I have treated several opiate addicts whose family members have reported them as being “angry” without opiates (“A life of drugs and ‘downtime’”, Current Psychiatry, August 2007). When these individuals are asked if they feel angry without opiates, their response has been “yes, how did you know?”
These patients also said they used opiates not to get high but to avoid being angry and impossible to be around. In these select few—who also had not responded to antidepressants or mood stabilizers—I have found thiothixene to be especially helpful to rapidly reduce anger. None of these patients were psychotic, and all had good work histories.
I recall a patient who was suicidal because she couldn’t stand how angry she was without opiates but knew that staying on the drugs wasn’t an acceptable option.
Sheridan Tucker, MD
Whitfield, MS