselling that I get. There are repeated references to how I might “get the urge to use again” if I continue my taper, etc. and it’s just like…“ugh, you don’t understand-- that’s not even me, that’s not my life!!”
I have been taught and have always held to the fact that the deficiency will right itself in time.
All the great things you’re saying about MMT may be true (I believe they are true, for some), but they aren’t true across the board. Many, many more people use methadone as just another drug of abuse. Even if their intentions are good, even if an addiction to methadone is better than an addiction to heroin…that’s still the reality of their situation and their relationship to methadone.
That’s one thing that bugs me so much about some of the required counselling that I get. There are repeated references to how I might “get the urge to use again” if I continue my taper, etc. and it’s just like…“ugh, you don’t understand-- that’s not even me, that’s not my life!!”
Shocked to hear this. I don’t doubt it’s true, but I have NEVER seen any of the five clinics I’ve been a part of stick to this. That’s four clinics spanning 3 different states across the country-- Texas, Washington, Kansas-- plus one clinic I attended for 2 months in northeastern England. All you have to do, at all of them, is show up with the clinic fees (some of them do walk-ins, others you have to make an appointment) and you have to be visably sick from withdrawl when you come in, unless you’re transferring from another clinic. At two of the clinics I was asked to show them my “track marks” and when I couldn’t, I just explained to them my history and the nature of my dependency on pain medication and that was that. No doctor’s records were EVER asked for.
I know that endorphin deficiency happens with opiate addicts…especially long-term addicts…but the part about it being irreversable in some cases is my sticking point. I’m not trying to be argumentative, but I really would love to see where this has been proven.
I have been taught and have always held to the fact that the deficiency will right itself in time.
Z
zenith15
Guest
archives.drugabuse.gov/PDF/Perspectives/vol1no1/03Perspectives-Neurobio.pdf
books.google.com/books?id=FwneDofoyq0C&pg=PA94&lpg=PA94&dq=endorphin+deficiency+permanent&source=bl&ots=Xo5AoK9JDE&sig=akVHvU5WxLWbcFTWWNlbUYPj-p0&hl=en&ei=W5pxTYmoMcfZgAex0IE_&sa=X&oi=book_result&ct=result&resnum=3&ved=0CCcQ6AEwAg#v=onepage&q=endorphin%20deficiency%20permanent&f=false
healthyminds.org/Main-Topic/Addiction.aspx
I actually have quite a few scholarly articles that discuss the often permanent nature of the endorphin damage but they are on my laptop which is with my husband at the moment so these are just quick examples from the internet. I will send the others in a bit.
I always find it interesting that people believe that for some reason, endorphin deficiency is the ONLY chemical imbalance in the brain that CANNOT be permanent and that will ALWAYS revert to normal with abstinence. We know that many other brain disorders caused by chemical imbalances are permanent–schizophrenia, bipolar disorder, often major clinical depression, etc–and no one questions the veracity of long term, continuous treatment for these chemical imbalances. Additionally, if I person is naturally deficient in endorphins before they begin using drugs, a return to “normal” for them would still just be a return to misery.
I don’t know if I mentioned this earlier but I once saw a show about the baseball player Jose Canseco called “Last Shot”. It talked about his long term steroid abuse, and how, as a result, he had symptoms of testosterone deficiency. He went to the doctor who diagnosed him and prescribed testosterone supplements. Jose asked if he would need this for life? The doctor told him there was a good chance he would, because oftentimes steroid abuse can cause permanent testosterone impairment. No one questioned the veracity of this, either.
There’s no reason to believe that endorphins are the only chemical that can NEVER be affected permanently by brain chemistry imbalances. I think the belief, in most cases, is tied to the strong 12 step belief that anyone, if they try hard enough to “work a good program”, can recover without medication, and/or that opiates are evil substances, instead of something our brains make naturally and that are crucial to normal function.
A
ac_claire
Guest
Thank you for the links, I’m going to read through them later today.
Look, believe me…I don’t have any deep set prejudice against the idea of a permanent endorphin deficiency syndrome. I would have no problem believing it if it’s real and could be proven to be real. The doctors at my clinics have (the two who’ve spoken about it) have discounted it. A LOT of things I’ve read online have discounted it. Only a small handful of things have supported it, and most of them weren’t written by seasoned clinicians or doctors. I will read the links you sent though. FWIW, I would absolutely LOVE for (permanent) endorphin deficiency syndrome to be fact because maybe then I could stay on methadone longer, instead of getting so much pressure form my fmaily to get the heck off of it already. It’s been a LOT of years so far and I deep down don’t believe that I can get by without methadone. It was started for one reason, but at this point…after trying to detox twice and succeeding once, only to get back on it…I really do think it serves as a sort of anti-depressant for me.
I’ve never heard of this case, but it sounds like this was his regular doctor though. If this same thing happened to a LOT of people and they couldn’t get their testosterone from private doctors, but HAD to go through special for-profit clinics who accept cash only and no insurance, than maybe people would look at it the same way as they do methadone?
Do you believe in or like the 12 steps? Just curious. Sounds like you don’t. I’m a big believer in the 12 steps. Anyhow, again, I truly don’t think it comes from any deep-seated prejudice. Seratonin deficiency (for example) has been well-documented-- that’s why we accept it without question. But some people just being born with not enough endorphins? I don’t know.
I do know, on a (maybe) interesting note, that my mother and farther were (and both still are, in their own separate ways) opiate addicts. They did heroin when I was a baby and took me with them to the methadone clinic. At every clinic there’s always the couple with a baby, you know? lol. That was me in the late 70s and early 80s. Anyhow…because of my parents addictions I was always told that I needed to be very, very careful around opiates (and alcohol, and any drug, etc.). And the truth is the first time I was ever prescribed an opiate painkiller I took to it like a fish takes to water. I did feel “normal” and I felt BETTER than normal, and at higher doses I got plain-out high and the truth was I loved it and couldn’t imagine ever being without it from that time forward. I learned later that that’s not really a “normal” reaction to painkillers lol.
Z
zenith15
Guest
I don’t think continuing this discussion would further anything. If you have doctors who have “discounted” this, it’s likely because they, like most of the rest of the addiction treatment world, are steeped in 12 step ideology, which gives lip service to addiction being a disease while contradicting it by saying that the treatment for this disease–and ONLY this disease–should be prayer and meditation, confession, looking at the “character defects” that apparently led you to have this disease (again, the only disease on earth caused by character defects, apparently), and leading others to do the same, and which holds that anyone who does NOT recover using this method simply did not “surrender” properly, do a thorough enough 4th step, etc–NEVER because they might have a chemical imbalance in the brain.
Despite common belief, studies show that abstinence based treatment–97% of which in the USA are 12 step based–has an absolutely ABYSMAL success rate, particularly with opioid addiction. Go into your average NA group and see how many people there who came in with long term, heavy/severe opioid abuse now have long term clean time. You will find a few, yes, but it won’t be the majority. In fact, the sheer volume of keytags/aa coins manufactured and sold for beginners and short lengths of clean time is overwhelming when compared to the tiny numbers made/sold for those with multiple years–and again, especially for those with opioid addiction.
As I said earlier, there is absolutely no reason on earth to believe that endorphins have special superpowers that they and they alone among all the chemicals in the brain can NEVER EVER be permanently impaired, nor can they ever be impaired NATURALLY (i.e., prior to drug use). However, if we SAY that this cannot ever happen–that they will ALWAYS return to normal if we just wait–it helps to support the 12 step party line that the program works for anyone who “works it” and that all this balderdash about needing medication long term is just nonsense, or “addictive thinking”, etc.
I spent almost twenty years attending 12 step groups, both AA and NA. I did every last thing they told me to do, and then some. I read every bit of their literature, including every last edition and back issue of their magazines, as well as a great many books ABOUT AA and it’s founders, and would dare to say I know more about the development of the 12 step groups than most people in the groups today do. I had several well intentioned sponsors, worked all the steps, prayed, led meetings, did 12 step work, etc etc. AT one point, I was clean for four years. And they were the most MISERABLE four years of my adult life.
I didn’t feel “happy, joyous and free”, I didn’t experience the “promises” or the “miracles”. Rather, I was deeply depressed–a depression unrelated to anything going on around me. I was extremely irritable, unable to concentrate on anything, unable to enjoy anything or take pleasure in my family and friends. Everyone kept telling me to “keep coming back–it WORKS!”–but it didn’t “work” for me. I was not beginning to feel better in any way or form at the end of that 4 years when I used again. And as I may have said earlier, even had I gone back to what was my “normal” state pre-drug abuse, that would not have been much of an improvement. I began using in the first place because I was miserably depressed, and nothing the doctors tried was working. I had been depressed all through my childhood. So, I could scarcely expect to begin feeling like normal people.
But let’s say for the sake of argument that endorphins, and endorphins alone, among all brain chemicals, never become permanently impaired, are never naturally deficient, and always spring back to perfect working order with adequate abstinent time. Even if that were so, surely you won’t argue that it can take a very long time in many people–weeks, months, years–to begin feeling normal again. During that time period, the vast, vast majority of patients WILL relapse. Studies show us that 90% relapse within one year of leaving MMT. Most people simply cannot tolerate feeling that bad for that long, never knowing when–or if–they will feel better. It would seem to make sense, then, that encouraging these patients to get off a medication that has stabilized them and enabled them to live a normal life, and is not harming them in any major way, when the most likely scenario if they DO is relapse, and the consequences of relapse are severe and serious, may not be the best course of action.
Here are a few more references:
"Mechanism of long-term potential for relapse
One of the most insidious features of opioid addiction is the tendency to relapse on the drug even weeks, months, or years after addicts stop using and withdrawal symptoms disappear. The mechanism for this type of relapse is being studied intensely. Animal studies suggest 3 distinct conditions that reliably induce relapse:
Stress
Exposure to conditioned cues related to past drug use
A dose of the previously administered drug or a drug with similar properties
There is evidence that long-term administration of opioids can permanently alter the density of dendritic spines in certain neurons, and these permanent changes may contribute to long-lasting vulnerability to relapse."
emedicine.medscape.com/article/287790-overview
Here is a link to a page in a textbook regarding pre existing endorphin deficiency:
books.google.com/books?id=FwneDofoyq0C&pg=PA94&lpg=PA94&dq=opioid+abuse+endorphin+impairment&source=bl&ots=Xo5ApJcKJC&sig=pcVle7emhFk9DljH_Qbu-oTygPk&hl=en&ei=QQZzTefPEIGdlgfc9fQk&sa=X&oi=book_result&ct=result&resnum=6&sqi=2&ved=0CEcQ6AEwBQ#v=onepage&q&f=false
Here is a link to an essay by an English physician with a good bit of experience in this area as well–I will close with it as I have to get to bed:
forum.opiophile.org/showthread.php?31753-PWS-PAWS-An-Analysis.
Despite common belief, studies show that abstinence based treatment–97% of which in the USA are 12 step based–has an absolutely ABYSMAL success rate, particularly with opioid addiction. Go into your average NA group and see how many people there who came in with long term, heavy/severe opioid abuse now have long term clean time. You will find a few, yes, but it won’t be the majority. In fact, the sheer volume of keytags/aa coins manufactured and sold for beginners and short lengths of clean time is overwhelming when compared to the tiny numbers made/sold for those with multiple years–and again, especially for those with opioid addiction.
As I said earlier, there is absolutely no reason on earth to believe that endorphins have special superpowers that they and they alone among all the chemicals in the brain can NEVER EVER be permanently impaired, nor can they ever be impaired NATURALLY (i.e., prior to drug use). However, if we SAY that this cannot ever happen–that they will ALWAYS return to normal if we just wait–it helps to support the 12 step party line that the program works for anyone who “works it” and that all this balderdash about needing medication long term is just nonsense, or “addictive thinking”, etc.
I spent almost twenty years attending 12 step groups, both AA and NA. I did every last thing they told me to do, and then some. I read every bit of their literature, including every last edition and back issue of their magazines, as well as a great many books ABOUT AA and it’s founders, and would dare to say I know more about the development of the 12 step groups than most people in the groups today do. I had several well intentioned sponsors, worked all the steps, prayed, led meetings, did 12 step work, etc etc. AT one point, I was clean for four years. And they were the most MISERABLE four years of my adult life.
I didn’t feel “happy, joyous and free”, I didn’t experience the “promises” or the “miracles”. Rather, I was deeply depressed–a depression unrelated to anything going on around me. I was extremely irritable, unable to concentrate on anything, unable to enjoy anything or take pleasure in my family and friends. Everyone kept telling me to “keep coming back–it WORKS!”–but it didn’t “work” for me. I was not beginning to feel better in any way or form at the end of that 4 years when I used again. And as I may have said earlier, even had I gone back to what was my “normal” state pre-drug abuse, that would not have been much of an improvement. I began using in the first place because I was miserably depressed, and nothing the doctors tried was working. I had been depressed all through my childhood. So, I could scarcely expect to begin feeling like normal people.
But let’s say for the sake of argument that endorphins, and endorphins alone, among all brain chemicals, never become permanently impaired, are never naturally deficient, and always spring back to perfect working order with adequate abstinent time. Even if that were so, surely you won’t argue that it can take a very long time in many people–weeks, months, years–to begin feeling normal again. During that time period, the vast, vast majority of patients WILL relapse. Studies show us that 90% relapse within one year of leaving MMT. Most people simply cannot tolerate feeling that bad for that long, never knowing when–or if–they will feel better. It would seem to make sense, then, that encouraging these patients to get off a medication that has stabilized them and enabled them to live a normal life, and is not harming them in any major way, when the most likely scenario if they DO is relapse, and the consequences of relapse are severe and serious, may not be the best course of action.
Here are a few more references:
"Mechanism of long-term potential for relapse
One of the most insidious features of opioid addiction is the tendency to relapse on the drug even weeks, months, or years after addicts stop using and withdrawal symptoms disappear. The mechanism for this type of relapse is being studied intensely. Animal studies suggest 3 distinct conditions that reliably induce relapse:
Stress
Exposure to conditioned cues related to past drug use
A dose of the previously administered drug or a drug with similar properties
There is evidence that long-term administration of opioids can permanently alter the density of dendritic spines in certain neurons, and these permanent changes may contribute to long-lasting vulnerability to relapse."
emedicine.medscape.com/article/287790-overview
Here is a link to a page in a textbook regarding pre existing endorphin deficiency:
books.google.com/books?id=FwneDofoyq0C&pg=PA94&lpg=PA94&dq=opioid+abuse+endorphin+impairment&source=bl&ots=Xo5ApJcKJC&sig=pcVle7emhFk9DljH_Qbu-oTygPk&hl=en&ei=QQZzTefPEIGdlgfc9fQk&sa=X&oi=book_result&ct=result&resnum=6&sqi=2&ved=0CEcQ6AEwBQ#v=onepage&q&f=false
Here is a link to an essay by an English physician with a good bit of experience in this area as well–I will close with it as I have to get to bed:
forum.opiophile.org/showthread.php?31753-PWS-PAWS-An-Analysis.
A
ac_claire
Guest
Zenith, I hope I haven’t offended you in my comments…your saying that it would be pointless to continue this discussion makes me suspect that I may have. I don’t come to this conversation with any uneducated pre-conceived notions about endorphin deficiency sydrome. I only come NOT knowing exactly if the irrevocable nature of it is, in fact, a fact. And if it is, how do we know WHO this is a fact for? In other words, does it apply to me? I don’t know. I *think *it doesn’t but the fact that it MIGHT scares me because I don’t want to stay on this drug forever and I don’t have the family support I’d need to do so. And that’s just IF I could ever discover and then prove to them that irrevocable endorphin deficiency sydrome is good science.
I think that the admitted good that your view can do for people as far as eliminating prejudices, etc., has a flipside…in that people who otherwise might just get on methadone to detox or for short-term and may become convinced through arguments like yours that they may have to be on it forever, and then may *choose *to be on it forever or at least longer than they might have been. Because, let’s face it-- for an ex-addict, methadone makes you feel good. Not just normal, but good. I don’t know. I’m not saying it’s harmful, but that’s one more reason why I’m hesitant to accept it. I said that only a couple of counselors told me abotu the endorphin deficiency theory/fact/whatever it is, and that was at my first clinic and it had a profound efect on me. I would have gotten off sooner had I not accepted that I NEEDED to be on methadone for, possibly, the rest of my life. Now, x number of years later, it has become my life and I’m not ok with it. This is all just my personal issue, and where I’m coming from.
Thanks again for the links, I’m reading all of them at the pace I’m able to. Your points about the length of time it takes for some to get through ALL the withdrawal effects of a methadone detox are good ones. These are the facts that haunt me the most as I continue on my taper and pray that I’ll be able to be free of this one day.
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