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PostPosted: Sat Sep 21, 2013 12:41 pm 
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I'm aware this topic, or similar topics has probably been discussed throughout other forums & threads, so I apologize in advance for any repetitive conversations.. The answers I've found have been inconclusive to say the least.... I've recently started taking suboxone bupe/naloxone 8mg/2mg. I am taking it to combat a year + long roxy and opana dependency (not addiction)due to an injury aquired from a combat mission in Afghanistan in 2011. After 2 surgeries and various PT regiments it has been established I will live with ongoing moderate to severe chronic knee pain... My question is my doc at the Veterans affairs has agreed to let me try a less addictive and supposedly just an opioid "like" medication for my ongoing pain called tramadol hcl 50mg(my choice by the way to rid myself from dangerous addictive hard narcotics). From my research it "seems" like tramadol doesnt act on the exact receptors as stronger synthetic opiods agonist, even though the exact mechanism of tram is unknow...The suboxone is from a private doctor not the va because the VA has a horrible program for opiate related dependancy individuals(different topic, different day).....I digress, so aaannyways, I was wondering will the naloxone in suboxone block the analgesic pain relieving effects of tramadol since it is classified as NOT a true synthetic opioid, just opioid "like"properties. Any oppinions or fact reported results would be greatly appreciated, I'm not exactly a science major so please try to explain layman's terms. It seems the extensive online research I've conducted is purely hypothetical and a lot of answers from addicts talking about catching a "buzz" and not respectable theraputical conclusions i am seeking... being that both of these drugs are relatively new and do not have a lot of truly scientific understandings there's not a whole lot to go off of. Thank you for your input and next time I won't write a whole book when I have a question, I'll keep it to just a short novel. ;-)


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PostPosted: Sat Sep 21, 2013 1:12 pm 
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Very interesting question! I don't have the answer, but I would think the section about pain management while on suboxone could yield some answers. You need a lot of narcotic to bump off that suboxone - but I don't know about tramadol.

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PostPosted: Sat Sep 21, 2013 2:27 pm 
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Hi Ranger,

Welcome to our little forum!

First off, I want to sincerely thank you for your service! I truly love our country and anyone who has fought for it in any capacity is IMO a real hero.

As for your pain issues. I believe you are on the right track. Tramadol or Ultram is a great choice to pair up with suboxone. I believe it is one of the only narcotic pain relievers (yes, I know it's not categorized as a narcotic. But it has basically the same effects as real opiate medications) that can be safely, and effectively used to treat breakthrough or chronic pain in patients who are using buprenorphine (active ingredient in suboxone/subutex).

I have experience with tramadol, and I found it to be pretty good at relieving my lower back pain. One of the other befefits of this drug is that it has pretty strong SSRI or SNRI properties...can't remember which one. So if you have any depression or anxiety issues it can help with that. If you have done much research on Tramadol you have probably seen that you cannot stop taking it all of a sudden if you have been on a regular regiment with it for very long. The SSRI properies of the medication are what makes it dangerous to discontinue it quickly. If it is used properly, as written, you shouldn't have any trouble with it at all.

So, in answer to your question, the suboxone will not block the effects of the tramadol. And, just to clarify for you, it isn't the naloxone in the subs that would block other opiates. It is the buprenorphine itself. The opiate receptors in your brain have a very strong affinity for the bupe, and other opiates are just not strong enough to bump it off of them in most cases. The naloxone really doesn't serve any purpose in the suboxone, other than making it a little bit harder to inject it. But, I've seen several people comment that it really isn't much of a deterrent at all. I guess if someone wants to abuse a drug, they will almost always come up with a way to get around whatever safety precautions are built in to the medication.

I hope I've answered all your questions. Anything else you would like to know just ask away! If you do have other questions it might be helpful to include a little info about your current dose of suboxone and how long you have been taking it.

Hope you have a good weekend!

Q

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PostPosted: Sun Sep 22, 2013 1:12 pm 
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Couple things. First off, it's pretty well established that those 'like' effects ARE opioid effects. The wild-card with tramadol is that it does also have effect on serotonin and (mostly) norepinephrine as SSRI and SNRI antidepressants do; this is the reason that SSRI and SNRI (Cymbalta) are often used adjunctively in pain management.

Be careful if your Dr's don't know what one another are doing. If you are taking an anti-depressant be careful as serotonin syndrome (REALLY SERIOUS STUFF!) has been an outcome of the concurrent use of tramadol and certain anti-depressants.

Just as an interesting fact: Tramadol is scheduled in a lot of states and even in states that it isn't it is one of the unscheduled medications that comes up on Prescription Monitoring Plan (PMP) inquiry's as a prescribed drug of abuse. So if you are in a state that uses the PMP one Dr or the other is going to see what the left hand has been doing.

I have experience personally with tramadol for pain while on buprenorphine; the two can absolutely be used together but the effectiveness is debatable in my opinion. In my experience, no opioid effects were noticeable due to the buprenorphine blockade effect. Tramadol can be used recreationally to produce a 'speedy and potent opioid effect' but that was not present within concurrent use in my experience. The only noticeable effect was akin to taking Cymbalta adjunctively, only perhaps a quicker and shorter-acting onset of those effects hence 4 time daily dosing for short-acting tramadol. The event really made me wonder personally if taking Cymbalta would not have been just as effective with less hassle and stigma.

Good luck and thanks so much for your service!

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