Dopamine Agonists and Opaite Withdrawal

[MttJocy]

Firstly I would like to point out Paarmol does not contain codeine it contains a stronger opioid called dihydrocodeine (dihydrocodeine tartrate 7.46mg and APAP 500mg) still quite a weak one though. The neurofen plus correctly contains codeine 12.8mg ibuprofen 200mg.

As for the dopamine antagonists never tried a psych medication for it like that so can't comment there but if it helps you go with it.

[The~Quinty~One]

Hi Everyone,

I've taken quite a few opiates in my time but at present I'm using the small amounts of codeine available in OTC products from the pharmacy. I combine a paracetamol-based preparation called Paramol with an ibuprofen-based one called Nurofen Plus, and together they contain the equivalent of ~50mg codeine. I started using these after quitting high dose clonazepam last year 'cause they helped a little with the depression and rebound anxiety.

I've taken them for nearly a year now and of course tolerance has developed. Now I hardly feel any effect at all. Also, I seem to have developed an NSAID-induced ulcer of some sort from the ibuprofen and my doctor has given me a month's supply of the proton pump inhibitor lansoprazole to allow it to heal. So I've been trying to come off them.

Last week I woke up feeling really low and grotty after quitting cold turkey for a few days. I had no codeine in the house but looking through my drug cupboard I found an old packet of Mirapex (pramipexole). I remembered that pramipexole seemed to ease my withdrawal symptoms back in March when I ran out of codeine, but at the time, although the idea that dopamine agonists might help opiate withdrawal symptoms made logical and intuitive sense to me, I thought this might just have been be a fluke. So opened the box and split off a 0.125mg dose and made my breakfast.

It didn't take long to feel the effect, within twenty minutes I felt warm and fuzzy with a tremendous sense of wellbeing. I went and put on some music and danced freely to it - that's not like me at all and a complete change from the hunched-over ball of suffering I'd been just minutes before. Obviously I considered if this was a placebo effect, but I've taken many psych meds and never felt a response like this even when I was expecting great things - well to honest the only drugs that met or exceeded my expectations have been opiates and benzos.

So I went on the net and searched for info and dopamine agonists and opiate withdrawal. This seems to be an intelligent and well-read forum so I guess many of you will be familiar with the story of William S. Burroughs' apomorphine 'cure' under the care of Doctor John Yerbury Dent? Well I was not until that point, but of course many things now fall into place. As I said, it seemed logical and intuitive to me that dopamine agonists might attenuate withdrawal symptoms from opiates and other drugs of abuse, so I'm sure other people familiar with these drugs will have had the same idea.

For that reason I'm puzzled as to why dopamine agonists have not become part of mainstream drug withdrawal treatment. One site I found in my search was this interesting account of Dr. Dent's apomorphine cure, and correspondence with William Burroughs himself: http://www.geocities.com/Athens/Crete/9445/apo.html. I'm in the process of writing up my account for the lady who runs the webpage and I'm wondering if anyone else here has had similar experiences, or any ideas as to why dopamine agonists are not in widespread use?

The initial euphoria from pramipexole faded within a few days, so I'm inclined to think that this was more a feeling of relief than drug-induced euphoria per se. Still it makes me feel good, but more in the way your Prozac (or maybe Lamictal - pramipexole has shown robust effects as a mood stabilizer in bipolar disorder) makes you feel 'good' when it works - the pain has gone away and life is more bearable, you're not high - but you're stable and content and able to cope. This is what pramipexole has done for me.

[The~Quinty~One]

Yeah, I know which opiate Paramol contains. As I said, from two tablets of each brand I get in total round about the equivalent of 50mg of codeine, not 50mg of actual codeine itself. I didn't want to go into an analysis of all this because that wasn't the main point of my post. I'm aware that is a small amount of a weak opiate, so it's certainly not like someone coming off Heroin or anything like that. But still it's very unpleasant if that's what's been keeping you going.

Here is my reasoning for giving the ballpark estimate of 50mg codeine:

Dihydrocodeine is said to be about 1.5x as potent as codeine, so from 7.46 x 2 you get 14.92mg of dihydrocodeine. 14.92 x 1.5 = 22.38, so this is roughly equivalent to 22mg of codeine, but of course there is considerable variability between people.

If we consider Nurofen Plus which contains 12.8mg codeine per tablet, 12.8 x 2 = 25.6.

Add both results together; 25.6 + 22.38 = 47.98, so in total I get the equivalent of roughly 50mg codeine from that cocktail if I take the two tablets of each brand since. So that's why I gave a ballpark estimate of 50mg of codeine - just for easy figures.


"As for the dopamine antagonists never tried a psych medication for it like that so can't comment there but if it helps you go with it."

Well if there's one thing I don't want to take during opiate withdrawal it's a dopamine antagonist! They are anti-psychotic drugs like chlorpromazine and quetiapine for example and are used to treat Schizophrenia and other serious mental illness. They make me feel like shit, but there's a trend now for psychiatrists to prescribe them for all manner of complaints, even for insomnia. Some people say they do well on them, some people feel lousy while taking them, and some are forced to take them against their will no matter how they make them feel...

They have some serious bad-ass side effects too.

[pharmboy]

In Scientific American this month there is an article
about how Ketamine helps control depression.
Of course for the first few hours it gets you high as
a kite but afterwords they say the anti-depression
effects last for a couple of days.
I always knew that real drugs like morphine, oxy, Etc.
worked a hell of a lot better than that SSRI shit they push.

[pharmboy]

Ohh Sorry, Its in the magazine
Scientific American MIND.

[The~Quinty~One]

I've seen those studies too! I have a friend who uses ketamine weekly for that purpose and he combines it with a low dose of lamotrigine to counter that NMDA receptor antagonist toxicity thingy. He says it works really well but I haven't tried it yet, but I'm not depressed at the moment and don't want to mess with my brain chemistry too much. Hmm... well maybe I'll give it a try some day - I've hardly been fussy with the pharms I've put in my body so far.

I saw a study just the other day over on PubMed where some researchers had combined pramipexole with the SNRI antidepressant venlafaxine and found it mimicked the reinforcing effect of cocaine in 99% of rats tested! I have some venlafaxine left over from one of my drug trials so I was thinking of trying it. I've already combined it with reboxetine in the hope of countering the drowsiness and mental fog pramipexole causes. It worked but made me very nervous.

Here is that study:

-------------------------------------------------------------------------------------------------------------------------------------------------------
Does combined treatment with novel antidepressants and a dopamine D3 receptor agonist reproduce cocaine discrimination in rats?
Filip M, Papla I.
Department of Pharmacology, Institute of Pharmacology, Polish Academy of Sciences, Kraków. filip@if-pan.krakow.pl

It is established that dopamine (DA) neurotransmission plays a critical role in the behavioral (e.g. discriminative stimulus) effects of cocaine in rodents. Nonetheless, research has also demonstrated that reciprocal signaling between DA and monoamine neurotransmitters, i.e. serotonin (5-HT) and norepinephrine (NE) has important implication for understanding the actions of cocaine. The present study was focussed on the ability of novel antidepressant drugs (milnacipram, reboxetine and venlafaxine), which affect either NE or both 5-HT and NE reuptake mechanism, to alter (enhance or antagonize) the discriminative stimulus effects of cocaine. Moreover, we investigated if the combined treatment with those drugs and a DA D3 receptor agonist (pramipexole) could reproduce cocaine discrimination. Male Wistar rats were trained to discriminate cocaine (10 mg/kg, ip) from saline (ip) in a two-choice, water-reinforced fixed-ratio 20 drug discrimination paradigm. Given alone, none of antidepressant drugs induced substitution for the cocaine-lever responses. Pramipexole (0.25 mg/kg) produced a partial substitution for cocaine (i.e. 43-52% cocaine-lever responding). In combination experiments, milnacipram (10 mg/kg) or reboxetine (10 mg/kg) given with submaximal doses of cocaine (1.25-5 mg/kg) did not affect the cocaine dose-response curve or its ED50 values. Venlafaxine (10 mg/kg) given in combination with submaximal doses of cocaine (0.6-5 mg/kg) produced significant enhancement of cocaine discrimination with a leftward shift in the cocaine dose-response curve and a decrease in its ED50 value. Pretreatment with either milnacipram (10 mg/kg) or reboxetine (10 mg/kg) failed to modulate the partial substitution evoked by pramipexole (0.25 mg/kg). On the other hand, venlafaxine (10 mg/kg) given in combination with a submaximal dose of pramipexole (0.25 mg/kg), which separately elicited 16 and 42% the cocaine-lever responses, produced significant enhancement of cocaine discrimination (up to 99% of the drug-lever responding). These results indicate that the discriminative stimulus effects of cocaine in rats can be enhanced by venlafaxine or mimicked by the combination with this antidepressant drug and the DA D3 receptor agonist. This finding, together with the recent data reporting the lack of rewarding properties of venlafaxine and the attenuation of morphine dependence and withdrwal signs in rats by the drug, may indicate a possible therapeutic use of this antidepressant in cocaine abuse.

PMID: 11985331 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=11985331&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstractPlus
-------------------------------------------------------------------------------------------------------------------------------------------------------

This passage in particular stands out in my mind:

"On the other hand, venlafaxine (10 mg/kg) given in combination with a submaximal dose of pramipexole (0.25 mg/kg), which separately elicited 16 and 42% the cocaine-lever responses, produced significant enhancement of cocaine discrimination (up to 99% of the drug-lever responding). These results indicate that the discriminative stimulus effects of cocaine in rats can be enhanced by venlafaxine or mimicked by the combination with this antidepressant drug and the DA D3 receptor agonist. This finding, together with the recent data reporting the lack of rewarding properties of venlafaxine and the attenuation of morphine dependence and withdrawal signs in rats by the drug, may indicate a possible therapeutic use of this antidepressant in cocaine abuse."

[djnarkotik]

the problem is with using a dopamine agonist, you are just affecting the dopamine system. your right in that drugs of abuse increase dopamine in the pleasure center, and it would make sense to stimulate it when your off drugs.

but opiates work on alot more then dopamine, they work on serotonin and many more neurotransmitter systems.


so you just affecting one aspect of the opiate withdrawl. if it helps you thats cool, but the extent of DA to be theraputic is limited.

[jonny-5]

plus we are talking withdrawls from codeine, and not a very high dose i might add. im sure it wouldnt help much for someone who is comming off a 4 month heroin binge.

[The~Quinty~One]

True, opiates and other drugs of abuse work on many different neurotransmitter systems, so if you're looking for a drug that can replace them directly then dopamine agonists probably won't satisfy you. That isn't the idea I'm proposing though, and that wasn't the intention behind Dr. Dent's treatment protocol either.

If you were to take away an addict's supply of opiates and replace them with a dopamine agonist he would very likely complain and be dissatisfied with it. If you were to give a dopamine agonist to an addict suffering severe withdrawal symptoms he would likely be very grateful and very satisfied if the dopamine agonist relieved his suffering. So it's partly a matter of perception I think. I'm wondering if you've ever used a dopamine agonist yourself to ease withdrawal symptoms? You seem fairly confident that the other neurotransmitter systems are as important, or more important than dopamine in withdrawal, but having personal experience of this treatment I don't think that's always true - pramipexole completely abolished my withdrawal symptoms.

I think dopamine agonists have greater potential than opiate maintenance therapy in some ways because:

* Dopamine agonists are not controlled substances.

* Dopamine agonists can be prescribed by ordinary doctors - they don't require a special license to dispense to addicts.

* A month's supply (or whatever) of dopamine agonist can be dispensed to addicts to take at home, removing the inconvenience of having to visit the pharmacy every day. I've heard some people complain this is a major disadvantage when trying to find work as they have to be at the pharmacy at a certain time and they don't want to explain to a potential employer why they need to leave work or choose a particular shift. So there's certainly an advantage there.

* Dopamine agonists and antidepressants carry less stigma than opiates, even in the eyes of doctors and pharmacy staff who might know the reason for the prescription.

I think the other neurotransmitter systems play more of an ancillary role with opiates, and it's possible to combine dopamine agonists with antidepressants to mimic some of these effects anyway, as outlined in the study I posted above. On the whole I think dopamine agonists have great potential in the treatment of drug withdrawal. This isn't simply my experience either.

[jacky]

venlafaxine and tramadol are both VERY similiar in structure, and as it turns out, both effect the serotonin, dopamine and opioid receptors to some degree...
this is why people, including me, suffered from strong opioid withdrawl effects when quitting effexor cold turkey.

I think the reason that more dopamine agonists are not used for opioid withdrawl is that alot of people might end up abusing the dopaminergic compounds.
I have used different dopamine agonists for opioid withdrawl, from meth, cocaine, to pukateine and tramadol...
with the exception of tramadol, the rest of those compounds always ended up causing me some anxiety, and increased means for relapsing.

there is a spot in the brain, the ventral tegmental region of the mesolimbic system....in this area dopamine and opioid receptors are very closely situated. a syndrome known as paradoxical stimulation can arise from the chronic use of opiates, this is basically in effect, the release of dopamine from consuming opiates. the effect is similiar in ways to forced withdrawl, anxiety, sweating are very strong, and doing more dope just seems to make matters worse.
it is VERY interesting, that when morphine is injected into this SPECIFIC area of the brain, the ventral tegmental region of the mesolimbic system, that NO tolerance/addictive effects to the opiates were noticed in the rat.

so maybe the interplay of dopaminergics and opiates might be used effectively by some individuals to their benefit.
I have some amfonelic acid sitting around that I have been toying with the idea of using to see if it is a good substance mixed with opiates...and is highly possible I think that a dopamine reuptake inhibitor like this might have a good effect on opiate withdrawl symptoms.

dopaminergics and withdrawl?
I think its obvious that certian ones might help some opiate addicts.
I think what we need is a thousand paths towards healing, not 1 or 2 or a few more alternatives to heroin or detox, or methadone/buprenorphine detox/maintenance, but hundreds of different options, herbal, medicinal and beyond.

I read one study in which freebase cocaine was used in ground up form as a nasal spray for arthritis sufferers. the freebase cocaine is slow release, due to not being water soluable. this created a slow release pain relieving effect that did not interfere with most peoples comfort level.
this snortable "crack" formula was used effectively in treating some peoples arthritis, some even recovered a bit physically.
sadly, the research was put to and end for reasons unknown to me, but it probably had something to do with the DEA.
I think that if you were going to try and use cocaine for opiate detox, that this ground freebase cocaine formula might work very well, just giving the person enough for a feeling of wellbeing and pain relief, but not causing strong stimulation or euphoria.

[The~Quinty~One]

jonny-5 did you read Dr. Dent's apomorphine treatment protocol? He was working with addicts suffering severe withdrawal symptoms from high doses of Heroin and morphine. I'm not simply reporting my own experience, I discovered Dr. Dent's work after my happy accident with pramipexole.

[The~Quinty~One]

Thank you for adding your experience jacky. I think the dopamine agonists available today mostly stimulate the dopamine receptors of the striatum and substantia nigra in the basal ganglia, which control movement (though I admit I'm not sure exactly what all these structures are and what they do). There may be some direct or indirect stimulation of the nucleus accumbens, which is the pleasure centre of the brain, or so I've been lead to believe. I guess the perfect substitute for drugs of abuse would be a nucleus accumbens dopamine agonist? I want one :cool:, pure heaven I would think, and the opposite on withdrawal I would imagine.

Yeah, that crack cocaine preparation was called Esterene. I read about it in this book by Ronald K. Siegel Ph.d. "Intoxication: The Universal Drive For Mind-Altering Substances" (http://www.amazon.com/Intoxication-Universal-Drive-Mind-Altering-Substances/dp/1594770697/ref=pd_bbs_sr_1/102-4834898-9340155?ie=UTF8&s=books&qid=1184787223&sr=8-1). I think the dopamine agonists on the market today have limited abuse potential and have scope beyond opiate maintenance therapy because of this, and their legal status. I guess they're in a similar league to dopaminergic antidepressants - hell, I even managed to get some abuse potential out of Parnate!

Sure, I'm with you completely in that we need as many alternatives to drug dependence as we can get. No method is going to suit everyone.

[nick]

jonny-5 did you read Dr. Dent's apomorphine treatment protocol? He was working with addicts suffering severe withdrawal symptoms from high doses of Heroin and morphine. I'm not simply reporting my own experience, I discovered Dr. Dent's work after my happy accident with pramipexole.

I've read Dr Dent's work on Apomorphine and you know why it's not used anymore?

May have something to do with a huge relapse rate.

and yes,I know ALL about the "politics" of addiction.

[Duckfeet]

Just out of curiosity, is this the same "apomorphine" that William Burroughs raved about? Said in his literature that is was only treatment that had worked for him, and in his day you had to fly to London, I believe, to see the one doc who would prescribe it...I don't know the timeframe, but I thought this was also the period when *individual* docs could perscribe diamorphine to addicts. It was a long time ago, and the chemistry of this stuff wasn't as well known...anybody who knows this literary link, I'd love to hear more about it...he seemed to say that it was really a quick treatment too...tho I know later he got on methadone maintenance himself...maybe because he was american, and couldn't get on diamorphine....

Thankyou for tolerance for sidetrack.

df



I've read Dr Dent's work on Apomorphine and you know why it's not used anymore?

May have something to do with a huge relapse rate.

and yes,I know ALL about the "politics" of addiction.

[nick]

Just out of curiosity, is this the same "apomorphine" that William Burroughs raved about? Said in his literature that is was only treatment that had worked for him, and in his day you had to fly to London, I believe, to see the one doc who would prescribe it...I don't know the timeframe, but I thought this was also the period when *individual* docs could perscribe diamorphine to addicts. It was a long time ago, and the chemistry of this stuff wasn't as well known...anybody who knows this literary link, I'd love to hear more about it...he seemed to say that it was really a quick treatment too...tho I know later he got on methadone maintenance himself...maybe because he was american, and couldn't get on diamorphine....

Thankyou for tolerance for sidetrack.

df

Yeah bro,it's the same Apomorphine.Uncle Bill was one of Dent's patients and look what happened to Bill........back to H-then 'done for the rest of his life.

I asked my consultant about Apomorphine when I first went in to treatment and no one is using it in the UK-or anywhere else to his knowledge.

The reason......relapse rate.

and the doc's writing diamorphine is what I meant about the politics.Dent and Franknau did'nt get on and diamorphine rxing displaced apomorphine.

[The~Quinty~One]

May have something to do with a huge relapse rate.

Well I can certainly confirm that - I've relapsed already! What is the relapse rate for opiate maintenance therapy, is it much worse? Who funded the study that showed the huge relapse rate, was it Dr. Dent himself?


and yes,I know ALL about the "politics" of addiction.

Yes, and that too.

[nick]

Well I can certainly confirm that - I've relapsed already! What is the relapse rate for opiate maintenance therapy, is it much worse? Who funded the study that showed the huge relapse rate, was it Dr. Dent himself?



Yes, and that too.

There is a VERY old report on Apomophine treatment.I'll try and dig it out for you.

You seem to be suggesting you were treated with Apomorphine in the Uk.If so tell us all about it,I wasn't aware it was rxed anywhere in the UK.

The point about maintenance is if done right you don't relapse because you're not clean.it's regarded as a success if you're alive,not in jail and not using hard drugs.

I was rxed diamorphine for many years and in these terms it worked......it probably saved my life.

Oh and if you're into codeine,find a chemist that sells codeine linctus or try collis browns.

[The~Quinty~One]

I've never taken apomorphine - I 'acquired' a supply of another dopamine agonist called Mirapex (pramipexole) partly because I'm a drug geek and I want to try everything I can lay my hands on, also because my main problem is social phobia/agoraphobia and there's a strong link to that and Parkinson's disease. Mirapex is used to treat Parkinson's disease. There's this simplistic hypothesis that both conditions are caused by dysfunction of the dopamine system. So that's how I came to be taking a dopamine agonist, then I ran out of codeine and had my happy accident. I discovered Dr. Dent's work only last week after searching the net, I knew nothing about William Burroughs's apomorphine treatment at the time of my first trial so it certainly wasn't influenced by that.


The point about maintenance is if done right you don't relapse because you're not clean.I'm not sure what this means but I sense it has something to do with the things I've just been thinking about. I guess if you're on a dopamine agonist you're 'clean' as opposed to someone taking methadone or another opiate as maintenance? So why is relapsing back onto opiates from a dopamine agonist worse than taking maintenance opiates? Because the illicit opiates carry greater health and legal risks?


I was rxed diamorphine for many years and in these terms it worked......it probably saved my life.That's really good to hear. I think I should point out that I'm not saying dopamine agonists can or should replace maintenance opiates in all cases, or that they're appropriate for everyone. But I do think they're a valuable option for some, perhaps a minority of addicts in certain circumstances. Here are some situations where I think dopamine agonists are most likely to be helpful, and I'm sure there are many others we can all think of:

* Where an addict is struggling to fund his addiction to hard drugs, sincerely wants to get off the opiates, and uses a dopamine agonist to suppress his withdrawal symptoms as needed so that he can avoid getting into serious debt with people nobody wants to indebted to.

* Where an addict needs to travel to another country and doesn't want to risk smuggling his supply of opiates into a foreign country with harsh penalties. Even if his supply of dopamine agonist were from an illicit source, the authorities are much more likely to take a tolerant view than if he was caught with a supply of illicit opiates.

* Somebody who wants to hold down a 9-5 job and can't get to the pharmacy at the time the pharmacy demands, but is willing to use a dopamine agonist as an alternative to suppress withdrawal symptoms.

* People addicted to mild opiates and want to get off the opiate quickly, for a urine drug test at work for example, or many other reasons.

Another thing to bear in mind is that all the while you're on a dopamine agonist your opioid receptors are presumably regenerating despite the fact you're no longer suffering withdrawal symptoms. This may translate into lower tolerance when the opiates are reinstated. This has been my experience too... I know a lady on another board who managed to lower her tolerance to benzos by substituting Lyrica in a similar manner to this. So perhaps we could add a further example:

* An addict who wishes to reduce his tolerance to hard opiates so that he may move to 'softer' opiates and taper off them directly or use them as a maintenance therapy.

I think one of the factors behind the high relapse rate might be that dopamine agonists are known to induce pleasure-seeking behaviours in people such as sex, gambling, and of course drug taking... So this needs special consideration and forewarning. I haven't had a problem with this myself but I was aware dopamine agonists can do this so was careful to watch my behaviour.


Oh and if you're into codeine,find a chemist that sells codeine linctus or try collis brown:cool: If only!!! Yeah, a guy I know in Australia suggested them to me a while ago too, but I don't think too many pharmacists are wiling to sell pure codeine products to guys in their twenties these days :(.

[nick]

I hear you and dopamine agonists are a very interesting avenue,but I work in the field and I have so MANY clients maintanence is the only way to go.I know it's a one size fits all prophalactic approach,but sheer wait of numbers wins.
The ultimate maintanence argument is.....dead addicts don't recover.So,better to maintain someone.

Oh and I hate to tell you this,but my local Llyods chemist has bottles of linctus on view.Many chemists stock it......you just have to know how to appproach them.It's like a script,you just have to know your lines.
Plus I think Collis Brown's is a far better deal.£5 for 20mgs of pure,legal M.

and if you don't mind me asking,what part of the UK are you from....a county would do.I'm in Leeds/London.

[The~Quinty~One]

I don't claim to know much about the field. All I will say is that from where I'm standing as a layperson dopamine agonists seem to be ideal candidates for dealing with the situation you describe. I say this because large volumes of addicts could (in theory) be maintained on monthly prescriptions of dopamine agonists in much the same way that depressed people are maintained on monthly prescriptions of antidepressants. As I said in my introductory post, when dopamine agonists work it's like switching from an opiate to a mood-stabilizing antidepressant that also alleviates your withdrawal symptoms. People can be maintained on dopamine agonists like this for long periods of time, just as they can with methadone. It seems to me that dopamine agonists are a form of maintenance treatment, and a safer and more practical one than methadone too. I haven't checked this thoroughly but it's a good bet dopamine agonists are safer in overdose than methadone, they're not on the controlled drugs register either so can be prescribed by ordinary GPs, they would have a lower street value that methadone and other maintenance opiates, and the pharmacy could dispense monthly prescriptions for addicts to self-medicate at home - surely that would reduce the burden on your staff of dealing with daily prescriptions and all the beurocracy that goes with it?

As I said, I'm not here to antagonize people who are doing well on maintenance opiates, and I'm not suggesting they go off them and onto dopamine agonists. I'm just curious as to why I'm meeting so much resistance to what seems to be a very reasonable and practical addition to the withdrawal clinic's arsenal. I wonder if this is what frustrated Dr. Dent too? That, and claims that his treatment protocol was an aversion therapy.

I do wish he hadn't insisted that people must find a dose that makes them vomit - that's unnecessary in my view, people know when their withdrawal symptoms are gone so there's no need for enforced vomiting. I find it reminiscent of the era when psychiatrists were working under the idea that they needed to raise the dose of a patient's antipsychotic until EPS appeared in order for the drug to be effective. That was totally wrong and barbaric by today's standards too. So I think that part needs to be updated.

I've never questioned the availability of codeine linctus, but I'm fairly sure few would willingly sell it to me since they won't sell me Paramol or Nurofen Plus in person either - I have to order them from an online retail pharmacy and they don't sell codeine linctus as far as I know. I'd be very grateful if you knew of one that did though :cool:. What lines do you recommend? I'm fairly machiavellian myself - managed to get doctors to prescribe me all manner of drugs off-label, including clonazepam but I've found pharmacists very reluctant to dispense codeine.

I'm in the North East, County Durham to be precise. I was treated by NECA (North East Council on Drug Addiction) and DISC (forgotten what that acronym stands for), for benzodiazepine withdrawal. In fact I wasn't really treated at all - the woman in charge of my case refused a Librium taper because I was 'too unstable at this point'. Yeah, most people would be after quitting clonazepam cold-turkey, that's why I needed the Librium taper love...

[mrklean]

Am I right that Blue Lotus resin contains Apomorphine? I have used resin extract of this plant to combat general opiate cravings/PAWS. Seemed effective. If I am in fact correct about the plant containing this stuff then it is a definite plus for dopamine agonists. Who needs a pharmacy when you can grow it on a tree? WD from months of wreckless Kratom use was insignificant with only lotus and a few other herbs to help. Other dopamine agonists specifically coke are great till you have to come down friends tell me they like to take a few days off of H to slam girl and this is not only barable but fun. For a little while anyways. Meth and coke definately keep withdrawals away pretty effectively but, as soon as you stop you will need opiates in a really bad way. Dopamine agonists seem like an effective alternative short term maintanance option but definately not a cure or anything close to it.

[jacky]

well mrklean, I hate to be the bearer of bad news, but the lotus/lilly flowers reported to contain apomorphine actually DONT contain natural amounts of the alkaloid.

the confusion is that a small amount of apomorphine was created when a certian chemist I know performed TLC's on various lotus/lilly products...the apomorphine is there in the treated samples, but not in the raw herb, it is a minor trace semi synthetic product apparently, produced when this chemist performed his analysis.

he reported this a few months ago, trying to stop the spread of the misinformation, of which I am one of the guilty parties for spreading.

I have taken lilly/lotus products to see if they help cover opiate withdrawl....in every case they seemed to help with the sweating/ hot flash sensations to a degree, but DO NOT hold back withdrawl.
they seem to contain the similiar/same alkaloids as the chinese date seed , ziziphus jujube does, and that product has been used for opiate withdrawl by the chinese for some time.

I have gotten some interesting effects from the lilly/lotus materials, enough to want to experiment some more with.

[Ragdoll]

There are no absolutely no OTC preparations in the US that contain codeine, correct?

[The~Quinty~One]

Other dopamine agonists specifically coke are great till you have to come down friends tell me they like to take a few days off of H to slam girl and this is not only barable but fun. For a little while anyways. Meth and coke definately keep withdrawals away pretty effectively but, as soon as you stop you will need opiates in a really bad way. Dopamine agonists seem like an effective alternative short term maintanance option but definately not a cure or anything close to it.

Cocaine and meth are not dopamine agonists mrklean; they're dopamine (and noradrenaline and serotonin) releasers and reuptake inhibitors in varying degrees. So you can't compare your experiences with them to that of using true dopamine agonists. Dopamine agonists don't make you high and they don't deplete stores of the neurotransmitters like dopamine releasers do. I suppose that's one reason why people tend to 'burn out' after a short while on coke and meth etc., but not on dopamine agonists. Of course dopamine agonists are also very useful for coke and meth withdrawals too, especially in combination with venlafaxine it would seem.

I think the theory behind this is that they allow your dopamine, noradrenaline and serotonin receptors to regenerate (after being downregulated due to tolerance) while still supporting the neurotransmitter systems at the core, thus avoiding the 'crash' normally associated with abrupt withdrawal from these drugs. You can then reduce your dose of dopamine agonist at a pace that suits you, or you can continue to use it as a maintenance therapy.

I don't think dopamine agonists are a cure for addiction as such. I prefer Dr. Dent's term 'metabolic regulator', meaning they support the dopamine system during withdrawal, preventing the painful crash and allowing the addict to maintain normal functioning without opiates (or coke, meth, whatever).

This has to be a bonus, and I've listed several advantages of dopamine agonists over methadone elsewhere on this thread. One thing people complain to me about methadone is the degree of control the doctor has over them. One said it felt like he was a prisoner released on probation with a time-controlled tag that had to be presented to the doctor at the same time each day or he would suffer punishment (withdrawal symptoms). This guy also found methadone extremely dysphoric and he became very depressed and suicidal during his withdrawal. I suppose experiences vary though. Anyway, I think dopamine agonists have a clear place in the management of addiction, and if I were ever addicted to Heroin and offered a choice of methadone or dopamine agonist I would choose the dopamine agonist first without a doubt.

[The~Quinty~One]

There are no absolutely no OTC preparations in the US that contain codeine, correct?

I think some states allow the sale of low-strength codeine preparations OTC at the discretion of the pharmacist so long as they're combined with acetaminophen/paracetamol, ibuprofen or aspirin to poison anyone that has the audacity to take more than the prescribed dose. You can get OTC products like this in Canada anyway, but I'm not completely sure about the US.

[OxyContinuously]

Quite interesting Quinty,

Although this is just another "band-aid" therapy, swapping one thing for another...and drugs like ropinirole and pramipexole are not necessarily safe for people who don't require them; in other words, it is bad medical practice and/or foolhardy behavior as the "patient" to do something like this; reason being if ur dopamine system is fine to begin with and u treat it with a specific dopamine agonist, eventually you will destroy the system entirely, coming close to not producing enough dopamine required for normal life. (Parkinson's like symptoms are one "bump" that may occur) ANd frankly, that's a terrible price to pay.

It is a wrong and misguided assumption to say that dopamine agonists are the answer or a potential cure, whatever. They do work, and quite well, for a awhile, but they have major drawbacks....Akasthesias, and Dyskinesias to name two, for example. If the dopamine system of receptors/neurons are fine to begin with and u start with these drugs, u can be in for a world of hurt.

Sorry, no dice....snake eyes;)

later
peace

Oxy

[The~Quinty~One]

Quite interesting Quinty,

Although this is just another "band-aid" therapy, swapping one thing for another...and drugs like ropinirole and pramipexole are not necessarily safe for people who don't require them; in other words, it is bad medical practice and/or foolhardy behavior as the "patient" to do something like this; reason being if ur dopamine system is fine to begin with and u treat it with a specific dopamine agonist, eventually you will destroy the system entirely, coming close to not producing enough dopamine required for normal life. (Parkinson's like symptoms are one "bump" that may occur) ANd frankly, that's a terrible price to pay.

It is a wrong and misguided assumption to say that dopamine agonists are the answer or a potential cure, whatever. They do work, and quite well, for a awhile, but they have major drawbacks....Akasthesias, and Dyskinesias to name two, for example. If the dopamine system of receptors/neurons are fine to begin with and u start with these drugs, u can be in for a world of hurt.Oxy

Yup, as I've said before, dopamine agonists are purely a band-aid to support the dopamine system during withdrawal they're no 'cure' (although I'm not sure what a cure would be). I'm not claiming dopamine agonists are "The Answer" or a potential cure; simply that they act to support the dopamine system during withdrawal and that they would be a useful addition to the armoury of people treating addiction withdrawal symptoms. Drugs like morphine and Heroin also cause problems for people that don't 'need' them, that's why people seek the treatment of withdrawal clinics in the first place. True, dopamine agonists have unique side effects of their own, but they're no worse than opiates, SSRIs, SNRIs, DARIs, NARIs dopamine antagonists and the sundry other drugs that interfere with neurotransmitters that are widely prescribed in psychiatry.

Dopamine agonists are no more likely to cause Parkinson's Disease when used by people that don't have Parkinson's Disease than are opiates themselves and other drugs that act on the dopamine system such as Ritalin and cocaine. That doesn't mean there is no risk from using opiates or other drugs of abuse (I've read reports that claim that children given Ritalin in childhood may be at increased risk of developing Parkinson's disease in later life). One thing to bear in mind is that smokers are known to have a much lower incidence of Parkinson's Disease than non-smokers, yet nicotine increases dopamine in the reward circuits in the brain... I don't know what to make of these seemingly contradictory findings (well to be fair, the Ritalin claims are only hypotheses - they're not proven fact; the nicotine findings are proven fact).

As for your other claims, I'm reminded of a 'debate' I once had with a guy on another board regarding opiates in treatment resistant depression. He believed that opiates would be neurotoxic and quipped 'I'm surprised you guys have any opiate receptors left'. He claimed that the opiates receptors never recover once you've taken an opiate and people who use them would be damaged for life. It was cheap 'Just Say No' propaganda. Yet he himself was a heavy user of SSRI antidepressants and foresaw none of the same problems re: downregulation of receptors and withdrawal symptoms upon abrupt discontinuation. Yet these do happen and are well documented. I tried to educate him on these things to no avail. In his mind opiates were the devil's sperm and no reasoning could convince him otherwise.

I was a heavy user of benzodiazepines for over five years, quit cold turkey and after a period of adjustment I have no problems that could be attributed to permanent damage of my benzodiazepine receptors or GABA system as a whole. I think in most cases the receptors regenerate and a full recovery can be made from all drugs of abuse, and from the effects of other drugs such as SSRIs and dopamine agonists, with an unfortunate minority of people being permanently affected for unknown reasons. This is just as likely to result from taking prescription antidepressants as prescribed as from opiates, benzos, coke and dopamine agonists as far as I can gather from all the evidence I've seen so far.

I'm more than wiling to answer any genuine criticism but nobody responds well to belligerence and name-calling.

[OxyContinuously]

Yup, as I've said before, dopamine agonists are purely a band-aid to support the dopamine system during withdrawal they're no 'cure' (although I'm not sure what a cure would be). I'm not claiming dopamine agonists are "The Answer" or a potential cure; simply that they act to support the dopamine system during withdrawal and that they would be a useful addition to the armoury of people treating addiction withdrawal symptoms. Drugs like morphine and Heroin also cause problems for people that don't 'need' them, that's why people seek the treatment of withdrawal clinics in the first place. True, dopamine agonists have unique side effects of their own, but they're no worse than opiates, SSRIs, SNRIs, DARIs, NARIs dopamine antagonists and the sundry other drugs that interfere with neurotransmitters that are widely prescribed in psychiatry.

Dopamine agonists are no more likely to cause Parkinson's Disease when used by people that don't have Parkinson's Disease than are opiates themselves and other drugs that act on the dopamine system such as Ritalin and cocaine. That doesn't mean there is no risk from using opiates or other drugs of abuse (I've read reports that claim that children given Ritalin in childhood may be at increased risk of developing Parkinson's disease in later life). One thing to bear in mind is that smokers are known to have a much lower incidence of Parkinson's Disease than non-smokers, yet nicotine increases dopamine in the reward circuits in the brain... I don't know what to make of these seemingly contradictory findings (well to be fair, the Ritalin claims are only hypotheses - they're not proven fact; the nicotine findings are proven fact).

As for your other claims, I'm reminded of a 'debate' I once had with a guy on another board regarding opiates in treatment resistant depression. He believed that opiates would be neurotoxic and quipped 'I'm surprised you guys have any opiate receptors left'. He claimed that the opiates receptors never recover once you've taken an opiate and people who use them would be damaged for life. It was cheap 'Just Say No' propaganda. Yet he himself was a heavy user of SSRI antidepressants and foresaw none of the same problems re: downregulation of receptors and withdrawal symptoms upon abrupt discontinuation. Yet these do happen and are well documented. I tried to educate him on these things to no avail. In his mind opiates were the devil's sperm and no reasoning could convince him otherwise.

I was a heavy user of benzodiazepines for over five years, quit cold turkey and after a period of adjustment I have no problems that could be attributed to permanent damage of my benzodiazepine receptors or GABA system as a whole. I think in most cases the receptors regenerate and a full recovery can be made from all drugs of abuse, and from the effects of other drugs such as SSRIs and dopamine agonists, with an unfortunate minority of people being permanently affected for unknown reasons. This is just as likely to result from taking prescription antidepressants as prescribed as from opiates, benzos, coke and dopamine agonists as far as I can gather from all the evidence I've seen so far.

I'm more than wiling to answer genuine any criticism but nobody responds well to belligerence and name-calling.

First, no one called any names or was being belligerent. If that were the case, I would have forsaken a response and nice explanation that I gave you and gone with my immediate first response which was simply to tell you that you were full of shit, without giving you a reason.:D That's number one. And I didn't say you will get Parkinson's; I said there is a high risk of developing Parkinson's like symptoms, which there is when u take drugs like these other than how they are prescribed.

Second, I didn't make any "claims"---> I stated medical fact. End of it;)


Have a nice day
later man
peace out

Oxy

[OxyContinuously]

There are no absolutely no OTC preparations in the US that contain codeine, correct?

No ma'am, sorry to say:(....our nice friends at the DEA say codeine is schedule 3 when mixed w/ tylenol,and schedule 2 when its just as the sulphate or the phosphate salt by itself...pointless, Rags, you know? Can't tell u how many times I would have killed for some OTC codeines, even the shitty ones with 8mg per tab...I mean it would be one helluva cold water extraction, but it would be better than nothing.:mad:

I know the U.K. and Canada, and most other countries, actualy, codeine is OTC.


later
Peace out
take care

Oxy

[The~Quinty~One]

Sure, you'll likely get movement (lack therof) problems if you quit from high doses abruptly. It's a similar story with opiates and coke too (though we don't normally call them Parkinson's-like). You turn into a hunched-up ball (well I do anyway) or shake and writhe about. I've nursed people with Parkinson's and it's a terrible disease - I'd never recommend (or take) any therapy that I thought was likely to cause that. I've had the akathisia myself after taking a 0.75mg dose all in one go - I couldn't lay down to sleep without wanting to kick my legs and writhe about, yet pramipexole is prescribed to treat these problems, so it all hangs on the dose and your individual response. It actually helps me get restful sleep at 0.125mg. I've also had akathisia from taking Abilify from my psychiatrist, yet he claimed it wouldn't be much of a problem.

[chopstix]

No ma'am, sorry to say:(....our nice friends at the DEA say codeine is schedule 3 when mixed w/ tylenol,and schedule 2 when its just as the sulphate or the phosphate salt by itself...pointless, Rags, you know? Can't tell u how many times I would have killed for some OTC codeines, even the shitty ones with 8mg per tab...I mean it would be one helluva cold water extraction, but it would be better than nothing.:mad:

I know the U.K. and Canada, and most other countries, actualy, codeine is OTC.


later
Peace out
take care

Oxy

Believe it or not it's actually up to the state (like how medical marijuana is legal in some states but the dea can always step in.)

Washington state is one of the few that actually allows OTC codeine but no one carries it, I've heard that if you poke around enough mom and pop shops in little towns, especially up near the border, that you can find it. I think it's usually in cough syrup form. I think Texas is another state that allows it and they have some cough syrup prep thats known for abuse.

I've thought about combing the little stores outside of Everett and around the reservations in WA but always figured it would just be quicker to drive to BC and buy the shit.

And those little 8mg tabs are fine for a CWE, if ya can handle half a gram of caffeine to go with your codeine :) I did that everyday for about three weeks, longest I've been without coffee since I was a kid..

[mrklean]

Thanks for all the corrections guys. I probably stepped out of my league the second I started using words like "agonist". Sorry if I spread stupidity.

I am reading more on the Blue Lotus and found a site saying that it does contain aporphine but not apomorphine. Is this were all the confusion came from? Either way I have definately enjoyed experimenting with it.

[The~Quinty~One]

No worries, I've enjoyed experimenting with it too :). It's one of the herbs used in a legal cannabis substitute called 'Spice' here in the UK. I don't know anything about the pharmacology of it though, I'll have a look.