The Author
My name is Howard Wetsman and I’m an addiction psychiatrist practicing in the New Orleans area. The ideas in this blog are solely my responsibilty and in no way represent anyone else’s beliefs. If I mention someone’s work, it is only my interpretation of their work, and I do not mean to imply any meaning on their part. If you think you’ve read something here that sounds like medical advice, think again. There’s no medical advice here. These ideas are for educational and entertainment purposes only. Always seek a professional medical opinion from a physician of your choosing before making any medical decision.
Now that I’ve made the lawyers happy, read on!
Howard Wetsman MD, FASAM
just read an article about (+)-naloxone. would love to get your thoughts on it. thanks
Jennifer,
I think it’s plux-naloxone, not plus naloxone, if the article I read was correct. It was a little difficult to make sense of as it seemed to suggest working through the immune response rather than the mu receptor. I have not found the scientific article and can’t really say what it is. The only thing I read was a newspaper article that didn’t make much sense. I’ll be looking into it.
thanks,
h
Jennifer,
You were right; it is plus naloxone, or dextro-naloxone. All the papers I’ve found so far seem to suggest that dextro-naloxone doesn’t effect the mu opioid receptor the way regular or levo-naloxone does. However they all reference the same 1978 paper discussing the creation of dextro-naloxone and stating that it had 1/1000 to 1/10,000 the strength of levo-naloxone at the opioid receptor. I can’t find a confirmation of this or an assay in a biological system. However, if they are correct, it suggests that the dextro-naloxone is acting to block the biological effects of opioids (as well as cocaine and amphetamine in earlier studies) but not through the opioid receptor. It does suggest that there is a specific “other” pathway that I had not heard of previously that may be acting. It doesn’t mean that it isn’t working through dopamine in the midbrain, only that we don’t understand what TLR4 does to dopamine in the midbrain. The real thing they are saying is that they can give opioid pain relief to people but block the “addictive” effects of it by giving dextro-naloxone. It may be the case. The real article doesn’t come out until tomorrow. I’ll try to get it.
thanks,
My only concern with tiankg a pill to reduce or eliminate cravings, is getting hooked on the pill ! Sooner or later cravings and obsession and other such triggers will occur. In fact, it is almost a given for a person in recovery. Learning tools how to not act on them is essential. As a recovering pill addict, I was addicted to more . I even had a run on vitamins! Not the effect, but the thought in the morning of getting out of bed, clutching the bottles and pouring the pill out of the bottle , than tiankg my pills , (even before coffee). My sponsor told me I probably shouldn’t take them,I could get addicted to them? I thought she was off her beam, but she was right, again!
It all depends on your view of addiction. If you think addiction is a set of behaviors, like taking pills or drinking alcohol, then you certainly wouldn’t want to be treated in any way that includes those behaviors. And you’d probably think that the craving only came from the behavior in the first place, so it would make no sense to use that behavior in treatment.
However, if you understand addiction to be a chronic primary illness of the brain that effects the reward and related circuitry, and if you believe that this dysfunction of the brain causes symptoms, and it is those symptoms that lead us to use, then you get a different view of what to do.
You would see from the latter model that the craving isn’t brought on by the behavior but rather by the dysfunction that led to the symptoms that led to the behavior. Yes, there is an association between the drug and relief that we experience as craving, but only because the drug causes relief or reward. In normal people it doesn’t, most normal people would be quite dysphoric if given a drug that raises dopamine in the midbrain. Rather than feeling better, they would feel much worse.
If addiction is an illness, there is no safe behavior or drug, because what ever we do, if it raises dopamine quickly, will become a compulsive thing for us. I’m glad you’re working with a sponsor, and I don’t want to get in the way of that, but as a physician I see it from a different angle. We don’t say that a diabetic who is taking insulin is hooked on insulin. The people I’ve seen who were well treated with medication, were with few exceptions, not at all compulsive about their medication. When I did see it in those few cases almost all were underdosed or taking two medications together which should not have been combined. I have seen few or none whose compulsivity about medication could not be resolved. (I don’t remember any, but that’s not iron clad so I’m holding out the possibility that there were a few.)
thanks for writing and don’t give up on recovery and the steps,
h