User talk:HeuristicA1

Welcome

Welcome!

Hello, HeuristicA1, and welcome to Wikipedia! Thank you for your contributions. I hope you like the place and decide to stay. Here are some pages that you might find helpful:

I hope you enjoy editing here and being a Wikipedian! Please sign your messages on discussion pages using four tildes (~~~~); this will automatically insert your username and the date. If you need help, check out Wikipedia:Questions, ask me on my talk page, or ask your question on this page and then place {{helpme}} before the question. Again, welcome! Literaturegeek | T@1k? 16:40, 17 May 2009 (UTC)[reply]

Clonazepam

Hi, saw your edits to the clonazepam page. Using stats for an entire drug class ie SSRIs against stats for a single drug in the benzodiazepine drug class is not putting things in perspective I don't feel but is doing the opposite.--Literaturegeek | T@1k? 16:51, 17 May 2009 (UTC)[reply]

To be honest, I think the entire study is problematic as a source for clonazepam abuse, but did not want to simply delete the section. I will attempt to find some better data, but I think it worthwhile to discuss whether the article should hang the entire misuse section on a study of this nature. If you scroll down to Appendix C in the study, where it describes its methodology, you'll find that there are eight types of cases which are used, including "other," which is a catch-all category, and could include therapeutic dosages and legitimate uses. The flow-chart is particularly illustrative. That there are more cases of SSRIs captured in this study than clonazepam indicates how broadly this study reached to find cases where a drug was "implicated" in an ED visit, given the general recognition of the safety of SSRIs. In that sense, it places what the number of clonazepam cases really means in context. Regarding the legitimacy of comparing an entire class of drugs to a single drug in another class, I'd just note that drugs within the SSRI class are extremely similar in action, and I have yet to encounter a claim, anywhere, that one is more subject to abuse or misuse than another. This is not the case with benzodiazepines, where some are known to be far more likely to be abused, and can differ substantially in effect. So I think the comparison to be valid. Thank you for the welcome, incidentally, I appreciate it! HeuristicA1 (talk) 17:17, 17 May 2009 (UTC)[reply]

Hello, thank you for your reply. I agree that getting better or at least additional sources might be worthwhile. I know that SSRIs are almost identical if not identical as far as mechanism of action goes. I was talking about numbers of people not mechanism of action. Table 9 and I think the entire study but certainly table 9 is describing non-medical use. I would say that the vast majority of SSRI ED visits were due to suicide attempts with a small number being drug abuse related. Stats for acute adverse reactions from therapeutic doses would not be included. Unfortunately you are misinterpreting the ref by not realising that non-medical use in the study means only getting high. It includes all forms of non-medical use, including drug abuse, self harm/overdose etc.--Literaturegeek | T@1k? 17:45, 17 May 2009 (UTC)[reply]

Fair point regarding the number of people, by which I understand you to mean that because more people are prescribed SSRIs than are prescribed clonazepam, it is misleading to simply compare the two numbers. I'm not sure whether the facts are accurate, but if they are, I agree. One of the weaknesses of the SAMHSA study is that it does not tell us how many people are actually prescribed any of the pharmaceuticals it lists.

I understand that nonmedical use includes more than simply "recreational" use--I noted that the number of cases of "nonmedical use" of NSAIDs is close to that of clonazepam--but I'm extremely wary of using Table 9 to draw any conclusions concerning drug misuse.

As far as SSRI use and visits related to suicide attempts, that's certainly possible; it's also possible for the clonazepam cases. It's simply impossible to tell from the study.

In any event, I noticed all the work you've put into this, and other articles, and I'm both impressed and appreciative. I hope you understand I'm offering the edits in the spirit of adding small improvements, and not to be needlessly contentious. HeuristicA1 (talk) 18:01, 17 May 2009 (UTC)[reply]

I agree that there are methodology problems with the publication. Partly yes but also because you are using an entire drug group versus one member of another group. It wouldn't have been as bad if you were comparing one commonly prescribed SSRI in the USA to say clonazepam which is commonly prescribed in the USA. Your concerns are valid and I think that the best way of resolving this would be to find a better reference. Yup indeed you are correct that a lot of the clonazepam cases would be suicide attempts as well. The abuse potential of SSRIs is extremely low whereas the abuse potential of benzodiazepines is higher.

Oh yes I understand your edits are to bring improvements to the article which is why I welcomed you to the project and you have gotten me thinking of how to better improve the drug misuse section.--Literaturegeek | T@1k? 18:11, 17 May 2009 (UTC)[reply]