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PostPosted: Sat May 15, 2010 7:58 pm 
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Hi...first my apologies if this is in the wrong section. I thought it may go in side effects but because my issue being really sick 1 day post induction, I thought it could go here as well.

I have never really taken more than 60mgs of roxycodone a day but have taken at least 30-45mgs every day for the last 3 years. I have been in pain management 10 years and have been on fentanyl, oxycontin and vicodin at one time or another. I have only used the roxys for the past 8 years and did not need to take them daily until about 3 years ago. I weaned myself from 45mg roxycodone to 22.5 roxicodone and lived w/ withdrawal for a 4 week period before I saw my doctor for induction on Thursday.

He initially wanted to put me on 8mgs/2 day. I thought this would be too much so we decided after I stabilized in office at 8mgs that I could stay at 8mgs unless I went into WD and needed more 6-12 hours later. I did get VERY sick about 2 hours after my appointment but it didn't feel like WD to me. I got very dizzy, confused, felt very high and broke out in sweat on my forehead which would precipitate vomiting. I had constant nausea for 7 hours and was nodding out for about 4-5 hours. My eyes were pin dots all day and I was chilled to the bone, wrapped in blankets, no chills just very cold.

My bf was nervous and asked me to call the doctor, whose associate told me I was in WD and to take the other 8mg. Having just been in WD 4 weeks earlier I knew this was different and didn't take the other 8mg. Sure enough by about 10pm (13 hours after 1st dose), I could actually drink water w/out wanting to throw up, I took off the blanket and felt significantly better.

I decided this morning I would try 2mg and sure enough I got very ill again. Same symptoms, but today they took 5 hours to come on instead of 2. The intensity was less but I still could not eat, eyes pinned, felt very high, bone chilling cold, dizziness and head pressure. Now it's almost 12 hours from my morning dose and all the symptoms except the confusion are gone.

I was thinking about trying 1mg tomorrow but after 8 hours today I felt the muscle twitching I know is associated w/ WD. Nothing major that I couldn't power through, just annoying.

Anyway I was wondering if I should attempt the 1mg or just stick w/ the 2mg for a while. I am pretty sure I was overdosed yesterday and was wondering if that also happened today even though I had 1 symptom of opiate WD. I have read that 4mg of suboxone is equal to 60mgs roxycodone. Not sure if that's right, but it would explain me getting sick. I plan on doing the liquid taper past 1mg and my doctor planned on having me off in 8-12 weeks.

Any insight would be greatly appreciated. Thanks :)

~Samantha


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 Post subject: my opinion only!
PostPosted: Sat May 15, 2010 10:43 pm 
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Hi Samantha,

Welcome to the forum. I'm sorry to hear that you have been feeling so horrible. This is only my opinion but I think, considering that you had not taken any opiates in a long time, that you were started on too high of a dose and that is why you were so sick. I'm glad that you didn't take more after you called your doctor even though you were told to. Some doctors do not know how to dose sub, and more importantly that everyone is different. I'm not saying that your doctor does not know what he is doing. I have just read through hundreds of different inductions and feel that you should be started at 2mg, then wait for at least an hour before you take any more.

Tomorrow, try 1 mg, maybe even half that although I know how hard it is to split a 8mg pill up so small. If you feel withdrawals coming on after 8 hours again or whenever you feel them, you can take 1 mg more or half a mg again. If your eyes are pinned after 2 mg, then you may not need that much.

Hopefully other people will be along soon to give you their advice. I would always suggest you follow a doctors orders but this clearly was not working for you.

So, try 1mg in the morning, no more than that, and if you feel withdrawals take another 1mg. It is possible that is all that you will need. Like I said, everyone is different and requires a different dose. You were not on a high dose of opiates to begin with and I'm not sure if you meant you took 4 weeks to taper down before you started, or if you were completely off opiates for 4 weeks but still experiencing withdrawals.

Again, I'm sorry you feel so horrible. Tomorrow will be better, but stick to 1mg or less and see how you feel. Please check in again in the morning and let me know how you are doing.

Take care,

Ginger


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 Post subject: Hopefully!
PostPosted: Sat May 15, 2010 11:12 pm 
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smat - I too am sorry you are having a tough time but don't give up hope... I can tell you this... I had a friend that did the same thing as you and was off Oxycodone for about 4-6 weeks before they inducted on Sub... My friend also had the similar symtoms like you. My friend went down to 1mg two times a day and had some tough days on the 1mg.... Within about a week all of the negative symtoms completely went away and he felt great. His doctor then upped his dose slowly from 1mg, to 2mg and then eventually to 4mg a day.. My friend has been at 4mg now for quite some time and has no negative effects.


Now, I also had a low dose habit of Oxycodone.. My normal was 90mg a day of Roxy's sometimes a bit more.... I inducted at 4mg of Suboxone after 16 hours of not having any Oxycodone. I walked out of the office 60 minutes after my induction in amazement on how well Suboxone worked for me. I was prescribed another 4mg dose of Suboxone in the evening and of course I dosed...and once again with no negative side effects.


I have zero experience with what you're going through but I wouldn't give up just yet after seeing what my friend went through.....Maybe doing what ginger61 suggested would be a good solution for you until you adjust to Suboxone. Keep us posted!!!

SuperBuper


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PostPosted: Sun May 16, 2010 7:11 am 
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Hello, my pdoc started me a 4mg 2 times a day , after I took my second 4mg at about 8 oclock PM , I got sooo sick, threw up all nite, the next day I only took the 1-4mg dose ( 8 mg broke in half ) and was fine.. I'm not a DR. but I also believe maybe your doc for saftey reasons started you at a dosage more than you need, the sub you need will be easy for you to figure out, just dont take any more than you really need, I've been on 2 mgs for 4 months now, getting below 2mgs is a task I'm to busy to fool around with right now, Good Luck and be well, Mike


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PostPosted: Sun May 16, 2010 9:04 am 
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Thank you so much for replying Ginger, SuperBuper and Mike :)

I should clarify that I was on 22.5 roxy. I came down from 45-30mgs (every day for about 3 years) over the last 4 weeks. I mistakenly made a 50% reduction before I knew any better. (I think I know better.....just like an alcoholic/addict right? lol) After the inital cut of 50%, it took 4 weeks to start feeling normal. 3/4 of a roxy (22.5)/day was my dose before induction. I waited 25 hours before induction and was in mild WD. Although my dr didn't do the COWS scale, I did it myself (based on how I felt in office pre-suboxone)when I got home just to be sure I wasn't in precipitated withdrawal. Other than resting pulse (which I couldn't know post induction), I scored a 10 so I was definitely in mild WD.

I started w/ 1mg today and I will see how it goes. I will wait and see if I have any WD and if needed start w/ .5 to see if that helps. If I do have to increase by .5 and it doesn't help, how long should I wait before taking the other .5? How do you all cut your pills so tiny? I lost 1/8 of a pill to dust when I cut it w/ a razor blade.

Thank you all again for your kind words of support. I got so afraid that this wasn't the right choice for me and that I should have continued to wean myself but I was so uncomfortable for so long!

I'll check in later w/ how I'm doing on the 1mg. Have a great day everyone :D


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 Post subject: Tough one
PostPosted: Sun May 16, 2010 10:09 am 
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Smat - thanks for the clarification it makes a big difference. You know since Bup is such a powerful medication, I really don't know if you will have different symtoms by taking anything less. I'm wondering even if you take 1mg vs 2mg if it's going to make a difference or not. As all say, I'm not a doctor...just my thoughts... :roll: It may just take a little time for you to get use to the medication. Can you see if your doctor can prescribe you the 2mg version of Sub...? This way when you break the pill in half it's easier to get a lower dose... Just an idea. Keep us posted.


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PostPosted: Sun May 16, 2010 2:27 pm 
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I do not know how powerful roxicodone is so this makes it difficult to me. What is roxicodone comparable to?

My guess right now is that the suboxone is too powerful for you. When I re-inducted on suboxone after being off a while I felt very similar to what you are describing. Had I taken a full 8mg I think I would have been throwing up. My doc had told me to take a full 8mg and instead I just took 2mg. I still felt very similar to what you are describing. It took about 4 days for that to subside. I had to then increase my dose for pain management reasons so all in all, it took about a week to 2 weeks to stabilize on it. I can say it was a WAY different experience than my first time when I went from taking +/- 280mg of oxycontin per day and then getting on sub at 24mg per day. It was like 24mg was barely enough then. I can't even imagine taking that much now. I would be zonked out on the couch.

Cherie


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PostPosted: Sun May 16, 2010 6:12 pm 
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Hello everyone just wanted to check in :D

Well I'm almost 10 hours in on 1mg and I feel fine. I had some side effects (slightly high feeling, dizziness, sleepiness and mild nausea all for about 5 hours) but nothing compared to what I went through the last two days. I even had an appetite and kept food and water down today which was wonderful.

I may try .5 tomorrow (dry cut) or maybe even .8 depending on whether or not I can figure out the liquid taper thing. I suck at math LOL!!!!! :oops: How do you all cut your pills? I lost 2mg today to dust when I used a razor blade.



Cherie I thought roxycodone was just like OC (which I am assuming is Oxycontin right?) but w/out the time release. It's just pure painkiller. They also call it oxycodone. One of those names is generic although I don't know which one.

How much OC were you on this time before taking the sub?

SuperBuper- I am going to see if I can get an appointment w/ him this week. I don't know that he will be able to fit me in though as it took 2 and a half weeks to get my first appointment w/ him. I do have a follow up scheduled w/ him on the 28th though.

So far no WD and my muscle twitching is just an annoyance. I'm just grateful I didn't spend the day on the bathroom floor today!

Thanks again all :)


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PostPosted: Sun May 16, 2010 6:36 pm 
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It sounds like the 2mg pill size will work much better for you.. Your Dr. will be happy to adjust your script to the lower sub amount, be carefull though, after you start using 2mg size ,he won't readjust it back up to the 8mg size, in other words take your time, so you fell real comfortable next time you see your doctor. You want to walk out of his office confident with the script he writes you... I can tell you will, Mike


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 Post subject: Roxycodone
PostPosted: Sun May 16, 2010 9:45 pm 
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Smat - I'm glad you are doing a better....that's a good sign...


Its hard to break the 8mg pill into 2 mg doses, as sometimes one half is bigger than the other. You can only try your best. The clinic I went to had a pill cutter designed for 8mg subs.. I believe the pill cutter sliced the 8mg pill into two perfect halves.

By the way the 2mg pills may cost a bit more if you don't have insurance. Not sure why the smaller pills cost more but that's what I was told by the clinic where I was first inducted.


You are correct. Oxycontin is Oxycodone with a shell covering the pill for time release - extended relief tablet. Roxycodone is oxycodone too but immediate release.

SuperBuper


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 Post subject: update
PostPosted: Tue May 18, 2010 5:15 pm 
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Just wanted to update everyone on how I'm doing. Maybe at this point I should start a separate thread in stopping suboxone or dosing questions.

I did wind up uncomfortably sick on 1 mg and my pupils were still huge. So I decided to cut some more to find my maintaining dose. I did .8 on the liquid taper suggestion and I felt fine, great even. Of course I pushed that one step further and today I tried .6.

7 hours after my dose and I don't feel very well. I've had some muscle twitching in my legs all along but today my muscles are twitching all over my body. I am also very dizzy, tired and cold. I have a little weakness in my legs as well.

I got some very upsetting news so I don't know if my symptoms are heightened because of that. I am experiencing heavy duty anxiety and shaking internally which could be a result of my bad news/anxiety or it could be that my .6 dose is not enough.

I am going to try to give it another hour or so but I would really appreciate any suggestions you have.

edited to add- I took the other .2 and I feel much better. I guess this is my maintenance dose. Thank you all for your help and support.


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 Post subject: Dose
PostPosted: Wed May 19, 2010 10:29 pm 
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Smat - So you are taking .8 mg daily now? Are you having any cravings on this dose? How about another update???

SuperBuper


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 Post subject: suggestion...
PostPosted: Mon Jun 07, 2010 6:17 am 
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Hi smat. How are you doing? Stabilized yet? Hope so. Anyway, here's some taper suggestion my boyfriend gave me (he's tapering off 10mg/day methadone veeery slowly, since he needs the drug for both the maintenance AND post-surgical pain, his legs have actual holes in them, ugh! :)) so here goes...

If you're having trouble cutting your pills to small pieces, or concerned about not getting an optimal dose with liquid taper method, try this - instead of lowering your dose, try making your regular dose last longer. Add hours instead of cutting down milligrams. Another advantage this system might have - you see, with Sub being so poorly bioavailable, only about 60% of what you take sublingually will eventually get into your system. Thus, when taking a 8 mg pill, the amount of Bupe that reaches your brain is something around 5 mgs. A little bit more of that 5 mgs is lost during the first couple of hours (at least that's how a specialist explained it to me). Maybe, with small doses, especially if you have to prepare your pill slices/solution yourself, best way to minimize loss and maximize effect is taking a slightly higher, stable dose - and making it last not 12, but 14, 16, 18, and then 24 hours, before cutting it down and repeating the same cycle with the lower dose. Just a suggestion, not a qualified or professional advice, nothing like that :)

Oh, by the way - you DID overdose on your induction, no doubts about that. Pinned pupils, nausea, being "cold to the bone" etc. - all those are symptoms of an opiate overdose, only without the warm fuzzy glow and dangerous respiratory depression that would happen if you had taken an equivalent dose of full-agonist opiates like Oxys or methadone. You see, Bupe does not make you "well" enough to enjoy a "little extra" like usual painkillers do. It just makes you feel drugged and _sick_ - not dope-sick, but actually ill, like any overdose SHOULD feel,when you think about it, heh. Besides, at high doses Buprenorphine becomes an evil little pill and instead of soothing your body, actually enhances w/d symptoms by turning into a complete assh.. sorry, antagonist. Something to do with opiate receptors, ion channels and dopamine release, some scientific voodoo I was not able to completely understand even on the "beginner" level (btw, "Brain from top to bottom" google it, comrades, lots of fun and interesting stuff with animation and really friendly interface, everything you wanted to know about your addicted brains and were afraid to ask! :) it'll help if you're a chemistry major, tho).

Well, that's about it. Hope you find some of that info useful... anyway, good luck to you and your b/f. Stay strong! :)

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PostPosted: Mon Jun 07, 2010 5:46 pm 
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"Besides, at high doses Buprenorphine becomes an evil little pill and instead of soothing your body, actually enhances w/d symptoms by turning into a complete assh.. sorry, antagonist. Something to do with opiate receptors, ion channels and dopamine release, some scientific voodoo I was not able to completely understand even on the "beginner" level"

Mathan....

First off, I am not a doctor, and I am certainly no scientist or pharmacist either, but this statement didn't make sense to me. One if the biggest benefits of bupe is the ceiling effect.....above a certain level, increasing dosing will not have any effect. Of course, a "newbie" user who has no tolerance may react differently and feel sick or high at certain doses (just as they would on any opiate), but regular opiate users and addicts should not experience this. Also, I don't think there is any way that bupe can "turn into" a full agonist.....at any level. If this were true, I would think that people on high doses would test positive for opiates (as a standard test looks for full agonists, and usually not suboxone), but they do not.

My point is not to start some huge fight with you. I think I was a little put off by the statement, "at high doses Buprenorphine becomes an evil little pill". I always think about new people coming onto this site, newly induced, and reading these posts. If they are on, say, 24mg a day, what would they read into this? Or, what does this say to a veteran member who has just had their dose increased, and may be unsure of following their doctor's orders? It was just really strong wording, and it sort of set me off.

Elizabeth

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PostPosted: Tue Jun 08, 2010 6:48 pm 
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Hello everyone! Sorry I never updated this thread but once I stabilized at .8 I forgot about it because I became very focused on tapering down.

I am doing a liquid taper and am actually in week three of my taper on my first day of .61

I am posting updates in the liquid taper sticky in the stopping suboxone forum of you're interested.

thanks for all your help! :)

Samantha


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 Post subject: My apopogies.
PostPosted: Wed Aug 11, 2010 7:41 pm 
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Yes, I guess I was too vague about this high-dose-antagonist effect thingie. Sorry about that.
I'll try to elaborate (and of course I had no intentions whatsoever to scare ppl off...) I just repeated what my Docs told me, that's all.

And I can see where confusion is coming from. In the beginning, they tell you the ceiling effect is reached at 32 mgs. But then later on you learn that it's actually 2 mgs, obviously, there's two different ceiling levels, two different effects - but what do we newbies know? Sounds confusing and a bit frightening too. Unfortunately there's not much research available (summaries are published openly, but most articles require subscription or registration for a fee, and they are not too fond of layman's terms either :) ) online these days, the thing is still kinda new and can be unpredictable at times. When I mentioned the antagonist effects at higher doses, what I actually meant was the fact that at doses higher than 32 mgs ALL our mu-receptors are occupied, and neither Bupe nor any other opioid painkiller would not have any opiate effect as long as Bupe is in the system, - therefore, when you take MORE that 32, all you're gonna do is prolong the blocking effect, and not much else. That's how it becomes an antagonist. It does not reverse itself :) (I see how one can misunderstand what I wrote, and I apologize for that misunderstanding). Higher doses just take longer to clear your system, that's all.

As for people with chronic pain, moderate to low doses every 6 hours can be most beneficial (again, according to my Docs) - since its opiate (analgesic) effects last for about 6 hours - and why that is I wasn't able to figure out yet.


But I was able to dig some stuff up regarding the ceiling levels and antagonist effects, although it's still not very clear, but at least its something to look at.

First and foremost, the receptors. There are a lot of them, and they are all different. Bupe does not just work on our junkie-friendly "mu" receptors alone, it is also
"partial or full agonist activity at the ORL1/nociceptin and delta opioid receptor, and competitive antagonist activity at the kappa opioid receptor."
(content from Wikipedia, where else?) :)
Simple, really... when you know what the heck are nociceptin and ORL1. Thank G-d wiki is there :
"Nociceptin is an opioid-related peptide, but it does not act at the classic opioid receptors and its actions are not antagonized by the opioid antagonist naloxone. Nociceptin is a potent anti-analgesic. Nociceptin is widely distributed in the CNS..."
O-ok... so it's, like, for pain, right? And opioid antagonists do not affect it. Moving on :

"Nociception (synonym: nocioception or nociperception) is defined as "the neural processes of encoding and processing noxious stimuli." It is the afferent activity produced in the peripheral and central nervous system by stimuli that have the potential to damage tissue. This activity is initiated by nociceptors, (also called pain receptors), that can detect mechanical, thermal or chemical changes above a set threshold..."

A-ha! there we go. Its that thing that makes us go "ouch" when we stub a toe. Or have a backache or something. Pain receptors react to painful stimuli, send signals to our brain. And then our brain is all like, "WTF?" And then Bupe goes and... wait, what?
"Partial or full AGONIST activity"?... really? How that's supposed to work? relieve pain by stimulating pain receptors... Cool. Google to the rescue...

behold, the "Agonistic effects of the opioid buprenorphine on the nociceptin/OFQ recepto", courtesy of sciencedirect-dot-com :
"The nociceptin/orphanin FQ (N/OFQ) receptor (e.g. the human ortholog ORL1) has been shown to be pharmacologically distinct from classic opioid receptors. Recently, we have identified buprenorphine as a full ORL1 agonist using a reporter gene assay. For further functional analysis, buprenorphine’s effects on ORL1 receptors were investigated using..." (some sophisticated biochemical scientific stuff) ... "In both assays, buprenorphine behaved as a partial agonist compared to nociceptin itself. The N/OFQ agonism of buprenorphine might contribute to actions of buprenorphine in pain models in vivo beside its μ- or κ-opioid receptor mediated effects."*

*Not sure about the quotes and copyright issues. Hope its ok.

So, now I think I get it. Nociceptin stimulates pain receptors fully, but Bupe binds to them and stimulates them just a little bit. So its partial, not full agonist for nociceptors, and full agonist for ORL1 only. And ORL1s behavior is still somewhat of a mystery, as I understand. Not sure about the affinity though - there's still some argument going on about who's "stickier", but in principle, I can see where it's going.

(and Yes, I get too carried away sometimes. Beats nodding off on a couch, though... Go Sub Go :) )


But what about the kappas? Wiki says :
"It has long been understood that k-opioid receptor agonists are dysphoric but dysphoria from κ-opioid receptor agonists has been shown to differ between sexes [...] k-opioid receptor has been strongly implicated as an integral neurochemical component of addiction and the remission thereof.
The involvement of the κ-opioid receptor in stress response has been elucidated.
Activation of the κ-opioid receptor appears to antagonize many of the effects of the μ-opioid receptor
"...
An article called "The Dysphoric Component of Stress Is Encoded by Activation of the Dynorphin κ-Opioid System" by [a bunch of Docs and scientists] on
National Center for Biotechnology Information (sorry, no link - forum rules are strick on that one)
summarizes that
"the dysphoric properties of chronic stress are encoded by the endogenous opioid peptide dynorphin acting on specific stress-related neuronal circuits. Using different forms of stress presumed to evoke dysphoria in mice, we found that repeated forced swim and inescapable footshock both produced aversive behaviors that were blocked by a κ-opioid receptor antagonist..." .. and lots and lots of other stuff. Its a big article.
DYNORPHIN, by the way, is a really weird thing. It's one of those things that makes us feel miserable when we're stressed or depressed. It can both relieve pain and intensify it, depending on... oh how the hell would I know. But that's insignificant in a way, what's important, however, is that
"Dynorphin inhibits dopamine release, that would counter the pleasurable effects of cocaine caused by the release of dopamine. There is also evidence suggesting that increased amounts of dynorphin can protect humans from cocaine addiction..." (and there's bound to be some heroin studies somewhere, I'm sure).

In a nutshell, - a really tiny nutshell, peanut-sized, really - the one my mind is actually capable to wrap itself around... it goes something like this.
1. Buprenorphine blocks Kappa-receptors
2. Blocking k-receptors reduces stress
3. Dynorphin effects kappa-receptors as a part of pain-depression-stress mediator mechanism... or something. Dynorphine is a kappa-agonist that intensifies stress.
3. People with increased dynorphin amounts are less likely to become addicted... (to something that messes with your dopamine release). Dynorphin also inhibits dopamine release.

Phew... I hope I got it right. And if not - please correct me before my head explodes :)


Summary : (hey, you see - I got my own "summary" :) More annoying than an full-blown addict is a sober one with Internet access... but I digress).

Buprenorphine does 3 major things.
1st, it relieves pain and aleviates withdrawal by partially stimulating mu- and inhibiting the pain repectors.
2nd, it occupies your opioid receptors so other opiates can't get it.
3d, it blocks the kappas, the ones that make us sad and irritated and drug-addicted. (You hear addicts? It's not our fault! We were made that way... i knew I was right to blame my parents for everything. So there.) ;) ;) ;)
But of course I'm kidding :) See the smileys? I'm kidding. It's a joke. One sad, pathetic joke...

Wait, what was i talking about? Oh yeah. the evil effects of a high dose. but you were right. It's not really evil when you think about it. But still, it's not a good idea to disrespect it :) I just wanted to warn a new patient about possible side-effects and undesired consequences of taking too much Bupe on induction. Please accept my apologies.

Best of luck to all.

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