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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by JeffH on November 7, 2001, at 16:27:22
Elizabeth,
I talked to a few docs, including one that Dr. Bodkin recommended. However, all are either not taking any referrals or don't dab in opioids.
It's a bit frustrating. One might think that the only ones who believe that drugs such as buprenorphine are worthy are researchers who don't see patients. I also don't care to be lectured by doctors who are flat-out against opioids without being fully-educated about their uses with some hard-core depressives.
What about your doc? Would he/she be willing to do a consult with my doctor in New Mexico? (I really don't mind the travel.) If you want, could you let me know how my family doc or myself could try to set something up?
Thanks again, Jeff
Posted by Elizabeth on November 8, 2001, at 20:27:01
In reply to Elizabeth - Need Buprenorpine Help, posted by JeffH on November 7, 2001, at 16:27:22
> I talked to a few docs, including one that Dr. Bodkin recommended. However, all are either not taking any referrals or don't dab in opioids.
Yeah, it's difficult. I had first started taking buprenorphine back in early 1999. It was prescribed by a doctor who had been seeing me for some time and felt he knew me well enough to trust me with it; he also did some consulting with Dr. Bodkin. I quit when the side effects and difficulty of administration became too much.
In December 2000, I was very depressed after having been on Remeron for a few weeks, so I checked in to a hospital in NC (I was staying with my parents). I gave my doctor at the hospital a copy of the Bodkin et al. article and the phone number for my pdoc in Boston (the one who'd prescribed it the first time). After looking into it, they decided to give it a try. After they saw my remarkable and rapid response, they gave me a prescription and discharged me less than 24 hours after I had taken my first dose of bupe there.
If you haven't taken it in the past, it's going to be tough. Here are some ideas:
* Show them some of the articles on opioids as ADs -- not just Bodkin et al.'s study, but others too, to show that it's not just a few doctors in one place. Go to a medical library or use Loansome Doc to get articles if you need to. There are also a couple of sites online that have copies of articles.
* Give them a list of the other meds you've tried and descriptions of your responses.
* You may need to be patient: go through other medication trials while allowing the doctor to get to know you better and get a better idea for what kind of person you are and how debilitating your depression is.
* Have other ideas of things you haven't tried, and bring in supporting literature for these too. Make them things that aren't supposed to be habit-forming, such as lithium, pindolol, high-dose Buspar, Tegretol, TCA + MAOI, etc. Even if you don't think they'll help, it will make you look a lot less like a "drug seeker" if you're willing to try them. Be sure you have supporting data for these too (get an article or two that suggests that they can be helpful for refractory depression).
* Giving them Dr. Bodkin's contact information might be good also.
* If you have any recollection of times you were depressed and took opioids for pain, mention these times. Giving specific details of what your reaction was -- exactly what symptoms were relieved by the opioid -- makes your claim more credible.I'm going to see someone in North Carolina next week (at the outpatient clinic at the hospital where I was seen last December), so I'll need to convince someone that this is an appropriate treatment for me. I'll let you know how it goes, if you'd like.
> What about your doc? Would he/she be willing to do a consult with my doctor in New Mexico?
I think Dr. Bodkin would be more appropriate, and I know he's been willing to do phone consultations with other doctors in various parts of the country about this.
I hope that this helps. Take care and good luck to you.
-elizabeth
Posted by Rudiger on November 9, 2001, at 2:40:58
In reply to Elizabeth - Need Buprenorpine Help, posted by JeffH on November 7, 2001, at 16:27:22
I truly sympathize with your situation, and not just because I find myself in the same one. Unfortunately, I'm quickly coming to the conclusion that virtually every pdoc would rather lose a limb (or two) before they would even consider prescribing what they ignorantly assume to be little more than a gateway drug to heroin. (These are supposed to be rational scientists?)
I'm discovering that most pdocs' practice of medicine is influenced much more by self-interest and paranoid fear (fear of litigation and the DEA) than it is by consideration of the well-being of their patients. The fear of litigation is why many, if not most, psychiatrists refuse to prescribe MAOI's, and some even do all they can to avoid prescribing tricyclics. If treatment-refractory patients don't respond to their limited arsenal of meds, well, that's unfortunate, but there's not much that can be done. "Maybe you should try ECT," is the standard refrain.
And if you don't bring up the option of buprenorphine yourself it's a pretty safe bet that your pdoc won't either. But if you do bring it up, you are usually rewarded with some suspicious looks and are almost immediately suspected of being a "drug-seeker." A rather lovely Catch-22.
It should be acknowledged that by not offering the full option of all reasonable and literature-based treatment options to their desperately-ill patients, physicians, in effect, are saying that suicide is preferable to trying these "evil" medications.
I am beginning to fear that Elizabeth is one of the very few that will ever get a chance see if buprenorphine can give them back their lives. Don't get me wrong, I'm very happy for Elizabeth, but the pain, misery and death of nameless thousands of others, whose only sin is that they had the temerity to fail to respond to what they should have, is a real tragedy.
> I talked to a few docs, including one that Dr. Bodkin recommended. However, all are either not taking any referrals or don't dab in opioids.
>
> It's a bit frustrating. One might think that the only ones who believe that drugs such as buprenorphine are worthy are researchers who don't see patients. I also don't care to be lectured by doctors who are flat-out against opioids without being fully-educated about their uses with some hard-core depressives.
>
> What about your doc? Would he/she be willing to do a consult with my doctor in New Mexico? (I really don't mind the travel.) If you want, could you let me know how my family doc or myself could try to set something up?
>
>
> Thanks again, Jeff
Posted by Elizabeth on November 9, 2001, at 13:23:11
In reply to Re: Elizabeth - Need Buprenorpine Help » JeffH, posted by Rudiger on November 9, 2001, at 2:40:58
> Unfortunately, I'm quickly coming to the conclusion that virtually every pdoc would rather lose a limb (or two) before they would even consider prescribing what they ignorantly assume to be little more than a gateway drug to heroin. (These are supposed to be rational scientists?)
Doctors *aren't* generally scientists, as a rule. But anyway, I wonder if they realize that heroin won't work (except at obscenely high doses) for a person who's on buprenorphine. I also wonder whether it's occurred to them that people who need opioids to treat a medical condition but can't get them from legitimate sources are more likely to try to get them from, well, illegitimate sources.
> I'm discovering that most pdocs' practice of medicine is influenced much more by self-interest and paranoid fear (fear of litigation and the DEA) than it is by consideration of the well-being of their patients.
Yup.
> "Maybe you should try ECT," is the standard refrain.
This from doctors who supposedly fear litigation???
> And if you don't bring up the option of buprenorphine yourself it's a pretty safe bet that your pdoc won't either. But if you do bring it up, you are usually rewarded with some suspicious looks and are almost immediately suspected of being a "drug-seeker." A rather lovely Catch-22.
Yeah, the "you know too much" reaction. Jeez. The best thing to do is bring in peer-reviewed medical articles. There's nothing more "legit" than that, right?
> I am beginning to fear that Elizabeth is one of the very few that will ever get a chance see if buprenorphine can give them back their lives.
Yeah, it always bothers me when people who need it can't get it. I think it may be easier to get once the sublingual formulation is approved, FWIW.
-elizabeth
This is the end of the thread.
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