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PostPosted: Thu May 31, 2012 2:17 am 
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I had mentioned previously on this forum that, as a patient with no dependence issues, I find buprenorphine to be an admirable opiate for chronic pain. I mentioned that, unsatisfied with the usual modes of administration (sublingual and intravenous), I undertook to find an alternative in the form of nasal spray. Below is my method and my findings.

METHOD: Using a spray bottle formerly for antibiotic, I calculated the volume of water and number of buprenorphine tablets required to reliably deliver a dose of two milligrammes per pump. Benzoate of sodium was also added to serve as a preservative. I dosed twice to four times per day as required for pain, taking eight milligrammes per day (out of the sixteen-milligramme limit imposed by my doctor). Both me and a close relative of mine use buprenorphine (as well as hydromorphone and morphine) strictly for pain, and we both use the same one-time dose. The below findings hold for both of us, as both methods of administration were used in succession.

FINDINGS: As compared to the sublingual tablet, onset of action occurred far more rapidly. Sublingual buprenorphine took an average of fifteen minutes to act and one hour to plateau; intranasally, buprenorphine acted in five minutes, and plateaued in twenty. Additionally, intranasal buprenorphine was, in my estimation, more bioavailable, creating a sense of higher potency. The spray felt approximately twice as potent as when delivered sublingually. I ascribe this success mostly to the innate mechanisms of the human body, as cells in the lining of the nose may be more receptive to buprenorphine. However, I also believe that a percentage of buprenorphine, taken sublingually, prior to absorption through the oral mucosa may enter the oesophagus and, eventually, the stomach, whereby it is deactivated by first-pass metabolism. Duration of action was unaffected.

There are some disadvantages to using this form of buprenorphine. If one does not possess unflavoured buprenorphine tablets or powder (as common in the United Kingdom), the lemon flavour of Suboxone® (the only buprenorphine product available in Canada) will remain in the mixture and may be unpleasant to the nose. If the volume of the spray is too large, when the user inclines his head, the mixture will leak either out of the nostrils or into the throat, both extremely unpleasant (this is the case with other sprays as well and does not affect buprenorphine only). Finally, if one does not possess a preservative such as benzoate of sodium, the aqueous mixture may be rendered unusable due to microbial activity.


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PostPosted: Fri Jun 08, 2012 6:53 am 
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So, you're using at least 8 mg a day (I can't tell, you said you dose up to 4 times a day?) of suboxone along with hydromorphone and morphine?

Even with Dr. Junig's new method of mixing full and partial opioid agonists, the dosage of suboxone you are using is very high. Usually when combining partial and full, from what I understand, the suboxone dosage does not need to be that high.

Dr. Junig found that patients on the full/partial combo had no euphoria and no tolerance building so there was no need for increased dosing over time (his study so far has been ~2 years). Also, patients reported even better pain control with this combination. Have you found all this to be true as well?

At this point in time I don't expect my doctor to dole out full agonists to me, but I'm hoping he might try the combination on my husband, who is a chronic pain sufferer and dependent, but not an addict.

Thanks for your time and opinions.

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PostPosted: Mon Jul 23, 2012 10:43 pm 
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It has been my experience that the Naloxone in Suboxone seems to work unless one uses only 1/4 tablet, then it takes about four hours for ANY effect is felt. These are my own observations and do not mean squat for others. If there is a more effective way of dealing with chronic pain I am VERY interested !!. To me the only way is to wait until 4:20 happens!!

johnsmith


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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