It is currently Tue Aug 22, 2017 3:40 pm



All times are UTC - 5 hours [ DST ]


Our Sponsors





Post new topic Reply to topic  [ 7 posts ] 
Author Message
PostPosted: Wed Apr 12, 2017 11:54 pm 
Offline
Moderator
Moderator
User avatar

Joined: Thu Feb 23, 2012 4:42 am
Posts: 4138
I want to share Dr. Junig's wisdom regarding psychological versus physiological symptoms people have from buprenorphine/nalaxone.

This is a response he wrote to a member of our forum who is an attorney and was asking about some specific things. Dr. Junig starts out by comparing medicine to the law as he answered the lawyer. That is the context of what Dr. Junig wrote here.

Please read!!!

"I'll share my thoughts for what they're worth.

As an attorney, you realize that there is a huge difference between what the general public believes about the legal system, vs. the actual system. You are likely frustrated when you hear people argue that evidence obtained through illegal searches should be used to convict a defendant. You know why evidence 'from that tree' needs to be dismissed. I come from a family of lawyers, btw-- dad, brother, and son. You also know that there are probably a few DAs out there who would use that evidence regardless of the legality of the search that obtained it.

The same is true with medicine. There are correct and incorrect interpretations of symptoms. I would stick with the person who argues whether your symptoms are physiological possible or not.

There is a large psychological factor to somatic (felt in the body) symptoms, and an even larger contribution for symptoms related to addiction and withdrawal. People can have withdrawal symptoms purely because of psychological factors. Withdrawal experiences can be remembered, and replayed after a number of cues. It is common for a person to have sweats caused by opioid effects, and then have those sweats trigger all sorts of other symptoms, that 'feel' like withdrawal. Those symptoms are VERY common.

Nobody can figure out whether his/her symptoms are psychological vs. physiological. To the person with the symptoms, they feel exactly the same. So if you truly want to get to the cause of symptoms, the only accurate way is to look at the science.

There is no difference between generic formulations beyond impressions based on mostly-unconscious thoughts about the size, shape, or taste of the tablet, or perhaps the music that played in the background when you first read about that specific manufacturer. Molecules are not products that vary from 'craftmanship'. Water is water. And buprenorphine is buprenorphine-- period. Excipients are the molecules added to bulk up certain pills, and there is a slight variation in the composition of those excipients from one tab to the next. But note that you don't get sick from one form of ibuprofen vs. another form-- or from one form of amoxicillin vs. another... or from one form of melatonin, or tylenol, or lexapro, or table salt. A molecule of buprenorphine is always a molecule of buprenorphine.

Likewise, there is truly no difference 'coming off buprenorphine' vs. coming off any other opioid. People often write about one drug causing more withdrawal, or causing worse PAWS, than another opioid. Any scientist knows that such a concept is utter nonsense. The 'flaw' during withdrawal is a high opioid tolerance. The cause of that high tolerance has nothing to do with anything. I don't usually argue that point, because people will always believe what they want to believe. But your brain and body don't know, and don't care, which opioid raised your tolerance!

You will do what you choose to do, of course. But I'll tell you how I would address the issue, as a person trained in the science of neurochemistry, psychiatry, and anesthesia. I would assume that my PERCEPTIONS about symptoms are incorrect, unless I can PROVE that there are reasons for them to be correct. That is how I live, and how I interpret my own experiences. I've seen, over and over, how people are blind to things that are obvious to everyone else-- and I assume that I'm just as blind. I've seen patients with no pathology experience blindness or paralysis that is eventually proven to be conversion disorder-- and I know that they truly believed they were blind or paralyzed. And I've seen many people who repeated behaviors that kept them stuck or miserable, believing they were acting in their own best interests when in reality they were punishing themselves. And again-- I assume that I do that too.

I suggest that you keep an open mind, that something is going on other than a problem with the manufacturer of a certain molecule. What is the chance that almost every other human can take a certain form of a medication, but you can't? If that was true, the difference in your body would have shown up by now in other ways. If you lived in a space suit, for example because every contact with certain chemicals made you sick, then I'd say maybe one type of generic is better than another. But 'not feeling right', specifically related to this one medication, just doesn't make sense.

I've written so much that I am probably going to repeat myself... but I also note the vagueness (and subjectiveness) of your symptoms. You feel 'off', or depressed for example. I feel 'off' every other day! If I wake and have the thought that I'm 'off', then I will immediately feel off! And nobody ever has a clue about why he/she is depressed. If a person comes in and says 'Im depressed because of X', then the one thing I know is that X is NOT the problem. People don't become depressed about things that they can see; they only become depressed by the things they don't want to recognize or realize. Psychiatrists discuss 'defense mechanisms' or 'reaction formation' as ways that people keep themselves in the dark. For example, a person who works hard to become a lawyer, but has an unconscious fear or perception holding him/her back from giving his all to that field, will believe that something else is holding him back-- something other than the real reason. That's just how human minds are wired.

A couple final thoughts. Once buprenorphine is in your bloodstream, it leaves at a certain rate-- that has nothing to do with the medication that put it there. Your dose of buprenorphine will wear off at the same rate, whether you took generic or brand. Also, most companies use the same excipients (the substances added to bulk up the active substance). Again, medications are NOT 'crafts'. They are not furniture that one person makes better than other. Buprenorphine is ALWAYS the exact same molecule, in any tablet or capsule. The FDA makes sure that buprenorphine is, in fact, buprenorphine. If it wasn't, the manufacturer would be liable to complete destruction with the first plaintiff motion.

Bottom line-- there is so much nonsense about medicine out there. But there IS truth. Find a good doctor, like the one who pointed out what makes sense and what doesn't make sense. The others are charlatans.

Dr. Junig

_________________
Done is better than perfect!


Top
 Profile  
 
PostPosted: Thu Apr 13, 2017 11:56 am 
Offline
Long Time Member
Long Time Member

Joined: Sat Oct 29, 2016 9:34 pm
Posts: 614
Hi amy,

I agree that this was a superb post by Dr. Junig. For your purposes, I think you could do even better by paring it down...with permission of course... to something a suffering newbie might be able to take in more easily. It seems it's usually the forum newbies who are convinced that bupe is turning their tongue purple and their nose green.

As I said, I agree it's a superb post, but the discussion about the legal system was meant for the OP, who I believe said he was an attorney. For the anxious, suffering new person, it might be confusing.

Just my suggestion. I applaud the effort and the intent behind it. The post as I said is excellent. It could
just use a little editing in my humble opinion for a more general readership.

Does this forum have "stickies?" Meaning posts that stay up all the time?

Edit: Perhaps if you just edit out the first paragraph it might do the trick.


Top
 Profile  
 
PostPosted: Thu Apr 13, 2017 1:18 pm 
Offline
Power Poster
Power Poster

Joined: Fri Mar 17, 2017 7:27 pm
Posts: 83
Hi, I am new here and still have a lot to learn. I am asking this question out of genuine curiosity and trying to understand. I completely understand that while the molecules of buprenorphine are all the same, and that the differences I am mentioning are probably slight and don't apply to the vast majority of people, but I did want to question this: there are inactive ingredients and "excipients", binders, fillers that should not cause problems because they are "inactive", but may affect the bioavailability for some people, especially those who are very chemically sensitive. For example- Some generic tablets use F&DC Red(I think that is how you say it) and strips Fdc yellow. I know some people have allergies to the red, maybe the yellow? I have a link to the FDA which states that every manufacturer is slightly different. Couldn't that slight difference affect at least some patients?

Also I have a link to an article about a generic form of Wellbutrin 300mg XL, originally thought to be identical to other forms of Wellbutrin. Patients complained that it didn't work, doctors and pharmacists say- it's all in your head- come to find out when the FDA tested it-

something was very wrong- I believe it was releasing all of the medication at once instead of throughout the day. Patients had horrible side effects in the morning and no relief later in the day. This generic was taken off the market only after several years of people receiving horrible treatment. Incidents like this further erode the trust patients have in the whole medical system (often times doctors, pharmacists, pharmacy companies, are all lumped together in people's minds, despite the fact they are each their own separate entity).

I don't mean to endorse the idea that the side effects people have from different generic /brands is the most likely culprit of the effects they are having, but I don't think it is bad to have a healthy bit of skepticism.

I welcome feedback and if I'm not reading all this right, please correct me- especially the docs on here who know far more about this than me. Below are links

http://fortune.com/2013/01/10/are-gener ... ded-drugs/

https://www.fda.gov/drugs/resourcesfory ... 167991.htm


Top
 Profile  
 
Our Sponsors
PostPosted: Thu Apr 13, 2017 4:05 pm 
Offline
Site Admin
Site Admin
User avatar

Joined: Sun Feb 24, 2008 11:03 pm
Posts: 1544
Thanks Amy. Tragicom, a couple thoughts- yes, the dyes are not tolerated by everyone. But those same dyes are used in much higher amounts in beverages, cereals, candy, and and other edibles-- and I suspect many of the people who are convinced that the dye in their Suboxone causes problems are ingesting much more of the same in other foods, without notice. People pay so much attention to how they 'feel' after taking buprenorphine, maybe because of years of focusing on how they felt after pills or heroin. Or maybe the fear of withdrawal makes people more vigilant about symptoms that may signal impending withdrawal.

About the Wellbutrin story, I should have added an exception to my 'craftmanship' comment. A molecule is a molecule. But delivery systems DO vary. The example that stands out the most (besides your bupropion article) is Concerta, a delayed-relase form of methylphenidate, which is a schedule II stimulant used mainly for ADD. The drug is released from the Concerta capsule in a certain way, so that the blood level slowly rises throughout the day and then quickly decreases at the end of the day. The release device is referred as an 'osmotic pump'. While all molecules of methylphenidate are the same, I would not be surprised if blood levels of methylphenidate were different between people on brand vs. generic. The release mechanisms and packaging, especially of delayed-release preparations, ARE subject to craftmanship.

But keep in mind that brand is not necessariy better than generic. Maybe a certain generic manufacturer just happens to produce it more carefully than the brand manufacturer. Or maybe onoe patient has unique aspects to his/her anatomy or digestion that favor the generic over the brand.

I think the bottom line is that we all should have an open mind about the symptoms we experience.


Top
 Profile  
 
PostPosted: Thu Apr 13, 2017 4:24 pm 
Offline
Power Poster
Power Poster

Joined: Fri Mar 17, 2017 7:27 pm
Posts: 83
Thanks Dr J. That does make sense and clarify better for me. Definitely understand that those of us addicted to pills tend to overthink how we are feeling and how we think we need to change it with medication. I'm still very much in that stage and trying to refocus energy on other positive things to distract from constantly monitoring how I feel, mentally and physically. Thanks again!


Top
 Profile  
 
PostPosted: Thu Apr 13, 2017 7:32 pm 
Offline
Moderator
Moderator
User avatar

Joined: Thu Feb 23, 2012 4:42 am
Posts: 4138
Hey Godfrey. This is a sticky that will make it stay at the top of side effects forever. That's exactly why I wrote it. I made another clarification at the top, but left the law analogy because I think people can understand it. If Dr. Junig thinks that anything should be added or subtracted he is welcome to edit the post how he likes. :)

Amy

_________________
Done is better than perfect!


Top
 Profile  
 
PostPosted: Fri Apr 14, 2017 5:46 pm 
Offline
Site Admin
Site Admin
User avatar

Joined: Sun Feb 24, 2008 11:03 pm
Posts: 1544
I started to add an explanation, but then I noticed Amy's description, which is better than what I would write!

If someone gets this far down the thread... there are many articles and forums out there where people will write about how they feel. The value of this forum, I hope, is that we try to approach things from a perspective supported by SOMETHING-- by science, by law, by medical experience, by the experience of addiction professionals, or by people who recognize the problems that come up from entirely subjective interpretations.

Sometimes, people are offended when they read feedback that 'maybe their symptoms are psychological'. That's a shame, because nobody here intends to ignore or mock a person's symptoms. We know you are distressed! But the easiest approach (and the most common approach taken on the internet) is to agree with you, and get you all fired up about those damn drug companies. Maybe that attitude is appropriate in some cases, but our goal is to help you find out the truth.

As Amy wrote, this post was in response to complaints by an attorney, and the legal references relate to how people from different backgrounds perceive things... differently.

Stick around-- other people will say things better!


Top
 Profile  
 
Display posts from previous:  Sort by  
Post new topic Reply to topic  [ 7 posts ] 

All times are UTC - 5 hours [ DST ]


Who is online

Users browsing this forum: No registered users and 0 guests


You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot post attachments in this forum

Search for:
Jump to:  
Our Sponsors
Suboxone Forum latest topics RSS feed Subscribe to the entire forum
 

 

 
Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

Powered by phpBB® Forum Software © phpBB Group