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warwick
08-05-2016, 01:44 AM
Paper:

http://www.ncbi.nlm.nih.gov/pubmed/27061230


Basic Clin Pharmacol Toxicol. 2016 Apr 9. doi: 10.1111/bcpt.12602. [Epub ahead of print]
The ABCB1, rs9282564, AG and TT Genotypes and the COMT, rs4680, AA Genotype are less frequent in Deceased Patients with Opioid Addiction (DOA) than in Living Patients with Opioid Addiction (LOA).
Christoffersen DJ1, Damkier P2,3, Feddersen S3, M÷ller S4, Thomsen JL1, Brasch-Andersen C5, Br°sen K2.
Author information
1Institute of Forensic Medicine, University of Southern Denmark, J.B. Winsl°ws Vej 17B, DK-5000, Odense C.
2Department of Public Health, Clinical Pharmacology, University of Southern Denmark, J.B. Winsl°ws Vej 19, DK-5000, Odense.
3Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C.
4Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J.B. Winsl°ws Vej 9, DK-5000, Odense C.
5Department of Clinical Genetics, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C.
Abstract
Sudden death due to acute intoxication occurs frequently in patients with opioid addiction (OA). In order to examine if certain genotypes were associated with this, we examined the frequencies of 29 SNPs located in candidate genes related to opioid pharmacology: ABCB1, OPRM1, UGT2B7, CYP3A5, CYP2B6, CYP2C19, CYP2D6, COMT, KCNJ6 and SCN9A in 274 deceased patients with OA (DOA), 309 living patients with OA (LOA) and in 394 healthy volunteers (HV). The main hypothesis of the study was that subjects homozygous for the variant 3435T in ABCB1 (rs1045642) occur more frequently in DOA than in LOA and HV because morphine and methadone more readily cross the blood-barrier in these subjects due to a lower efflux transporter activity of the ABCB1 (p-glycoprotein) transporter. Our results did not support this hypothesis, since no statistically significant difference (p=0.506) in the frequency of the TT genotype of rs1045642 was observed between the DOA, LOA and HV cohorts. However, for another ABCB1 variant, rs9282564, we found that the frequencies of the AG and TT genotypes were 13, 21 and 25% in DOA, LOA and HV, respectively, and after correcting for age, sex and multiple testing, the differences between DOA and LOA were statistically significantly different (p=0.027). The COMT rs4680 AA genotype frequencies were 25%, 35% and 31% in DOA, LOA and HV, respectively, and the difference between DOA and LOA was also statistically significant (p= 0.0028). In conclusion, this study generated two hypotheses suggesting possible associations of a reduced risk of death and carrying, respectively, the ABCB1 rs9282564 AG and TT genotypes and the COMT rs4680 AA genotype among patients with OA. These findings should be confirmed in independent cohorts, and if a causal relationship between these variants and fatal poisoning in OA is confirmed, then it may be possible at least in theory to personalize prevention of sudden death in this patient group. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
KEYWORDS:
Addiction; Methadone; Morphine; pharmacogenetics; sudden death

warwick
08-05-2016, 01:46 AM
News:
http://www.theguardian.com/society/ng-interactive/2016/may/25/opioid-epidemic-overdose-deaths-map



America is in the midst of an unprecedented drug overdose epidemic. Nationally, overdose deaths have more than doubled over the past decade and a half, driven largely by opioids – initially prescription painkillers, but increasingly heroin.

Today, more Americans die from drug overdoses than car crashes or gun fatalities. In all, drug overdoses killed 47,000 people in the US in 2014, the latest year for which data is available. That’s 130 deaths per day, on average. The majority of those deaths – 29,000, or 80 per day – involved an opioid.

AJL
08-05-2016, 02:10 AM
In Canada there's certainly heroin problems but addiction to Fentanyl and other prescription opioids really seems to be at least as bad a problem.

http://www.theglobeandmail.com/news/british-columbia/fentanyl-related-deaths-soar-across-canada-report-says/article25920303/

warwick
08-05-2016, 02:48 AM
News:
http://www.theguardian.com/society/ng-interactive/2016/may/25/opioid-epidemic-overdose-deaths-map

We're beginning to see evidence that could help guide heroin treatment with methadone:


extensive metabolizers required a higher dose of methadone (p=0.035),
http://www.ncbi.nlm.nih.gov/pubmed/24016178

MikeWhalen
08-05-2016, 11:46 AM
its interesting to see the patterns of drugs of choice amongst my inmates that I classify

...one aspect that is often not noted is a certain practicality amongst the addicts, meaning price and availability
...you can always get whatever specific drug you want in the metropolises (Toronto, Vancouver, Montreal) but never forget the issue of price and duration of the high, a key point for most addicts
-in many of the smaller locals, depending on which crime organization controls the territory, will have easier access to one type of drug and be limited in another-ie biker areas often have better access to crystal meth where as Asian ones have better heroin

...while most addicts have specific preferences, usually defined generally by the overall 'family' of the drug...ie is it an 'upper' (coke, speed, crystal meth) or a 'downer' (opioids, alcohol) simple economics of what is cheapest, lasts longest and most easily available is key to what they use-remember, the vast majority of criminals live a lousy subsistence-level type lifestyle and are quite poor despite the occasional windfalls they get via crime

not counting alcohol, due to how common it is a co addiction, I found that a few years ago, the #1 drug most used by my criminals was oxycontins, then that switched to fentanal patches and most recently, over to crystal meth...in each case, price and length of high was the main reason for the use
I also found, in my neck of the woods, that morphine was more popular than heroin, again, usually due to price point

btw, as a small tidbit, in the Canadian Federal prison system (and I suspect most others in the West), the most popular illicit drug used is heroin...why?
...because medically, it is the fasted drug metabolized by the body and flushed out of the system, taking only a day or 2 for all traces of it to disappear
...that is critical for inmates trying to 'beat' the drug tests (piss test) administered by the prison, cannabis is avoided because it can last up to 30 days


BTW, I despise the methadone treatment used in country....I have had inmates as young as 18 on the stupid thing which is utterly contra indicated as the key criteria that made the program useful in the Nordic countries where it was first tested on old very experianced addicts
....when used as a last drug/treatment of choice, for addicts that had tried for many years to quit and failed, it could have good success in a harm reduction sort of way

...giving it to an 18 yr old kid just gives them another source of income or high...when administered in prison, we have to go to ridiculous lengths to make sure a guy that gets his methadone does not regurgitate it back up and then sell it to another inmate for a mild high
...true story, that is quite common

Mike

Ryukendo
08-05-2016, 12:27 PM
its interesting to see the patterns of drugs of choice amongst my inmates that I classify

...one aspect that is often not noted is a certain practicality amongst the addicts, meaning price and availability
...you can always get whatever specific drug you want in the metropolises (Toronto, Vancouver, Montreal) but never forget the issue of price and duration of the high, a key point for most addicts
-in many of the smaller locals, depending on which crime organization controls the territory, will have easier access to one type of drug and be limited in another-ie biker areas often have better access to crystal meth where as Asian ones have better heroin

...while most addicts have specific preferences, usually defined generally by the overall 'family' of the drug...ie is it an 'upper' (coke, speed, crystal meth) or a 'downer' (opioids, alcohol) simple economics of what is cheapest, lasts longest and most easily available is key to what they use-remember, the vast majority of criminals live a lousy subsistence-level type lifestyle and are quite poor despite the occasional windfalls they get via crime

not counting alcohol, due to how common it is a co addiction, I found that a few years ago, the #1 drug most used by my criminals was oxycontins, then that switched to fentanal patches and most recently, over to crystal meth...in each case, price and length of high was the main reason for the use
I also found, in my neck of the woods, that morphine was more popular than heroin, again, usually due to price point

btw, as a small tidbit, in the Canadian Federal prison system (and I suspect most others in the West), the most popular illicit drug used is heroin...why?
...because medically, it is the fasted drug metabolized by the body and flushed out of the system, taking only a day or 2 for all traces of it to disappear
...that is critical for inmates trying to 'beat' the drug tests (piss test) administered by the prison, cannabis is avoided because it can last up to 30 days


BTW, I despise the methadone treatment used in country....I have had inmates as young as 18 on the stupid thing which is utterly contra indicated as the key criteria that made the program useful in the Nordic countries where it was first tested
....when used as a last drug/treatment of choice, for addicts that had tried for years to quit and failed, it could have good success in a harm reduction sort of way

...giving it to an 18 yr old kid just gives them another source of income or high...when administered in prison, we have to go to ridiculous lengths to make sure a guy that gets his methadone does not regurgitate it back up and then sell it to another inmate for a mild high
...true story, that is quite common

Mike

Do you work in addiction medicine? One of the most interesting fields in medicine, but receives so much less attention than it deserves...

MikeWhalen
08-05-2016, 02:39 PM
Ryukendo
for the first 13 yrs of my career in Corrections, I ran treatment groups for high risk violent criminals in a unique treatment center that was an experiment in having joint federal and provincial prisoners.
It was an intense cog behav. treatment that was mostly group based. The issues I focused on were substance abuse, long history of violence, domestic violence and criminal thinking. I have an MSW

after 13 yrs doing that, I switched over to the operational side of Corrections and do security classification of all offenders that were sentenced to more than 90 days incarceration

So to answer your question, I'm not in medicine, but I was in the Prison treatment scene and you can believe that despite the proof that a good system will save you 7 bucks for every 1 dollar you spend on *scientifically proven treatment...getting funds to treat inmates is a pretty unpopular thing
There are now only 2 small treatment centers in the Province of Ontario with bed space for a tiny fraction of the prison population...the thousands of others are, as we say, 'racked and stacked'-just warehoused.

Mike

warwick
08-05-2016, 10:16 PM
I did some due diligence and took a test of my P450 and other drug metabolism enzymes. I plan on explaining the results to my doctor.

rock hunter
08-06-2016, 06:19 PM
Did the crackdown on drinking and driving and the work place force those who drank alcohol as self medication to seek
harder to detect illegal drugs or questionable doctors prescriptions and so opening the door to abuse later. I used to
know old timers ( in the 1960s&1970s ) who kept a slight buzz on all day without a problem or the stigma of
today ,maybe even functioning better than someone using an opioid pain pill .

Gaku
08-19-2016, 11:03 AM
Did the crackdown on drinking and driving and the work place force those who drank alcohol as self medication to seek
harder to detect illegal drugs or questionable doctors prescriptions and so opening the door to abuse later. I used to
know old timers ( in the 1960s&1970s ) who kept a slight buzz on all day without a problem or the stigma of
today ,maybe even functioning better than someone using an opioid pain pill .

Harder to detect? Cannabis or THC stays in your urine for 30 days. A singular use, if you have just used it once, stays in your urine for 8 days. Heroin, on last usage, can be detected 12 hrs.

It is comical, pathetically comical mind you, when we have patients going to the pharmacy next door and buying not one or two but three bottles of water and swallowing it down in a desperate attempt to dilute the drugs in their system before taking a "piss test". It is even more comical when they try every trick under the sun to excuse the drugs showing up in their system. You don't want to know how many patients ask the pharmacist if Drug A [an OTC] can be confused as a narcotic or similar worse in a piss test.

And there's no such thing as a functioning addict or drunk. Functioning drunks for example still experience blackouts, memory loss, delayed reaction time, etc. Such people just require more booze before they find themselves face down and making a temporary friend with the pavement.

Gaku
08-19-2016, 11:04 AM
I work in addictions treatment and 90% of our clients don't give a rat's arse about other people as long as they can get their fix. A number of them have come inches from causing accidents and/or killing people in simply arriving or leaving the clinic / pharmacy's parking lot they are so "desperate".

And they will lie through their teeth. Some of them are of the personality that I wouldn't doubt they'd happily dance a jig on their mothers' grave while spinning lies that'd make the devil himself proud. As my colleague who has worked in addictions treatment for 30 years says - do not trust a single word they say. Ever. It is one reason why he has me handling most of the patients face to face because with my background I am not frightened of them and likewise I take their stories with a grain of salt the size of Russia.


This is something people who are not in addictions treatment do not realize. They think addictions treatment is fantastic.

But as Mike has probably realized or suspected such "treatment" is in a way an enabler. He has 18 year olds in jail - in this area that age is OLD. We've had 15 year olds on methadone treatment which is okayed by their parents signing away on papers like any other form of medical treatment.

I say enabler because we have patients selling drugs even before they get them from the pharmacy to other patients so that they can walk away with a pocket full of cash for the drugs they really want. Patients saying that their last dose of methadone was on the street is far more common than you'd like to believe - a dangerous game seeing as the wrong dose of methadone can kill someone not that the patients selling their carries care because the money they get goes to better things.

More often than not patients come here and/or to the pharmacy for their treatment only when they can't pay Fred or Joe or Bobby-Jane on the street corner the money for what they really want. If, and a big if, these patients were serious for their treatment they would go daily or close enough yet there are countless patients who have to restart [3 day time frame] because they found something better on the street and only show their faces when the stash or their money runs out.

And it is pathetically sad when patients who the doctors trust to take carries home with them end up lossing those carries as they sold these carries for money, got something off the street, and then failed the piss test because of that indulgance. And then lie about it - asking the pharmacist if again this drug can be mistaken as an illegal in a piss test - or get offended as if someone switched the samples on them when their back was turned.


Of course patients don't care seeing as 98.5% are on welfare. As long as they provide a monthly drug card here their drugs are paid for by the government. Free. Lot better than Fred or Joe or Bobby-Jane asking for money.



Addictions treatment in a clinical setting - such as a detox center - has better results. Or maybe not. We've had one girl in and out of detox four times in the last six months. Last time she got out she phoned the pharmacy two hours later and was so drunk if not for recognizing the voice I'd have not a single clue who was on the other end of the line as she couldn't even pronounce her own name intelligibly.

leonardo
08-19-2016, 03:01 PM
A bag of heroin is as cheap as $10 in the area where I live. A cheap high. A good number of the overdose deaths are because the heroin is cut and mixed with fentanyl. The opoid addict is frustrating. They will lie and steal from their own mother, take food from their child's mouth, to feed their habit. It can be most challenging to support them. At times they are hard to love. Yet, for most, there is a genetic disposition. Their bodies physically crave it. I doubt many would choose to live the life of an addict of their own free will. Methadone and suboxone are merely replacements for the opiates, but, for many it allows them to function. They can hold a job and don't have to steal to get their fix. So, I have mixed feelings on their use. In principle, I don't believe in replacing one drug for another. In practice, the daily dose of methadone or suboxone may be the difference between an addict who steals, cheats and lies, who then ends up imprisoned or dead, versus one who can raise their children, go to work and generally contribute to society.

Gaku
08-19-2016, 09:04 PM
Yet, for most, there is a genetic disposition. Their bodies physically crave it. I doubt many would choose to live the life of an addict of their own free will. Methadone and suboxone are merely replacements for the opiates, but, for many it allows them to function. They can hold a job and don't have to steal to get their fix. So, I have mixed feelings on their use. In principle, I don't believe in replacing one drug for another. In practice, the daily dose of methadone or suboxone may be the difference between an addict who steals, cheats and lies, who then ends up imprisoned or dead, versus one who can raise their children, go to work and generally contribute to society.

One of our patients had a very successful business here. His brother, a real thug that we've been told many times would happily kill you not just lay you out cold but outright kill you for cash, was the one that introduced him to opiates. He lost his business, his wife, and has spent the last fifteen years in and out of jail. Does he choose to have a life of an addict? Oh you better believe it. Before his business partner basically said "f-off" and sold the business this chap went to every addiction treatment center around and was even shipped off to Europe where his parents were from and where family members still lived.

He is still an addict. It has aged him so horribly that the first time I ever laid eyes on him I thought the woman that came in with him was his wife. I was terribly wrong. That woman was actually his mother and she, I now know, is in her 80s. There's more than 30 years between them.


There's another patient who has spent 30 years in and out of jail. It is a dang shame he will likely never be able to get "permission" having a criminal record longer than your arm to speak in public schools about the dangers of addiction. He is a smart man, definitely is not someone who fried his brain cells with drug abuse, and he would definitely teach brats just what drug addiction does to you beyond the - age horribly and wreak your health.


And though methadone & suboxone allows functioning as I said most in this area, and I seriously doubt it is any different anywhere else, sell it. After all, most are on welfare and they really don't have to work. There's also the fact that both drugs happen to slow you down - our typical patient gets to the clinic / pharmacy well in the mid-day because they can't drag themselves out of bed - and that's not including the side effects of typically more than one drug. That's if they're not conning the system and double doctoring / poly-pharmacying.

I've watched patients with jobs loose them faster than you can say "poo" because they can't keep with scheduled work. Or because their employers get wind that X is an addict. There's one guy whose work truck has a GPS and he is always jumping rushing to go because he is paranoid if he stays too long at the pharmacy his employer will put 2 + 2 together.


By the way do you think being "treated" will keep a thief from stealing, a liar from lying, a cheater from cheating? I just said I work in addictions, my colleague has worked in addictions for 30 years, and well he'll find that belief more than just amusing. As for going to work we have many thousands of patients. Want to know the number who actually work? 5% may have a job you'd call legit.

leonardo
08-19-2016, 10:17 PM
One of our patients had a very successful business here. His brother, a real thug that we've been told many times would happily kill you not just lay you out cold but outright kill you for cash, was the one that introduced him to opiates. He lost his business, his wife, and has spent the last fifteen years in and out of jail. Does he choose to have a life of an addict? Oh you better believe it. Before his business partner basically said "f-off" and sold the business this chap went to every addiction treatment center around and was even shipped off to Europe where his parents were from and where family members still lived.
He is still an addict...

By the way do you think being "treated" will keep a thief from stealing, a liar from lying, a cheater from cheating? I just said I work in addictions, my colleague has worked in addictions for 30 years, and well he'll find that belief more than just amusing. As for going to work we have many thousands of patients. Want to know the number who actually work? 5% may have a job you'd call legit.

In response to the first part of your post, I don't believe few - if any - choose to be an addict. Do some have more control over their usage than others? I would say yes. But, one who has a genetic disposition to drugs and alcohol is battling the inability to stop, once they start. I suppose that one could argue, then they should have never started. But, how many of us never tried alcohol, weed or more as a teen or young adult? Once somebody with a genetic disposition starts, it is hard to stop. If one believes that this genetic disposition isn't real, then none are. In regard to the second part of your post, are you saying every liar, cheat and thief has been one since birth and will be until the day the die? Because my experience is most are not that way. In regard to an addict, they become that way to feed their habit. In your post the business partner must have been upright at some point, or he wouldn't have made it that far. I have seen people who lived good lives go bad from addiction. They weren't always a thief, liar and cheat.

Saetro
08-19-2016, 11:21 PM
Recently heard an expert on this area mention the brain chemistry involved in addiction, not only for opiates but also for gambling addicts, which is also a lesser but still major problem in some modern societies. Strangely, another, earlier addiction was also mentioned.
In mediaeval W Europe there was concern about lovesickness.
Ordinary attraction was fine, but lovesickness was regarded as a pathology - we now know this extreme form of attraction was involved with those same addiction brain chemicals.
Fortunately it often tended to wear itself out, but as Romeo and Juliet illustrates, it could cause youth violence, family disruption and indeed, the death of the affected persons. So, although rare, it was by no means trivial. The lesser form of one-sided lovesickness was often parodied in popular literature.

Gaku
08-19-2016, 11:36 PM
In response to the first part of your post, I don't believe few - if any - choose to be an addict. Do some have more control over their usage than others? I would say yes. But, one who has a genetic disposition to drugs and alcohol is battling the inability to stop, once they start. I suppose that one could argue, then they should have never started. But, how many of us never tried alcohol, weed or more as a teen or young adult? Once somebody with a genetic disposition starts, it is hard to stop. If one believes that this genetic disposition isn't real, then none are. In regard to the second part of your post, are you saying every liar, cheat and thief has been one since birth and will be until the day the die? Because my experience is most are not that way. In regard to an addict, they become that way to feed their habit. In your post the business partner must have been upright at some point, or he wouldn't have made it that far. I have seen people who lived good lives go bad from addiction. They weren't always a thief, liar and cheat.

Genes don't write your fate in stone. You are predisposed to be an addict but if they were written in stone then people from addict littered families [such as in the slums] would eternally be stuck in the slums selling crack on the street corner. They aren't.

I know one kid in a ghetto in Chicago that well his family was, in his own words, trash. His mother was an addict, her parents were both crack-heads, and his father a small time dealer who used more than he sold. In your logic he should have been an addict from birth and might as well just kicked up his heels and become an addict. Oh he did drugs. But then, after taking a look around at the hovel he called a home, he made the decision and said I an't going to let this crap live my life for me - dragged himself through university and now works high up in corp. office for a major computer company.

And to your logic once an addict, always an addict, so if that's the case why bother giving them treatment? Waste of money an't it if you know 4 months down the road they're addicted to something else. Might as well put that money to something more useful such as better educational systems about the problems of drugs than serving as an enabler for addicts.


As for once you start you can't stop.

A close friend of mine his mother's a drunk. His father a heroin addict. He tried both. Nearly killed himself with the booze. He hasn't touched a drop in 15 years.

My mother's family are all drunkards, my mother was a drunkard, and I supposedly am as per genes predisposed to be a drunk. Also I supposedly have addiction problems as per genetics. I rarely drink. So rarely in fact that I don't even bother telling people that I drink because it is too much of a pain in the arse to explain to them that the only time I let booze pass my lips is a single glass of brandy on my birthday that I drink so slowly it lasts me hours. Addiction problems. Bah. I smoked weed in university with friends. A couple of times. Haven't done that in nearly 12 years. I don't smoke cigs for that matter nor do I gamble. I broke both legs once and needed a morphine drip for the pain which of course is one of the easiest drugs to get addicted to. Yet despite the fact that an injury in the military meant I busted my shoulder to pieces, broke the bone and tore the muscle to degree that nowadays even I twist it wrong and I can pop it completely out of the socket, I don't take anything for pain aside from typical old aspirin that as it is due to pinched nerves hurts quite a bit.


But to your logics and my genes I should be on the other side of the counter as a patient being served not the one serving the patients.


As for the second part of the posts yes people are predisposed as liars. It is in human nature to cheat and lie and steal to better one self. The difference between a real thief or a real liar or a real cheater is they do so consciously and knowing full well that they are causing harm to someone because they don't possess the upbringing for morals or ethics saying "this is wrong".

But you didn't answer do you seriously think "treatment" will stop such people. The pharmacies around here have plenty of cameras, plenty of staff, and some of them have hardly anything on display [easy to grab] that would say otherwise. In fact a number of patients have called themselves professional "boosters" - thieves - and they've even offered to sell stuff to our staff with all the calm cool collect of those kids selling chocolate bars outside shopping malls cause they really do believe it is their right to steal something and sell it for cold hard cash.

They've stolen dogs outside of people's backyards and almost every bike in this area typically doesn't belong to whoever is riding them.

khanabadoshi
08-20-2016, 12:23 AM
A middle ground between Gaku and leonardo's statements:

Consider Diabetes type II. One maybe predisposed to becoming a diabetic. If they cross a certain threshold -- pre-diabetic -- there is a way back. If they cross the next threshold -- diabetic -- that is a point of no return, and they are now a full-fledged type II diabetic. For people who aren't predisposed to Diabetes type II, it would take considerably more sugar consumption on their part to reach these stages than one who is predisposed.

Now once someone has type II Diabetes, it can be managed/controlled or spiral out of control. Controlling you sugar-level and minimizing the symptoms does not equate to curing Diabetes or no longer being a diabetic. Once you are a diabetic you are always a diabetic. The same scenario applies for alcohol and drug addiction. The adage is "I am an addict" even when someone is no longer using and in a program. This serves to remind themselves they are not "cured" and if they use again they will again spiral out of control -- they are and always will be an addict.

EDIT: An interesting note, that predisposition doesn't change the overall effect of being a diabetic or an addict. Once, you've crossed the threshold, whether or not you were predisposed to it becomes irrelevant. A predisposed diabetic/addict and an addict/diabetic with no predisposition are ultimately in the same boat -- the difference is how quickly they got on the boat. So predisposition is only useful in the context of prevention, in the context of treatment, it becomes far less important.

leonardo
08-20-2016, 12:29 AM
Genes don't write your fate in stone. You are predisposed to be an addict but if they were written in stone then people from addict littered families [such as in the slums] would eternally be stuck in the slums selling crack on the street corner. They aren't.

I know one kid in a ghetto in Chicago that well his family was, in his own words, trash. His mother was an addict, her parents were both crack-heads, and his father a small time dealer who used more than he sold. In your logic he should have been an addict from birth and might as well just kicked up his heels and become an addict. Oh he did drugs. But then, after taking a look around at the hovel he called a home, he made the decision and said I an't going to let this crap live my life for me - dragged himself through university and now works high up in corp. office for a major computer company.

And to your logic once an addict, always an addict, so if that's the case why bother giving them treatment? Waste of money an't it if you know 4 months down the road they're addicted to something else. Might as well put that money to something more useful such as better educational systems about the problems of drugs than serving as an enabler for addicts.


As for once you start you can't stop.

A close friend of mine his mother's a drunk. His father a heroin addict. He tried both. Nearly killed himself with the booze. He hasn't touched a drop in 15 years.

My mother's family are all drunkards, my mother was a drunkard, and I supposedly am as per genes predisposed to be a drunk. Also I supposedly have addiction problems as per genetics. I rarely drink. So rarely in fact that I don't even bother telling people that I drink because it is too much of a pain in the arse to explain to them that the only time I let booze pass my lips is a single glass of brandy on my birthday that I drink so slowly it lasts me hours. Addiction problems. Bah. I smoked weed in university with friends. A couple of times. Haven't done that in nearly 12 years. I don't smoke cigs for that matter nor do I gamble. I broke both legs once and needed a morphine drip for the pain which of course is one of the easiest drugs to get addicted to. Yet despite the fact that an injury in the military meant I busted my shoulder to pieces, broke the bone and tore the muscle to degree that nowadays even I twist it wrong and I can pop it completely out of the socket, I don't take anything for pain aside from typical old aspirin that as it is due to pinched nerves hurts quite a bit.


But to your logics and my genes I should be on the other side of the counter as a patient being served not the one serving the patients.


As for the second part of the posts yes people are predisposed as liars. It is in human nature to cheat and lie and steal to better one self. The difference between a real thief or a real liar or a real cheater is they do so consciously and knowing full well that they are causing harm to someone because they don't possess the upbringing for morals or ethics saying "this is wrong".

But you didn't answer do you seriously think "treatment" will stop such people. The pharmacies around here have plenty of cameras, plenty of staff, and some of them have hardly anything on display [easy to grab] that would say otherwise. In fact a number of patients have called themselves professional "boosters" - thieves - and they've even offered to sell stuff to our staff with all the calm cool collect of those kids selling chocolate bars outside shopping malls cause they really do believe it is their right to steal something and sell it for cold hard cash.

They've stolen dogs outside of people's backyards and almost every bike in this area typically doesn't belong to whoever is riding them.

You missed my point regarding liars, cheats and thieves. Some may be born that way, but most addicts aren't. The point I am trying to make is people who get addicted, good people, become this way because of their addiction. They are mutually inclusive for most. As for your question, does treatment stop people from using, if I understand your previous posts, you work in a treatment facility. If so, you tell me? My answer is yes, under the right conditions. This is also my response to your comment regarding those who are predisposed and recover versus those who don't. Obviously, each person is unique. Some who are genetically predisposed try alcohol and or drugs and can cease. Others can't. Is willpower part of the reason for success or failure? Of course? Is it possible that some have greater addiction tendencies, genetically? I would not be surprised. Are coping skills and forms of interpersonal support factors in recovery? I would think so. Does the basic virtue of hope come into play? In my mind it does. Briefly stated, some may be able to beat their addiction more readily than others and not evryone who fails does so willfully, in my opinion.

leonardo
08-20-2016, 12:35 AM
A middle ground between Gaku and leonardo's statements:

Consider Diabetes type II. One maybe predisposed to becoming a diabetic. If they cross a certain threshold -- pre-diabetic -- there is a way back. If they cross the next threshold -- diabetic -- that is a point of no return, and they are now a full-fledged type II diabetic. For people who aren't predisposed to Diabetes type II, it would take considerably more sugar consumption on their part to reach these stages than one who is predisposed.

Now once someone has type II Diabetes, it can be managed/controlled or spiral out of control. Controlling you sugar-level and minimizing the symptoms does not equate to curing Diabetes or no longer being a diabetic. Once you are a diabetic you are always a diabetic. The same scenario applies for alcohol and drug addiction. The adage is "I am an addict" even when someone is no longer using and in a program. This serves to remind themselves they are not "cured" and if they use again they will again spiral out of control -- they are and always will be an addict.

I agree with your analogy. There is a point of no return for some. What physical cravings these people have, combined with psychological cravings as well, I can't tell, and I imagine nobody can - perhaps not even the addicted individual. I suppose in the most theoretical sense, even these addicts "can" stop. But in practice, the real world where we live, some, unfortunately, can't. If one wishes to hold judgement over them, they can. Just be aware, not everybody will judge in the same manner, especially if you have spent time walking in those shoes.

Gaku
08-20-2016, 01:14 AM
A middle ground between Gaku and leonardo's statements:

Consider Diabetes type II. One maybe predisposed to becoming a diabetic. If they cross a certain threshold -- pre-diabetic -- there is a way back. If they cross the next threshold -- diabetic -- that is a point of no return, and they are now a full-fledged type II diabetic. For people who aren't predisposed to Diabetes type II, it would take considerably more sugar consumption on their part to reach these stages than one who is predisposed.

Now once someone has type II Diabetes, it can be managed/controlled or spiral out of control. Controlling you sugar-level and minimizing the symptoms does not equate to curing Diabetes or no longer being a diabetic. Once you are a diabetic you are always a diabetic. The same scenario applies for alcohol and drug addiction. The adage is "I am an addict" even when someone is no longer using and in a program. This serves to remind themselves they are not "cured" and if they use again they will again spiral out of control -- they are and always will be an addict.

Yes but if you have a pre-diabetic do you turn them loose in a candy store and say have fun? Does a person who knows diabetes runs in the family eat like a horse or tries to stay healthy?


Mike said he has 18 year olds, baby addicts really compared to the hard core ones who will never change, on methadone in his jails. We have 15 year olds here on the same thing.


Addiction treatment in that sense, particularly at such young ages, is a bandage. It doesn't treat the actual issue it gives them a bandage for their "booboo". Now a number of our patients have led some rather rough lives. And I am not talking just substance abuse. I won't even begin to try and tell you what I've heard and most of it is not something you'll tell your family about over the dinner table when they ask "how was your day, dear". Not to mention that when one is feeding a habit, typically with little in the way of cash, you might be doing things that will eat at you later on.

Guess what tips the scales around here medicine wise - anti-depressants.

But the thing is, is if you keep giving someone a bandage when do you stop and actually tackle the issue? Is it before or after they pull a "Humpty Dumpty"?


And I am not talking singular to patient alone. Leonardo's last post about people being "born that way".

Well babes can be born addicts.

But more it is a lot of things. I'll never forget the girl, 8, I called CPS on years ago who was panhandling outside the local store to feed herself because her parents were too stoned and drunk out of their minds to even get out of bed. We have a number of families in the addiction treatment - mother / son, father / son / daughter, cousins, etc. Is it genetics? Or is it when you have horrible role models, crap parents, little options, and no where else to turn then what do you think happens? The result a repeating badly broken record with a few pieces of tape to hold it together.

They try to cope. Some become drunks, others become drug abusers. Still some say no way jose and hightail it the heck out of dodge.


My thing is, is if you knock it down to genes you are only looking at one side of the story. A 2 x 2 flashcard and not the big picture. Anyone can become an addict, just as how anyone can become a diabetic, even if their genes state that they should be the shining example of sainthood given the right conditions. People continually go on about nature vs. nurture and it applies here. Take a kid out of the slums, give him something to make of his life and he'll likely never look back. Will he become an addict? Potentially but it is less likely than where he was to start.


Leonardo - you said heroin is dirt cheap around your area. It is the same around here. I have a good rapport with the patients, as I treat them like people and really couldn't careless if they look as if dragged through a bush backwards or with arms littered with tracks, and they tell me all the "good stuff" or whoever is doing what as if spilling the beans on their fellow patients will earn them favor. The locals around here love to tell me stories about buyers, sellers and they aren't always addicts / criminals but the people who you think should be law obeying cause they're supposed to uphold it.

A lot goes on in such areas that people think they see, and even more goes on behind the scenes.


In that regard do you think cheap easily available drugs on the street helps? Do you think all the addicts in your area are predisposed to be addicts by their genes? That they can't shake the addiction because of those genes? Or is it more that becoming an addict is painfully easy? And to some being an addict is easier than "real life"?

There is, after all, a reason why you get repeat offenders and it isn't because they think the jail bars are pretty. It is more because life behind bars is better than life out. I have a friend in corrections - couple years ago a guy killed himself rather than be let out of jail as life was so miserable for him on the other side.

Saetro
08-20-2016, 01:30 AM
It is good that someone is trying to help affected people.
Even if a correlation is found by a larger trial, how might it be useful?
If every addict were tested beforehand, what could we tell those with the particularly dangerous allele - "don't take the stuff or you may die"?
Don't we do that now?

Saetro
08-20-2016, 04:12 AM
Epigenetics surely has eventually to be considered as part of treatment of drug takers.
These changes mean the person is not the same after drug taking as they were before.
Schmidt (2013) describes a variety of epigenetic changes. http://perspectivesinmedicine.cshlp.org/content/3/3/a012047.short
Even if treatment is behavioural, the reversal of some epigenetic markers may demonstrate positive changes.