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PostPosted: Mon Feb 21, 2011 9:15 am 
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I was doing some reading on depot formulations of buprenorphine, and came across this page:

http://www.anesthesia-analgesia.org/content/102/5/1445.full

Most importantly, I found this incredibly ignorant piece of observation:

Quote:
Buprenorphine (Fig. 1), a derivative of the morphine alkaloid thebaine, is a potent analgesic with a potency 25 to 50 times higher than that of morphine (1,2) and has been used in the treatment of acute and chronic pain (1,2). Its main advantages over morphine are a ceiling effect for respiratory depression, low tolerance liability, and a lack of significant withdrawal symptoms (1,2).


Hmmm. A lack of significant withdrawal symptoms? My f*&(ing arse!

It's for exactly this reason that so many people on this forum have ended up addicted to their pain medication, namely that the medical community often refuse to detail, or gloss over the negative aspects of their treatments.

First, do no harm.

Hypothetical situation. You have two researchers. One writes his / her paper in a balanced, objective fashion, detailing all the potential benefits as well as the pitfalls of some a new treatment X. The other has realised that such a paper wouldn't appear too groundbreaking, so he / she glosses over the pitfalls & focuses on the benefits. The result is a paper that sounds fantastic. New treatment, no side effects, no addictive potential. Revolutionary - and it has their name on it.

Somehow among the egoic desire for a researcher to be published in a credible journal, pharmaceutical companies refusing to highlight potential issues with their treatments and the difficulty many doctors have in hearing their patients from their pedestals, the best interests of the patient has become a lesser priority.

Not all the medical world is like this, but it's the predominant flavour I've come across in my dealings.


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PostPosted: Mon Feb 21, 2011 9:34 am 
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I would agree there is a tremendous amount of flase information given to medical providers and that this is why they do not properly advise their patients. I think it is a huge problem that the medical community is not well informed.

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PostPosted: Mon Feb 21, 2011 11:47 am 
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That's just ridiculous!...


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PostPosted: Mon Feb 21, 2011 11:49 am 
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Thanks so much. This is something I can show my doctor. Hopefully, he'll actually read it.

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PostPosted: Mon Feb 21, 2011 1:21 pm 
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In addition to the falsity about the withdrawals: Bupe may have an affinity for the recptors that is 25 to 50X that of morphine, but it is definately not more potent as a painkiller as the author implies. Shame on him!


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 Post subject: In Agreement
PostPosted: Mon Feb 21, 2011 1:35 pm 
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Why is it that the medical community knows less about Bup than those of us who take it? I go to two different Bup forums (this being the better of the two) and it seems like doctors have many opposing positions on this drug.

My doctor goes by what the pharmaceutical company rep tells them, as it should be. They will not allow any benzo use while on Sub, no matter what. But I read here that other doctors freely write a script for them all the time. Didn't they all go through the same training to administer Bup?

I just find it frustrating that we don't have concrete information to go by. Most of what I rely on is what is posted here by those who have first hand experience with it. Isn't that the best indicator of drug knowledge?

Good article with the exception of the withdrawal sentence. I will feel so much better when I'm off this and can post in the Rear View Mirror section. Maybe another year at most. Stay tuned.


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PostPosted: Mon Feb 21, 2011 2:03 pm 
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I guess I'm going to have to at least provide a little different view - even though it may seem like I'm taking the other side here. What is quoted is written in "medical speak". What they are saying actually does have some truth and is supported by research and data. I know that it may sound like they are saying something else, but in medical speak, they really are not. It's sort of how you and I can look at something and it seems pretty simple what the answer is, yet an attorney can look at it and see something totally different.

What they are measuring is the potency of the chemical itself with regard to blood levels, etc. They are not talking about how well the medication works or how effective it is in treating pain. For example, fentanyl is said to be 80 to 100 times more potent than morphine. That does not mean that it works 80 to 100 times better for pain. Morphine is sort of the "gold standard" from which other pain medications are measured or compared. All they are saying is pound for pound - or in this case milligram or microgram - bup is 25 to 50 times more potent. I have no way of confirming that, but also have no reason to think it is not true. It just means if you take 1 milligram of bup, it will be roughly equal to 25 to 50 milligrams of morphine. Now, how well it works for pain, is a completely different issue. They are not making comment on that. Potency can be measured in a lab. The amount of pain relief is subjective and reported by patients and cannot be measured with a blood test.

Certainly I don't think many would argue with the statements about ceiling or low tolerance. I'm pretty sure that most all of us have experienced the ceiling effect - where taking 100 mg of bup does not produce any more effect than taking, say 25 mg (or even less). We also have seen that unlike other opiates, we do not require higher and higher doses over time to achieve the same effect. I think most of us can agree on these.

Then there is the final statement of "a lack of significant withdrawal symptoms" I guess we could debate what each of us would call "significant withdrawal symptoms". Again, however, I think if you look at what many have said, going cold turkey from bup is not at all like going turkey from full opiates. I have read the experiences of many people who have said that they stopped (or ran out) of oxy or whatever and could not go to work, were sicker than sick, could not get out of bed, were beyond miserable. Those same people then have stopped bup at even high levels like 8 mg or more, and have felt crappy but still were able to go to work, were able to continue on with life. Perhaps a better way to have written what they wrote was less significant withdrawal symptoms when compared to full opiates (or something like that). But in general, again, I would say that those who have gone through both withdrawal from full opiates and withdrawal from bup, there is really a large difference between the two.

So, while at first blush it may seem like they are really off in the ozone here, in medical terms, they are certainly on pretty solid ground - or at the very least, are in the ballpark of reality. It's just how "medical speak" is done that tends to confuse and confound. I just don't know if this rises to malpractice and the like. There is no doubt, that when reviewing any medical study or research, you really do have to look at the methods, etc. and also look at who is conducting and funding the study. Looking at the journal that the study appears in also plays a part. A paper has to go through a lot of scrutiny to land in something like JAMA (Journal of American Medical Association) or the like. The paper is peer reviewed and passes through a review panel/board. Study design, methods, etc. are all looked at. Even then, after being published, others will challenge the study. In the end, a single study often does not mean squat. We have all seen where one study seems to show one thing while another study shows the exact opposite. It is often only after many, many studies show the same thing that we start to understand and believe. In fact, there are "studies" that are made up of the results of other studies. Researchers will look at say 50 different but similar studies to compare the results and gain a consensus. It's all so much more difficult and in depth than most people might imagine.

Now, all that said, I still agree that some docs just don't get it. They think we can stop bup on Friday and be just fine by Monday, and we all know that is not the case. I'm just not sure that a study like the one presented is the cause for that. Doctors know what they are reading. I just don't think they understand how truly horrid opiate withdrawal is and therefore even though bup is perhaps 25% of that, it's still 25% of total misery. It's sort of like being shot with a hand gun or a pellet gun - bup being the pellet gun. Either way, you are still being shot and it's going to hurt and may cause damage - even though it likely won't kill us.


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PostPosted: Fri Jun 17, 2011 11:28 pm 
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I agree with donh about both the withdrawal from Sub issue and the potentcy issue. I would say Sub withdrawal is less horrifying that outright agonist withdrawal. But hey, we've all done it and survived. Whever I ran out of Oxy's I would be through the worse withdrawal after about 5 days. I think it's all in the variable makeup of every person whether you get a bad withdrawal or not. However, you can make jumping off Sub a lot less painful by getting your dose down as far as possible before jumping.

With potentcy, it does not mean that the drug is more euphoric or effective. Simply put it high potentcy drugs require less milligrams to achieve the same effect as higher milligram drugs.

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PostPosted: Sat Jun 18, 2011 11:07 am 
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I wasn't focusing at all on the potency side of things. What they were saying was kinda like fentanyl being thousands of times more potent than morphine based on dose level. Such things are incredibly relative. ie a dose of around 30-40mg of diamorphine (aka heroin) is the same as 100mg of morphine or thereabouts (by memory, I may be off so don't quote me). So a person who takes 100mg of morphine gets the same analgesic effect as 30-40mg of heroin. Sounds about right.

The 'lack of significant' withdrawal symptoms was the issue I had. It sounds like a complete furphy (love that word). I've jumped off 8mg of suboxone, and the withdrawal I felt was beyond any full agonist withdrawal I'd ever suffered, in both duration and intensity. Mind you it did take longer for the symptoms to peak.

The first time I withdrew off buprenorphine, I'd reduced to 1mg then jumped off. It was worse than any heroin withdrawal I'd felt at that stage of my addiction. In fact, I still believe it was the first major detox I'd felt. I don't know about Oxys or hydrocodone. I was a class A opiates fiend. Heroin, suboxone, and methadone, are the only full agonists I've withdrawn off. And IMO in intensity it went heroin -> buprenorphine -> methadone being the strongest.

At the time I posted this thread I was quite angry at the medical world. I was in the process of coming off Pristiq, a novel SNRI, which apparently people only suffer a "mild discontinuation syndrome" when they stop it. "Mild discontinuation syndrome....." That's outrageous. What you feel coming off that stuff is in many ways harder to endure than methadone. I'd be driving along the street, then all of the sudden get a weird shock, pull over the car and puke my guts out. Constant headaches. A general inability to function. Sweats & nightmares. The only relief came from being horizontal. This went on for a number of weeks.

I'm not as angry these days. I was reading a lot about ex pharma reps confessions, and the kinda spin they put on side-effects to present their meds in a better light. "Mild discontinuation syndrome" was a watered down way of saying "withdrawal", that both managed to distance their anti-depressants from addictive substances while discouraging "discontinuation", thus maintaining long term sales. Sad really.

I'm not as angry now. Only when I think about it. Rant over.


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 Post subject: Re: In Agreement
PostPosted: Fri Sep 30, 2011 12:00 am 
rule62 wrote:
Why is it that the medical community knows less about Bup than those of us who take it? I go to two different Bup forums (this being the better of the two) and it seems like doctors have many opposing positions on this drug.

My doctor goes by what the pharmaceutical company rep tells them, as it should be. They will not allow any benzo use while on Sub, no matter what. But I read here that other doctors freely write a script for them all the time. Didn't they all go through the same training to administer Bup?

I just find it frustrating that we don't have concrete information to go by. Most of what I rely on is what is posted here by those who have first hand experience with it. Isn't that the best indicator of drug knowledge?

Good article with the exception of the withdrawal sentence. I will feel so much better when I'm off this and can post in the Rear View Mirror section. Maybe another year at most. Stay tuned.


Reckitt Benckiser tells many lies. The bupe/benzo lie is one of them. People who aren't on benzos need to take more of their shitty Suboxone. You don't think Temgesic is prescribed with benzos all the time?

Subutex all the way!


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PostPosted: Fri Sep 30, 2011 12:18 am 
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Hey Tearj3rker -

In this study do you know if they're talking about high-dose bupe or are they talking about the microgram doses used for pain management?

Because if they're looking at withdrawal from the kind of bupe doses that are normally used to treat pain, I think that might explain the lack of significant withdrawal symptoms. Just a thought.

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PostPosted: Fri Sep 30, 2011 12:37 am 
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It still doesn't make much sense. I'd challenge the idea that buprenorphine in comparison with its equivalent morphine dosage would differ markedly in in withdrawal intensity.


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PostPosted: Fri Sep 30, 2011 12:43 am 
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Fair enough.

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