Talk:Opioid/Archive 03

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This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

This is Archive 3, which cover discussions which began in 2006.

Contents 1 senile dementia, geriatric depression, chemotherapy, terminal diagnosis 2 geriatric depression 3 Note to the person who changed Clinical Use: 4 added citation on STAR*D and clarification on "act surely" 5 Etonitazene 6 Recurring Abdominal pain and nasuea 7 Added DSM-IV terminology note 8 Uncited Statements-again 9 opioid word 10 Last reversion by Daksya 11 Compare and Contrast

senile dementia, geriatric depression, chemotherapy, terminal diagnosis

I added this paragraph:

"Opioids are prohibited for psychological relief (with the narrow exception of anxiety due to shortness of breath), despite their extensively reported psychological benefits. The prohibition has no therapeutic basis; its basis is fear of addiction and of diversion. The prohibition allows no exceptions, even when opioids might be especially effective and when the possibility of addiction or diversion is very low – for example, in the treatment of senile dementia, geriatric depression, and psychological distress due to chemotherapy or terminal diagnosis".

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CITATIONS regarding the idea that opioids can relieve psychological distress and can act as antidepressants:

“In the middle nineteenth and well into the twentieth century”, morphine “was used as a tranquilizer and sedative. . . . It was used in mood disorders . . . until such applications were discouraged by enforcement” (note that Dr. Way says “discouraged by enforcement”, not "discouraged by results of clinical trials").

- Way, E. Leong (Department of Pharmacology, School of Medicine, University of California, San Francisco, San Francisco, California, USA), "History of Opiate Use in the Orient and the United States", in Opioids in Mental Illness: Theories, Clinical Observations, and Treatment Possibilities, edited by Karl Verebey, The New York Academy of Sciences, New York, New York (1982), p. 18.

“From being in a state of agony and apprehension the patient is calm and at ease. . . . Closely allied to the pain-relieving effect of opiates is their ability to influence mood. This effect is again a property of great value to medicine and very much the therapeutic ally of the pain-relieving effect; even when the pain of a spreading cancer is not fully abolished by the drug injection, the mood effect can make the residual pain more tolerable and generally produce a lessening of emotional distress. The patient is in a way emotionally distanced from what is happening, and floats as it were on the surface of his experience”.

- Berridge, Virgina, Opium and the People: Opiate Use in Nineteenth-Century England, 1987, pp. xxf.

“Exogenous opiates . . . have analgesic, anxiolytic, euphoric, and calming effects”.

- Gold, Mark S., A. Carter Pottash, Donald Sweeney, David Martin, and Irl Extein (Fair Oaks Hospital, Summit, New Jersey, USA): "Antimanic, Antidepressant, and Antipanic Effects of Opiates: Clinical, Neuroanatomical, and Biochemical Evidence", in Opioids in Mental Illness: Theories, Clinical Observations, and Treatment Possibilities, edited by Karl Verebey, The New York Academy of Sciences, New York, New York, 1982, p. 145.

“Morphine . . . allays . . . apprehension”.

- Reynolds, A. K., PhD, and Lowell O. Randall, PhD, Morphine and Allied Drugs (1959), p. 145.

“It may be anticipated that opioids could be highly effective, therapeutically, in depressive illness".

- Emrich, H. M., P. Vogt, and A. Herz (Max-Planck Institute for Psychiatry, Munich, Germany), "Possible Antidepressive Effects of Opioids: Action of Buprenorphine", in Opioids in Mental Illness: Theories, Clinical Observations, and Treatment Possibilities, edited by Karl Verebey, The New York Academy of Sciences, New York, New York, 1982, p. 108.

In a study of depressed patients, buprenorphine provided “clinically striking improvement in both subjective and objective measures of depression”.

- Bodkin JA, Zornberg GL, Lukas SE, Cole JO (McLean Hospital, Consolidated Department of Psychiatry, Harvard Medical School), “Buprenorphine Treatment of Refractory Depression”, Journal of Clinical Psychopharmacology, February, 1995, 15(1):49-57.

In another study of buprenorphine in the treatment of psychiatric patients (mostly Vietnam veterans), “most [patients] commented on how much better they felt after BPN [buprenorphine], using words like ‘relaxed’, ‘peaceful’, ‘more friendly’. . . . Some went into a discussion group after BPN and for the first time spoke about painful experiences. . . . The only responder who did not like BPN was the normal subject”.

- Mongan, Lou and Enoch Callaway, Letter to the Editor, Biological Psychiatry, 1990, Volume 28, Issue 12, pp. 1078ff.

In cases of terminal disease, “the analgesia, tranquility, and even euphoria afforded by the use of opioids can make the final days far less distressing for the patient and family”.

- Gutstein, Howard B. and Huda Akil, “Opioid Analgesics: Clinical Summary”, in Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 11th Edition, 2006, edited by Brunton, Laurence L., John S. Lazo, Keith L. Parker, Iain L. O. Buxton, and Donald Blumenthal.

(The authors make no comment on the plight of those who might appreciate the “tranquility, and even euphoria” but have no need for analgesia.)

“Then Helen, daughter of Zeus, turned to new thoughts. Presently she cast a drug into the wine whereof they drank, a drug to lull all pain and anger, and bring forgetfulness of every sorrow. Whoso should drink a draught thereof, when it is mingled in the bowl, on that day he would let no tear fall down his cheeks, not though his mother and his father died, not though men slew his brother or dear son with the sword before his face, and his own eyes beheld it".

- Homer, The Odyssey, Book IV, lines 219-222, translation by Samuel Butcher & Andrew Lang. It is not certain that the drug is opium, but no other reasonable candidate has been proposed. The effect of opium may be exaggerated in this report, but the scene is a good proxy for the psychotherapeutic use of opium by early physicians such as Hippocrates, Dioscorides, and Galen.

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CITATIONS regarding the idea that thymoleptics (SSRIs, MAOIs, etc.) are always superior to opioids as antidepressants:

Thymoleptics are unreliable and slow: “patients must be aware that antidepressants take at least four to six weeks to have a full therapeutic effect and that only about half of patients respond to the first medication prescribed”.

- Whooley, Mary A., MD and Gregory E. Simon, MD, MPH, "Managing Depression in Medical Outpatients", The New England Journal of Medicine, December 28, 2000, p. 1948.

The study called “Sequenced Treatment Alternatives to Relieve Depression” (STAR*D), sponsored by the National Institute of Mental Health, found that only half of the 1500 patients in the study “achieved remission – virtually the complete absence of symptoms. . . . About half the patients in the study who improved did not show benefits until eight to 10 weeks into the study".

- Maugh, Thomas M. II, “New Hope amid Depression”, San Francisco Chronicle, March 23, 2006, p. A3.

Opioids, on the other hand, act quickly: “We have found that most patients experience benefits of an adequate dose within three hours”.

- Callaway, Enoch, Editorial, Biological Psychiatry, June 15, 1996.

And opioids act surely: I have found no reports of opioids failing to have a positive effect, except in the case of "normal" people (see above and below) and the case of negative side effects such as nausea.

Marcia Angell, MD, former editor-in-chief of the New England Journal of Medicine, reports on a survey (enabled by the Freedom of Information Act) of FDA reviews of drug-company submissions that found placebos to differ from the six top-selling antidepressants by only two points on the sixty-two-point Hamilton Depression Scale – a difference that she says is “unlikely to be of any clinical significance”.

- Angell, Marcia, MD, The Truth About the Drug Companies: How They Deceive Us and What to Do About It (2004), p. 113.

Pharmaceutical companies can hide their failures: they are not required to make public “all clinical trials, even the ones where the drugs failed to work”.

- Lamb, Gregory M., “A New Corporate Villain – Drugmakers?”, The Christian Science Monitor, September 20, 2004, http://www.csmonitor.com/2004/0920/p11s02-ussc.html.

Pharmaceutical companies surreptitiously magnify their positive results: they “publish positive results more than once, in slightly different forms in different journals. The FDA has no control over this selected publishing. The practice leads doctors to believe that drugs are much better than they are. . . . There is a general inflation in the notion of the good that drugs can do (and a deflation in concern about side effects)”.

- Angell, The Truth About the Drug Companies, p. 112.

Pharmaceutical companies can apply suspicious selectivity when recruiting for clinical studies. A survey and a study of 803 outpatients at Brown University showed that from one-sixth to 95 percent of “depressed patients treated in an outpatient setting would be excluded from the typical study approved by the federal Food and Drug Administration to determine whether a new antidepressant medication works”. The study concludes that "subjects treated in antidepressant trials represent a minority of patients treated for major depression in routine clinical practice”.

- Zimmerman, Mark, MD, Jill I. Mattia, PhD, and Michael A. Posternak, MD, “Are Subjects in Pharmacological Treatment Trials of Depression Representative of Patients in Routine Clinical Practice?”, American Journal of Psychiatry, March, 2002, 159:469-473.

“The current practice . . . may actually skew the findings of the drug trials”, according to Zimmerman.

- Rosack, Jim, “Clinical-Trial Criteria Leave Limited Study Population”, Psychiatric News, V folume 37 Number 10, May 17, 2002, p. 28.

Opiates can be superior to thymoleptics for psychological relief: “As shown in the present investigation, the mixed opiate agonist/antagonist buprenorphine exhibits antidepressant properties in cases not responding to conventional thymoleptic therapy. This is a remarkable finding, since for this type of patient, an inevitable consequence would be the application of electroconvulsion, . . . which . . . is not a desirable choice in the treatment of psychiatric patients”.

- Emrich, H. M., "Possible Antidepressive Effects of Opioids: Action of Buprenorphine", in Opioids in Mental Illness: Theories, Clinical Observations, and Treatment Possibilities, edited by Karl Verebey, The New York Academy of Sciences, New York, New York, 1982, p. 111.

Opiates can be superior to thymoleptics for psychological relief: “We have personally treated five patients with BPN in whom the results were impressive. Three were more or less typical cases of depression who had failed adequate trials with various treatments, including, in one case, a thorough course of ECT [electro-convulsive therapy]. Of the two less typical patients, one was a case of panic disorder with onset in childhood and what could better be called dysthymia rather than typical depression.... All five patients were followed for several years while good results were maintained”.

- Callaway, Enoch, Editorial, Biological Psychiatry, June 15, 1996.

Opiates can be superior to thymoleptics for psychological relief: “Through advances in medicine, the human life span has lengthened with a consequent increase in the population of geriatric patients with dementia and depression. The choice of psychotropic medication for these patients poses special problems owing to their increased susceptibility to adverse drug reactions [here the authors quote three sources]. The side effects of major tranquilizers, e.g. extra-pyramidal restlessness, parkinsonism, and hypertensive episodes, may complicate the clinical picture of an elderly, agitated patient. However, the main clinical problem with these drugs is that there is often mental hebetude even though target symptoms have abated. The patients appear overdrugged, and relatives often refer to them as “zombies” and are discomforted in their presence. Many of these patients display rapid clinical improvement following discontinuation of maintenance doses of psychotropic drugs, calling in question the advisability of long-term medication for psycho-geriatric patients. . . . As for tricyclic medication for the depressed aged patient, there is a lowered threshold for toxic confusion, glaucoma, urinary retention, cardiovascular embarrassment, and parkinsonism. This may at time[s] seriously limit their use in the elderly. . . . During the past 27 years, the senior author has treated many cases of senile dementia with suitably adjusted dosage of opium-related compounds [mostly deodorized tincture of opium]. The results have often been superior to those obtained previously in the same patients with other medications, including phenothiazines and tricyclic antidepressants. Not only the target symptoms (depression, confusion, paranoid ideation, etc.) abated, but a cheerful and cooperative mood appeared, rendering the patient amenable to rehabilitative measures”.

- Abse, D. Wilfred, William J. Rheuban, and Salman Akhtar, “The Poppy: Therapeutic Potential in Cases of Dementia with Depression”, in Opioids in Mental Illness: Theories, Clinical Observations, and Treatment Possibilities, edited by Karl Verebey, The New York Academy of Sciences, New York, New York, 1982, pp. 79ff.

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CITATIONS regarding the idea (voiced above, months ago, without citation) that opioids would just make a person sleepy:

Opiates may produce “excitation” and “stimulation”.

- Reynolds, A. K., PhD, and Lowell O. Randall, PhD, Morphine and Allied Drugs (1959), p. 19.

Berridge provides considerable discussion of opioids as stimulants, and shows that they were not uncommonly viewed as such.

- Berridge, Opium and the People: Opiate Use in Nineteenth-Century England, 1987.

Takano discusses farmers who take opium to help them work a long, hard day in the fields.

- Takano, Hideyuki, The Shore Beyond Good and Evil: A Report from Inside Burma's Opium Kingdom (2002).

Way discusses the use of opium as an aid to work.

- Way, E. Leong (Department of Pharmacology, School of Medicine, University of California, San Francisco, San Francisco, California, USA), "History of Opiate Use in the Orient and the United States", in Opioids in Mental Illness: Theories, Clinical Observations, and Treatment Possibilities, edited by Karl Verebey, The New York Academy of Sciences, New York, New York (1982).

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CITATIONS regarding the idea (voiced above, months ago, without citation) that constipation and nausea might be major obstacles to the use of opioids for mood therapy:

“Constipation . . . is treated [with laxatives and stool-softeners]. . . . Opium-related nausea might occur after an increase in dosage or initiation of opium therapy".

- Burton, Allen W., "Acute, Chronic, and Cancer Pain: Clinical Management", in Opioid Research: Methods and Protocols, edited by Pan, Zhizhang Z., 2004, p. 277.

(The implication is that easing in to the target dosage will greatly reduce constipation and nausea. Since opioids act so quickly, easing in is not necessarily a long process.)

"It is very important to watch out for constipation, which can be severe” and “can be a very considerable complication”.

- Abse, D. Wilfred, quoted in “Opiate Antagonists in the Treatment of Mental Diseases: General Discussion”, in Opioids in Mental Illness: Theories, Clinical Observations, and Treatment Possibilities, edited by Karl Verebey, The New York Academy of Sciences, New York, New York, 1982, p. 129.

“Nausea and vomiting are relatively uncommon in recumbent patients given therapeutic doses of morphine”.

- Gutstein, Howard B. and Huda Akil, “Opioid Analgesics: Effects”, in Goodman and Gilman’s.

(The implication is that nausea is manageable, given that just lying down can make it a relatively uncommon symptom.)

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CITATIONS regarding the idea that addiction, triggered by euphoria, is a speedy and frequent result of therapeutic use of opioids:

The dosage required to produce euphoria is significantly greater than the dosage required to relieve distress, and tolerance appears to develop much more rapidly for euphoria than for other effects of opioids. For example, Hideyuki Takano says of his second use of opium: “On the one hand, the opium worked on the symptoms unbelievably well and quickly. On the other, that blissful pleasure of floating in air, experienced the first time, disappointingly never recurred. However, the milder euphoria that came instead was pleasant”.

- Takano, Hideyuki, The Shore Beyond Good and Evil: A Report from Inside Burma's Opium Kingdom (2002), pp. 188f.

While anodyne effects are common, perhaps universal, euphoria seems to be unavailable to many: “Euphoria is not a universal accompaniment of opiate administration. Indeed, to the well-adjusted individual, morphine effects may be anything but pleasant. It is in the emotionally unstable person who is liable to be abnormally excited or depressed, that is to say, the individual who is removed from normal psychological equilibrium in relation to the immediate environment and circumstances, that euphoria is most marked. . . . Opiates afford an escape mechanism from reality and the burdens and disappointments of everyday life”.

- Reynolds, A. K., PhD, and Lowell O. Randall, PhD, Morphine and Allied Drugs (1959), p. 125.

“When therapeutic doses of morphine are given to patients with pain, they report that the pain is less intense, less discomforting, or entirely gone; drowsiness commonly occurs. In addition to relief of distress, some patients experience euphoria”.

- Gutstein, Howard B. and Huda Akil, “Opioid Analgesics: Effects”, in Goodman and Gilman’s.

“Although tolerance does develop to oral opioids, many patients obtain relief from the same dosage for weeks or months”.

- Gutstein, Howard B. and Huda Akil, “Opioid Analgesics: Clinical Summary”, in Goodman and Gilman’s.

“Tolerance and dependence are physiological responses seen in all patients and are not predictors of addiction. . . . These processes appear to be quite distinct. For example, cancer pain often requires prolonged treatment with high doses of opioids, leading to tolerance and dependence. Yet abuse in this setting is very unusual (Foley, 1993)”.

- Gutstein, Howard B. and Huda Akil, “Opioid Analgesics: Effects”, in Goodman and Gilman’s.

“The importance of the issues of tolerance, dependence, and respiratory depression have been exaggerated”.

- Walsh, T. Declan, MSc, “Prevention of Opioid Side Effects”, Journal of Pain and Symptom Management, December, 1990, p. 362.

“The existence of so-called chippers, individuals who use heroin recreationally on a periodic basis, indicates that exposure to an opioid alone does not reliably lead to escalating use or addictive behaviors, even in those who consume these drugs for purposes other than pain control”.

- Portenoy, Russell K., MD, “Chronic Opioid Therapy in Nonmalignant Pain”, Journal of Pain and Symptom Management, February, 1990, p. S54.

“An early concern that self-administration of opioids would increase the probability of addiction has not materialized”.

- Gutstein, Howard B. and Huda Akil, “Opioid Analgesics: Therapeutic Use”, in Goodman and Gilman’s.

“Interestingly, according to reports of that [Kraepelin’s] time, although a standardized evaluation of the therapeutic efficacy was, and is, lacking, this treatment was effective and did not result in opiate addiction, possibly since the doses applied were comparatively low”.

- Emrich, H. M., P. Vogt, and A. Herz (Max-Plack Institute for Psychiatry, Munich, Germany, "Possible Antidepressive Effects of Opioids: Action of Buprenorphine", in Opioids in Mental Illness: Theories, Clinical Observations, and Treatment Possibilities, edited by Karl Verebey, The New York Academy of Sciences, New York, New York, 1982, p. 108.

“[J. H.] Jaffe many years ago [in 1968] opined that the fear of addiction is out of proportion to the actual frequency of its occurrence. In the cases of opium-treated dementias with which we are concerned, this fear seems especially misplaced. In our experience, [the patient] does not require increasing doses . . . over time”.

- Abse, D. Wilfred, William J. Rheuban, and Salman Akhtar, “The Poppy: Therapeutic Potential in Cases of Dementia with Depression”, in Opioids in Mental Illness: Theories, Clinical Observations, and Treatment Possibilities, edited by Karl Verebey, The New York Academy of Sciences, New York, New York, 1982, pp. 79ff.

"Some 20 years ago at the University of North Carolina where I was working, people were interested in some of the opiate effects on elderly people at the psychiatric unit for whom the drug was euphoric. Also, these researchers investigated cheerful, young adults who were being given various drugs and opiates to see their reactions. Healthy, cheerful students who received opiates became depressed after they had a dose, which was the opposite of what was happening with the older people with impaired nervous systems."

- Abse, D. Wilfred, quoted in “Opiate Antagonists in the Treatment of Mental Diseases: General Discussion”, in Opioids in Mental Illness: Theories, Clinical Observations, and Treatment Possibilities, edited by Karl Verebey, The New York Academy of Sciences, New York, New York, 1982, p. 129.

TH 01:09, 18 February 2006 (UTC)

geriatric depression

Further research with respect to the last paragraph of "Clinical use" produced additional citations and the addition of "geriatric depression" to the list - formerly "senile dementia, chemotherapy, terminal diagnosis", now "senile dementia, geriatric depression, chemotherapy, terminal diagnosis".

To keep all the citations in support of the paragraph in one place, I went back up in this Discussion page and inserted them into the original list. The new citations are:

1. Regarding thymoleptics: "Through advances in medicine, . . . limit their use in the elderly".

2. Regarding constipation: "It is very important . . . considerable complication".

3. Regarding addiction: "Some 20 years ago . . . impaired nervous systems".

TH 01:25, 3 March 2006 (UTC)

Note to the person who changed Clinical Use:

If you want to alter my paragraph, you must, per Wikipedia policy, provide citations. And make sure your citations have more authority than the 38 citations that I provided, on the discussion page, in support of my paragraph.

TH 05:05, 11 March 2006 (UTC)

added citation on STAR*D and clarification on "act surely"

In support of the last paragraph of the "United States" section of the article, I added a citation regarding the STAR*D study of 1500 patients. I also added the paragraph regarding "opioids act surely".

I made these two additions above here on the Discussion page, so that all the citations would stay together.

TH 05:38, 1 April 2006 (UTC)

Etonitazene

Just started a page on Etonitazene, but don't know/can't find very much information. Anybody want to help me?

http://en.wikipedia.org/wiki/Etonitazene

Miserlou 20:09, 7 April 2006 (UTC)

Recurring Abdominal pain and nasuea

I have been to and worked in detox facilities and methadone clinics, was a junkie for over five years, my dad has been on opiates for chronic pain for half my life. I've known hundred of junkies, and never once heard of recurring abdominal pain and nasuea due to taking painkillers...that section (it's under withdrawl and dependence) is just bizarre to me...can anyone provide a source for this? —The preceding unsigned comment was added by Azrayl (talk • contribs) 21:09, May 22, 2006 (UTC)

Since that paragraph discusses "when the pain medication runs out," I think it's talking about nausea and abdominal pain as withdrawal symptoms. They are, of course, very common withdrawal symptoms. However, nausea is also a very common side effect of all opiate based drugs. Abdominal pain is also a common side effect and in some cases can be a manifestation of the chronic constipation (and even bowel obstructions) opiate based drugs can cause. One reference which states this is The Drug Guide by Dr Jonathan Upfall, ISBN 0957988338, p.471, which lists "constipation, dry mouth, stomach ache, nausea, vomiting" as side effects of morphine, for example. Sarah Ewart (Talk) 10:16, 2 July 2006 (UTC)

Okay, yeah I'm not sure why I said naseau wasn't a side-effect, because it is. and abdominal pain can present itself due to constipation or withdrawal. --Azrayl 09:11, 15 July 2006 (UTC)

Added DSM-IV terminology note

The terminology section has definitions that differ from the standard used in psychiatry. To avoid confusion by readers who may have received diagnoses from their healthcare professional, I added a note explaining the variation. With any luck, the addictive disease workgroup at the APA will address nomenclature as part of the DSM-V development. At this time, that's still in the plan. Drgitlow 02:11, 7 July 2006 (UTC)

Uncited Statements-again

Someone deleted (probably just an accident) all the explanations I gave for the changes I made, along with all of the peer reviewed professional references that I gave to substantiate them. Well, here they are again.

I took out:

"it rarely develops in persons who are taking opioids under medical supervision for legitimate therapeutic purposes (such as pain management), particularly when the dosage used is too low to produce any feeling of euphoria."

and also "the emerging medical consensus is that most chronic pain patients can safely use opioids for years with a minimal risk of addiction or toxicity and that the overall increase in quality of life outweighs any adverse effects of opioid use."

and "Typically, persons taking opioids under medical supervision for the usual clinical purposes (such as pain management) are less likely to develop addictions or patterns of abuse than those who begin using the drug specifically for its other effects such as euphoria. However it is very likely that many addicts began using because they experienced the great relief from some types of "psychological pain" that only opiates can provide."

and "Although physical dependence is nearly universal among those who use opioids regularly, true addiction is quite rare even when large amounts of opioids are used over long periods of time to treat chronic pain under the close supervision of a doctor. This is thought to be because of the rapid development of tolerance to the euphorigenic properties of opioids; without euphoria, only the unpleasant side effects (such as bowel dysfunction) remain, so there is no motivation to take more than is needed to manage pain.

Because these statements are untrue and no evidence or citation is given, while evidence to the contrary is well known in the peer reviewed medical community, addictionj rates are higher among those who use opiates for medical use do to exposure. Please cite a peer reviewed source if you with to replace it. My sources are listed below thank you. 76.20.176.60 12:52, 5 October 2006 (UTC)

Miller NS, Disease Orientation Taking Away Blame and Shame, Chapter 6, in Addiction Recovery Tools, pp 99-109, R. H. Coombs, ed., Sage Publications 2001.

Dackis CA and Miller NS, Neurobiological Effects Determine Treatment Options for Alcohol, Cocaine and Heroin Addiction, Psychiatric Annals, 33(9): 585-592. 2003.

Miller, NS, “Drug Abuse”, Rakel and Bope: Conn’s Current Therapy, W.B.Saunders Co., 2002, pp. 1117-1124

Miller NS and Goldsmith RJ, Craving for Alcohol and Drugs in Animals and Humans: Biology and Behavior, Journal of Addictive Diseases, 20(3): 87-104. 2001.

I took out "One of the advantages of opioids is that there is no upper limit to the dosage and the achievable pain relief as long as the dose is increased gradually to allow tolerance to develop to adverse effects (especially respiratory depression)." because this is untrue. There is ALWAYS a dose at which adverse effects or lethality occur for every substance man can physically intake. This includes opiates, for example, one could never titrate a dose of oxycontin up to say, 100 grams a day. 76.20.176.60 12:52, 5 October 2006 (UTC)

Source: Katzung B, Basic & Clinical Pharmacology, 9th ed., McGraw Hill, 2006.

Brunton L, et al, eds, Goodman and Gilman’s The Pharmacologic Basis of Therapeutics, 11th ed., McGraw Hill, 2006.

76.20.etc's assertions above are false. most of the above quotes that he opposes are consistent with accepted practice in the pain-specialist community -- although it's understandable that you *CAN* find sources that are opposed, especially if you quote only from the anti-addiction literature and choose articles all from the same source. as for his assertion about upper limits, there are documented cases of late-stage cancer patients receiving a few grams of intravenous morphine each hour without strong negative effects. granted, this is an extreme case but it clearly shows that his assertions are untrue. Benwing 05:04, 8 January 2007 (UTC)

some sources: [1] [2] [3] [4] —The preceding unsigned comment was added by Benwing (talk • contribs) 05:18, 8 January 2007 (UTC).

opioid word

i think it should be noted that Opioid is actually opi(um) + (alkal)oids

Last reversion by Daksya

This research you cite as "new developments" showing that chronic opiate users can take these drugs without dependance is flawed. It is nothing more than a case report, it does npt meet the criteria of being evidence based clinical research. RCT are the gold standard, and even a cohort study would have some credibility, but a case report is not evidence based to proove causality or lack of association. It proves nothing and is not a "development." {{76.20.176.60 20:04, 29 October 2006 (UTC)}}

You seem to have missed the second cite which contains results of various clinical trials (including Phase III) and controlled animal studies, alongwith in vitro experiments. - daksya 06:41, 30 October 2006 (UTC)

Sorry about that, I did not see the second citation. The clinical trials you mention seem to indicate that withrawal effects can be reduced using opioid receptor antagonists. If you want to say that in the artice, ok, but to say "although recent research points the way towards chronic opioid use without tolerance or withdrawal" makes in invalid conclusion. Maybe you could say something like "recent research shows that, when used with opioid antagonists such as naltrexone, withdrawal effects can be reduced" However, the statement you made as it is written is not supported by the research you cited. {{76.20.176.60 16:48, 30 October 2006 (UTC)}}

I went ahead and changed it to say "All persons receiving opioids for any reason will develop some degree of tolerance and dependence over time, although recent research suggests that these effects can be reduced by the concominant administration of opioid antagonists. [1][2]. " I think this pretty much acknowledges the research findings for what they are. It just sounded misleading the way it was written before. {{76.20.176.60 16:55, 30 October 2006 (UTC)}}

Compare and Contrast

What has been bothering me is that when I read the opioid article I see a great deal of clinical information and though some is pretty biased, a lot is quite irrefutably factual and informative. Then, I read the opium article and am wildly disappointed. Is it the social-acceptance syndrome that causes this? Papaver Somniferum is one of (and perhaps the highest-importance of) the five most important plants humankind has ever discovered. The plant and its active derivatives are still the most effective and safe analgesics, cough suppressants, anti-diarrhoeals known. I wish the vast majority of you would stop bashing the plant and hypocritically lauding all its derivatives. DrMorelos 00:44, 25 November 2006 (UTC)