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PostPosted: Mon Jan 27, 2014 8:38 pm 
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I'm just wondering how many people are on a combination of Subutex and another opiate for pain management. I am on one myself and oddly enough it has been working well for me. Some of the best pain relief I have had in quite sometime. Just curious as to who else is taking this off the wall approach.


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PostPosted: Tue Jan 28, 2014 12:52 am 
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I'm curious too. I presented the combination technique at a meeting of the American Society for Addiction Medicine a couple years ago-- http://www.slideshare.net/jeffreyjunig/buprenorphineagonistasam-meeting?from_search=1

The technique is pretty amazing; pain relief without the pull of addiction... I had patients who could never control pain meds, who could control them with no problem if combined with buprenorphine. I sent emails to a number of pharmaceutical companies, seeing if anyone was interested-- but nobody 'bit'. Frankly, I think that the technique could be a total 'game changer' for pain treatment... if only pharma would take a look....

I don't use the method very often though-- because no other docs seem to get it, and I don't want to be hanging in the breeze with the medical board.


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PostPosted: Tue Jan 28, 2014 1:19 am 
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I never thought it would be possible for it to work but it does. The pain clinic I went to originally didn't listen to my concerns very well. I was at that time taking oxycodone 10 4 times a day and tramadol 200 once a day. When the medicine started to no longer work as well for me they wanted to switch me to Fentanyl patch. I'm a preschool teacher and I have a 4 year old son so that just worried me. I didn't know if my kids would be in harms way if they accidentally touched it or if I would even remain clear headed. That was something I was not comfortable with and they gave me no other options.
So I found a new doctor, he has been amazing. He said it's not prescribed this way much but he has seen it in patients work wonders. I'm currently taking subutex 8mg 3 times a day and oxycodone 30mg 4 times a day. I stay completely clear headed and my pain is very minimal. I know the FDA doesn't approve this combination and I'm not sure why they don't start doing so. I was always hurting before and became very depressed knowing my medicines wereno longer helping me and I had no other choice but to live in pain or choose something stronger I wasn't comfortable with. I'm VERY thankful my new pain management doctor cares more about his patients and their pain relie.


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PostPosted: Tue Jan 28, 2014 12:59 pm 
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I would have thought 8mg, 3 times a day, of Subutex would completely block or occupy the opiate receptors. I'm not trying to question the OP, I'm just wondering how the Oxycodone is getting to the opiate receptors when the Buprenorphine should have a stranglehold on them. Are Buprenorphine and Oxycodone acting on different opiate receptors?

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PostPosted: Tue Jan 28, 2014 5:47 pm 
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I'm not sure how it works I just know it works. If I just take the Subutex alone I hurt, if I just take the Oxycodone alone, I hurt. Beforehand I was taking the combo Subutex 8mg 3 times a day, Oxycodone 30mg 4 times a day, and Dilaudid 4mg 4 times a day and that worked wonderful as well. I just had an emergency health issue pop up so I had to add the Dilaudid.


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PostPosted: Tue Jan 28, 2014 6:11 pm 
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is subutex better than suboxone for pain? my ins co wouldn't pain for the suboxone films, so they switched me to the generic brand. and since I started taking them, my neck pain is horrible. and my headaches are much worse than when I was taking the films. I was on the films for a little over a month and was actually feeling pretty good, and now since I started taking the generic tabs, I feel like shit and I don't know what to do. if subutex is better for pain, I need to tell my dr so she can switch me asap. I don't want to feel like this everyday :(


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PostPosted: Tue Jan 28, 2014 6:23 pm 
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This is an interesting topic, and it's something I have wondered about myself.

I have often wondered if the buprenorphine is blocking the receptors that give the euphoric effect but still allowing the analgesic properties of the opiate to do what it's supposed to do. This may not make any sense, medically speaking, but my mind doesn't really grasp those concepts anyway.
Is this AT ALL the way it is actually working Dr. J? Maybe you could give us the dumbed down version of the facts so that we can grasp the concept.

@Snowwhite,

Subutex and Suboxone both have the same active ingredient, buprenorphine. The only difference between the two medications is that Suboxone has the added ingredient Naloxone. The Naloxone is put into the medicine to prevent it from being abused by those who would attempt to shoot it. From what I understand there should be no difference between the pain relieving effects of Suboxone vs. Subutex because when taken orally, as intended, the Naloxone isn't absorbed in the system much at all, if any.

My guess would be that you may be getting a slightly lower concentration of buprenorphine in the generic pills. This could account for the difference in your pain control unless it is psychosomatic.
I have read that the generic pills are allowed to be slightly lower or higher in their concentration of the active ingredient...within a certain percentage which at the moment I can't recall. You may want to do a search in the forum for threads about the new generics available on the market currently. It may be possible to have your doctor or pharmacist switch you to a different brand and see if you have any improvement in your symptoms.

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PostPosted: Tue Jan 28, 2014 6:42 pm 
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qhorsegal2 wrote:
This is an interesting topic, and it's something I have wondered about myself.

I have often wondered if the buprenorphine is blocking the receptors that give the euphoric effect but still allowing the analgesic properties of the opiate to do what it's supposed to do. This may not make any sense, medically speaking, but my mind doesn't really grasp those concepts anyway.
Is this AT ALL the way it is actually working Dr. J? Maybe you could give us the dumbed down version of the facts so that we can grasp the concept.

@Snowwhite,

Subutex and Suboxone both have the same active ingredient, buprenorphine. The only difference between the two medications is that Suboxone has the added ingredient Naloxone. The Naloxone is put into the medicine to prevent it from being abused by those who would attempt to shoot it. From what I understand there should be no difference between the pain relieving effects of Suboxone vs. Subutex because when taken orally, as intended, the Naloxone isn't absorbed in the system much at all, if any.

My guess would be that you may be getting a slightly lower concentration of buprenorphine in the generic pills. This could account for the difference in your pain control unless it is psychosomatic.
I have read that the generic pills are allowed to be slightly lower or higher in their concentration of the active ingredient...within a certain percentage which at the moment I can't recall. You may want to do a search in the forum for threads about the new generics available on the market currently. It may be possible to have your doctor or pharmacist switch you to a different brand and see if you have any improvement in your symptoms.




thank u! I definitely notice difference since starting the generic. I knew there weren't going to be as strong, I just didn't think I would notice this much of a difference. i also cant seemto keep the generic pill in my mouth as long and have to spit it out sooner than i was with the films. the pill makes my throat really dry and ive been swallowing some by accident. i think that's also contributing to my headaches. ill do a search to see if i can find out which generics work better.


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PostPosted: Tue Jan 28, 2014 6:52 pm 
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Thats exactly what I was thinking because I get no euphoria feeling whatsoever and the amount of pain relief I get from the combination is very substantial compared to what I would get with taking the Subutex or Oxycodone alone. I've been very happy with my results.


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PostPosted: Tue Jan 28, 2014 7:01 pm 
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@snowwhite
I'm on the generic version of Subutex tablets and it says each tablet contains 8.64 mg of buprenorphine HCI, equivalent to 8 mg buprenorphine base.
I do know the taste is different. Mine is okay but the aftertaste is horrible to me. It could be possible it's not working as well as the films for you but it is so much cheaper. If your insurance wont cover it maybe your doc can up your dosage.


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PostPosted: Tue Jan 28, 2014 7:11 pm 
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LizS28 wrote:
@snowwhite
I'm on the generic version of Subutex tablets and it says each tablet contains 8.64 mg of buprenorphine HCI, equivalent to 8 mg buprenorphine base.
I do know the taste is different. Mine is okay but the aftertaste is horrible to me. It could be possible it's not working as well as the films for you but it is so much cheaper. If your insurance wont cover it maybe your doc can up your dosage.


hi liz,
have u ever taken suboxone? i was just wondering if u have and if u preferred the generic subutex?


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PostPosted: Tue Jan 28, 2014 7:26 pm 
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snowwhite wrote:
LizS28 wrote:
@snowwhite
I'm on the generic version of Subutex tablets and it says each tablet contains 8.64 mg of buprenorphine HCI, equivalent to 8 mg buprenorphine base.
I do know the taste is different. Mine is okay but the aftertaste is horrible to me. It could be possible it's not working as well as the films for you but it is so much cheaper. If your insurance wont cover it maybe your doc can up your dosage.


hi liz,
have u ever taken suboxone? i was just wondering if u have and if u preferred the generic subutex?


I did take Suboxone. I was on it for about 2 months and in that 2 months I gained 20 pounds on fluid weight and had massive swelling in my legs. My doc said it was a side effect he had never heard of and I don't have the issue with the Subutex. So my doc assumes Im allergic to naxalone or hypersensitive. I did notice the films were stronger feelin. Every flim I took made me feel hung over and I hated it. I don't feel that way with the Subutex. I really can't say which was better for pain cause I've always been on a opiate too.


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PostPosted: Thu Jan 30, 2014 1:13 pm 
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LizS28 wrote:
I'm just wondering how many people are on a combination of Subutex and another opiate for pain management. I am on one myself and oddly enough it has been working well for me. Some of the best pain relief I have had in quite sometime. Just curious as to who else is taking this off the wall approach.


so u take pain meds with the subutex? im in a lot of pain and don't know what to do. im waiting for my dr to call me back. I know they say dr's wont give subutex unless you are pregnant but I think my dr would. she knows me well enough to know I didn't start taking pain meds to get high, i take them for chronic pain. can u let me know what pain med you are taking with the subutex, i want to tell my dr.
thanks for responding to me, i really appreciate the advise :)


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PostPosted: Thu Jan 30, 2014 1:18 pm 
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LizS28 wrote:
snowwhite wrote:
LizS28 wrote:
@snowwhite
I'm on the generic version of Subutex tablets and it says each tablet contains 8.64 mg of buprenorphine HCI, equivalent to 8 mg buprenorphine base.
I do know the taste is different. Mine is okay but the aftertaste is horrible to me. It could be possible it's not working as well as the films for you but it is so much cheaper. If your insurance wont cover it maybe your doc can up your dosage.


hi liz,
have u ever taken suboxone? i was just wondering if u have and if u preferred the generic subutex?


I did take Suboxone. I was on it for about 2 months and in that 2 months I gained 20 pounds on fluid weight and had massive swelling in my legs. My doc said it was a side effect he had never heard of and I don't have the issue with the Subutex. So my doc assumes Im allergic to naxalone or hypersensitive. I did notice the films were stronger feelin. Every flim I took made me feel hung over and I hated it. I don't feel that way with the Subutex. I really can't say which was better for pain cause I've always been on a opiate too.


wow, ive been really swollen lately too. and im REALLY thin and would love to gain weight. but now that u said that im wondering if im having an allergic reaction to the naxalone? by any chance to you feel dizzy when taking the suboxone?
thanks again for responding


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PostPosted: Thu Jan 30, 2014 2:11 pm 
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Yes I am on Oxycodone 30 mg 4 times a day along with the Subutex. I did get dizzy immediately after taking the Subxone but my main issue was the fluid. I just coudnt take enough Lasik to get the fluid down and it literally got unbearable to walk with how swollen my legs were. Once my doc made the switch to Subutex within days my swelling was gone so he actually called the Subxone people. Because that is not listed anywhere as a side effect. Talk to your doctor about the swelling. That's not good. That can lead to fluid into other organs and in turn lead to congestive heart failure. That's why he had me on Lasik and he was working with my primary care doctor to see my records within the past few months so they could find out the real cause. My primary doc knew it was the Subxone, but without any reports of it ever happening he wanted to make sure he could have everything documented and sent to help others. He also told me of this website :)


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PostPosted: Fri Jan 31, 2014 1:11 pm 
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LizS28 wrote:
Yes I am on Oxycodone 30 mg 4 times a day along with the Subutex. I did get dizzy immediately after taking the Subxone but my main issue was the fluid. I just coudnt take enough Lasik to get the fluid down and it literally got unbearable to walk with how swollen my legs were. Once my doc made the switch to Subutex within days my swelling was gone so he actually called the Subxone people. Because that is not listed anywhere as a side effect. Talk to your doctor about the swelling. That's not good. That can lead to fluid into other organs and in turn lead to congestive heart failure. That's why he had me on Lasik and he was working with my primary care doctor to see my records within the past few months so they could find out the real cause. My primary doc knew it was the Subxone, but without any reports of it ever happening he wanted to make sure he could have everything documented and sent to help others. He also told me of this website :)


I spoke to my dr and she has no problem changing my RX for me. I told her all the side effects and how horrible I feel. Im not sure if my in co will cover subutex, its not on the RX list but the zubsolv is. What is the generic brand of subutex you are taking? Maybe that's on the RX list for my ins co.
Sorry Im bothering but your info is really helpful to me b.c u have chronic pain and side effects with the suboxone. Thanks again Liz


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PostPosted: Fri Jan 31, 2014 1:21 pm 
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I'm glad to help!! It's no bother at all. The medicine just says Buprenorphine 8 mg. Hopefully with your change in medicine you will start to feel better soon.


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PostPosted: Fri Jan 31, 2014 1:42 pm 
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LizS28 wrote:
I'm glad to help!! It's no bother at all. The medicine just says Buprenorphine 8 mg. Hopefully with your change in medicine you will start to feel better soon.


thank u! that's what I thought it was. I don't know why its not on the list. It doesn't make sense, I could understand the ins co not covering the brand name but the generic should be approved. And its the same dosage 8mg. I am so sick of these dam ins co's dictating what and what not people can take. Its so frustrating,


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PostPosted: Fri Jan 31, 2014 1:47 pm 
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Call your pharmacy. They can tell you if your insurance will cover it or not. Typically the insurance will cover generics.


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