Re: Some comments about opioids

[Guest guest]

Hi , Hi All,

This reply is coming very late, but when so many mails are posted, then I

save those which seem interesting to me for later reading & reply,... and

now I am in a process of reading old mails!

I had the same feeling by reading this issue. One of the problem is that the

medical community has still difficulties to differentiate between opioids

for euphoria and opioids for medical purposes. And for the medical

applications, the distinction is lacking between doses needed for having

narcotic/analgesic effet on chronic pain and doses needed for having

antitussive effects (or RLS-sensation relieving effet!).

Interestingly, in the same issue (Bedtime stories) a RLS-sufferer reports

having taken codeine for the last 17 years on a regular basis and has

increased doses till morphine to relieve RLS AND CONTINUOUS PAIN. He

switched then abruptly to Ultram without withdrawing trouble. In fact, the

development of tolerance (increase of dosis to obtain the same effect) is

specific for the antinociceptive (analgesic) effect of opioids, IHMO this

phenomenon was never demonstrated for the cough suppressant effect.

Concerning the dependency (implying the psychological and physical

withdrawal troubles), this possibility is now automatically cited by

practitioners or in publications, as soon as opioids are envisaged as an

option for RLS treatment. Amusingly, in a majority of publications a

sentence usually follows saying that this probability is nevertheless

remote! In fact, I was able to find only one single publication which is

reporting a case of dependency using oxycodone for RLS, and the case was

rapidly regularized by changing the opioid and dosis. Of importance but

usually ignored from the medical community is also the fact that different

opioids have various potentiality to produce dependency. The opioids with

the highest dependency potential are morphine and oxycodone, medium

potential is hydrocodone and very low potential is codeine. IHMO, it is non

sense to prescribe oxycodone in cases where codeine is sufficient. One

further problem is that it is possible that codeine may not be sufficient.

In Europe, dihydrocodeine is preferred since 2-3x more efficient than

codeine with the same low dependency potential. A possible reason why

dihydrocodeine is not found in the US is because US is a major producer of

hydrocodone (fully synthetic drug) of the world and dihydrocodeine is

produced by a simple chemical modification of codeine, issued from opium

(natural product --> more expensive).

best regards

Bernard, the fellow non-sufferer and Mireille (fellow-sufferer) from

Switzerland

At 07,51 2.03.99 +0200, you wrote:

>

>

>

>I have been enrolled for a couple of weeks and have enjoyed reading

>all of the discussion. I am 48 years old and have had RLS since I was

>12. I am a pharmacist by profession. I would like to make a couple

>of comments.

>

>3. In the February, 1999 Nights Newsletter there was a question

>regarding the use of narcotics in RLS. I was a little disturbed by

>the tone of the response by Dr. Barbara . She states that

>she has a " rather large RLS practice " but only has two patients which

>she has seen fit to treat with narcotics and those are treated only

>with Tylenol #3 rather than the stronger narcotics which seem to work

>much better than codeine. She goes on about the addiction potential

>of narcotics when in fact, scientific research has shown that for both

>pain and RLS, addiction has never been a problem. Short term physical

>dependance on the narcotic may occur but is easily controlled by drug

>holidays. I would submit to Dr. and other reluctant

>physicians that it should be easy to screen patients exhibiting drug

>seeking behavior from those who have a legitimate need for the regular

>use of a narcotic. Several studies in the Journal Sleep, will support

>this view. Many physicians still cling to the unenlightened view that

>narcotics are dangerous drugs rather than a useful tool that can

>improve someone's quality of life whether used for pain or RLS. I

>think that Doctors fear of monitoring by State regulatory boards fuels

>this fear.

>

>Once again, I thank you for all of your comments and sharing your

>experiences with a fellow sufferer.

>

>Best regards,