For Those Who Have Used Suboxone????
Question by serenity113001: For those who have used Suboxone????
I have a few questions about this medication…My bf is currently on it for his heroin use and I would like to hear from anyone who has/is been on this medication and how they dealt with it while using it and those who have been able to live life without it. Did you experience any side effects? Did you drink more caffeine? (My boyfriend asked bc he is up to 10 cups a day…though I think it is him getting back to work and the time change…) What was life like once you were off of it? Any withdrawal symptoms? Did you use again or did you have the urge? If so, how did you fight it??? Any answers would be appreciated from those who have any sort of experience with this subject as I worry considering what I have been through with my bf before he decided to finally get clean…Thanks : )
Best answer:
Answer by sofie a
Buprenorphine sublingual preparations are often used in the management of opioid dependence (that is, dependence on heroin, oxycodone, hydrocodone, morphine, oxymorphone, fentanyl or other opioids). The Suboxone and Subutex preparations were approved for this indication by the United States FDA in October 2002. This was only possible due to the Drug Addiction Treatment Act of 2000 that for the first time since 1914-1920 (conflicting Supreme Court rulings – rulings that would not stand to today’s Supreme Court as they ruled that maintenance or detox treatment is not medical treatment, and likely was not what was intended by Congress) made it legal for doctors to prescribe opioids themselves to manage addiction (“maintenance”) or for short-term detox (special doctors in registered clinics are excluded from these blanket restrictions). This law is limited to Schedules III through V only – thus excluding methadone and stronger opioids.
The use of Medication assisted treatment in the management of opioid dependence is highly regulated, owing to the sometimes controversial nature of this aspect of harm reduction policy. In the United States, a special federal waiver is required to prescribe Subutex and Suboxone for opioid addiction treatment on an outpatient basis. However, if the doctor meets none of the other clarifications, an 8-hour course is all that is required). Each approved prescriber is allowed to manage only 30 patients on buprenorphine for opioid addiction as outpatients;[11] the U.S. Senate has passed a bill relaxing this restriction for group practices only as of May 25, 2006[citation needed]. Legislation was passed by Congress in the last few hours prior to Holiday recess in December, 2006 allowing physicians with one year of clinical experience Physicians are only required to have had their original waiver for 1 year, NO clinical experience is required to request an additional exemption within DATA 2000 allowing 100 patient limit effective 12/29/2006 (public law 109-469). Similar restrictions are placed on prescribers in many other jurisdictions. Buprenorphine is heavily regulated in Australia relatively, and while the number of patients isn’t limited generally daily visits for supervised dosing at a pharmacy is required, such as methadone, and methadone where used is used in lower relative doses.[citation needed] On September 21, 2006, actor and comedian Artie Lange revealed on The Howard Stern Show that he had overcome heroin addiction the previous year. He said buprenorphine was essential to countering the effects of opioid withdrawal and described it as a ‘miracle pill’. However, others have found that once they begin the treatment, they become addicted to the Buprenorphine, this is because Buprenorphine is still an opioid. The withdrawals from Buprenorphine is quite similar to that of other opioids, but like methadone, it has a long half life, causing a longer, but milder withdrawal.
Answer by AJ
Hi,
I have used the equivalent of Subutex (Buprenorphine-only tablets) in many patients to wean them off of opioids. Before Subutex and Suboxone were even approved in the US, countries like France and India had already implemented this therapy on a large scale.
Buprenorphine has a very complex pharmacology that is not yet fully understood. We have learned quite a lot about this drug in the many years that we were using it to treat people for opiate/opioid addiction. Buprenorphine by itself should not be seen as the answer to detox. It should be used in conjunction with counselling and other forms of therapy.
Buprenorphine’s mode of action is very complicated. It is classified as a “partial opioid agonist”. What this means is that buprenorphine binds to the opioid receptors but activates them partially. If you have a tolerance to opiates then Buprenorphine will give you enough stimulation at the opioid receptors to cover withdrawal symptoms, but not enough to get you high. Here are a few important things that we have learned about this drug:
1) Buprenorphine has very high affinity for receptors. What this means is that Buprenorphine competes with other opiates/opioid drugs for the receptors, and in most cases Buprenorphine wins. This implies that you should not give this drug to people who are already taking opioid drugs like Morphine or Oxycodone, because Buprenorphine will compete with them for the receptors. If oxycodone or morphine for example is still bound to the receptors and you take buprenorphine, it will kick the other drug off of the receptor. This will place you in what is called “precipitated withdrawal”. This is extremely uncomfortable and more severe than ordinary withdrawal. That is why they insist that you have to already be in withdrawal before starting this drug.
2) Adding Naloxone to Buprenorphine (Suboxone) was done to prevent the tablet from being injected. When taken as directed (sublingually), not enough Naloxone (Narcan) gets into the system to cause problems. However when the tablet is injected, Naloxone is supposed to be active and will place the injector in immediate withdrawal. This was the whole reason that they added Naloxone to Buprenorphine. Unfortunately, this only works out in theory and not in practice. Again it involves that concept called Affinity. Bupe (buprenorphine) has even higher affinity than Naloxone and will displace even Naloxone from the receptors. What this means is that adding Naloxone to the formulation (Suboxone) does NOT stop people from injecting it and getting a mild rush, or by crushing the tablets and snorting the powder. This is of course very very dangerous. Buprenorphine tablets are NOT like morphine or dilaudid tablets which are chalk-based. Rather, they are starch-based. When the tablets are crushed and heated in warm water, it forms the consistency of gravy. Injecting this can be severely damaging (even worse than injecting morphine or dilaudid tablets).
3) There are studies done that show Buprenorphine increases the urge to smoke cigarettes. However I have not noticed any effect on caffeine intake (either in patients or in myself even). Most of my patients here prefer tea anyway.
4) Sometimes when beginning Buprenorphine, you may find that half of your withdrawals are gone but you still have withdrawals in some parts of the body (ie. aching in the legs, stomach upset). This can be caused if too much of the tablet is swallowed and not enough is absorbed under the tongue. The full explanation is rather technical. I won’t bore you with it.
5) In some people suffering from Treatment-Resistant Depression, Buprenorphine can have an anti-depressant effect. Again, reasons are technical. If you want me to explain it, let me know.
6) Buprenorphine does not work for everyone. If your tolerance is too high, or it cannot be managed by 54mg of Methadone or less, then Buprenorphine may not work for you at all. This is because of Buprenorphine’s ceiling effect. Beyond 4mg sublingual, Buprenorphine will not produce anymore analgesia. Rather, doses above 4mg will prolong the analgesia over a greater period of time. Also, Buprenorphine “caps” at 24-32mg Sublingual. If this dose is exceeded, Buprenorphine will try and kick itself off of the receptors (auto-antagonism) and this will result in “precipitated withdrawal”.
7) There has been a lot of accounts from people on the web, saying that Buprenorphine should never be combined with benzodiazepines. I disagree. Benzodiazepines (like Klonopin and Valium) can still be used safely, as long as they are not injected together with Buprenorphine. Many of my patients take both Buprenorphine and Diazepam or Clonazepam (Klonopin) to help them sleep at night.
8) Buprenorphine will produce a certain degree of stimulation. If it is taken too close to bedtime it can result in insomnia.
All in all this is a very useful drug. However it is certainly no panacea. A lot of people (not everyone though) who stay on Buprenorphine for more than a month, have great difficulty stopping. Buprenorphine withdrawals are of lower intensity but the problem is that they last for a very long time. Also, I’ve found in a lot of people that after the first few months, Buprenorphine does not eliminate their cravings anymore. This is why Buprenorphine should be used in conjuction with counselling and other forms of therapy.
Hope all this helps. Feel free to drop me a line if you need more. Sorry for the length of this answer but Buprenorphine (Suboxone/Subutex) is a very complex drug.
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