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 Post subject: Narcan and induction
PostPosted: Sun Feb 19, 2017 6:31 pm 
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Can narcan be used to put one in w/d so that induction can safely be started?


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 Post subject: Re: Narcan and induction
PostPosted: Mon Feb 20, 2017 11:15 pm 
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No. Narcan (if given intravenously or by IM injection) would precipitate withdrawal if given to someone tolerant to opioids. The withdrawal would be immediate and severe, if you took a significant amount of Narcan-- anything over 0.4 mg or so. But in about 20 minutes the withdrawal symptoms would fade, the huge amount of sweat covering your body would evaporate, and your tolerance would still be where it was 20 minutes earlier. If you took repeated doses of Narcan, say every 2 hours, you would get just as sick every 2 hours for at least a few days.

It takes time to reset tolerance, and a dose of Narcan doesn't last long enough. When they do 'rapid detox' they infuse narcan for hours, and then implant naltrexone- which pulls tolerance down over a few days. After rapid detox, though, people feel moderate withdrawal for a week or two, and minor withdrawal for a month or two. It takes 6-8 weeks for the body to establish normal tolerance after significant opioid tolerance is established.

The best pathway to buprenorphine is the one that is used the most-- i.e. a period of abstinence until moderate to severe withdrawal, and then induction. In essence buprenorphine acts like a longer-acting version of Narcan, pulling tolerance down and holding it down, while activating the receptor to some degree. People with high opioid tolerance often feel mild withdrawal for a week or two after starting buprenorphine-- but they don't notice it very much, given the misery they left behind.


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 Post subject: Re: Narcan and induction
PostPosted: Sun Feb 26, 2017 9:45 am 
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suboxdoc wrote:
No. Narcan (if given intravenously or by IM injection) would precipitate withdrawal if given to someone tolerant to opioids. The withdrawal would be immediate and severe, if you took a significant amount of Narcan-- anything over 0.4 mg or so. But in about 20 minutes the withdrawal symptoms would fade, the huge amount of sweat covering your body would evaporate, and your tolerance would still be where it was 20 minutes earlier. If you took repeated doses of Narcan, say every 2 hours, you would get just as sick every 2 hours for at least a few days.

It takes time to reset tolerance, and a dose of Narcan doesn't last long enough. When they do 'rapid detox' they infuse narcan for hours, and then implant naltrexone- which pulls tolerance down over a few days. After rapid detox, though, people feel moderate withdrawal for a week or two, and minor withdrawal for a month or two. It takes 6-8 weeks for the body to establish normal tolerance after significant opioid tolerance is established.

The best pathway to buprenorphine is the one that is used the most-- i.e. a period of abstinence until moderate to severe withdrawal, and then induction. In essence buprenorphine acts like a longer-acting version of Narcan, pulling tolerance down and holding it down, while activating the receptor to some degree. People with high opioid tolerance often feel mild withdrawal for a week or two after starting buprenorphine-- but they don't notice it very much, given the misery they left behind.


Can Suboxone be used if someone has overdosed? In place of Narcan?

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 Post subject: Re: Narcan and induction
PostPosted: Sun Feb 26, 2017 6:02 pm 
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Quote:
Can Suboxone be used if someone has overdosed? In place of Narcan?


Hey Sis (very glad you like the nick name :D

You mean on the theory that the subs would knock the offending full agonist off the receptors, thus perhaps ending the overdose episode by putting the person in severe WD?

It's an interesting question. I'm guessing no, but I really have no clue. I guess I'm basing that on
the likelihood that: we'd have heard of this use if it were possible..

Maybe we'll get lucky again and one of the docs will check in....


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 Post subject: Re: Narcan and induction
PostPosted: Sun Feb 26, 2017 8:27 pm 
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Hey Sister, Interesting question. Agree, w Godfrey, hope one of the Drs can answer. Imo, during an overdose -- it is all about time and oxygen. Maybe 3" time before brain starves for oxygen. Also depends on a person's tolerance and if any benzos are on board. We're more used to high tolerances here. But if person is low opiate/benzo tolerant and OD's on say oxy and benzos, then bup would likely worsen/hasten the OD. If person has higher tolerance than bup and ODs then likely bup would displace the opiate and cause PW. Takes time to dissolve/inject or much longer to absorb sublingually. I'd begin rescue breathing. The new CPR guidelines to focus on chest compression are for a cardiac arrest. But an OD is initially a respiratory arrest so rescue breathing is important. I guess if no 911/no narcan available and if you knew the person had a higher tolerance and w the hope the person could survive till bup got absorbed, bup's higher affinity might work... But will need a medical opinion on this!

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 Post subject: Re: Narcan and induction
PostPosted: Sun Feb 26, 2017 9:39 pm 
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Excellent points on the issue of tolerance, Pelican....
I hadn't thought of that.


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 Post subject: Re: Narcan and induction
PostPosted: Mon Feb 27, 2017 12:45 am 
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:D Thanks to you Doc and all the others who responded. I am so grateful for the intelligent responses based on sound research and not on speculation. This information is valuable.


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 Post subject: Re: Narcan and induction
PostPosted: Mon Feb 27, 2017 1:45 pm 
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Quote:
Can Suboxone be used if someone has overdosed? In place of Narcan?


OK, so there IS naloxone in Suboxone…will Suboxone work for an OD?

Using buprenorphine to reverse an overdose is not something that has been scientifically studied. However, there are reports of this working. This is probably because the buprenorphine has a stronger affinity or attraction to the opioid receptors than heroin or other opioids, so it displaces the opioids. The reason Suboxone may reverse an overdose is probably not because of the naloxone in it—it is a very small amount—and it is most likely the buprenorphine that causes the person to wake up. Remember: during an overdose it is all about time and oxygen. Anything that is done to reverse an overdose should not sacrifice time or oxygen. Preparing a Suboxone to inject takes precious time, and waiting for the pill to dissolve in the mouth takes even longer.


This is from The Harm Reduction Coalition
I had a patient report that she had seen this done once. If they were unconscious for any reason other than opiate overdose then a bad situation just went off the cliff. With Narcan becoming more and more available I hope Suboxone doesn't get seen as a viable option. Someone unconscious for any reason will not be affected by Narcan.
http://harmreduction.org/issues/overdos ... se-faqs/#4

Sorry JD3 for taking your thread off the rails.


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 Post subject: Re: Narcan and induction
PostPosted: Sun Mar 05, 2017 10:47 pm 
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thanks for responding about using suboxone for an overdose because of the naloxen.

i was just curious. a boy od'd in my town and someone mentioned someone must have given him a suboxone or something. theres a really long response time for paramedics. we learned later they put him in the shower and out friend gave him CPR till the paramedics finally got there.

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