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PostPosted: Thu Nov 03, 2011 5:38 am 
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I found a really interesting study that appears to go against a lot of what we are told by RB and other medical professionals. Basically, John Hopkins University (they do good research). Unfortunately there was only a sample of 9 people, but naloxone precipitated withdrawal in five of those people.

Quote:
Effects of sublingually given naloxone in opioid-dependent human volunteers.

Preston KL, Bigelow GE, Liebson IA.


Source
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224.


Abstract
To determine whether sublingual naloxone could precipitate withdrawal in opioid-dependent subjects, naloxone was administered in increasing doses (0-8 mg in four or six sessions conducted over 2 days) to six heroin abusers and three methadone (30 mg/day, p.o.) maintenance patients. Two or three sessions were conducted per day with 2- to 2.5-h intervals between same-day sessions. Naloxone precipitated withdrawal in two of six heroin abusers and in all three methadone subjects. Naloxone is sufficiently absorbed sublingually to precipitate abstinence in dependent subjects, but naloxone doses up to 1-2 mg can be administered sublingually to opioid abusers/addicts without precipitating withdrawal.


As you can see, I am not a member of pubmed, and can only see the abstract. It will cost me $36 to read, and while I'm quite interested, I'm not that interested.

But does anyone here who is a member of a subscription based service, or if someone who has a copy of this study, can they elaborate a bit? (I'm not requesting copyright infringement, just some more "insight" :lol: )

Thanks.

tj


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PostPosted: Thu Nov 03, 2011 11:19 am 
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That is very interesting and explains why I feel so much better on subutex. It wasn't that I felt horrible on sub, in fact I didn't even notice some of my symptoms until I switched and they were gone. It's a shame more Drs don't take the time to learn about the naloxone in sub and refuse to prescribe the cheaper alternative.


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PostPosted: Thu Nov 03, 2011 11:46 pm 
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Breezy_Ann wrote:
That is very interesting and explains why I feel so much better on subutex. It wasn't that I felt horrible on sub, in fact I didn't even notice some of my symptoms until I switched and they were gone. It's a shame more Drs don't take the time to learn about the naloxone in sub and refuse to prescribe the cheaper alternative.


I don't know if we can use that study to explain anything just yet.

It only had 9 subjects, which is tiny, and it wasn't double-blind. Those 5 people could have just been experiencing some placebo effect. Also I don't know if it was peer-reviewed at all.

I think they do these little studies often to try and demonstrate that further research is needed, and until it is done, we can't really draw any conclusions. ie The study has shown that it's worth doing a proper, large sample, double-blind study on the subject. Strangely, there has been no further research I can find, though. And I'm not 100% surprised.

The reason I looked this up was because my prescribing doc yesterday said "You don't absorb any, zero, naloxone anyway when you take it the right way." I must have had a slightly doubtful face on, because he started laughing and mentioned something about my cynicism!


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PostPosted: Fri Nov 04, 2011 12:58 am 
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Yeah I agree, I just meant that it goes along with my experience. I don't think I had a placebo effect because I actually thought I was going to feel worse when I switched from strips to tabs. I never thought about the Naloxone being the cause of some of my problems prior to switching.


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PostPosted: Fri Nov 04, 2011 8:37 am 
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Yeah it's weird hey.

I saw my prescribing doc yesterday and he said that 4 of his patients have tried the film, and all 4 of us immediately switched back. I then said I was concerned that we might not be able to get the pills, just like we couldn't get Subutex anymore. And he said something along the lines of "well... that may well be. But I do talk to RB regularly and they will definitely hear my patient's experiences."

Anyway, we've been down this road before. :?


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

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