The Straight Dope

Go Back   Straight Dope Message Board > Main > General Questions

Reply
 
Thread Tools Display Modes
  #1  
Old 06-07-2006, 10:02 PM
Cisco Cisco is offline
Guest
 
Join Date: Apr 2000
What can vicodin do to a fetus?

My brother's wife is 6 months pregnant and taking vicodin.

I have no idea what dosage or how often.
Reply With Quote
Advertisements  
  #2  
Old 06-07-2006, 10:04 PM
Zabali_Clawbane Zabali_Clawbane is offline
Guest
 
Join Date: Mar 2003
Does her Ob. Gyn. know she is taking Vicodin?
Reply With Quote
  #3  
Old 06-07-2006, 10:40 PM
astro astro is offline
Guest
 
Join Date: Jul 1999
Special information if you are pregnant or breastfeeding



Quote:
The effects of Vicodin in pregnancy have not been adequately studied. Do not take this drug if you are pregnant or plan to become pregnant unless you are directed to do so by your doctor. Drug dependence occurs in newborns when the mother has taken this drug regularly prior to delivery. If you take it shortly before delivery, the baby's breathing may be slowed. Acetaminophen does, and hydrocodone may, appear in breast milk and could affect a nursing infant. If this medication is essential to your health, your doctor may advise you to discontinue breastfeeding your baby until your treatment is finished.
Reply With Quote
  #4  
Old 06-08-2006, 03:31 AM
irishgirl irishgirl is offline
Guest
 
Join Date: May 2001
It's an opiate, so it could cause a neonatal withdrawal syndrome, making the baby twitchy, restless and miserable. Neonatal withdrawal is treated with sedatives.

If your SIL is taking Vicodin recreationally, she needs to tell her OB, so that they can be prepared for her baby's dependence. Either that, or she needs to get into a drug treatment programme. It would be in her best interest to let someone know well before the birth, because if the baby does have withdrawal syndrome and it comes to light after the fact, she could find medical staff and social services less forgiving.

If her Vicodin is being taken for a legitimate medical condition, her OB should be aware of it, and have already taken steps to make sure the baby is looked after.
If your SIL needs pain medication for a medical reason, she needs pain medication. It is safer for the baby if mum's pain is treated adequately than if it is not treated properly, as pain releases a lot of stress hormones (adrenalin, cortisone etc) which are not good for the baby on a long-term basis. Plus, of course, leaving someone in severe pain for a long period of time simply because they are pregnant is inhumane and medically unjustifiable.

All this is moot if the Vicodin is being taken short term (i.e. a week or two) for an acute problem (like after a dental procedure), because it should have left her system (and the baby's) long before the birth, and the baby shouldn't suffer any long term ill effects.


One last thing: no pregnant woman with any sort of drug or alcohol dependence should attempt to detox themsselves without medical supervision. If it is recreational and she has a dependence, simply staying home (or being kept at home by well-meaning family) and going cold turkey is not an option. She needs to see a doctor so that she and her baby can be monitored during withdrawal.
Reply With Quote
  #5  
Old 06-08-2006, 03:49 AM
Alex_Dubinsky Alex_Dubinsky is offline
BANNED
 
Join Date: Jan 2003
Location: New York City
Posts: 2,859
Quote:
because it should have left her system (and the baby's) long before the birth, and the baby shouldn't suffer any long term ill effects.
Well, to be a devil's advocate here, but how exactly does neonatal withdrawal cause long-term ill effects?

You combine people's craziness about babies with people's craziness about drugs, and I think a lot of mistaken thinking can result.

First of all, I know you don't know the dosage, but that seems to be the most important part. If she herself isn't addicted, then the baby is pretty much in the clear itself (maybe he'll have some cravings, but we care if he's miserable, right?).

Furthmore, what I don't understand is how even significant addiction and neonatal withdrawl poses a serious long-term threat to the baby. I can fully understand how the baby will be uncomfortable and even miserable for maybe as long as two weeks. But judging by their crying, babies are miserable much of the time anyway. And it's not at all clear if trauma (ie assuming we'll go so far as to call it that) during the first two weeks of life has any effects later on whatsoever (I should mention the incessant crying again). Isn't that the argument for performing circumcision without anasthesia?
Reply With Quote
  #6  
Old 06-08-2006, 04:24 AM
irishgirl irishgirl is offline
Guest
 
Join Date: May 2001
Where I'm from neonatal circumcision without anasthaesia is illegal. The only exception is when it is performed by a trained religious professional.

Some people argue that neonatal withdrawal could "re-wire" the brain and lead to problems later in life with pain perception and response to analgesia and difficulties with behaviour in childhood. Withdrawal syndrome itself can lead to sleep-wake problems and disruption of the bond between mother and child.

If you've ever seen a baby with withdrawal syndrome (and with 17,000 heroin addicts in Dublin, I've seen a few) you'll know that they are miserable beyond anything a normal newborn will display. They display odd motor mannerisims (sneezing, exaggerated sucking) and it's pretty obvious that something isn't right.

Although it is believed that in most cases the babies recover brain function in early infancy, there will always be some who don't. Neonatal withdrawal can lead to seizures, and neonatal seizures can lead to brain damage or epilepsy in later life. It's not a huge leap to suggest that if neonatal withdrawal can be avoided, it should be.

Basically, few long term studies have been done (and a lot of them have compounding variables, such as poor parenting or being raised in the foster-care system), but the argument that because we don't know for sure if there is long-term damage, we shouldn't care is not one I would support.

Certainly, neonatal withdrawal needs treatment, and to think otherwise reveals a lack of knowledge of what these babies are actually going through.
Reply With Quote
  #7  
Old 06-08-2006, 05:13 AM
Alex_Dubinsky Alex_Dubinsky is offline
BANNED
 
Join Date: Jan 2003
Location: New York City
Posts: 2,859
alright, so in a few cases the baby may have seizures, and seizures can lead to brain damage (although, am I right in saying that we don't know if the former kinds of seizures lead to the latter?).

In addition to that there's all sort of speculation about other long-term effects. However, I think it's reasonable to say that if haven't discovered anything clear yet, then anything we'll find in the future will not be major.

And here we are talking about heroin addicts. Just think of what happens to an adult who has to go through heroin withdrawal. The body really does get close to shutting down. This is the extreme case, and yet nothing is certain even for this.

Looooong way to go from a girl popping vikes, don't you think? (And I hope I don't have to mention the whole dose-poison thing.)

I respect that you are trying to be objective and you are not adamantly arguing something unreasonable. Still, I must say I am largely unconvinced that in this case it is a problem. (First because I doubt she's a serious addict, second because even if she were, vikodin withdrawl ain't heroin withdrawal, and third, because even heroin-addicted babies do not seem, at this point, to be at a clearly large risk.)

As for continuing to give the baby opiates after birth (which is the treatment which no one seems to want to actually explain). Well, it won't hurt. Don't think there's too much of a point, either. (And given the risks that people might mistake controlled recreational use of a substance they think is evil as reason to judge a mother unfit, it may be ill-advised in practice.) I also don't understand why an addict couldn't try slowly cutting down on the dosage herself, without a doctor over her shoulder. (I mean at least try.)
Reply With Quote
  #8  
Old 06-08-2006, 06:00 AM
Broomstick Broomstick is offline
Charter Member
 
Join Date: Mar 2001
Location: NW Indiana
Posts: 18,006
Quote:
Originally Posted by Alex_Dubinsky
And here we are talking about heroin addicts. Just think of what happens to an adult who has to go through heroin withdrawal. The body really does get close to shutting down.
No, it doesn't. Assuming no other medical problems, the addict will be miserable, but cold-turkey opiate withdrawal is actually safer than cold-turkey alcohol withdrawal on many levels.

Quote:
I respect that you are trying to be objective and you are not adamantly arguing something unreasonable. Still, I must say I am largely unconvinced that in this case it is a problem. (First because I doubt she's a serious addict
You're either an addict or you aren't.

Quote:
second because even if she were, vikodin withdrawl ain't heroin withdrawal
Actually, it's closer than you think, as they are both opiates and produce similar forms of dependence and withdrawal symptoms.

Quote:
and third, because even heroin-addicted babies do not seem, at this point, to be at a clearly large risk.)
First of all, babies are not "born addicted". They can be born with a physical dependency on a drug, but that is not the same as addiction.

However, the vast majority of children exposed to drugs pre-birth are going to grow up into normal, healthy adults. Obviously, it's best to limit such exposure as much as possible, but these days there seems to be a sort of panic about this. In the larger scheme of things, there are MUCH worse drugs to expose a fetus to than opaite painkillers or acetaminophen. Again, best to avoid entirely but if you can't don't have a meltdown over it.

Quote:
I also don't understand why an addict couldn't try slowly cutting down on the dosage herself, without a doctor over her shoulder. (I mean at least try.)
1) If she had that much self control she wouldn't be an addict

2) Pregnancy complicates withdrawal medically. In fact, the body has a tendency, during withdrawal, to essentially say "this is all too much" and miscarry the baby. Back when I worked at a methadone clinic (a controversial form of a treatment in itself) not only were the pregnant addicts told NOT to attempt dose reduction or withdrawal on their own, but in many cases their daily dose was increased because dosage is affected by body weight and of course in pregnancy body weight goes up, meaning that the old dose was insufficient to prevent withdrawal after a couple months. (and immediately after delivery we could almost always drop the dose - because a woman loses body weight during childbirth - but this needs medical supervision because it's a delicate balancing act) The justfication in those cases was that it was healthier for the mother to be on oral methadone rather than shooting up street drugs, and to maintain a steady state in regards to physical dependency rather than stressing her body further by attempting withdrawal. Of course, we tried to get them to go to pre-natal doctor visits, eat better, treated whatever other medical problems they might have, including STD's. We followed the resulting offspring for a number of years. There was a very clear correlation between early intervention (off street drugs, doc visits, better diet, etc.) and better outcomes, but no strong connection between opiate dosage and outcome. In other words, messed up "drug babies" typically have a lot more to do with the general poor health of the mother and a deplorable environment than having to go through detox in the first two weeks of life.

If the Vicodin is being taken for an injury... yeah, treat the mother. A week or two mid-pregnancy in therapeutic doses is quite unlikely to cause any long-term trouble. Being in enough pain to disrupt sleep or discourage movement isn't healthy for a pregnant woman, either, and can also complicate things. If this is "recreational" use, that's a whole different kettle of fish, but really there's no way to tell from the OP which it is.
Reply With Quote
  #9  
Old 06-08-2006, 06:42 AM
irishgirl irishgirl is offline
Guest
 
Join Date: May 2001
Alex_Dubinsky- I'm still trying to work out what you're trying to say, but basically, I'm saying what Broomstick did.

You, seem (and as I said, I can't quite be sure) to be saying that Vicodin in pregnancy is no big deal and that we should all just calm down. Am I right?

You seem to think that I'm a coming from a very judgemental position about drug use (I'm not), you also seem to think that there is some sort of line between just popping a few Vicodin and being addicted to something.

One of the definitions of dependence (the WHO has said since the 1980s not to use addiction) is continuing to use something despite harmful or adverse consequences to that use. Now that definition goes equally for smoking cigarettes despite having bronchitis, drinking despite liver disease, or taking unnecessary opiates despite being pregnant. If you can't or won't stop when it is a good idea for you to do so, you have a problem.

You may not have seen someone in heroin withdrawl (I have), and while it's not pretty, it is nowhere near a body "shutting down"- cold turkey from heroin won't kill you (alcohol withdrawal might). In a pregnant woman it may, however, cause a miscarriage, premature labour or foetal distress and in utero hypoxic brain damage, and that is why it is not recommended without close medical supervision.

Anyway, my advice (and it's just advice from me, not to be construed as medical advice in any way) to Cisco is the same:
If your SIL is taking the Vicodin under medical supervision, she should be fine.
If not, try and get her to make sure her health care providers are aware of the situation so that they can act in her best interest and the best interest of her baby.

Nobody will be thinking about trying to take a baby away from its mother, or any kind of legal proceedings, they will just want to have as much information as they can so that they can make the right choices when it comes to the health of this woman and her baby. For example, this pregnancy may be re-classified as high risk, they may want to have a paediatrician in the room at the delivery with neonatal resuscitation equipment, the OB may want to intervene earlier at signs of foetal distress, the choice of maternal pain relief during labour may be different, that kind of thing.
Reply With Quote
  #10  
Old 06-08-2006, 07:58 AM
Qadgop the Mercotan Qadgop the Mercotan is offline
Charter Member
 
Join Date: Apr 2000
Location: Slithering on the hull
Posts: 22,045
Quote:
Originally Posted by Alex_Dubinsky
I also don't understand why an addict couldn't try slowly cutting down on the dosage herself, without a doctor over her shoulder. (I mean at least try.)
Addicts can't do this. That's why they're addicts.

Otherwise, Broomstick and irishgirl speak wisely.
Reply With Quote
  #11  
Old 06-08-2006, 09:16 PM
Alex_Dubinsky Alex_Dubinsky is offline
BANNED
 
Join Date: Jan 2003
Location: New York City
Posts: 2,859
Alright, it seemed that I erred in exaggerating the effects of heroin withdrawal. I readily admit fault. However, vikodin withdrawal is still less severe, no?

However, I still disagree with the people who seem to claim that there is only one type of addict. I assume you think that an "addict" is an "addict", and the only degrees can come as a result of dosage. However, I feel it is accurate to say that someone who takes a higher dosage can be described as a more serious addict. Moreover, someone may take an opiate twice a week, have cravings toward this drug, may rightly be called in a state of "addiction," and be referred descriptively as a "slight addict."

What's so wrong with that usage? Maybe there isn't a fundamental difference between someone who shoots up five times a day or ten times. Maybe they'll require the same treatment, and it's fine for people in your profession to all call them the same thing. However, I don't think it is entirely appropriate. I also think using such terminology reflects a value judgement that all drug abusers are "damned" and we oughtn't be making distinctions. Maybe you don't feel that way, but maybe whoever taught you that usage did.

Quote:
you also seem to think that there is some sort of line between just popping a few Vicodin and being addicted to something.
On the one hand you say that someone popping vikodins regularly but not too frequently is addicted, and I completely agree. Then you say (alright, fine, Broomstick said) that all addicts are addicts are addicts. This just isn't fair. It is an abuse of language, it implies all sorts of things that it shouldn't, and it is clearly a reflection of that aforementioned value judgement. Maybe you'll be able to convince me that giving up a twice-a-week habbit takes as much effort and has the same withdrawal symptoms as a five-times-a-day habbit. If so, then I'll concede you're right. I've never been addicted to vikes, but somehow I don't think that that could be true. Is it?


As for addicts cutting down on dosage... Well, it depends. Irishgirl relevantly pointed to the definition of dependence, saying that it already implies that someone has been shirking responsibility. If someone's been doing that, then there's rason to think they'll continue. However, boy, do I hate arguments from definitions. You apply the word dependence to a person for one reason, and suddenly everything else in the dictionary must be true as well? That's why the usage of the word "addict" by a mind like yours is such a dangerous thing. Anyway, a kid popping vikes likely never thought it to be dangerous and never had real reason to quit or confront her moderate physical dependence. Pregnancy might really inject a shot of newfound responsibility and necessity into someone and actually give them reason to take control. Maybe it won't, but I think there's a much better chance that it will than you think. Especially if the father and her friends take responsibility too.

Quote:
Nobody will be thinking about trying to take a baby away from its mother, or any kind of legal proceedings
Is that right? If so, it should be communicated very directly and repeatedly. If it's true, then I would completely agree that the mother should let her doctors know, no matter what the details of her use.
Reply With Quote
  #12  
Old 06-08-2006, 09:31 PM
samclem samclem is offline
graphite is a great moderator
Moderator
 
Join Date: Aug 1999
Location: Akron, Ohio
Posts: 21,271
MODERATOR WARNING

Alex_Dubinsky

Just to make sure you read my post, I'll email it to you.

I'm tired of your medical opinions being posted in General Questions. In fact, I'm tired of your opinions in general being posted in General Questions, but I'll let that slide.

If you continue to post your opinions in medical matters in this forum, I will ban you. Period. If you continue to argue about nitpicking language in medical threads in this forum, I will ban you. Period. I am warning you to stay out of threads about medical matters in General Questions. Am I getting through to you? Am I clear?

If you wish to offer your opinions on medical matters, feel free to open a thread in another forum. But don't do it in General Questions. Period.

I'm tired of your half-baked, half-assed opinions when what the question asks for is facts.

samclem General Questions Moderator
Reply With Quote
  #13  
Old 06-09-2006, 01:09 AM
Alex_Dubinsky Alex_Dubinsky is offline
BANNED
 
Join Date: Jan 2003
Location: New York City
Posts: 2,859
Somehow it seems you are much more concerned about what I was saying, not how I was saying it. I don't think I was introducing any misleading statements that were meant to be facts (except the thing about heroin withdrawal that was quickly corrected.) I was trying to get a different perspective on the facts as others have stated them.

Is that wrong? Should only one interpretation of the information be heard? Should debate be quelched? Is some disclaimer called for saying that nothing in my posts should be taken as information?

A good part of the others posts were opinions and value judgements as well, so I don't understand what exactly you're saying, except that MY opinions and value judgements are banned.

Quote:
If you continue to argue about nitpicking language in medical threads in this forum, I will ban you.
Uhh... you're not even talking about GQ anymore? I only responded to a nitpicking of my language, and I think the discussion has a lot of relevance.

And anyway, anyway, the defintion of an "addict" is hardly a medical one. It is a social one. Saying that people get addicted from infrequent use is perhaps a statement of medical fact. One with which I, in fact, agreed. Saying that people have the same withdrawal symptoms no matter what their dosage would also be a fact, if someone could confirm it. Saying that everyone should be just called an addict without a modifier no matter their dosage or withdrawal symptoms is a SOCIAL definition. I'm not arguing what "aorta" means here. The biggest danger throughout modern history has been the masking of debatable statements as "scientific" or "medical" fact (and I don't even need to begin making the list). I think I have pointed out a clear example of such creep.

Why are you so upset?

Say that I may be misleading people and that I should make it very clear in every post that I am no source of medical information, and I'll agree.

But I still think you are suppressing a particular opinion (whose danger lies in the fact that it just might be a reasonable one.. or else nullify it with its fault), not upholding some rule on medical opinions in general. Opinions, value judgements, and biases are present in every answer on GQ, whether medical or not (and especially in a topic such as this... which combines both drugs and babies). They are also present in the sources cited in responses. You can't escape opinions. Your best option is to gather as many as you can.

But I mean whatever, just say you don't have to explain yourself, and I'll have no choice but to fall under your power.
Reply With Quote
  #14  
Old 06-09-2006, 01:28 AM
Excalibre Excalibre is offline
BANNED
 
Join Date: Nov 2003
Location: Michigan
Posts: 7,585
Quote:
Originally Posted by Alex_Dubinsky
A good part of the others posts were opinions and value judgements as well, so I don't understand what exactly you're saying, except that MY opinions and value judgements are banned.
The thing you're leaving out here is that they are medical opinions from medical professionals. Not that anyone should take advice from a message board too seriously, but there is a thorough precedent on the SDMB for not permitting people to give bad medical advice.


Quote:
And anyway, anyway, the defintion of an "addict" is hardly a medical one. It is a social one.
Actually, "addiction medicine" is a recognized specialty, and furthermore, the neurophysical processes of addiction - while not wholly understood - have been the subject of very thorough scrutiny, and a lot is known about addiction from a medical perspective.


Quote:
The biggest danger throughout modern history has been the masking of debatable statements as "scientific" or "medical" fact (and I don't even need to begin making the list). I think I have pointed out a clear example of such creep.
That belief is so bizarre I'm not sure how one could respond to it.

Suffice it to say I'm not convinced.


Quote:
Why are you so upset?
Because it's believed that giving bad medical advice may endanger people. Your uninformed guesses, when they contravene accepted medical practice, count as "bad" medical advice. If you would like to debate addiction and the term's meaning and its social and medical significance, you should start a Great Debate. GQ is not the forum for such things even if you weren't busying yourself giving bad advice.


Quote:
But I still think you are suppressing a particular opinion (whose danger lies in the fact that it just might be a reasonable one.
It seem safe to say that's not the case.


Quote:
Opinions, value judgements, and biases are present in every answer on GQ,
Hence the board's oft-repeated catchphrase, "Cite?"

There's a reason we believe in evidence around here.


Quote:
You can't escape opinions. Your best option is to gather as many as you can.
Your mistake is the implicit assumption that all opinions are of value. The general assumption around here and in society is that the opinions of laypeople on complex medical topics are not particularly of value. That's why we have doctors like our beloved Qadgop.


Quote:
But I mean whatever, just say you don't have to explain yourself, and I'll have no choice but to fall under your power.
You have a choice. You have a choice between "falling under his power" or leaving the SDMB.


I'm just saying this because I think it's a tad on the arrogant side to argue with the people upthread - everyone giving advice but you is medically trained or has experience dealing with addiction - Qadgop, in fact, is a doctor and a recovering addict, and he makes no secret of either fact.

I'm honestly not trying to be mean here - just straightforward. And I think there's some value in recognizing what you don't know, especially when there are other people around who do know about it.
Reply With Quote
  #15  
Old 06-09-2006, 02:13 AM
Alex_Dubinsky Alex_Dubinsky is offline
BANNED
 
Join Date: Jan 2003
Location: New York City
Posts: 2,859
Quote:
Your mistake is the implicit assumption that all opinions are of value. The general assumption around here and in society is that the opinions of laypeople on complex medical topics are not particularly of value.
I think discussions are of value. I never say "it's like this." You know I always a attach a long post arguing why I believe it. I expect others to return arguments in exchange, and I think I am usually able to parse them and respond relevantly. There are many ways to undermine my argument on this thread, and I even sometimes point out what statement of fact would do it. I like to think that I at least serve the role of getting people to excercise their debating skills. At best, I might even get someone to reconsider their beliefs, though I'll admit that that would be a rare occurance.

I would like to restate what I was trying to state before. I won't say anything else, but maybe people will respond anyway. I will also italicize things unconfirmed by others on this thread. Opiates do not pose a danger to babies except due to their symptoms of withdrawal, which may affect the mother, leading to miscarriage, or the baby, possibly leading to brain damage in case of seizures, but usually only to psychological discomfort... err, misery. A miscarriage would be bad, but we as a society have not chosen to judge harshly abortions and by extension prenatal death. It is for the mother to judge. If a miscarriage does not occur, the pain of the baby would be real, but research does not indicate that it will lead to long-term harm (except in the extreme cases of seizures). However, the intensity of addiction, ie the dosage, plays a significant role (as does the nature of the opiate). A person who may take vikodins once or twice a week might develop cravings, but neither they nor the baby will suffer signficant symtoms of withdrawal. As a rule of thumb, the risk of both miscarriage and suffering of the infant are proportional to the intensity of withdrawal. If a mother starts to feel sick, she should resume her opiates at regular dosage immediately (proportional to weight, which will usually mean a higher dosage)! But like I said before, risk of miscarriage is a value judgement for the mother. If she does not feel sick, she will be able to cut down on her use without risk (er, if she's even able to cut down on her use, that is). In cases of light recreational use, this self-treatment might be advisable for legal reasons in regards to concerns both immediate and long-term, such as those of custody. In case of daily use which cannot be slowly reduced by the mother (as would be the most likely situation in case of daily use), going cold-turkey is illadvised (unless maybe you do want an abortion), and medical personnel ought be advised so that they may ease the baby's pain after birth. Also, they'll know if your baby's in withdrawal, and you won't be able to hide it. So here it is in your best interests to let them know ahead of time.

I repeat, the italicized parts are statements made by me, and are uncited and unconfirmed. DON'T BELIEVE THEM! DON'T TAKE THEM AS ADVICE! THEY'RE THERE FOR KNOWLEDGABLE PEOPLE TO ARGUE AGAINST! Now was what I said all that unreasonable? But maybe it should be silenced because of that fact? Should it be silenced because of the contained unorthodox views that treat miscarriage as a threat to be assessed by the mother? Should it be silenced because it gives consideration to the practical implications of the law? Should it be silenced because it doesn't treat everyone with an addiction to be an addict identical with any other?

It would be helpful if people could give actual statistics for the risk of miscarriage and seizures/brain-damage.

But anyway, I swear I won't post on this thread again.
Reply With Quote
  #16  
Old 06-09-2006, 02:40 AM
Excalibre Excalibre is offline
BANNED
 
Join Date: Nov 2003
Location: Michigan
Posts: 7,585
Quote:
Originally Posted by Alex_Dubinsky
I like to think that I at least serve the role of getting people to excercise their debating skills.
Forgive my impertinent observation, but you seem not to do that in the only place around here intended for actual debates of that nature.


Quote:
I repeat, the italicized parts are statements made by me, and are uncited and unconfirmed. DON'T BELIEVE THEM! DON'T TAKE THEM AS ADVICE! THEY'RE THERE FOR KNOWLEDGABLE PEOPLE TO ARGUE AGAINST! Now was what I said all that unreasonable?
Yep! It's inherently unreasonable to sit around debating what could be better served through application of the appropriate knowledge. When debate consists of nothing but people bouncing words off each other, it's far less useful than when people find evidence to support their beliefs. In this thread, I have not seen you do so - rather than doing research, you rely on nothing but assumptions. Assumptions and guesses and the conclusions we can draw from them are, I guess, interesting to you. They are not interesting to me, since my preference is to maintain the rigor of thought that comes from testing it against the real world and building to conclusions on a base of demonstrable fact.

It is even more unreasonable to start the debate in a completely inappropriate circumstance, like this thread.


Quote:
But maybe it should be silenced because of that fact?
Yes, dear. You're a victim, and the man's keeping you down. And as a dedicated fan of the man, I suggest you go down one forum where you can debate this in an appropriate place and manner - without tossing off medical advice completely free of any basis in fact and without hijacking someone else's GQ thread.


Quote:
Should it be silenced because of the contained unorthodox views that treat miscarriage as a threat to be assessed by the mother?
I'm not sure at all why you consider that view "unorthodox", let alone something that would be silenced. Pregnant women, and their doctors, make risk analysis decisions all the time in what medical care is appropriate given the potential for harm to the child and the benefits offered by the medical care. This isn't even faintly unusual; frequently, in fact, pregnant women use drugs whose effects are not sufficiently understood for there to be any certainty that they don't cause a risk of miscarriage.

I fail to see why you think this idea is something controversial.


Quote:
Should it be silenced because it gives consideration to the practical implications of the law?
On the contrary, no democratic society can be maintained if the laws aren't subject to debate. I think engaging in such discussion of public issues is one of the primary responsibilities of a citizen living in a free society. No doubt that was a part of the decision on the part of The Powers That Be around here to open up a forum that is perfectly suited to such debates, along with debates over other issues of equal import.


Quote:
Should it be silenced because it doesn't treat everyone with an addiction to be an addict identical with any other?
Nope. You should bring evidence to support your views.

Dear me, I believe I've inadvertently found myself sucked into the hijack. My apologies to Cisco.


Quote:
It would be helpful if people could give actual statistics for the risk of miscarriage and seizures/brain-damage.
Oh, dear. I seem to be full of impertinent observations this evening. At the moment, I'm observing a nearly blinding flash of irony.

Whoops, my head asplode.
Reply With Quote
  #17  
Old 06-09-2006, 02:41 AM
Garfield226 Garfield226 is offline
Guest
 
Join Date: Jun 1999
Quote:
Originally Posted by Alex_Dubinsky
I like to think that I at least serve the role of getting people to excercise their debating skills.
We have a forum for that. This isn't it.

Quote:
Originally Posted by Alex_Dubinsky
I repeat, the italicized parts are statements made by me, and are uncited and unconfirmed. DON'T BELIEVE THEM! DON'T TAKE THEM AS ADVICE! THEY'RE THERE FOR KNOWLEDGABLE PEOPLE TO ARGUE AGAINST!
We have a forum for that. This isn't it.



Quote:
Originally Posted by Alex_Dubinsky
Now was what I said all that unreasonable? But maybe it should be silenced because of that fact? Should it be silenced because of the contained unorthodox views that treat miscarriage as a threat to be assessed by the mother? Should it be silenced because it gives consideration to the practical implications of the law? Should it be silenced because it doesn't treat everyone with an addiction to be an addict identical with any other?
No, it should be silenced because you're apparently incapable of reading forum descriptions. General Questions is not for debating. Insults aren't allowed outside the pit. You've violated those rules numerous times. We've had a poster banned for continuing to post medical information and advice after being warned against it. You wouldn't be the first.
Reply With Quote
  #18  
Old 06-09-2006, 03:27 AM
irishgirl irishgirl is offline
Guest
 
Join Date: May 2001
Alex_Dubinsky, you have so many misconceptions about dependence and medical care in pregnancy that it would take a better woman than me and a more appropriate forum than this to set you straight.

Anyway, if Cisco is still reading this thread:
I hope that you can take something useful away from it, and I wish only good things for your SIL, brother and their baby. May I suggest that if your SIL is abusing Vicodin and you are unsure where to begin to help her, you could do worse than Al-anon. I know it is set up for the friends and relatives of alcoholics, but the people there will be able to give you some practical advice to help your SIL. Note- Narconon is not related to AA, Al-anon or any other 12 step programme, although it has a seemingly related name. It is run by the Church of Scientology, I advise you to stay well away.
Reply With Quote
  #19  
Old 06-09-2006, 05:59 AM
Broomstick Broomstick is offline
Charter Member
 
Join Date: Mar 2001
Location: NW Indiana
Posts: 18,006
Quote:
Originally Posted by Alex_Dubinsky
Alright, it seemed that I erred in exaggerating the effects of heroin withdrawal. I readily admit fault. However, vikodin withdrawal is still less severe, no?
No. Withdrawal from any opiate is much the same. Heroin has such a reputation, but it's not that different from anything else in its category. There can be a difference in length of effect - heroin only lasts, if I recall about 4-6 hours before withdrawal starts, and a detox can be done in about 3-4 days. Something like methadone, which is a long-acting opiate whose effects (both beneficial and abused) last 2-3 days, will take much longer to leave the body, so cold-turkey withdrawal will last a lot longer than for heroin. This is one of the criticisms of methadone maintenance - an addict cut off from the supply will be in withdrawal a much longer time. During that time, they are sorely tempted to ease their symptoms by use of another opiate - any opiate. Sufficient quantities of even a "mild" opiate will step in for their usual choice, relieving withdrawal or even producing a high. However, with something like codeine, which is frequently mixed with aceteminophen, or Vicodin, which also has aceteminophen, one can consume a lethal dose of aceteminophen before the opiates in the tablets build up sufficiently in the bloodstream to produce either withdrawal relief or a high. People who OD on such medications more typically die from the aceteminophen destroying their liver than from the effects of the opiates. This is also a problem as tolerance/resistance builds up in the addict towards opiates - one does not in increase one's tolerance to aceteminophen, just the opiate, so if the addict increases the dose/frequency of Vicodin consumption they could do Bad Things to their body - from the aceteminophen, not the opiate. Nonetheless, withdrawing from a Vicodin addiction will produce the same symptoms as withdrawal form a heroin addiction, and depending on the person, may be just as severe.

Quote:
However, I still disagree with the people who seem to claim that there is only one type of addict. I assume you think that an "addict" is an "addict", and the only degrees can come as a result of dosage. However, I feel it is accurate to say that someone who takes a higher dosage can be described as a more serious addict.
There is very little correlation between intensity of addiction and dosage.

Someone who has required long-term pain treatment as a result of an injury, for example, and developed a physical dependence - that is, will suffer withdrawal symptoms if the medication is cut off - will usually be taken off the medication in 2-3 weeks of dose reduction regardless of what dose they started at. Properly managed, they will not have been "high", will not have cravings, and in some cases I've known actually want off the drug faster than their doctors want to wean them. Such a person is not an addict, no matter how high the dosage used.

Back when I worked at the clinic you simply could not tell from simple observation who were the high dose addicts and who weren't. We had people on 140 mg daily doses of methadone (twice the usualy lethal level for non-tolerant people) who did the program in record time, got clean, and stayed clean. We had other people who couldn't shake a 10 mg/day habit.

That's because addiction isn't just a physical disease. There's a mental component at work, a problem between the ears, in the brain. Why some people get into that state and others don't is a a mystery. It's known that when you soak your body in artificial opiates you body shuts down production of its natural opiates. These chemicals are necessary to normal function, which is why withdrawal is so miserable - the body takes a while to resume production of its own chemicals. Some peoples bodies bounce back quicker than others. Why? We don't know. Probably there's a genetic component. It is known that eating right, getting enough rest, and exercise can help. Well, heck, that help most health problems, doesn't it?

Quote:
Moreover, someone may take an opiate twice a week, have cravings toward this drug, may rightly be called in a state of "addiction," and be referred descriptively as a "slight addict."
Nope.

Or at least, they aren't physically addicted. At that low a rate of usage they won't be suffering withdrawal symptoms. That really is (depending on reason for use) either therapeutic or recreational use. Almost no recreational opiate user stays in that category very long. Once you start using to prevent withdrawal as well as get high you're over into addiction. Addiction is much like being pregnant - you can't be "just a little".

Quote:
What's so wrong with that usage? Maybe there isn't a fundamental difference between someone who shoots up five times a day or ten times. Maybe they'll require the same treatment
Or the fives times a day user might require more treatment than the ten times a day individual. Dosage has little to do with addiction. It's like arguing you're lightweight alcoholic because you only drink beer, not hard liquor. Doesn't matter. At a certain level a drunk is a drunk. You don't have "drunk lite".

What's wrong with a casual recreational opiate usage is that is almost never stays there. It's like casual smoking - very few smokers can hold to 1 or 2 cigarettes a week long term.

Quote:
However, I don't think it is entirely appropriate.
Why? Because it's judgemental?

To get an addict to confront their problem - the first step to dealing with it effectively - you have to be blunt about it. They have a problem. The nice little old lady hooked on OxyContin is just as much an addict as the junkie shooting heroin in the back alley.

Quote:
I also think using such terminology reflects a value judgement that all drug abusers are "damned" and we oughtn't be making distinctions.
If I thought all drug users were "damned" I wouldn't have spent four years of my life in a treatment center trying to help them.

You help none of these people by refusing to see what they all have in common.

Quote:
On the one hand you say that someone popping vikodins regularly but not too frequently is addicted, and I completely agree. Then you say (alright, fine, Broomstick said) that all addicts are addicts are addicts. This just isn't fair.
I agree - it's not fair some people have to deal with this in life. But it's true - all addicts have certain things in common, even if their drug of choice differs.

Quote:
Maybe you'll be able to convince me that giving up a twice-a-week habbit takes as much effort and has the same withdrawal symptoms as a five-times-a-day habbit. If so, then I'll concede you're right. I've never been addicted to vikes, but somehow I don't think that that could be true. Is it?
If the person can't function without that twice weekly use - and "can't function mentally" counts as much as the physical - then they are addicted. If they continue that twice weekly usage despite legal, social, and financial problems associated with it they are certainly displaying symptoms of addiction, even if the syndrome hasn't fully developed. Addiction isn't just a matter of physical symptoms. You can be addicted to something that doesn't have a physical withdrawal component.

Quote:
Anyway, a kid popping vikes likely never thought it to be dangerous and never had real reason to quit or confront her moderate physical dependence.
Yes, that's one way people get into this sort of mess - they don't think it's dangerous to take something for fun. And they aren't uncomfortable enough to do the hard work of giving it up.

Quote:
If it's true, then I would completely agree that the mother should let her doctors know, no matter what the details of her use.
Regardless, a pregnant woman should tell her doctor. In Illinois, at least at the time I was working in the addiction area, there is no waiting list for a pregnant addict to get treatment - they go to the front of the line. A pregnant addict in treatment has legal protections regarding her children - out of treatment, her children might be taken away. A addicted pregnancy is high risk, and should be treated as such. One of the small social goods the clinic I was at did was host a study that proved treating the addicts in pregnancy was a hell of a lot cheaper than treating their babies after they were born damaged. If I recall, it was something like $5,000 in prenatal care for a newborn that was 95% likely to be normal and healthy versus $50,000 and up about 60% of the time with no prenatal care, and a significant percentage of "million dollar babies" who were really messed up.
Reply With Quote
  #20  
Old 06-09-2006, 06:12 AM
Zabali_Clawbane Zabali_Clawbane is offline
Guest
 
Join Date: Mar 2003
Quote:
Originally Posted by irishgirl
<snip>Note- Narconon is not related to AA, Al-anon or any other 12 step programme, although it has a seemingly related name. It is run by the Church of Scientology, I advise you to stay well away.
Narcotics Anonymous A.K.A. N.A. however is fine.
Reply With Quote
Reply

Bookmarks

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off

Forum Jump


All times are GMT -5. The time now is 01:45 AM.


Powered by vBulletin® Version 3.8.7
Copyright ©2000 - 2014, vBulletin Solutions, Inc.

Send questions for Cecil Adams to: cecil@chicagoreader.com

Send comments about this website to: webmaster@straightdope.com

Terms of Use / Privacy Policy

Advertise on the Straight Dope!
(Your direct line to thousands of the smartest, hippest people on the planet, plus a few total dipsticks.)

Publishers - interested in subscribing to the Straight Dope?
Write to: sdsubscriptions@chicagoreader.com.

Copyright 2013 Sun-Times Media, LLC.