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 Post subject: My first go on the film.
PostPosted: Wed Oct 19, 2011 12:06 am 
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Got to the pharmacy today, and he told me that the new film was in. I figured I'd give it a go.

It has been about half an hour now, and while I'll give it a good 24 hours before I decide whether they're for me, so far I'm a bit unimpressed.

The things I don't like so far are the tongue burn, the headache and the definite feeling of mild precipitated withdrawal. For one, the film is definitely stronger. I could tell within a few minutes of putting it in my mouth that it felt like I was getting 12mg from an 8mg strip. This might explain the headache, and buprenorphine itself has always given me a bit of a headache.

Thankfully I take 8mg in the pharmacy, and take home 4mg for night time dose. If it turns out I don't need the extra 4mg tonight, I will leave it, and get the doc to change my dose to 8mg.

But the dizziness, nausea. and speediness and slight scattered feeling is undeniably mild precipitated withdrawal. I actually got raised goosebumps for a few minutes. I've experienced this feeling before, and it's definitely there. You get a really mild feeling like this when you first switch from Subutex to Suboxone I think, but it's almost unnoticeable, and I believe I felt it in some pills more than others. However with the film, the only way I can explain this feeling is if the naloxone was more bioavailable as well. IMO naloxone does have the capacity to kick ..some.. buprenorphine off its receptors for a short while (about half an hour), so hopefully this effect will fade away in the coming hour.

Anyway, you guys have been through it all before! Just the thoughts of a film newbie. Also be aware that I am on a pretty full on chemotherapy-style treatment, so it may be making me more sensitive to the side effects.

t


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PostPosted: Wed Oct 19, 2011 2:32 am 
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Okay. Things have calmed down a bit, thankfully. I couldn't shake that headache though, so took a Panadol (acetaminophen) a couple of hours ago which really helped. I still feel a bit of general ickyness in the head, but it's much better than before.

I definitely have more buprenorphine in my system than I got from my 8mg tablet. I even feel that slight buprenorphine "stone" you get when you increase your dose.

I'm interested in knowing whether any of you were advised to drop your dose when you switched to the film? I really feel that doctors should at least provide this option. Patients who are unaware of the increased bioavailability of the film could potentially get screwed around - ie they could end up adjusting to the dose provided by the film, then should they choose to switch back to the pills, they may find their dose insufficient and end up going into withdrawals. In the long run, this could potentially have the effect of "locking in" people into taking the film if they remain unaware, or don't compensate for the strength difference.

I'll make one more post tomorrow.


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PostPosted: Wed Oct 19, 2011 6:34 am 
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Nearly bed time. I'm definitely have absorbed more buprenorphine thanks to the film. My girlfriend said I looked 'pinned'. I've also had excess energy, and dragged my girl on a walk that ended up going for 6km's at least.

It's difficult, but part of me definitely wants to stay on the film because of this mild Suboxone stone. I know it'd only last a few days before I adjusted to it, but still ... I'm still an addict! :lol:

There is a benefit in staying on the film, and that is I will only have to have 8mg in the morning, without the extra 4mg at night. This would be more convenient.

I will give the film ..one.. more go tomorrow, and if it still makes me feel sick after dosing, I will switch back to the tablets... If I can!


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PostPosted: Wed Oct 19, 2011 6:50 am 
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Your doctor should have told you that it's possible the film could be stronger. I think it says that right on the package insert.

Some people do have to drop their dose, but the funny thing is, there are people out there that actually had to raise their dose when they switched to the film, too. So everyone is different, as they say.

I have to say, though, that I highly doubt that what you experienced was precipitated withdrawal. But you definitely got a shitload more bupe in your system than you're used to, in my non-medical/professional opinion.

Oh and I have a question for you: You mentioned that your chemo-style treatment might make you more sensitive to side effects. Why would this be? I'm asking because I'm on a low dose of chemo (methotrexate), so what you said piqued my interest.

Anyway, if you don't like the film, will they let you go back to the tablets?

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PostPosted: Wed Oct 19, 2011 7:45 am 
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They will let me go back to the tablets in the short term future, but unfortunately the 'professional consensus' is that the film is much harder to divert, so it's likely the pills will be phased out by pharmacies in the coming months.

Re the treatment - it's the interferon. Since I've had to shave my head from the hair loss, I just tell people I'm on chemotherapy. It spares any judgement, is easier to explain, and people are more understanding. It seems anything that's not good for my body just makes me feel more unwell. It also makes me really angry. Riba rage!! :lol: Clearly I'm taking it out on the pharma companies (as usual.. yawn!) I just wanna get off it, and get on with my life. 10 weeks to go.

Re the naloxone. You are probably right as it's really hard to tell what is the side-effects of naloxone, and what is side-effects of buprenorphine. I do know though the naloxone is about 40% more bioavailable in the 8mg film than the tablet (by memory, will find the quote).

Quote:
Study 20-273-SA compared single doses of the 8/2 mg soluble film with the 8/2 mg sublingual tablet. It showed that the bioavailability of buprenorphine from the soluble films is significantly greater than from the sublingual tablets: AUC and Cmax are increased by 20% and 28%, respectively. The bioavailability of naloxone from the soluble films is also significantly greater than from the sublingual tablets: AUC and Cmax are increased by 30% and 41%, respectively. There is no significant difference with regard to plasma levels of norbuprenorphine.


This means that any potential side-effects from the naloxone would be between 30-40% worse on the film. You are right though, it's really hard to differentiate whether the effects are from increased buprenorphine or naloxone, and it has been many years since I was on Subutex. I do have a vague memory of subutex feeling cleaner, but that was a long time ago.


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 Post subject: I like the film
PostPosted: Wed Oct 19, 2011 8:40 am 
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Tear I much rather the film. I started on the film and to me it taste better. I seem to have alot more spit with the pill. The film desolves alot faster and you can feel the affect quicker and stronger. I traded a film for the pill to try it. I will stay with the film any day. but it goes to show you everyone is different. Good luck
Mel

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 Post subject:
PostPosted: Wed Oct 19, 2011 9:08 am 
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Totally. IMO the more options we have as consumers, the better, as long as there is correct information given to make an informed choice. Some will prefer the film, others the pills. It does anger me slightly that people are not made aware of the increased risks in taking the film. If people are made aware but still take it, then that's their choice, and I think it's awesum.

I just looked at my strips, and it seems in my country there are no warnings on the film packaging stating increased bioavailability.

Quote:
Bioavailability studies suggest that the Film and tablets produce similar plasma levels... Australian studies indicate no significant differences in the dose effects, side effects or clinical outcomes for the Film and tablets.
...
Reassure patients that the Film and tablets are generally equivalent in dose, and most patents do not require a dose adjustment. Some clients may warrant a minor dose change after review.
(Posted to ENEWS for Niki Earls on behalf of Reckitt Benckiser)


Sounds a bit different to the study I pasted above! :lol:

Suboxone is great, I have no doubt many people will find Suboxone Film great. It is the misinformation at the expense of informed choice about my health care that I find offensive. :lol:

I've decided that next time I see my prescribing doc, I'm going to request to go back on Subutex. I think he knows me well enough to know I'm one of the last people who would inject their dose. I have absolutely no desire to. Will let you know how it goes.


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 Post subject:
PostPosted: Wed Oct 19, 2011 8:07 pm 
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Look. I know I can get worked up about this stuff. I just find moreso than any other kind of medical treatment, in my country, people on methadone and Suboxone are ignored and mistrusted the most. And it's understandable as we are recovering addicts - we're not the most credible bunch.

Yesterday I went to the pharmacy and there was a real messy looking guy - the kind anyone would pick as a junkie - picking up his doses before me. This guy has been around for a while. Just as the pharmacist told me that the new film was in, this guy chimed in to me and said "I don't like em. I ask for the white ones, if ya know what I mean" and he turns around and gives me a sly wink, and I see a bottle of 5 Subutex on the counter being handed to him.

It's because of this kinda shit that people like me are distrusted by doctors, pharmacists, pharmaco's. I know this guy's just a "sick guy", I've been there myself, and I know this stuff will always happen, but it just makes the possibility of creating change for us on the program feel ... futile, ya know? We won't be listened to unless we have people's trust. And let's face it. While this treatment is fantastic, it does have its shortcomings, and it has the potential to save many more lives than it does.

It would be nice if we had options, that we could choose between different products. Implants, patches, generics, methadone, antagonists. That us patients were read out accurate information before starting treatment, and we're shown the tapering procedures for each before we sign up. I have been around since the beginning of buprenorphine treatment. I have seen us get funnelled from Subutex, to Suboxone, to Suboxone Film, as soon as these drugs patents expire.

I'm either going to switch to subutex and start my taper in the coming months, or at least try to initiate some change before I do. God knows I got enough time at the moment! :lol:


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PostPosted: Sun Oct 23, 2011 7:36 pm 
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Hi TearJerker,

It looks like my insurance coverage is changing, and they will not pay for the tablets anymore, but now will pay for the strips, or for Buprenorphine by itself, or for the Subutex. Generic, name brand, whichever.... This will happen at the beginning of next year. I'm looking forward to trying the films. It makes me wonder how they can pack 8mg of anything on a tiny little strip like that, LOL. How do they do it?

Did you comment that you thought the naloxone can knock buprenorphine off of the mu receptors? Is that possible even? I don't swallow my spit, I spit it out, so I haven't had any issues with headaches, or with the naloxone, not that I'm aware of. I'm still trying to get down to the molecular level and understand HOW the brain works, and if we generate new mu receptors during our addiction, and if we actually 'shed' those receptors while on Suboxone? I can't seem to find a good source of info about this.


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PostPosted: Mon Oct 24, 2011 12:43 pm 
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Really good questions. I have no idea! I haven't done enough reading on the subject. I was told in rehab by the professor that when we're in addiction our neurons grow heaps more receptors to accommodate the saturation of opiates we send to our heads. Then when we quit all opiates, including Suboxone, slowly those receptors 'heal over', and it takes months. He said the problem is if who's quit opiates then has just one taste. All those 'healed over' receptors immediately open up again, screaming for more opiates. That's why it can be so hard for us to stop at one.

I don't know if our receptors heal over as I haven't seen any studies or heard anything. I can take a guess and say that because buprenorphine binds to our receptors stronger than other opiates, I can't imagine it being any different to the full agonists. But that's just a guess. Not all's lost though. Of course our natural opiate system's gotta recover a fair bit from Suboxone, as with all opiates, but how much does the other parts of our 'brain' and our thinking repair while we're on Subox and not in addiction?

About the naloxone in Suboxone. I know we're told that you can't absorb the naloxone unless you inject it, but I've had some weird experiences and this is the only way I can explain it. A few times after I've had my Subox tablets, I've had ..really mild.. symptoms that reminded me of precipitated withdrawal. It was like the Subox made me feel worse before I felt better, ie I'd get goosebumps, cold hands and feet, and sweat a bit. Then miraculously after 20 odd minutes I would be fixed! It was never enough to get in the way of my life, but it was curious. Today I put it down to minor discrepancies in the naloxone doses in each tablet. How else can I explain it? It never happened with Subutex.

Everyone gets really trace amounts of naloxone absorbed when they take their suboxone, same as if a person licks a stamp they will get some minute amount of glue in their blood (Seinfeld? :lol: ). Buprenorphine does have a stronger affinity value to our opiate receptors than naloxone, so really it shouldn't have too much of an impact. But just because it has a stronger affinity, doesn't mean that some of the naloxone can't swap with the occasional bupe molecule while it's bouncing around the synapse. Naloxone is only a small bit less binding than buprenorphine. I think affinity values (higher = weaker) were buprenorphine 0.2, and naloxone 1.5(?). Bear in mind that morphine's value is around 50!. That puts things in perspective. The moment one opiate has a higher affinity value than another doesn't mean that all our receptors will put up 'no vacancy'. Does the stronger boxer in the ring always win without fail? Often they get lucky, or the ring's set up to their advantage, or the stronger guy just doesn't show. Am I making sense?

:shock: It's been a couple of days without sleep now :? :shock:


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PostPosted: Mon Oct 24, 2011 1:11 pm 
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I agree with you about the naloxone, i would have some of the same symptoms when I was on suboxone. I didn't really even notice it until I was switched to subutex. Then there's always the question that if you don't absorb the naloxone why do they switch pregnant women. It makes no sense, you have a Dr saying no you do not absorb any naloxone but if your pregnant you need to switch to subutex so the baby doesnt get any naloxone.


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PostPosted: Mon Oct 24, 2011 3:47 pm 
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Good point, Breezy Ann! And TearJerker, thanks so much for your thoughts and explanation. I was following along until you started talking about values and affinities, LOL. And I had to LOL because you mentioned Seinfeld and just last week?--the week before maybe?--- they put on the episode where George was getting married, but his wife died from some toxin she'd licked off of the wedding invitation's glue, hahahahaha.

Well, so does this all mean that as long as I'm on Suboxone, I won't shed those extra receptors my brain made? How will I ever get back to 'normal' if I don't heal my brain?

I'm going to ask my psychiatrist about this when I see him later in the week. Thanks again, for your input, you guys! I appreciate it. ;)

And TearJerker, GET SOME SLEEP!!! (I hope you can). I wish I could swap my sleep problem with you; my psych put me on Wellbutrin, and I'm SURE that this is what is making me sleep so much. I slept for 14 hours last night! Ridiculous! I have the hardest time waking up and getting up! I am sure it's the wellbutrin. I easily sleeping 12 hours a night. I'm sleeping half of my life away! :(


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PostPosted: Tue Oct 25, 2011 1:14 am 
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There's not much I can do about my insomnia at the moment. I'm doing a hefty treatment that's knocking me around, but I have 2 months to go. I slept lastnight thank the heavens.

Yeah it's so true Ann. Another example is that when I was first switched from methadone to Suboxone, the doc made sure the pharmacist knew to give me 3 days worth of Subutex before I switched to Suboxone. He said that people switched straight to Suboxone get worse precipitated withdrawal symptoms.

Ever since then I had my doubts about the "you don't absorb any naloxone" statement.

Apparently in my country when Suboxone first came out, doctors were supposed to give patients Subutex for "induction", then switch to Suboxone after a few days. That idea must have gone to the dogs though, cos it never happened to me!


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PostPosted: Tue Oct 25, 2011 6:30 am 
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Oh and hey. The film isn't "bad", just different, and not better.

I'm just concerned that what happened after we were all funnelled from Subutex to Suboxone will now happens with Suboxone Film, and in a few months pharmacies will stop stocking Suboxone tablets. We now now that all the benefits of Suboxone over Subutex was pharma company hype, and Suboxone isn't harder to abuse. Now I see the similar hype talking up the film, and I'm concerned that pharmacies and doctors will believe it, and stop stocking the tablets, just like what happened with Subutex.


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PostPosted: Tue Oct 25, 2011 8:10 am 
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Those "extra" receptors start to "go away" once the opiates start being removed from the brain and then are fully gone. That's the way I understand it to be based on reading Dr. J's posts. As long as opiates are still stimulating the receptors, they are still there. There is no damage to the receptors and no "healing". It's just a matter of the extra receptors going away once the opiates are totally gone. Again - that's the way I understand it.

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PostPosted: Tue Oct 25, 2011 11:04 am 
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Okay healing probably wasn't the best word. He said our extra receptors "grow over". Seeing it as "healing" is the way I try to look at it.


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