A question from a reader:
I had a very serious back injury and was prescribed pain medications for this and it snowballed from there. I went from taking percocet for pain as prescribed to stealing oxycontin and crushing it whole just to stay out of withdrawal in a matter of a couple years. While I never injected or snorted anything, I feel my addiction was just as serious as a heroine abuser. I was also never caught at work or luckily in any legal trouble. But, I lost friends and family and most of all my self esteem and my health began to deteriorate. I looked in the mirror one day and completely broke down when I saw what I had become. I am now beginning my journey to recovery which is much harder than I had ever imagined. I am trying to do it the natural way. While I find suboxone to be very helpful and therapeutic to many patients, I think that I may end up trading one addiction for the next. I know that you are a very busy doctor, but I have a question for you if you have time to answer it for me. I wondered if you have heard of amino acid therapy to repair the damaged neurotransmitters in the brain. I have heard of IV and PO administration of these amino acids. I just would like as much info. on natural remedies as possible. If you have an opinion on any of these topics, I would greatly appreciate it. It’s people like you who help us beginning our journeys to sobriety. I understand also how busy that you are, so please don’t feel obligated to take time from your busy day. Thanks for any advice that you may have.
Thank you for sharing your story. I am not a big fan of amino acid ‘treatments’. I am aware that there are people who recommend using such an approach to treating addiction. The reasons for my lack of excitement are first that there are no reasons that I can see why amino acids would offer anything beyond a placebo effect. People toss around phrases like ‘damaged receptors’ and ‘neurotransmiter deficiencies’… but in reality, those things do not occur in opiate dependence. There is damage done to serotonin-containing neurons on the cortex from use of ecstasy– probably because of production of some toxic degradation product from the actions of ecstasy on metabolic pathways. But opiates bind reversibly to receptors; they are NOT toxic; there is NO depletion of transmitters during opiate use…and why WOULD there be? If anything, if I had to guess how things would work, I would expect the opiates to act at presynaptic receptors to block the release of endogenous opiates like the endorphins, allowing if anything LESS depletion!
Another problem with the idea that amino acids can ‘treat’ addiction relates to the issue of absorption of amino acids and the effects of amino acids on CNS neurotransmitters. This is a short subject… because there is nothing to say! L-Dopa IS absorbed, and DOES cross the blood-brain barrier… but other transmitter precursors do NOT get into the brain. The body is made this way, by evolution, deliberately; there is a barrier to entry into the CNS of most chemical substances. Again, thinking about how the body works, OF COURSE we don’t change brain chemicals based on our diets— can you imagine the chaos at synapses if dietary changes DID affect brain chemistry? A related point: There are MANY times when a person ingests a ‘unique’ diet; if a person decides to take in certain amino acids to treat addiction, THAT PERSON may know what he is doing… but his BODY and his LIVER and his BRAIN have no idea what is going on! To those organ systems, he might as well be eating a bratwurst! In both cases, the liver gets flooded with amino acids and has to ‘decide’ what to do with them; the liver cells are alive with millions of metabolic pathways that are in balance based on current levels of serum proteins and other molecules; if a certain type of molecular substance is deficient, the pathways move toward greater production of that substance. If a person’s albumin levels are low, the liver will make more albumin– using the amino acids he swallowed either in pills or in a burger. The liver doesn’t think, ‘oh, we need these amino acids in the brain! The liver works to create a constant availability of amino acids for use by muscles, brain (to a much lesser extent!!), and other organ systems. With the exception of L-dopa I don’t know of any evidence for changes in brain levels of a transmitter because of a change in diet– especially in a person who is not starving to death.
I have a post about nutrients on another blog of mine– read it here— about the many errors of logic made by people who take supplements, using the example of taking ‘serotonin’ and thinking it is going to work like an SSRI.
(I just realized that it isn’t at that blog– so instead I will put it as an addendum below)
Finally, I write ad nauseum about the ‘replacing addictions’ issue. In my opinion, there is no such thing with Suboxone as ‘replacing addictions’. First, you can’t ‘replace’ opiate dependence with ANYTHING– it is PERMANENT! The pathways that are established in the brain during addiction cannot be eliminated any more than you can forget how to ride a bike. An opiate addict will ALWAYS be an opiate addict… the question is whether he/she will use or not. Suboxone gets to the very essence of addiction– which is the obsession to use. Most people who take Suboxone properly find that their addiction goes into remission– the desire to use goes away. This is not just semantics– this is actual treatment of a disorder, in my opinion. It is no different from any other treatment for any other disorder! It eliminates the obsession to use, which is the essence of addiction. It is NOT permanent; like most meds, it must be continued indefinitely. Just like insulin for diabetics.
I have seen many people relapse over and over, all out of the fool’s errand of finding a ‘cure’ for their own addiction.
SD
Addendum: An example of the errors of logic used by people who push ‘nutrients’ over ‘medications’:
We know that it is NOT serotonin that improves mood; when an SSRI like prozac is given to a depressed patient, there is an immediate increase in CSF (spinal fluid) serotonin but the depression does not improve for at LEAST several weeks. There is evidence that the improved mood occurs when the dendrites (the receiving parts of neurons) in a part of the brain called the hippocampus start to grow and branch out; the improved mood is correlated with ‘thickness’ of the cell layer that includes these newly-grown dendrites, and this occurs after several weeks. So, what is the connection between increased serotonin in the CSF and the growth of dendrites several weeks later:? Here is one theory: The CSF serotonin comes from ‘spillover’ of serotonin from the synapse– the space between neurons. Serotonin is released by axons and binds to receptors, having an effect on the next nerve in the chain. The neuron that released the serotonin then pumps the serotonin back into the axon and recycles it. That is ‘reuptake’, the process blocked by prozac. The recycling of serotonin is blocked by prozac and other SSRI’s, making the serotonin ‘spill’ out of that space between neurons, into the spinal fluid. The neuron that released the serotonin can’t take it back up and recycle it– so it has to instead make NEW serotonin. This requires these neurons to fire up their metabolic machinery and expend energy to make the serotonin. One thought is that this ‘firing up’ of the machinery of the neuron to make serotonin ALSO results in new growth of dendrites– the process that reduces depression.
Now compare this effect by prozac to the effect of giving serotonin DIRECTLY. First, you can’t get much serotonin absorbed from the GI tract; some of it is broken down by the liver; more is broken down by an enzyme called ‘COMT’, and just maybe a small fraction diffuses across the ‘blood brain barrier’ into the spinal fluid. Let’s assume that it actually gets to the neurons where we want it to go. So now we have extra serotonin, and the reuptake is NOT blocked– because we aren’t giving any antidepressant, bur rather giving serotonin directly. So there is MORE serotonin to be taken up and ‘recycled’– and MORE serotonin in the neuron– not LESS, which is the case with an SSRI! Having extra serotonin turns DOWN the metabolic machinery– instead of how the SSRI turns it UP!! So by this mechanism, giving serotonin would raise the CSF level of serotonin, just as SSRIs do… but the effect on the neurons would be the exact OPPOSITE of what happens with an SSRI, and ther person would get LESS dendrite growth, not MORE, and would get even MORE depressed!
The reason that more docs don’t give supplements is NOT because they are ‘ignorant’ or ‘closed minded’, but rather because there are good, scientific reasons NOT to do those things.
Addiction
More Methadone, If WE Can Profit From It.
A short holiday post today. Reading my newsfeed I came across an article by Jason Kletter, President of BayMark Health Services, complaining about Section 4 of the proposed Opioid Treatment Act that would allow pharmacies Read more…
2 Comments
johnpal716 · May 12, 2009 at 7:09 am
Dear Doc,
About a month ago, I visited a naturalist to find some natural relief from the pretty relentless constipation from the Suboxone. Through the course of conversation some supplements were suggested to me that (I was told) would help my body recover from the “damage” I had done. Some of these things are: an “Adrenal Energy” supplement (from a bovine source), L-Tyrosine, and a “Lymph Cleanser”… also GABA for relaxation.
While the supplements for my constipation are definitely working (some herbs and a wonderful magnesium drink powder called “Calm”) I am just in question in the first place of just how much damage I have done to my lymphatic system and adrenals. Some pretty surface research has told me that GABA does not cross the blood brain barrier. As for the Tyrosine I see it recommended in places on the internet, but am still unsure.
Am I being scammed? Or rather, is someone who is severely misinformed trying to prescribe me things that I just don’t need? My drug use ran the gamut over the years (opiates, lots of ecstasy and cocaine) but I ended up on a significant amount of intranasal Oxycontin. Just from reading your blog I would think that if any specific supplements did any significant amount of help, it would have been mentioned at this point.
Thanks,
John P.
GatorGirl99 · August 14, 2012 at 12:58 pm
I can agree with your concern about amino acids being used as cures for addiction. I don’t know that they necessarily “cure” anything, but there are some that do seem to alleviate symptoms that might lead a person to use again. When I take Tyrosine I definitely feel an increase in mental clarity and when I D-Phenylalanine (hard to find since it usually comes a DL-Phenylalanine). But some of the others, not so much. But none would have served as a substitute for opiate cravings the way Suboxone does.
The nutrients I do take are by IV. I do this a couple of times a month. This therapy is typically recommended for cancer patients or fibromyalgia patients. For the typical patient, I wouldn’t necessarily consider this is a “cure” either. Except in the issue of people like myself who had a particular type of bariatric surgery where the duodenum and upper jejunum are bypassed as well as reducing the stomach to the size of a thumb. In my case, it’s more of a matter of maintaining normalcy.
What I noticed after the surgery, was that everyone I knew that had this type of surgery was developing problems. These include mood disorders, depression, alcoholism, substance abuse and suicide. And none of them had any history of problems before. When the phenomena was first noticed on a larger scale, many psychologists came out to say this was the result of deep-seated and unresolved emotional issues that had previously been treated by eating and after surgery, since they could no longer do this they turn to something else. They called this “addiction transfer” and would say this might be the result of disappointment that their life hadn’t become what they thought.
But what I knew was that this just didn’t ring true. Everyone I talked to said “they felt different”, “anxious”, and “ill at ease”. But my friends that had different types of surgery (ie., lap band) never seemed to have these issues.
My personal experience was recently confirmed by two studies (Dr. Wendy King and Magdalena Ostlund) where they show the risk of developing problems like I mentioned above actually QUADRUPLES when a person has a weight loss surgery that bypasses the intestines (ie .Roux-en-Y which is the most common and Duodenal Switch which is what Congressman Jesse Jackson had)…but no increase when they have restrictive procedures (such as lap band or sleeve gastrectomy). When you look at the primary function of the duodenum and jejunum which is absorption of nutrients, I could only conclude this had something to do with these problems.
Dr. King came out and said flat out ‘addiction transfer’ in gastric bypass patients is a myth. Another finding of hers is that these problems don’t typically hit until about year 2 after surgery. If this was an emotional issue, you would expect to see it sooner rather than later.
I think what’s going on is the people start experiencing neurological problems associated with nutrient deficiency. Many diseases previously only found in third-world countries are being diagnosed in gastric bypass patients. Now they even use the term ‘bariatric beriberi’. There is also pellagra, hypomagnesemia, pernicious anemia and B-12 deficiencies all whose deficiency symptoms include severe psychological and behavioral changes.
When people feel bad or “off” and then find relief (albeit temporary) from alcohol, prescription drugs, or behaviors such as gambling or sex….the brain pretty quickly decides it would rather feel good rather than bad.
So in that context, I think supplements can provide relief in that they can alleviate symptoms of nutrient deficiency that could otherwise leave a person vulnerable to addiction.
To John P, there are some ‘naturalists’ that are basically just trying to sell expensive vitamins which you may not need. You’re research is correct, GABA doesn’t pass the blood-brain barrier to give you more GABA. But Tyrosine does provide some increase in clarity, similar to caffeine without the jitters and I am a huge fan of magnesium. But you need to make sure it isn’t Magnesium Oxide which is the most common and inexpensive form (but only about 4% absorbable). Look for chelated magnesium such as magnesium taurate or magnesium glycinate or liquid magnesium chloride solution. If you are deficient in magnesium, you can experience symptoms that mimic panic attack. Anxiety and insomnia are also symptoms. B-12 via IM injection or nasal spray is good too, especially if there is alcohol abuse involved which can deplete B vitamins. But “Lymph Cleanser” and “Adrenal Energy”? Also, you don’t need to spend a lot of money on these from the naturalist. Many of these can be purchased much less expensively online or your doctor can prescribe the B-12 (ask for methylcobalamin rather than cyanocobalamin).
I don’t think nutrients are a cure per se, but I think they can be a tool in returning someone who is in poor health back to optimum health….and less susceptible to returning to old destructive behaviors.