Yeah, I’m not sure wher Lib is getting the idea that there is some way to magically determine who is an upstanding respectable addict and who is just a regular addict. I’m wondering if there’s really any difference at all.
I work for a prescription insurance agency and have had the same experience. I’ve never ever heard of a beneficiary spilling cholesterol or allergy medication down the sink or toilet, but for some folks taking pain meds it seems to happen with startling regularity.
I witnessed this just the other day. The proprietor refused to sell a very inebriated man another bottle of cheap wine. I thought that was very reasonable and responsible.
Anyway, back from din-din, and I wanted to add a few words about harm reduction and opiates.
What’s the problem with giving opiate addicts unrestricted access to heroin and the like? Especially if the stuff is decriminalized so no laws are broken in having and obtaining the substance?
Well, an active opiate addict (and I was one, nearly 17 years ago, and have treated hundreds professionally since then) tends to focus solely on getting and using the drug. And the drugs which give a great deal of euphoria are the short acting ones, so they need to be dosed 3 or 4 or more times a day. And during the intense euphoria, these folks aren’t capable of doing much. And while coming down, they tend to be crabby.
So even if these folks aren’t stealing to support their habit, they still will generally find it difficult to hold down any sort of employment, or manage to support themselves, much less a family. That tends to leave them on the dole.
Enter a drug like methadone, which is long-acting (dosing once a day), gives a minimal buzz, but blocks not only withdrawal from opiates but also the buzz generated by most doses of heroin/morphine/oxy/etc. These folks tend to get tired of sitting around being sort of mellow but not able to get much higher from other drugs, and have often been observed to get out and hold down jobs and support themselves!!?!! Hey, lets get our opiate addicts on methadone!!
Well, for some it works okay like that, but others tend to continue to chase the rush, often skipping/selling their methadone doses to take heroin/oxy/hydrocodone instead, or doubling their methadone doses or adding other opiates to the methadone to try to get a better rush. We call these people “treatment failures”.
Now a new opiate is being used instead of methadone. It’s called suboxone, and it too blocks the effects of other opiates, but with even less sedation/euphoria/constipation than methadone. We’re using this now to keep relapsing addicts off the hard stuff. We’ll see how well that works in the long run.
And that’s it in a thumbnail sketch. It’s really much more complicated than that, but we needn’t elaborate, since I’m not sure anyone will be reading this post with interest anyway.
I disagree, QtM, I think a lot of people are interested in posts like yours since this once-upon-a-time pit thread has turned into a far more interesting one looking at the effects and issues surrounding addiction and prescription medication. Thanks for sticking around and giving your input.
I guess it depends on how you take it. If you inject heroin or smoke it, you certainly get a rush. But I certainly don’t think methadone is any different from morphine, heroin, or oxycodone if you take it orally. The effects just last longer and dissipate slower. Of course, by the time most addicts get on methadone treatment, they have an insanely high tolerance anyway, so they don’t get the euphoric effects.
I’ve never heard an opiate-naive person who takes methadone complain that it didn’t have the same effects as the shorter-lasting opiates taken orally. I’ve heard them complain that it doesn’t have the same effect as injected heroin, though.
Without breaking the board’s rules about discussing drug use, I would say that I disagree here too. Based on not only data assembled by interviewing opiate addicts about the intensity of various substances and routes, but based on personal experience, too.
Short-acting opiates tend to have more intense euphoric peaks than long-acting opiates, no matter the route of intake. So much so that many addicts have expressed a strong preference for oral oxycodone over injected methadone.
I think you’re over-generalizing here (even though you did say “tends” and “generally”). I know you are aware that there are plenty of historical and modern cases of opiate addicts who manage to be productive members of society despite their addiction. Certainly there are plenty of people who aren’t as well, but I would say that at least half of the people I’ve interviewed at the methadone clinics are what I would consider “productive members of society.” Of course, these are generally voluntary clinics that cost a fair bit to use, so it may be that most of those people are people who had money and decent lives – good incentive to continue behaving well.
Well, I have heard lots of quotes from interviewees saying essentially “Methadone is just like taking a Vicodin, but last longer.”
In my admittedly limited personal experience, that rings true. But then, I’ve never experienced what I would describe as an intense euphoria from opiates, the way some people apparently do. I’ve noticed quite a discrepancy in the way people describe the euphoria they experience from opiates; some describe it as orgasm-like, but more say something like “It’s a pleasant warmth” or “It’s like being wrapped in a security blanket that makes your problems go away.”
Yup, many do continue to work productively long into their addiction. William Halsted was the father of modern surgery while addicted to opiates.
But many don’t, also. Some estimate that at least 55% of opiate addicts are not able to provide for themselves. Other estimates are as low as 25%. But either way, that still results in a large number of folks who are incapacitated by their addiction, and need societal support.
And as you note, the folks who find their way to methadone clinics tend to be the motivated survivors. I’ve worked with such populations, too. I’ve also treated (and pronounced dead) the ones who were unable to get into, or stay in, the methadone clinics.
Opiate addiction is a terrible disease. I’m not sure what the best treatment for it is in general, but I don’t think it’s making opiates of any type widely available to the public at large. Treatment involving a 12-step style abstinence program seems best to me, followed by methadone or suboxone treatments for those whom abstinence just doesn’t seem to work.
For me, opiates were like a hug from God. All my anxieties, fears, cares, pains, worries about the future, about whether I was okay, or would be okay, just went away, and were replaced by the the assured knowledge that I was just great, and everything would be wonderful. Forever.
That was what it was like at first, anyway. Eventually, it became more like getting a Dutch rub from my uncle Bill. Not real pleasant, but familiar, and better than what I’d been feeling a moment earlier.
But that’s me. Tho it does reflect a lot of congruence with feelings expressed by a lot of my recovering pals.
I’m just glad I don’t need that shit anymore. Life’s never been better.
We’re all glad you’re here. I know I personally have benefited quite a lot from our interaction on the board.
This is fascinating and educational, your discussion with Qadgop about how opiates affect people. I’ve taken Vicodin a few times for dental pain and the only euphoric effect it’s offered me is the emotional relief when the pain stops. But then, my practice is to take only half a pill, since a whole pill knocks me out (while still not giving me any kind of woo-hoo rush). There’s no problem for me in stopping the once or twice daily half-dose after two or three days when things have settled down.
Whenever I’d hear about people being addicted to painkillers it always seemed, well, very odd, since they do nothing pleasurable for me beyond the immediate cessation of pain. This discussion is an eye-opener.
And for me as well. If this one wasn’t worth half the price of a subscription, then nothing is.
My wife similar. Her female relatives have a long history of needing hysterectomies by the time they’re in their late 20’s, so when she was diagnosed with severe endometriosis, it was no surprise. So needless to say, she often gets pretty uncomfortable during her time of the month. But she really doesn’t like taking opiates of any kind – they make her feel dizzy, nauseated, and tired, but they evidently do work for pain relief, especially if I combine them with some ibuprofen (the combination of hydrocodone, acetaminophen, and ibuprofen seems to work pretty darn well). She’s had a bottle of 30 Lortab 10/500* tablets that has lasted her for three years now, because she only takes them when I basically force them down her throat because I can’t stand to see her suffering any longer. The whole idea of people getting addicted to those things is nuts, to her.
Other people I’ve interviewed have had a completely different description of the effects – some people have described taking opiates as like having a whole-body orgasm that lasts half an hour (though I get a lot more of that when people describe the effects of crack or cocaine, predictably), and there’s a lot of “hug from God” and “warm blanket” imagery.
- 10mg of hydrocodone, 500mg of acetaminophen
Careful, those are probably close to expired if not already expired.
Oh, yeah, they expired long ago. But they’re kept in a cold, dry, dark place, and they don’t seem to have lost any potency.
Yes, Qadgop, thanks for opening up part of your private life for us, in an attempt to make other dudes lives better.
At the risk of hijacking this into a praisefest for QtM, his posts make me want to commit a felony in Wisconsin.
By the way, in the other thread when I said that the DEA was “excited” about prescription drug abuse, I wasn’t trying to belittle the problem.
My job brings me into contact with drug addicts now and then, and these people will do anything to get more drugs. They will tell any lie, they will steal from their family . . . it’s terrible.
But I do admit that many of the societal problems from drug addiction are really the result of prohibition. A lot of the lying, cheating, and stealing by drug addicts results from the fact that drugs are difficult and expensive to obtain.
What would life be like if we went back to the 19th century when opiates were basically unregulated? I don’t know.