Deciding when it is time to start doing drug therapy

[badnights]

I would (if I had been on here sooner) have recommended Sinemet but only if you really truly needed it only a few nights a week. I would further have suggested that tho you were sounding brave, you probably were suffering nightly and therefore Sinemet would not be a good choice. So, I still think that, having read all the posts. We tend to compare the nights we get poor sleep with the nights when we get almost no sleep, and end up thinking we're doing ok on the poor-sleep nights, simply because we've lost sight of the healthy baseline.

[Polar Bear]

I agree wholeheartedly with Badnight's comments on losing sight of what is a healthy baseline for sleep.
I reckon if we have nights where there is no sleep or many nights with only a couple of hours sleep, then we are so grateful and think we are doing well if we get 4 or 5 hours sleep. And of course 4 or 5 hours is totally inadequate.

And to expect 8 hours is beyond our dreams (excuse the unintentional pun).

Eventually what is inadequate becomes our 'normal'.

[Neco]

My doctor prescribed the low dose of .25 mg every night. Prior to taking Xanax, the RLS was breaking through every night. It had pretty much ceased to be an occasional occurrence and was regular.

I recognize the danger of dependence, but I can't really see much difference between becoming dependent on Xanax versus Requip or Mirapex or any of the other RLS treatments. Perhaps some of you have worked with this drug before and can advise. Right now, I am sometimes experiencing RLS sensations about an hour before bed. I take the Xanax at bedtime and by the time I've finished reading a few pages of my book, the symptoms are gone and I get a restful night with zero lingering aftereffects the next morning. I can certainly experiment with taking Xanax only when I experience the sensations before bedtime. I've been enjoying the good sleep so much that I haven't been willing to experiment up to now.

My concern is, like with the other treatments, my body will develop tolerance and require higher doses over time. I just can't see any way to avoid that regardless of what drug I take. Xanax seemed to be the least risky over the long-term. Perhaps my doctor and I are wrong.

I'm not a Doctor, so take this for what you will..
In my opinion the safest long-term treatment for RLS/WED is and has always been opiates.

Opiates have one of the longest documented histories out of all the drugs that we use to treat chronic pain/discomfort related conditions, and in RLS they are pretty much recognized by experts as 99% effective especially for the severe sufferers like myself and many others on the Forum.

That being said, many doctors are both scared and ignorant when it comes to prescribing opiates for anything, even chronic pain. They have been conditioned by the government to treat everyone as suspect drug seekers, looking to make money by selling, or get high by using, on the side; and they have reinforced this by instilling a fear of legal prosecution and threats of taking away medical licenses if anyone steps "out of line" by prescribing what they deem to be too much to any one patient, or group of patients as a whole.

It is really very sad, that chronic pain is one of the most under-treated problems in the USA and the victims are people like us, and others with more more sever pain... All because 10% of the population is said to abuse prescription drugs and gets them lumped in with everything else in the farce that is the "war on drugs"...


Yes, it is true there is dependence with any medication we take, and tolerance can and will at some point increase over time, requiring more of the drug. But dependence is NOT addiction, one is a legitimate medical side effect stemming from appropriate treatment, the other is a psychological issue that people need to overcome on an individual basis.

But I would rather be on an opiate than a benzo, because if I had to stop suddenly, be it cut-off "cold turkey" or because of some emergency preventing me from getting to a place where I could properly obtain my medication, at least going through opiod withdrawal won't possibly kill me. Sure you might hurt a lot for a few days, and have flu-like symptoms and all that comes with it..

Benzos on the other hand, give horrible withdrawal symptoms sometimes with even the slightest reduction in dose.. Sometimes you can even suffer seizures and other life threatening withdrawal symptoms, similar to alchohol and barbituate withdrawal syndromes.


I'm not trying to "scare you straight" or anything like that. I just tend to be a blunt person, and if you are interested in taking a medication that actually works for you, but is also the safest, then I would choose opiates before benzos, IMHO.

You may want to discuss this with your doctor more, although I would approach the subject carefully I guess because I don't want to be responsible for you giving them the wrong opinion.

In the interest of full disclosure I am a Methadone patient, and I have only ever been treated with opiates successfully. I did suffer from an addiction problem but after a lot of hard work and swtiching to Methadone I have been able to keep both my RLS/WED and addiction under control. If I had been treated with benzos instead I don't know if I would be here to write this post right now...

[Eweforia]

Thanks Zach and everyone. This is definitely something I will discuss with my doctor. I had tried 50 mg Tramadol one time for my degenerative back disease and had to take the entire next day off from work. My doctor probably decided that the opiates wouldn't be suitable, but I will revisit that with her. I was not aware that withdrawal from benzos could be so severe. In your opinion, should I consider a test withdrawal to determine if I am one of the people who does or does not become addicted? If I am not addicted after 6 weeks, is it likely that I will not become addicted? I'm trying to gauge the long-term consequences of this very inexpensive and thus far very effective drug.

[Neco]

That should be discussed with your doctor also, probably..

But no one can predict whether or not you will become addicted. For some people all it takes is one exposure to the drug, for others it may develop gradually. Addiction can't really be quantified in scientific terms, because it is a psychological affliction.

Don't confuse addiction with dependence. Whether or not you are addicted will not determine what kind of withdrawal symptoms you experience, that will be up to your bodies individual chemical reactions.


Also, tramadol isn't really an opiate. It does act on some opiod receptors in the body, but it does not share the same chemical makeup as other true opiates. Also, with opiates a bad reaction to one does not mean a bad reaction to another, etc.

I can't take tramadol anymore because it causes me to have seizures, but I have no problem taking other opiates.

[Chipmunk]

Addiction is where you need an ever-increasing dose to get the same effect.

Dependence is where you need a certain dosage and suffer ill effects if you try to reduce.

When it comes to RLS/WED meds, the disease is worse than possible dependence on a med, so I would never NOT try a med that might help for fear of being dependent. JMHO.

[Eweforia]

Chipmunk, I will disagree slightly with your definition of addiction. My understanding is that addiction is a neurobiological disease characterized by compulsive drug use or continued use of a drug despite physical, mental and/or social harm. In contrast, tolerance is when the body adapts or gets used to a particular medication, lessening its effectiveness and requiring higher doses to get the same effect. I think that is what you meant here.

I apologize for derailing the conversation. I did misread Zach's 11/28 post and thought he was suggesting that benzos were addictive rather than perhaps causing dependency. My mistake, and it definitely changes the conversation I'll have with my doctor, although the same questions apply. I need to know if I have or will become dependent on benzos and what she considers long-term consequences as compared to those of low-dose opiates. I think if we are going to experiment, it would be best to do it now rather than later.

[Neco]

Just going to offer some clarification here.


Addiction is a psychological compulsion to chemically alter your brain chemistry to produce (and reproduce) an extremely pleasurable state.. This varies from person to person (as different drugs have different effects, i.e uppers like cocaine, speed/meth vs downers like benzos and opiates and then psychotropic drugs like marijuana, Acid, LSD ).

In my case, Hydrocodone provided extreme euphoria that was not matched by other opiates (Codeine comes close, Oxycodone is...different).. The psychological component is what differentiates addiction from dependence, albeit this is a simplification of the problem. I routinely went beyond what I physically needed to take to relieve my symptoms, because I wanted to recreate the state I was in, the first time I realized I was high and that I liked it. This leads to "chasing the dragon", a never-ending cycle of taking more and more to obtain the same pleasurable effects as you become tolerant to the effects you are seeking.

Although there is some minor overlap, Dependence is markedly different from addiction because most importantly, it lacks the psychological component. Most people just want to take their medicine to relieve the pain and usually make it through the crucial early stages of initial exposure to opiates for various reasons.. They aren't paying attention, they only take it before bed, or in some cases it doesn't really produce much in the way of pleasurable side effects - that allows most people to make it to the point where they would be tolerant to the psychological effects anyway. Whereas a small percentage of people, like myself, pop a couple pills and all of a sudden realize "Damn, this feel gooood."

There is no science I know of to back up what I just said, but that is my personal view

So when people talk about chemical dependence, it can get a little blurry because generally that is an informal way of referring to an addicts condition.. However dependence on a substance, is still a legitimate medical side effect and it functions on the same pattern as addiction, but without the needed psychological component, that pattern is much more stable, much safer, and much less destructive to the persons life.

If you take 5mg of Hydrocodone and it kills your pain for 3 or 4 hours, then one day you notice the pain is not going away, or is still there but less severe, albeit still leaving you in pain; that is the function of dependence. Your body physically needs more to treat the pain because it has become tolerant to the dose you are taking.

Addiction and Dependence converge somewhat in the area of "I need this drug to function like a normal human being". For the addict, this is the Apex of their addiction; If they have survived long enough to get to this point without killing themselves (via overdose), or ended up dead over money and other disputes involved with illicit activities, they reach the point where they don't even care about getting high anymore... They just want to take the drug to make the withdrawal symptoms go away, so they can function on a basic level and survive. But make no mistake if they can get their hands on enough of the substance at an affordable price, they will go right on trying to get high again.

Medical dependence works in much the same way, like with my 5mg Hydrocodone example. You are legitimately taking medication to stop your suffering, but your dose starts to fail and you eventually have to increase your dose to obtain the same amount of legitimate pain relief, so that you can continue to function like a normal person on a daily basis and survive.

I could not function without Methadone at all. I would not be able to sleep for more than a few minutes at a time, for maybe a couple fragmented hours in a full day. I wouldn't be able to do anything but be miserable from sleep deprivation and then my RLS/WED on top of that. If I had to live untreated by truly adequate medication, I would most likely resort to suicide after 2 - 4 weeks.

So that lumps me into a rather tough and unique position to be in.. I am chemically dependent on opiates for entirely legitimate reasons; but I am also a recovering addict with a rocky medical chart history. As a result I am extremely paranoid of always being cut-off at any moment. It's no way to live.

One final personal opinion. If our bodies did not work this way, and we could take X amount of a substance forever without having to increase the dose, addiction would be a drastically less severe social problem for lots of people, as well as much safer for the individual. But sadly life does not work this way.

[ViewsAskew]

And, to hopefully offer more clarification....

There can be both, one, or neither responses to taking these drugs regarding addiction and dependence.

Person A could become dependent on benzos, but not addicted.

Person B could become dependent AND addicted to benzos.

Person C could become addicted, but not dependent.

And, Person D could be neither addicted nor dependent.

As I understand it, people who take opiates regularly eventually become dependent. That said, I was able to stop methadone without any side effects when I took it once a day. When I stopped tramadol after a few weeks, I was in the hospital with extreme withdrawal symptoms.

About 50% of people become dependent on benzos (if I am remembering correctly). The other 50% have no issues with dependence. Of those dependent, it can vary from a bit difficult to very difficult to stop the drug.

About 7% of people become addicted to a substance, based on what I've read. While addiction is indeed a psychological response, many people believe there is a genetic component. In addition, the brain changes in some people in response to the addiction, making it even harder to escape the addiction. "The Craving Brain" is an interesting read about it.

For a basic overview, read here: http://drugabuse.gov/scienceofaddiction/addiction.html.

[Neco]

Those are very good points Ann, thanks.

[Chipmunk]

I remember reading something about studies on smokers and ex-smokers. It said that the brain produces more nicotine receptors (or whatever neurotransmitter nicotine activates, details are fuzzy) in response to smoking.

Quitting smoking allowed the brain to get rid of some of the receptors, but not most, so that the brains of ex-smokers were neither like the brains of smokers nor the brains of one who had never smoked. The implication was that addiction/dependence did indeed have a biological basis.

Whether or not the results can be extrapolated to WED meds is up for debate, but as someone on neurotransmitter drugs it sure gave me pause for thought. However, my pre-drug state was such that I had difficulty functioning day-to-day, so I would consider myself dependent on anti-depressant, but not addicted.

Addicted to me means that you have withdrawal symptoms along with recurrence of whatever the original issue was. Dependence is just that the original problem will come back if the drug is discontinued.

So Ann was both dependent and addicted to the benzo, but others may just be dependent on it to relieve their WED symptoms but able to quit cold-turkey with no ill effects.

This is actually quite an interesting discussion - thanks for edumacating me!

[Neco]

No no no... I have never seen anything from Ann leading me to believe she was addicted to benzos.. I don't think she was taking them for warm fuzzy feelings, at any rate..

She was certainly dependent on benzos, because they treated her RLS and if she stopped them she got ridiculously ill.

As far as I have been aware, I am the only openly acknowledged addict on the forums, which is good news for the rest of you, statistically speaking.

That is the whole point I've been trying to make. Addiction and Dependence may often co-habitate, but one is NOT an indication of the other.

Withdrawing from a medication is not a criteria for addiction. It is only an addiction if there is a psychological component involving the desire to get a buzz or whatever you want to call it.


Finally, yes for those of us who take opiates, our bodies produce more/new opiod receptors.

[badnights]

I think Chipmunk you're still confused about the definition of addiction.

In addiction, you take more than you need, in search of an effect other than relief of your symptoms.

DEPENDENCE has occurred when you need an increase in dose to relieve your symptoms.

Technically, I should say dependence has occurred when you need an increase in dose is get the same effect - whether the effect is relief of your symptoms or an addiction-related mental state separate from that. But the main point is that dependence is almost inevitable with many of these drugs, leading us to require increasing doses over time to relieve our symptoms, and that is dependence, not addiction. If we regularly take more than is needed to relieve our symptoms, that could be addiction.

[Neco]

Sorry... folks, but you're still muddying the waters...

Dependence means, simply, that you require a certain amount of the drug in your system to be able to function normally, to stave off withdrawal symptoms, etc..


When you need to start increasing your dose to achieve the same desired outcome, that is called Tolerance

[ViewsAskew]

Bingo what Zach said .

I was never addicted, only dependent. I also did not have tolerance with either the benzo or tramadol - needing an increased dose to achieve the same outcome.


Dependence = your body is dependent on (needs) the drug on a regular basis - take it away, and you are sick.

Tolerance = you need more drug than you used to to get the same effect

Addiction = you WANT the drug more frequently, you want more of the drug, you LOVE the feeling you get taking the drug, so you do WHATEVER you have to to get it. Steal, lie, cheat.... Logic is out, physical need is out, your brain wanting it controls your actions.