Opiate W/D/ neurotramsmitter pathology

[wannawean]

I enjoy reading all your posts they are very helpful-Thanks… I am a RN who has been addicted to opiates for over 5 yrs. My DOC: ultram and hydrocodone. I am preparing myself for yet another CT attempt. I know you have said you’re not a big believer in supplements. I had heard praises Re: amino acids to repair damage? Any thoughts? For me I know what damage I have done to my neurotransmitters. I worry that it will take soo long to feel normal. In my opinion ultram is a very misunderstood drug by the medical community @ large. It gives me more euphoria then any other opiate including sch II ect…  I take 8-12 daily along w/ 50 mg hydro. I have tapered down to 4-5 ultram a day. What are your thoughts on SSRI’s for recovery? One last question I take melatonin for sleep and was told by a colleague that would cause down regulation of my melatonin production? Thanks again for your candid help!

[J T Junig, MD PhD]

Hi,
The actions of most drugs of abuse consist of reversible interactions at receptors;  in my opinion and from what I know, I just don't see, first of all, where the damage would be, and second, why amino acid supplements would be necessary or helpful.  One piece of steak or spoonful of peanut butter will have an abundance of amino acids;  our bodies know how to make every neurotransmitter using readily available nutrients.  Even in cases of severe malnutrition-- cases of child abuse where kids are almost starved to death-- there are no deficiencies of neurotransmitters.  

There are a couple exceptions-- ecstasy is toxic to serotonin-containing neurons, and even single doses will cause extensive nerve cell death in some unlucky individuals;  There have been various 'designer drugs' that turned out to be neurotoxic, such as the drug-induced parkinsons disease cases in the mid-1990's.  

The change that occurs with most addictions is receptor down-regulation, a reversible process that is behind tolerance and withdrawal.  If a person feels that certain amino acids are helpful, more power to them-- provided they have the money to spend on them.  I don't recommend them as a basis for defeating addiction though.

Your comments about Ultram are interesting.  I notice that people have a range of reactions to that medication;  I have heard others describe the euphoric effects of the drug (a few people), but most people don't have that type of reaction.  It is scheduled low by the DEA because it isn't thought to be very addictive, but some people consider it to be their DOC.  

As a healthworker in recovery, I encourage you to seek definitive treatment on your own terms.  I waited too long-- as most people do-- and had to have treatment on the terms of the Board!  Opiate dependence is progressive, if not treated.  The attempts to stop one's own are always short-lived.  Also, be careful with the Ultram-- doses over 400 mg per day are associated with seizures--- and a seizure at work would leave a lot of 'esplaining to do.  I don't know much about melatonin, so I had better pass on that one.

If I can ever help with the professional recovery issue, don't hesitate to send me a message.  Be careful--  nurses always seem to get prosecuted more than docs do.

[wannawean]

Just wanted to say thanks for your time.
It is amazing how insightful and personal your responses are.
Again Thank you.