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PostPosted: Sun Dec 26, 2010 12:44 pm 
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Most people know my attitude about stopping buprenorphine, at least for most people. Most of the people I've known and/or treated over the years have either stayed on the medication, or stopped and then returned to the medication-- sometimes after spending months torturing themselves through different tapering methods, only to eventually relapse after several months off the medication. Those patients, I'm sure, color my perception.

I'm sure that it is appropriate for some people to go off buprenorphine. But people under 30 years of age, for whatever reason, have a very poor record of stopping opioids by any method, so if you are in that category I strongly encourage you to consider staying on the medication until you are a little older, and your risk of relapse is also lower.

There is NO evidence that withdrawal from buprenorphine worsens over time. In fact, the mechanism of buprenorphine at the receptor is to hold tolerance in place (because of the ceiling effect). With agonists, tolerance increases over time--- but that is not true of the partial agonist buprenorphine.

Anyway... for people looking for a reason to wait a little longer, there is something on the horizon that by my perspective should make tapering easier for those who are appropriate tapering candidates. Butrans was approved by the FDA a number of months ago; it has been available in Europe for years, and will soon be available in the US as well. Butrans is a transdermal buprenorphine delivery system that releases buprenorphine in lower doses than typically used for addiction (Butrans will be indicated for chronic pain). The highest dose of the patch will be about 1 mg total buprenorphine per day; the lowest dose will be 5 micrograms per hour, which is about 100 micrograms total per day.

I would think that those patches, used in various combinations, would be a perfect solution to the tapering problem-- a constant release of drug; a non-oral delivery system; and the ability to taper down to very low doses.

I don't know when it will hit the shelves, and I don't know which doctors will use it and which ones won't-- but it looks like an excellent solution to the 'taper problem'.


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PostPosted: Sun Dec 26, 2010 3:38 pm 
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It seems that most of MDs won't prescribe this unfortunately. My doctor, and many others from what I noticed, "stick like glue" to the brand name of Suboxone. They don't like to prescribe bupe w/out the deterrent....but I think the 2mg / 0.5mg Suboxone Film shows more promise than anything I have read about thus far, considering the film's ability to accurately divide larger pieces of it by bending creases and tearing or using sharp-pointed, precision scissors for dividing smaller pieces accurately. You could easily get a dose of 62.5 micro grams or 0.0625 mg from a 2mg film strip since it is the same size as the 8mg strip....I think.


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PostPosted: Sun Dec 26, 2010 3:56 pm 
Mike T:

I dont see why their would be any need for a deterent with a patch.


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PostPosted: Sun Dec 26, 2010 7:13 pm 
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I agree with Lifesavor, I think you might be missing the whole point here Mike T. To begin with, the amount of active ingredient - that being the buprenorphine - will be much less in quantity within a patch than a strip is. But even beyond that, the whole reason for naloxone being placed in either the tabs or strips is if (in theory) an addict were to dissolve the tabs or strips in water, draw the solution up and inject it, the naloxone would both block the medication and throw the person into withdrawals. When it comes to the patches, it is much less likely and much, much more difficult to get the active buprenorphine out of the patch and into a syringe. I don't want to say it's impossible, but I will say it's very unlikely and extremely difficult to accomplish. So what we'll have is a low quantity of active drug, "locked" inside of a patch - greatly reducing the need for naloxone. Those docs who are reluctant to prescribe a pill without naloxone included are not nearly as likely to deny a patient the patch - especially if the whole point is to taper and stop in the first place.

I don't know how much the whole "ritual" of cutting strips or prepping a liquid taper adds to our addiction, but you would certainly think that applying a patch every 3 to 7 days (depending on the delivery system and length) and then just going on with your life, would have to be the closest thing there is to being off of Suboxone. Tapering off of this drug seems to clearly be both a mental and a physical challenge. Having to think about your next dose every 12 or 24 hours has to play some level in all of this - not to mention the potential for uneven doses. The patches seem to address these items. As for a physician refusing to prescribe a patch because it does not include naloxone, I'd say if that happens, you really need to find a new physician - for a variety of reasons.


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PostPosted: Sun Dec 26, 2010 7:23 pm 
That is yet another very good aspect of a patch. Not having to think about taking a dose each day. That could definitely progress your recovery even further it seems. Applying a patch every few days and getting out of the routine of taking the tablet/film would definitely be a good benefit toward the end. I think this is gonna be a step in the right direction!!


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PostPosted: Wed Dec 29, 2010 1:19 am 
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lifesaver wrote:
Mike T:

I dont see why their would be any need for a deterent with a patch.


I don't see why there would a reason for naloxone in a patch as well. The point I am trying to make is MD's don't like to prescribe any bupe meds w/out naloxone in it. I once asked for Subutex and my doc told me he couldn't do it. I think the patch ultimately would be the best method if you could get lower doses like the 2mg films. Since I could cut a 2mg film into as many as 32 individual pieces if I wanted to. Giving me 62.5 mcg.

IMO the naloxone is pointless, other than the fact that it has a small effect with stretch receptors in the large intestine. It would be more effective if they put more naloxone in it actually, like they did with the new oxycodone med that is supposed to help w/ constipation.


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PostPosted: Wed Dec 29, 2010 1:28 am 
I dont see the point why naloxone is in the pills or strips for that matter. I happen to know a few people who are needle junkies and shoot there suboxONE not subutex every single day. They say that 8mg and under and they will get no effect from the naloxone but after 8mgs it starts to get iffy. Im not making this up either, I know for a fact that they shoot the strips and the orange hexagon suboxone tablets everyday, I have seen them prep a shot and shoot it and no precipitated withdrawal. It all comes down to that the bupe will beat out the naloxone when it comes to binding the receptors anyway so it makes no sense to put in the naloxone. Dont get me wrong tho in no way do I codone doing something as stupid as IVing suboxone and Ive told these people how idiotic they are for doing it but Im just trying to make the point that the naloxone is not effective.


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PostPosted: Wed Dec 29, 2010 9:56 am 
The thing is, this patch would be nothing like subutex. Subutex is a pill. A patch is practically not possibly to be abused, in my opinion. Im sure some geniuous will come along an find a way but its not likely. I just dont see a problem prescribing a patch. Their is not need for nalaxone anyways, as suboxonwned said. Mike T, you say you think they should put more nalaxone iin sub? I find the nalaxone absolutely pointless anyways. It seems as if its only a scare tactic because suboxonwned clearly said he has saw people shoot suboxone and no PWD's. So, that proves right their that nalaxone is useless and only a scare tactic. I have also heard, not seen but heard of people who shoot suboxone. Not looking for debate or anything. Just trying to explain myself.


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PostPosted: Wed Dec 29, 2010 1:55 pm 
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Some people have shot up with sub and did get P/W's. I think it just depends on their addiction history and what's in their system already.

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PostPosted: Wed Dec 29, 2010 2:57 pm 
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lifesaver wrote:
The thing is, this patch would be nothing like subutex. Subutex is a pill. A patch is practically not possibly to be abused, in my opinion. Im sure some geniuous will come along an find a way but its not likely. I just dont see a problem prescribing a patch. Their is not need for nalaxone anyways, as suboxonwned said. Mike T, you say you think they should put more nalaxone iin sub? I find the nalaxone absolutely pointless anyways. It seems as if its only a scare tactic because suboxonwned clearly said he has saw people shoot suboxone and no PWD's. So, that proves right their that nalaxone is useless and only a scare tactic. I have also heard, not seen but heard of people who shoot suboxone. Not looking for debate or anything. Just trying to explain myself.


The reason why I think they should put more naloxone in sub is for constipation issues. Taken orally, or as you swallow saliva when you take sub sublingually, naloxone passes through the gastrointestinal tract GI and eventually the large intestine. I forget the actual physiological response, JJ should know, but naloxone, despite not having a direct effect on the central nervous system [CNS] as far as what the naloxone is intended to do, it does actually do something by way of activity as the CNS communicates with the peripheral nervous system [PNS].

There are "stretch receptors" in the large intestine [LI] AKA the colon that are activated when it expands from fecal material, water from an enema, etc. Opioids interfere with the CNS ability to communicate with the PNS which lowers the amount of action potentials the neurons in the LI can produce as the colon works its magic. The naloxone, when bonded with these neuron's receptor's in the LI, similarly like when bupe binds with receptors in neurons in are brains will out compete the bupe since it has a greater affinity for that receptor. But the problem is there is so very little naloxone in comparison to bupe in suboxone, and the chances of a molecule of naloxone finding a place to dock in the receptors in the LI decrease. So if there was like 10 or 20 mg of naloxone in sub, it would help those on higher doses of suboxone with their severe constipation issues. Constipation isn't that big of an issue w/ doses of 2mg or lower.

There are holes in this physiological explanation but it is accurate enough to explain the basic process. The reason why I say "holes" is because there are more things going on then just the stretch receptors, but this is my best guess. I should be able to fill in the blanks in a few semesters, but this issue is not that important to me as much as explaining it I guess.


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PostPosted: Fri Dec 31, 2010 4:48 pm 
hatmaker510 wrote:
Some people have shot up with sub and did get P/W's. I think it just depends on their addiction history and what's in their system already.
Well yeah I mean if they have a full agonist in your system it will cause PWD, I dont know if thats what you meant tho when you said it depends on whats in there system. Just the fact that it is said to be nearly impossible to reverse a sub OD even with big doses of naloxone pretty much says it all to me. I dont have any problem with the little bit of nalox in the sub because I use them as directed but the problem I do have with it is that doctors believe all the BS Reckitt tells them about subutex being easily abused so they wont prescribe the generic. Other than that it doesnt bother me.


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PostPosted: Fri Dec 31, 2010 5:32 pm 
Man, that mess about subutex being abused, im sure it happens but i havent ever seen anyone who does it. Most people i know who are taking sub are serious about staying off opiates and i just dont see someone spending so much money on sub to abuse it. Someone wanting to abuse sub could go a much cheaper route an use a full agonist if they wanna abuse something. Hopefully, with time that idea will fade away because i myself have to take subutex and i've never even been tempted to abuse it. I just think its a scare tactic from Reckitt Benkiser to keep doctors from prescribing it since theirs a generic. Reckitt Benkiser knows that if doctors prescribe subutex a lot of people would get the generic and RB would lose out on a whole lot of money. However, i think its time RB release's the hold they have on this medication. They've had their time to shine with it. Let some other companies have a turn. RB's probably made more money than i can count off this medication alone. Personally, i feel like they operate for all the wrong reasons. Yea, they produce this medication and it has been a lifeline for me but man, it has cost me as much to take the sub as i was spending on my DOC. I know thats not the same for everybody but for me its true because im not rich. I have to work for a living. I spent more time in withdrawal than i did using my DOC. However, sub is much better than active addiction and with that i cant complain. Anyways, im way off topic here and i apologize.


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PostPosted: Thu Sep 13, 2012 2:26 am 
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I found it postponed my detoxification by at least a month. Trying to find where you are on the patches was difficult. With the pills you can keep cutting down and you never have a set exact amount always going threw you. Only 3 doses and trying to taper was extremely painful. Can't take emergency doses. Can't cut a little to be tolerated. You get to cut a patch. Hard to go from a 20 to 15. You have to buy two patches. Expensive too and Medicare would not help pay. I hope others find it easy, but I tried. Had to go back to tabs at higher dose than I started the patch at. Took a month to cut down again. Painful balancing back. As of today I am on .25 twice a day and getting ready to jump. Yea... Good luck all. Study more about suboxone. Not just what you read from people. They can misread or misinterpret the information they then believe is true..


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