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PostPosted: Sat Nov 03, 2012 12:48 pm 
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With added pressure on doctors from the DEA and other regulatory agencies, many doctors are utilizing very sophisticated testing facilities which utilize multi-million dollar laboratory equipment, rather than simple drug test strips to ensure that their patient(s) take their medications as prescribed. The growing problem of drug abuse and diversion of drugs has caused many doctors to go to extreme measures to protect their licenses to prescribe narcotics for instance. A lot of doctors still only use the test strip(s) on UDT's to determine only the presence or absence of the drug(s) metabolites.

A few words on "metabolites", this is a word used to describe what drug(s) are secreted in urine after the drug(s) have been processed by various organs of the body, or simply "after the body metabolizes a drug.." Some patients reporedly have placed say a tiny amount of crumbled up drug(s) into the urine sample a stir it up in the thinking that the drug screen will see that the drug(s) is in the urine and will therefore "pass" the UDT. Those people would very likely fail the UDT becasue they placed the drug into the urne before metabolism has taken place on it. This may have casued many patients to be discharged from their doctor. Some dotors reportedly give a second chance, but that is of course a cases by case scenario.

Many of the doctors/clinics are now using companies such as Ameritox to perform initial baseline drug testing where typically a blood and urine samples are taken from the patient. These go to the lab where they undergo analysis by gc/ms which tell the specific gravity, ph, creatine levels, enzymes, etc. in addition to illicit drug(s) present and prescribed drugs. This initial testing is used in the future for comparison to future analysis and is then placed into a data base of several thousand other "compliant" patients analysis. From these analysis the lab uses the data to form a "compliance" curve. The "curve" has an upper limit and also a lower limit. The curve also factors to consider such as age of the patient, and accounts for natural metabolism, and all these combined can be used to determine if the patient is taking their medication(s) as prescribed.

Examples:
1) If a patient is prescribed 24 mg of Suboxone to be taken at 8mg every 4 hours. A pattern would from over time for that individual which would be typical for that individual. If the person were to take only 12mg of Suboxone for the several days or even a day or two prior to testing, then their analysis would fall below the test curve indicating that the patient may not have been taking the full 24mg as prescribed. This could lead a doctor to possibly suspect that the patient may be diverting their medication.

2) On the other hand, if a patient is prescribed 24mg of Suboxone to be taken at 8mg every 4 hours. If the person were to take 32mg of Suboxone for several days or even a day or two prior to testing, then their analysis would fall above the test curve indicating that the patient has likely been taking more of the medication than is being prescribed. This could lead a doctor to suspect that the patient may be abusing their medication.

3) The last most and reportedly the most disputed test result occurs when a patient has not been taking their medication as prescribed and may not be taking any on some days even. Some patients "load up" their UDT with the medications metabolite so they hope to not fail the test and continue to receive their medication(s). When a drug is metabolized by the body, some of the drug leave traces in fattty tissue(s) which beuild up over a period of time, and then when the medication(s) is/are discontinued the amounts in the tissue decline, sometimes rapidly, sometime slowing depending on the drug specifically. If the level of the drug in the tissue is not within the test curve for that patient and other patients in the data base, this could lead the doctor to suspect that the patient may not be in compliance with the drug regime and that the patient may be "haording" the medication.

Ameritox has been in the "spotlight" in the courts for some time now for their claims on the preciseness of their testing , especially for "compliance". Ameritox lost a lawsuit to Milennium Lab. this July for false advertising. I started a thread last month about that lawsuit. (see Misc. Suboxone Issues using the drop box at the bottom right of you page)

The process Ameritox uses is called GuardianRX, as discussed a very sophisticated analysis which has been scrutinized many times.

Even with all of the pressure placed on Ameritox, many doctors continue to use their lab (Ameritox) to ensure patient compliance, and as we discussed do all the doctors/clinics can do protect their license(s).

I thought this would be useful to some people who are now taking or considering Suboxone or other drugs, and hopefully this may shed some light on how sophisticated some analysis' have become.

It may even be the beginning of a new era of drug screening that may do away with the testing many of us have known to be pretty much standard drug screening, that indicates only "is the drug there or not".


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PostPosted: Sat Nov 03, 2012 3:00 pm 
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Yes, this is definitely interesting............

I remember my doctor telling me how "incredibly expensive" it is, to test for the actual "levels"
now, it makes more sense, for sure.

when you first go in, where I go to,,,,,,
You take BLOOD TESTS, becuz sooo many people have "cheated" on the urine screens.
no way to fake the blood,,, unless your name's lance armstrong, I guess, LOL
that was a JOKE,,,,,, I actually like Ol' lance......................

anyways,,,, do you have the link or web address where you found this?????
I was kinda curious, if there was more information, and who wrote it up????????

plus, we ARE kinda sopposed to "site" where stuff comes from,,,,,,
but it was more about MORE info than that!!
LOL

Thanks for posting this boxer.

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PostPosted: Sat Nov 03, 2012 5:23 pm 
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I found this website which describes Ameritox's drug screening, etc...The information was from Ameritox themsleves!

The URL was too long to copy but if you Google this up this will be a good place to read for starters.


Ameritox - Rx Guardian, with next-generation Rx Guardian CD

In the article above it talks about the data base of compliant patients, and has a good video which describes some of the process they use and is easy to understand.

Copy and paste this into your web browser.

I was not citing any particular article in particular, but I summarized many months of research into the RX Guardian by Ameritox process after I was asked by many people to look into this new lab process after people were being discharged from their doctors.

I do have copies of the actual lab results showing the huge amount of things this process looks for.

Some of the more detailed inforation was unfortunately deleted after the lawsuit I spoke of.

You may perhaps be interested in reading the findings of the lawsuit in a thread I posted earlier about Milennium Lab vs Ameritox.

I may spend more time this evening to obtain a more detaled, but yet concise description.

I do know that many doctors believe that this new process is the "law" lol, when it comes to testing their patients, and many doctors will drop a patient in the blink of an eye if found out of compliance with this monitoring.

More info later...

bxr


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PostPosted: Sat Nov 03, 2012 5:31 pm 
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This a link to an advertisement by Ameritox and was the first hit I got of thousands when I searched again.

www.Ameritox.com

This advertisement shows the curve I spoke of and tells more how it works and even shows peple onder the curve, in the curve and over the curve and label them as abuser, etc...In this link it talks in good detail about the data base CD they use to develop this curve, etc...

I hope you all find this information useful, I know many people who sure have !

More l8r,

bxr


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 Post subject: About me and my research
PostPosted: Sat Nov 03, 2012 5:41 pm 
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I thought a brief description abput at this time amy be useful considering the lengths I took to design this particular thread.

I am in my 50's, I am a retired Engineer with 24 years of experience. I spent the marority of my time working for a Fortune 500 Company who contracted witht DOD, DOE, FEMA and other regualtory agencies for remedial purposes. I was a tehnical writer and Project Engineer for this company until 1995, when I became permanently diasabled. So my writing and spelling skills are very rusty.

Fortunately, my brother is a doctor with over 40 years experience in practicing. This helps me when the areas I ma need help in are outside of my particualar field(s) of study.

I only submit information that I know I can back up. I was not aware that references we required for threads, by bad.


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PostPosted: Sat Nov 03, 2012 6:00 pm 
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I researched further and located a link to a study by a well established company about the RX Guardian process in use by Ameritox.

http://www.lifetreeresearch.com/pressro ... tudy-finds

Sincerely,

bxr


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PostPosted: Sat Nov 03, 2012 9:42 pm 
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Here is another link which may be useful.

http://www.ameritox.com/urine-drug-test ... echnology/


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PostPosted: Sat Nov 03, 2012 9:49 pm 
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add. info:

http://ameritox.monitoringadherence.com/


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 Post subject: No worries
PostPosted: Sat Nov 03, 2012 11:20 pm 
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Good stuff Boxer and thanks for the research...don't worry, you are not supposed to site anything here as you are not writing a paper nor are you claiming this info to be you own. I don't really know where that came from


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PostPosted: Sun Nov 04, 2012 12:30 pm 
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I was only saying,,,,
since we sopposidly ONLY represent facts on this site,,,,,

it says on the top of the page to "further eduacation" about the use of buprenorphine..... I WOULD go thru,, ALL the threads
that say "Im so glad you guys only post facts about things/topics/withdrawl/cielings/ETC.ETC.ETC
but I dont want to..........

You cant deny,,,, that we DO have alot of FACTS, articles, research papers, stuff like that here,,,,,


ALL I was MERELY saying was to "site" anything thats actually PROVEN, ANYWAYS,
im not saying EVERYTHING you write HAS TO BE A FACT, or HAS to be "proven"

I was saying, SINCE IT IS proven, might as well, put ONE LIL LINK where it came from.
THATS IT!!!!!!!!!!!!!! ( wasn't even saying its a RULE, or anything)

I wasnt meaning for a person to site every sentence, ya know????

does this make sense?????


lets say for JUST a minute, YOU had been having a side effect, the WHOLE time you were on suboxone, and NOBODY
believed you,,,,,,,,
and somebody came on here, and said, Oh the BLANK paper says this side effect is from using suboxone.

You'd want to know WHERE THE HELL to find it, right??????????????????????

Just a thought.................................

Sorry, I guess i just "FORGET" sometimes that there's this big huge thing above my name
that says MODERATOR and my words get taken WAYYYYY too seriously sometimes.

[marq=right]SORRY[/marq]

have a great sunday

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hold it together, when everyone would understand if you fell apart
That's TRUE STRENGTH
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 Post subject: Ok
PostPosted: Sun Nov 04, 2012 3:21 pm 
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I didn't see "moderator" above your name but that wouldn't change anything. I was just trying to make the gentleman who posted feel more as ease as it seemed he felt attacked in a way. I'm confused, are you or are you not mad at my post? I can't tell because you typed in CAPS a lot and threw in white a bit of sarcasm. Not how to respond


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PostPosted: Sun Nov 04, 2012 6:16 pm 
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If I was mad, You would definitely know....................



the reason some stuff was in bold,,,, is because of your line "I dont know where that came from"
Like Im some kind of idiot???????

I felt a LITTLE attacked...... NOT mad, but I DID feel the need to EXPLAIN why I wrote what I did.........


and NOW "now how to respond "
I think your PICKING at me, TRYING to make me mad?????????

Im not sure WHY you even say that, because I actually APOLOGIZED to you in the above post.

why would you think I was mad, when I said Im sorry????

If I did something to PISS you off, I truely AM sorry. But I dont think I deserve to be picked at.

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hold it together, when everyone would understand if you fell apart
That's TRUE STRENGTH
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 Post subject: Oops
PostPosted: Sun Nov 04, 2012 6:21 pm 
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"Now how to respond" was suppose to say "not sure how to respond". Typing on the pad can be unreliable


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PostPosted: Sun Nov 04, 2012 10:57 pm 
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As has been discussed previously in this and other threads, according to research on the www, a lot of doctors are getting the heat from regulatory authorities for prescribing narcotics.

To help the doctors be more confident that patients are sticking with the prescribed medications regime, they are starting to use more and more sophisticated test(s) to determine compliance when it comes to taking too much, none or too little of their medicines.

As the arrest for street drugs rises and the number of overdoses from precripton drugs are still on the rise. Doctors are reportedly very suspicious when a patient has more, none or less of a narcotic in their system when they are tested. With test(s) results like these, it would be easy for one to think that some or even all of the drugs are being diverted to the streets or that too much of a drug is being taken.

Once the drugs get onto the streets, then doctors are sometimes targeted when people are arrested or have a prescription bottle in their possession with the doctors name, date, and amount of drug, etc, on the bottle. Math can easily tell then if the person is in compliance then.

If the person is in an OD situation, then it could be too late to consider comliance, and sometimes the doctor could get part of the blame, so now we are having to endure the rising cost of lab test and other expenses that are passed on to individuals that are in compliance and taking as prescribed and need their medication(s).

This may well be why intensive and sometimes expensive drug testing is now being used in order to reduce the number of problems when it comes to narcotics.


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 Post subject: Re: No worries
PostPosted: Mon Nov 05, 2012 1:52 am 
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Tndb wrote:
Good stuff Boxer and thanks for the research...don't worry, you are not supposed to site anything here as you are not writing a paper nor are you claiming this info to be you own. I don't really know where that came from


We get a lot of people on this forum posting completely ridiculous statements as scientific fact. In fact, it's a pretty regular occurrence. ie claims that it causes permanent brain damage, that it makes your toes fall off etc etc ... Yet when people press them for details to back up their claims their response is usually ambiguous and evasive.

I don't think there's a rule to cite where you get your information from. But it's still a good idea, and a good habit to get into esp when people are posting on a really important subject like health and addiction treatment. Posts on this board can end up influencing a person's treatment decisions which can affect the rest of their lives, so it's a good idea to let people know where they got their information from, so they can form their own opinion on how credible it is.


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PostPosted: Mon Nov 05, 2012 3:41 pm 
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I have read an article by American News Report, National Pain Report from 2010 where it found that in 2009 only a couple thousand of patients being prescribed narcotics rose to 1/4 million patients being tested in 2010.

This sounds like a good way for some people to get rich? I wonder how many patients are getting drug tested now days? Wouldn't be doctor's would it, just for starters. jk

I can understand that a doctor(s) are paranoid lol now since so much drug abuse is going on everywhere from the poor communities to the richest communities, and reports I have read on the www indicate that even law enforcement officers and other officials are getting "busted" for selling and using drugs now days....It is all over the local gossip to the national news about the problem.

Why should we as people in need of our Suboxone have to pay the price increases because others are junkies or recreational users?

IMO because of the $$$$ involved !

I know many Suboxone users are trying to do their best to stay clean and off of illicit drugs, with some Suboxone users having to pay for their medicine, doctor visits, and testing, not to count getting to these places ! There has to be a limit to the accuracy of testing and price of teating necessay to determine compliance with a drug regime, and also help the doctors feel more confident in prescribing not on Suboxone but other medicines that are required without putting an even deeper dent in a lot of peoples pockets.

I just wonder whith the high cost of Suboxone and high cost of lab fees, etc..when will these increases start to taper off?

Quest Diagnostics and Labcorp have been under congressional investigation for a multi-billion dollar scam for giving doctors discount lab fees, then they billed excessive fees to Medicare and Medicaid and possibly other insurance companies. This led to increased sales in the drug testing industry, which is reportedly around 2 billion a year for just a handful of labs to compete over. (see following article for more information)

Many patients have and will be wrongfully discharged from the doctors, which will possibly put a bad mark on their medical record and may make it difficult for them for find the help they need. The big five drug testing laboratories are now coming up with test(s) which try to prove to the doctors to use their service because their testing is more accurate than,,,so n so's test are.

Some labs are reportedly even making false claims on the accuracy of their test(s) in order to get every piece of the money in the drug testing business. (see following article)

Sadly, but true (Goolge up: false negative on drug screen) a lot of patients are being discharged due to drug analysis coming back with false negatives and other determinations which can give the doctor a reason to dismiss a patient. Many doctors do not wait until the next doctor visit to discuss the findings of the drug test from the last appointment in a lot of cases, but rather they send a [i]certified letter[/i] to the patient which they receive a couple of weeks later staing that the patient has been discharged and that they "can only see the patient on an emergency basis for 30 days", and by word of mouth from practices, and my personal experiences, needing your medicine (like even Suboxone) is not an emergency according to the doctors, nurses, etc. This is epecially true about narcotics.

Some patients are lucky enough to have a doctor that will let them give an explanation for the test results. Others are going to the means of having independent blood work done for the presence / absence of drugs to try and prove to the doctor that they were in compliance. According to various blogs on the www, some doctors are willing to review the results and some doctors are not. PERIOD !!!

WOW imagine knowing for sure you were in compliance and one of the "fancy" lab test with all of their bells and whistles, etc..says you are not in compliance with your Suboxone....hmmmmm what do we do now? :shock:

I thought you mayu want to read the following article which talks about the cost(s) of these new drug test (which we have to pay for) and about other topics that apply to drug testing. I hope th article is useful to you. I sure was shocked to see that some of the analysis cost as much as $3,000.00 each ! wooooooooooooooo


Millennium Laboratories Sues Ameritox for Libel

by Pat Anson, Editor on April 27, 2012


Drug screening is a growth industry in the United States. And so are the lawsuits and countersuits being filed by some of the nation’s drug test companies against each other.

This week Millennium Laboratories sued Ameritox for libel in California federal court, alleging the nation’s largest drug screening lab made false and misleading statements about Millennium’s business practices. The lawsuit is the latest chapter in an escalating feud between the two companies – as they battle for their share of a growing test industry worth an estimated $2 billion annually.

Millennium’s latest lawsuit against Ameritox stems from a press release issued by Ameritox last week, in which it claimed that Millennium encouraged doctors to retest negative drug samples, allowing it to charge additional fees. Ameritox also alleged, in a lawsuit of its own, that Millennium gave illegal kickbacks to doctors for referring business to the company.

In its lawsuit, Millennium denied giving kickbacks or having a standing practice to retest negative drug samples. It accused Ameritox of a “smear campaign” and said the Baltimore based company was “notorious for engaging in fraudulent business practices to gain a competitive advantage.” In 2010, Ameritox paid $16.3 million in fines to the federal government to settle charges that it gave illegal kickbacks to doctors.

Asked to comment on the Millennium lawsuit, Ameritox released a brief statement to American News Report, saying “instead of focusing on physician services and client care, Millennium Laboratories is instead focused on filing as many lawsuits as possible against competitors in the industry.”

Martin Price, Millennium’s general counsel, calls the recent Ameritox actions a “sideshow” to distract attention from yet another lawsuit that is coming to trial next month. In that case, the San Diego based company alleges that Ameritox used a misleading marketing campaign to promote Rx Guardian, a drug test that can tell physicians if their patients are taking medications at the proper dosage and frequency. “The science simply doesn’t support those advertising claims,” Price told American News Report.

The number of drug screening tests has soared in recent years, as many doctors require patients on pain medications to submit to drug screens as a condition for receiving prescription painkillers. According to a recent study, the number of drug screening tests billed to Medicare by family practice doctors soared from a few dozen in 2000 to over a quarter of a million tests by 2009.

As the testing industry has grown, so have the abuses, kickback schemes and fraud.

“The great majority of labs that have entered this space in the last 5 years have focused and promoted their services based on how much money the doctors can make, while significantly increasing the need for and amount billed for confirmation testing,” one industry insider told American News Report. “This has increased the cost of a test from $300 to $2,000-$3,000 and decreased the quality of the test being run so the doctor doesn’t always have accurate test results.”

At least two national drug labs, Quest Diagnostics and LabCorp, are under congressional investigation for a multi-billion Medicare scam, as recently reported in the trade publication The North Report. Quest and LabCorp allegedly gave kickbacks to insurance companies in the form of discounted lab fees. In return, the insurers encouraged doctors in their networks to refer drug tests to Quest and LabCorp, which then billed excessive charges to Medicare and Medicaid.


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 Post subject: Human Error can be Great
PostPosted: Wed Nov 07, 2012 1:29 pm 
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I found a good article about one lab ChemStation that uses complicated gc/ms to determine compliance for taking prescription drugs by comparing an individuals drug concentrations to large data bases.

The article has a detailed slide show of how the extremely complicated analysis is ran, calibration and selection of many variables are used to determine the compliance curve.

After looking at this slide show, it is easy to see how that one wrong click on the wrong place could alter the results dramatically.

I hope that this and other articles in this thread could be used to hopefully prevent a wrongful discharge from a doctor could be appealed, or that when one might be asked why the test(s) results show they may not be in compliance.

www.docstoc.com/docs/24063508/Secrets-o ... n-Revealed

With the process being so complicated, I would like to know how often the equipment is calibrated, what are the qualifications of the people running the actual test and what control settings are used to determine if a human error has or has not occurred.

I think that is should not be such a secret as to how these results are obtained considering the very serious implications that these analysis are making on patients and their patient/doctor relationship.

Is it in your opinion that our drug concentrations should be compared to others in a "data base", who are those people, did human error occur when the data base was created?

Sure, these labs claim that their analysis is like 99.9% accurate, does this take into account that one wrong mouse click at many places during the analysisi could give false negatives, false postitives, out of compliance.

I had no idea that so much of the analysis replies on the accuracy of data enetered by humans!

I am starting to wonder if our rights under HIPPA could even be being violated?

No one is perfect, not even a lab etch that is playing dice with peoples livelyhood, don't you think the analysis should be done in a way that human error is less of a factor?


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PostPosted: Wed Nov 07, 2012 10:27 pm 
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boxer wrote:
Why should we as people in need of our Suboxone have to pay the price increases because others are junkies or recreational users?


A similar argument. Why should WE patients who take our buprenorphine as prescribed and NOT inject it or snort it or sell it... Why should we have to put our bodies at more risk by having our buprenorphine laced with naloxone just because a small few who try and abuse it? And even then find it has little deterrent effect anyway...

The answer is probably similar to yours boxer... $$$$$


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PostPosted: Wed Nov 07, 2012 11:11 pm 
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I read on the www that there isn't much money to be made in selling generic drugs like Subutek like the millions of dollars that are being made off of the brand name drug Suboxone. RB seems to be convincing people that Subutek has a higher abuse potential, but from I hear, the high that may be achieved from Subutek is not anything to brag about.


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PostPosted: Sat Nov 10, 2012 1:15 pm 
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I wanted to take a moment to reply to TJ, I am not certain really why we have to take a drug that contains naloxone for sure?
I know that it is an opiate receptor site blocker, but I have read some reports that people have been using suboxone to get by until they could get another fix, I think that may be one reason why most doctors want the NX in the mix. According to some, the majority of people being arrested for distribution of suboxone, a Sch III narcotic reportedly sell them to drug abusers not for the drug abuser to get high, but to have a "plan b" in the event that they run out of their regular dope. Since NX has attched to it the warning about potential serious / bad side effects if injected makes almost any sane person lean away from using it in that manner. I have not been able to find nearly as much info about the long term effects of using naloxone either, no where near as much as for suboxone or even just plain bupe (subutek). I wonder how long the effects of Naloxone will have on our body's own ability to produce pain killers in the brain too. I wonder if there is any permanent alteration in mu/u opoid receptor sites that is large enough to be of concern that naloxone could partially block these natural pain killers down the road after long term use of suboxone?
As you and I tend to agree, the addition of naloxone with buprenorphine to make the compound called suboxone, could be mostly about the money [fade] $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$[/fade]______________________________________________________________________________________________________________

According to Redwood Toxicology Laboratory, 95% of suboxone is excreted from the body in about 144 hours. Suboxone is eliminated from blood plasma much faster.

The remianing 5% would take a long time to diminish due to the very long half-life of suboxone.

It seems almost funny that some people think that Suboxone will be out of their system in like 3-4 days like a lot of other opiates, as we know with the half-life os sub being about 32 hours plus/minus a few hours, so I did some math. Let me know if I ma any where close on his, I am no doctor just was trying to calculate this drug's concentrations over time.

Ok, 32+/- hours is about 1.33 days.

If I took 24 mg of suboxone on day one, I would have

24 mg in my system (of course), each 1.33 days the amount in my system will divide by 1/2, assuming that no more suboxone is taken into my system.


amt. of sub in body [u]days
24mg day one
12mg 1.33
6mg 2.66
3mg 3.99
1.5mg 5.32
0.75mg 6.65
0.37mg 7.98
0.18mg 9.31
0.09mg 10.64

If my math is even close, then 10 days after I tood 24mg of suboxone, 10.64 days later, I would have 0.09mg of suboxone still in my system. Does this anywhere near equal the 95% theory Redwood stated?

144 hours equals 6 days, so by looking above I calculated on 6.65 days that I would still have 0.75mg in my system. So, 0.75 divided by 24 mg is 0.03125 or about 3.1 % still in system after over 6 days. Seems fairly close?

With all this said, if the doctor one is going to uses a dip stick test for bupe, then it would be depend upon how sensitive the test is for bupe. As for GC/MS testing, if they are looking for bupe I feel confident that a "spike" on the results would occur, it would be a small spike, but it would be there.

As many of us know, suboxone (bupe) is not a typical narcotic/opiate and I have read that suboxone will not show up on a regular urine test which uses a 5-10 panel test for say, marijuana, oxycontin, morphine, heroin, benzodiazepines, amphetamines, ectasy, lsd, etc... or whatever strip type they use, of which there are many.

I saw on the internet where people can buy online home test for suboxone. These test only tell whether the drug is there or is not there, I researched these kits more and found that they are not detecting the suboxone as well as some of test used at clinics and by doctors.


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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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