Recreational Tianeptine Has Potential for Abuse

DEAR DR. ROACH: I’ve been hearing about tianeptine being sold at gas stations. Is it really dangerous? -- S.F.

ANSWER: Like so many substances, tianeptine can be a useful drug when prescribed and taken correctly (it’s used in several countries for depression), but it is indeed dangerous when used recreationally. Its use has been banned in several (unfortunately not all) states across the U.S. It is sold (yes, especially at gas stations) as a dietary supplement. Because it acts on the same receptor as morphine, when used at high doses far beyond the medically approved dose, it has potential for abuse and even overdose, with a handful of deaths ascribed to its use.

I recommend in the strongest possible terms against its recreational use and hope it is completely banned soon.

***

DEAR DR. ROACH: I have severe pain in my right shoulder. I have seen two orthopedists and received X-rays, MRI scans and a cortisone injection, which didn’t work. Both surgeons recommended a shoulder replacement. I am taking three adult aspirins each morning (I am allergic to NSAIDs), which makes the pain go away. Is this safe? I am 83 and otherwise healthy. -- J.B.

ANSWER: Aspirin is a type of non-steroidal antiinflammatory drug and has the toxicities common to all the drugs in that group, including an increased risk for bleeding and potential damage to the stomach and kidneys. But it has additional toxicities beyond NSAIDs like ibuprofen, especially at higher levels. I am very cautious about prescribing aspirin and generally prefer other anti-inflammatory medicines. However, people have long taken aspirin -- sometimes at much higher doses -- usually without problems. The fact that you are taking it only once a day reduces the toxicity, but I have to say I am surprised the benefit is lasting all day. The risk of toxicity is higher at older ages. At 83, you are at a significantly higher risk (seven times the risk) than younger people. Most of the data on exactly what your risk is comes from people taking low-dose aspirin (81 mg, not the 975 mg you are taking), so I can’t give you an evidence-based answer. But, for men in their 80s taking low-dose aspirin, about 1.5% will have a serious bleeding event per year. Your risk will be significantly higher due to the much-larger dose you are taking. However, one has to consider both the benefits of the aspirin treatment (the pain being gone is the best possible outcome) and the toxicity of other possible treatments, such as surgery (which is very significant).

There are many classes of NSAIDs, with very different chemical properties, and it is likely there is another type of NSAID you could safely take, with a lower risk than the dose of aspirin you are currently on. On the other hand, you can’t get any better effectiveness, at least in terms of pain, and the absolute risk is still fairly small, so I’m not sure I recommend you change. I am always very cautious about recommending surgery to someone in their 80s when there is an effective medication available to treat the issue.

***

Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

© 2023 North America Synd., Inc. All Rights Reserved

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Indirect Dental Fillings

Indirect fillings are used to repair teeth that don’t have enough structure to support a traditional filling but aren’t damaged enough to require a crown. Unlike traditional fillings, indirect fillings are created in a dental laboratory and require two visits to install. During the first visit, the decay or old filling is removed and an impression is taken of the tooth being repaired. A temporary filling is placed to protect the tooth in the meantime. At the second visit, the temporary filling is removed and the indirect filling is permanently affixed. There are two types of indirect fillings: inlays are used to restore the chewing surface,whileonlaysrestoreadditional surfaces and are sometimes called partialcrowns.

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P.S. Indirect fillings are more durable than traditional fillings and can last up to 30 years.

My name is Kaley. I will be 3 years old next month. After I came home, from a breeder in Florida, my mom & dad found out from Cornell that I was born with 3 abnormally large bones at the base of my spine. I will be on pain medication for the rest of my life. But, I give my mom and dad all the love in the world.

Kathryn Logan

February 27, 2023

BERGEN - Kathryn Logan, 96, of Bergen, passed away Monday, February 27, 2023, at her home in Bergen.

“Katy” Logan was born on November 7, 1926, in Shippenville, PA, the daughter of the late Milton and Mabel Greenawalt. Katy graduated from Shippenville High School and served with her husband Jack Logan in the pastoral ministry of the Free Methodist Church for 50 years. In addition, she worked as the manager of the bookstore at Roberts Wesleyan College for several years. She was predeceased by her husband, Jack Logan, whom she was married to for 73 years.

Kathryn is survived by four children, Stephen (Donna) Logan of TN, Connie Logan of Bergen, Keith ( eresa) Logan of MI and Mark (Ruth, deceased) Logan of Churchville; 14 grandchildren, Jonathan (Candice) Logan, Jason Logan, Jamie (Wade) Humphries, Allison Nichols, Meredith (Stefan) Bauroth, Nicole (Matthew) Rapp, Maria Baltazar, Melinda (Jonathan) Cardenas, Melissa (David) Fite, DeWayne (Emily) Logan, Jordan (Raina) Logan, Tyler (Rebecca) Logan and Elise (Shane) Fraser; 31 great-grandchildren; 4 great-great-grandchilden; 1 sister, Arvella Sherman of Erie, PA.

She was the sister of the late DeWayne Greenawalt, Norman Greenawalt, Junior Greenawalt, & James Greenawalt.

Friends may call on April 22, 2023 from 1:00-2:00 p.m. at Pearce Memorial Free Methodist Church, 4322 Bu alo Rd., N. Chili, NY. Memorial Service will be immediately following at 2:00 p.m. at Pearce Memorial Church, with the Rev. Walter Fleming o ciating. Interment will be in North Chili Cemetery. In lieu of owers, please consider memorials in Kathryn Logan’s name to Northgate Free Methodist Church toward “Gahanda Rwanda Fund”, 8160 Bank Street Road, Batavia, NY 14020.

Arrangements for Katy were entrusted to H.E. Turner & Co. Funeral Home in Bergen.

Please leave a condolence, share a story, or light a candle at www.bataviafuneralhomes.com

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