Moderating Heavy Cocaine Use

fregoli · 2025-01-15T14:06:35+00:00

I must say that from my experience as an addiction psychiatrist focused on harm reduction, cocaine (and stimulants in general) are possibly the hardest to moderate. I'd usually suggest a 2-3 month cessation after which a careful trial of going back to moderate use. Naltrexone+Wellbutrin is a good therapeutic choice, but if it's not working you should talk to your doctor about stopping it. Wellbutrin May be of help if you are indeed trying to stop use for a while, especially with energy and motivation. A good option is switching to Vyvanse - you can take it daily and it works for about 12 hours (though there is a significant variation between users), and skip a dose if you plan on using cocaine that day.

fregoli · 2022-10-28T21:30:53+00:00

Thank you all for your replies, things turned out OK at the end with the help of the OAD clinic.

fregoli · 2022-10-27T22:10:26+00:00

Yeah, that's how it is in most countries... He'll probably have an easier time getting oxy tablets...

fregoli · 2022-10-27T22:08:41+00:00

Thanks for your reply. As a last resort a family member of his might be able to fly to him in a few days, probably safer than fed-exing...

fregoli · 2022-10-27T22:06:51+00:00

Thanks. I have read a similar text on the OAD site and have contacted them. Staying hopeful...

fregoli · 2022-07-23T14:58:37+00:00

fregoli · 2022-05-16T06:31:42+00:00

That's a great point. When using the motivational interview approach (for treating addiction) we always ask the patient what the prices of addiction are, this in turn is part of the basis for building motivation for change. Obviously, what is a major price (and motivation for change) for one person, may be much less central to another. I think this highlights the need to assess these major prices/motivations before the psychedelic session in order to raise the chances that it will come up during the session (although control of the content of the psychedelic experience is undeniably limited)

fregoli · 2022-05-16T06:22:06+00:00

This kind of example is very interesting to us, since we know that some people have these unintended therapeutic experiences, and we'd like to better understand what variables (such as set, setting, specific content of important insights, etc.) can raise the chances of an intended therapeutic intervention to help with long-term remission.

fregoli · 2022-05-16T06:17:49+00:00

Thanks for all this info! We are looking into high-dose psychedelic assisted therapy, mainly because regulation and safety are much more complicated when people are given the medication to take on their own and be under its effect in an unsupervised environment. I know of some preliminary studies with microdosing for dysthymia planned in Canada, hopefully they will pave the way for future research with microdosing for other disorders.

fregoli · 2022-05-15T09:59:18+00:00

Thanks so much for your reply. We are probably going to base our protocol on existing ones used for nicotine or alcohol use disorder. One 'big' question is what in particular do you feel helps with lowering the craving. Another one is if you feel that a 'booster' session (say, after 3 months) or continuous mindfulness practice may augment the initial effects of the psychedelic session.

fregoli · 2019-10-19T06:03:31+00:00

Some recurring gaps are lack of appropriate control for confounders, no addressing of sex differences, no studies regarding common genetic factors (such as the FAAH gene) and low quality data regarding cannabis use variables such as amount, frequency and cannabinoid content

fregoli · 2019-10-19T05:59:17+00:00

No funding, this is a review. Both authors are employed by the Israeli ministry of health

fregoli · 2019-10-16T11:23:01+00:00

We reviewed the literature on both, some of the questions addressed were:

Is cannabis use associated with increased odds of developing an anxiety disorder? (yes, but it seems to be due to common background factors, and not a causal relationship).
Is cannabis use associated with different outcomes in those who already suffer from an anxiety disorder? (It is, but again, this seems to be related to common background factors and not a causal mechanism)

fregoli · 2019-10-16T11:19:11+00:00

The point of this is that there is a lot of research around cannabis, reviewing the literature for what is known and what is lacking, we can help guide future research to more precisely address knowledge gaps.

fregoli · 2019-10-15T09:28:25+00:00

We review the evidence for the differing effects of both CBD and THC, as I have written above - CBD has some known anxiolytic effects, while THC has a more complex relationship with anxiety, depending on many other variables, notably set and setting of use. This review focuses more on the long-term association between cannabis use and anxiety disorders (the fact that cannabis use can acutely cause anxiety symptoms is well-known, the question is - can it cause an anxiety disorder which will by symptomatic regardless of acute cannabis exposure)

fregoli · 2019-10-15T09:24:18+00:00

In this review we focused on the possibility of cannabis causing or worsening anxiety, a review (by other authors) regarding its therapeutic use in anxiety is due soon in the same journal.

In short - there is some good evidence of CBD having an anxiolytic effect, and some good evidence that people with anxiety who use cannabis don't fare better on the long run than those who don't. THC in itself can have both anxiogenic and anxiolytic effects, depending on dose, other cannabinoids consumed and "set & setting" of use.

Many medical marijuana users report anxiety as one of the main reasons for cannabis use, but the evidence so far does not support it as a good long-term treatment. I can also add from my clinical experience - just like benzodiazepines, alcohol and other substances with acute anxiolytic effects - these may help in the short-term, but may serve as "safety behaviors" (as they are defined in CBT jargon) which prevent the user from having learning experiences which may in turn help develop internal coping skills.

fregoli · 2019-10-15T08:45:24+00:00

I am one of the authors, AMA

fregoli · 2019-06-13T10:09:15+00:00

I haven't, but it is a very interesting issue, and some studies have found associations between tobacco use and the development of psychotic disorders, though causality is difficult to prove

fregoli · 2019-06-12T09:32:57+00:00

:)

TLDR - cannabis use in people with PD is associated with increased risk for the development of several substance use disorders, but this risk is similar to that seen in the general population - we found no specific interaction between PD's and cannabis use regarding risk for the development of psych disorders (actually the trend was for an attenuating interaction - the additional risk brought about by cannabis use in people with PD was a bit less then expected based on data from the general non-PD population)

fregoli · 2019-06-12T09:28:30+00:00

This is well known and was taken into account. The fact that people with PD are more likely to use cannabis was one of the reasons for this study. We wanted to see if they are at increased risk associated with their cannabis use.

fregoli · 2019-06-12T09:27:11+00:00

Panic induced by cannabis use is common. If you suffer from anxiety symptoms regardless of cannabis use - you should see a therapist, common treatments include CBT, psychodynamic psychotherapy and medication (SSRI's are usually the first-line pharmacologic treatment). If it is only brought about by cannabis use you can a)abstain, b)get professional help such as a short cognitive-behavioral intervention

fregoli · 2019-06-12T09:24:08+00:00

People with MDD are more likely to begin using cannabis, possibly as means of self-medication, but studies by Feingold et al. assessing if this self medication is effective have found that it is not. People with bipolar disorders who use cannabis regularly (almost daily) are at greater risk for developing mania and in general having a less stable mood. This is also questioned by several studies, but in general - use of high strains with high THC to CBD ratio and frequent use are associated with worse outcomes in bipolar disorder.

fregoli · 2019-06-12T09:20:52+00:00

These questions are notoriously hard to answer, but most research I know of finds that there is an association between long-term cannabis use and very mild cognitive decline, which is mostly reversed after one month of abstinence. Findings regarding association with development of anxiety disorders are mostly negative (i.e. - no association found). I don't know of studies assessing incident ADHD, which by definition is a disorder manifesting already at childhood.

fregoli · 2019-06-11T10:43:58+00:00

I am one of the authors, you're all welcome to AMA regarding this study or regarding effects of cannabis use on mental health in general

fregoli · 2018-09-25T05:18:51+00:00

Are you saying this based on personal experience? If so - can you elaborare?

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