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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by MB on January 27, 2002, at 20:14:46
One time in detox (heroin) I was given buprenorphin sublingually to ease the withdrawal. I wasn't too impressed with it. It didn't seem to help much, but then again, there was no way of telling how bad I would have felt if I *hadn't* been givin that accepably palatable liquid to suck on. For all I know, it was a godsend, but my intuition tells me that I wouldn't have been much worse off without it.
At one point, during a physical exam (required by the clinic) the physician actually gave me an intermuscular shot of the stuff and it was wonderful (well, wonderful given the state I was already in): the goosebumbs went away, my nose quit running, and that feeling of simultaneous fever with hypothermia was moderately relieved. I would not say, however that it completely blocked the withdrawal. I still felt bad, just not quite as wretched as before. The above anecdote exhausts my experience with buprenorphine.
My limited and extremely adulterated experience with buprenorphine compels me to ask this question: what is the medication like under normal circumstances--i.e., circumstamnce where the patient is neither habituated to opoid agonists nor in a state of withdrawal from such agonists.
Is is sedating? Is it nauseating? Dysphoria, euphoria, etc. Is there a waiting period before antidepressant effects are noticed, or is relief immediate as with the pure agonists?
I've taken butorphanol before. That was weird. A lot of kappa agonism I think. Is buprenorphine anything like butorphanol?
MB
Posted by 3 Beer Effect on January 28, 2002, at 21:35:08
In reply to What is buprenorphine like?, posted by MB on January 27, 2002, at 20:14:46
>I read in a book called Pills a-go-go that Immodium AD is a good way to detox from heroin, dilaudiud, morphine, percodan etc.
Immodium AD is some kind of opiate agonist that doesn't cause a "high" but eases withdrawl from opiates & is much cheaper than methadone etc.
Be sure to get the regular Immodium AD brand name, not Immodium advanced w/ simethicone (an anti-gas agent). Loperamide is the ingrediant that is effective in this case. When it first came out Immodium was a schedule III but when they figured out it wasn't abusable it was eventually downgraded to otc status.
One time in detox (heroin) I was given buprenorphin sublingually to ease the withdrawal. I wasn't too impressed with it. It didn't seem to help much, but then again, there was no way of telling how bad I would have felt if I *hadn't* been givin that accepably palatable liquid to suck on. For all I know, it was a godsend, but my intuition tells me that I wouldn't have been much worse off without it.
>
> At one point, during a physical exam (required by the clinic) the physician actually gave me an intermuscular shot of the stuff and it was wonderful (well, wonderful given the state I was already in): the goosebumbs went away, my nose quit running, and that feeling of simultaneous fever with hypothermia was moderately relieved. I would not say, however that it completely blocked the withdrawal. I still felt bad, just not quite as wretched as before. The above anecdote exhausts my experience with buprenorphine.
>
> My limited and extremely adulterated experience with buprenorphine compels me to ask this question: what is the medication like under normal circumstances--i.e., circumstamnce where the patient is neither habituated to opoid agonists nor in a state of withdrawal from such agonists.
>
> Is is sedating? Is it nauseating? Dysphoria, euphoria, etc. Is there a waiting period before antidepressant effects are noticed, or is relief immediate as with the pure agonists?
>
> I've taken butorphanol before. That was weird. A lot of kappa agonism I think. Is buprenorphine anything like butorphanol?
>
> MB
Posted by Elizabeth on January 30, 2002, at 16:36:21
In reply to What is buprenorphine like?, posted by MB on January 27, 2002, at 20:14:46
> One time in detox (heroin) I was given buprenorphin sublingually to ease the withdrawal. I wasn't too impressed with it.
How much were they giving you? The sublingual dose needs to be rather high, I think, especially for addicts and especially if you're using the injectable solution marketed in the U.S. Some addicts say it really helps them to detox and others don't, so you're not alone.
> It didn't seem to help much, but then again, there was no way of telling how bad I would have felt if I *hadn't* been givin that accepably palatable liquid to suck on.
It's in a 5% dextrose solution (a type of sugar), hence the funky-sweet taste. How long did they tell you to keep it in your mouth?
> For all I know, it was a godsend, but my intuition tells me that I wouldn't have been much worse off without it.
Have you ever experienced heroin withdrawal without buprenorphine?
I'd expect buprenorphine to do more for you if you took it outside the context of opioid dependence (i.e., when you hadn't taken heroin for a while and so did not have any tolerance).
BTW, when the doctor in the hospital gave you the IM injection, do you know what the dose was?
> My limited and extremely adulterated experience with buprenorphine compels me to ask this question: what is the medication like under normal circumstances--i.e., circumstamnce where the patient is neither habituated to opoid agonists nor in a state of withdrawal from such agonists.
(Right, that's what I meant. You expressed it a lot better.)
> Is is sedating?
For some people. It seems that there are people who experience paradoxical stimulation on opioids (like myself), though. My experience is that every opioid I've tried has been activating, not just buprenorphine. I think sedation is more common. I don't know if the paradoxical response is predictive of antidepressant response.
> Is it nauseating?
Yeah, you have to be cautious about the dose.
> Dysphoria, euphoria, etc.
Neither, but a feeling of calm and "wellness." (Again, there's a subset of people who get dysphoric on opioids; these people will probably feel dysphoric on buprenorphine too, but this is a general reaction to mu agonists, not a specific reaction to buprenorphine.) I also find that it clears up "brain fog."
> Is there a waiting period before antidepressant effects are noticed, or is relief immediate as with the pure agonists?
It takes about an hour when administered intranasally, IME. Presumable it's faster when given IM.
> I've taken butorphanol before. That was weird. A lot of kappa agonism I think. Is buprenorphine anything like butorphanol?
Its pharmacological profile is opposite that of Stadol (butorphanol) -- buprenorphine is a kappa antagonist, partial mu agonist. I've never taken Stadol so I can't really say anything about how they compare.
HTH
-elizabeth
Posted by MB on January 31, 2002, at 2:12:54
In reply to Re: What is buprenorphine like? » MB, posted by Elizabeth on January 30, 2002, at 16:36:21
> > One time in detox (heroin) I was given buprenorphin sublingually to ease the withdrawal. I wasn't too impressed with it.
>
> How much were they giving you? The sublingual dose needs to be rather high, I think, especially for addicts and especially if you're using the injectable solution marketed in the U.S. Some addicts say it really helps them to detox and others don't, so you're not alone.They gave me an ampule and a straw and said suck the whole thing under your tongue and hold it there for as long as possible (of course, detoxing, I was salivating badly, and the buprenorphine was pretty quickly diluted...seemed like a waste). I don't know how much was in the ampule: glass bottle with a scored, breakable neck.
> > It didn't seem to help much, but then again, there was no way of telling how bad I would have felt if I *hadn't* been givin that accepably palatable liquid to suck on.
>
> It's in a 5% dextrose solution (a type of sugar), hence the funky-sweet taste. How long did they tell you to keep it in your mouth?
>
> > For all I know, it was a godsend, but my intuition tells me that I wouldn't have been much worse off without it.
>
> Have you ever experienced heroin withdrawal without buprenorphine?
Yeah, but I had tons of Xanax and clonidine. I prefere benzos and clonidine when it comes to easing opiate detox (clonidine stopped the chills and the Xanax let me sleep--for a little while at least).> I'd expect buprenorphine to do more for you if you took it outside the context of opioid dependence (i.e., when you hadn't taken heroin for a while and so did not have any tolerance).
>
> BTW, when the doctor in the hospital gave you the IM injection, do you know what the dose was?
No I don't. Probably the same amount that was in the ampules they gave me to use sublingually. I'm looking in the PDR and the .3 mg ampules look like the ones they gave me.
> > My limited and extremely adulterated experience with buprenorphine compels me to ask this question: what is the medication like under normal circumstances--i.e., circumstamnce where the patient is neither habituated to opoid agonists nor in a state of withdrawal from such agonists.
>
> (Right, that's what I meant. You expressed it a lot better.)
>
> > Is is sedating?
>
> For some people. It seems that there are people who experience paradoxical stimulation on opioids (like myself), though. My experience is that every opioid I've tried has been activating, not just buprenorphine. I think sedation is more common. I don't know if the paradoxical response is predictive of antidepressant response.
I get activated on opiates, but they also give me narcoleptic type nods. One time I was doing fine, standing in the check out line in the supermarket, and I fell asleep (standing up!!) right when the checker was reading my total. I feel like getting out and "living life" on opiates, but I do tend to nod in weird situations.> > Is it nauseating?
>
> Yeah, you have to be cautious about the dose.
>
> > Dysphoria, euphoria, etc.
>
> Neither, but a feeling of calm and "wellness." (Again, there's a subset of people who get dysphoric on opioids; these people will probably feel dysphoric on buprenorphine too, but this is a general reaction to mu agonists, not a specific reaction to buprenorphine.) I also find that it clears up "brain fog."
I get dysphoric on opiates only if the dose isn't high enough. I wonder if it has to do with the way different receptors are hit at different doses. Or, more honestly, it may just be because I'm a junky at heart...a low dose is just an annoying tease.> > Is there a waiting period before antidepressant effects are noticed, or is relief immediate as with the pure agonists?
>
> It takes about an hour when administered intranasally, IME. Presumable it's faster when given IM.
>
> > I've taken butorphanol before. That was weird. A lot of kappa agonism I think. Is buprenorphine anything like butorphanol?
>
> Its pharmacological profile is opposite that of Stadol (butorphanol) -- buprenorphine is a kappa antagonist, partial mu agonist. I've never taken Stadol so I can't really say anything about how they compare.I kind of liked Stadol...I think kappa agonism is pretty strange.
I've never understood how a drug could be a "partial" agonist at a receptor. It seems counterintuitive to my relatively pharmacologically naive view on things that something could agonize and antagonize a receptor at the same time. How does that work?
MB
Posted by Lorraine on January 31, 2002, at 10:32:40
In reply to Re: What is buprenorphine like? » MB, posted by Elizabeth on January 30, 2002, at 16:36:21
Elizabeth, it's Lorraine. My pdoc took my pulse last week and told me I had tachycardia and referred me to a heart doctor to wear a halter. I went home and just did some blood pressure and pulse measurements of my own and what I found was that laying down my bp was 107/67 pulse 74, then standing still at three minutes 111/87 pulse 104 and standing still at 10 minutes 116/90 pulse 113--which to me sounds a bit like POTS (postual othostatic tachycardia syndrome). My pdoc thinks that I may be randomly throwing out NE to generate the tachycardia--though I think there is a standing, sitting, laying, walking component to it as well. Have you ever heard of such a thing? For a long time, two of my primary complaints have been fatigue and anxiety. Anyway, I did try a beta blocker sometime back (propanolol) which made things worse in terms of fatigue.
It has all made me wonder, whether I have adequately "ruled out" physical problems that may be contributing (or causing or interfering with treatment success by causing side effects etc). I have never had a thorough "work-up", neurological or otherwise. Though I have been told that I have some brain lesions and that my alpha waves are low. I'm thinking of getting a full neurological work-up, MRI of head and neck area and so forth. Do you have any thoughts you'd be will to share with me on this? I so value your input.
Thank-you.
Lorraine
> > One time in detox (heroin) I was given buprenorphin sublingually to ease the withdrawal. I wasn't too impressed with it.
>
> How much were they giving you? The sublingual dose needs to be rather high, I think, especially for addicts and especially if you're using the injectable solution marketed in the U.S. Some addicts say it really helps them to detox and others don't, so you're not alone.
>
> > It didn't seem to help much, but then again, there was no way of telling how bad I would have felt if I *hadn't* been givin that accepably palatable liquid to suck on.
>
> It's in a 5% dextrose solution (a type of sugar), hence the funky-sweet taste. How long did they tell you to keep it in your mouth?
>
> > For all I know, it was a godsend, but my intuition tells me that I wouldn't have been much worse off without it.
>
> Have you ever experienced heroin withdrawal without buprenorphine?
>
> I'd expect buprenorphine to do more for you if you took it outside the context of opioid dependence (i.e., when you hadn't taken heroin for a while and so did not have any tolerance).
>
> BTW, when the doctor in the hospital gave you the IM injection, do you know what the dose was?
>
> > My limited and extremely adulterated experience with buprenorphine compels me to ask this question: what is the medication like under normal circumstances--i.e., circumstamnce where the patient is neither habituated to opoid agonists nor in a state of withdrawal from such agonists.
>
> (Right, that's what I meant. You expressed it a lot better.)
>
> > Is is sedating?
>
> For some people. It seems that there are people who experience paradoxical stimulation on opioids (like myself), though. My experience is that every opioid I've tried has been activating, not just buprenorphine. I think sedation is more common. I don't know if the paradoxical response is predictive of antidepressant response.
>
> > Is it nauseating?
>
> Yeah, you have to be cautious about the dose.
>
> > Dysphoria, euphoria, etc.
>
> Neither, but a feeling of calm and "wellness." (Again, there's a subset of people who get dysphoric on opioids; these people will probably feel dysphoric on buprenorphine too, but this is a general reaction to mu agonists, not a specific reaction to buprenorphine.) I also find that it clears up "brain fog."
>
> > Is there a waiting period before antidepressant effects are noticed, or is relief immediate as with the pure agonists?
>
> It takes about an hour when administered intranasally, IME. Presumable it's faster when given IM.
>
> > I've taken butorphanol before. That was weird. A lot of kappa agonism I think. Is buprenorphine anything like butorphanol?
>
> Its pharmacological profile is opposite that of Stadol (butorphanol) -- buprenorphine is a kappa antagonist, partial mu agonist. I've never taken Stadol so I can't really say anything about how they compare.
>
> HTH
>
> -elizabeth
Posted by Elizabeth on February 1, 2002, at 23:44:32
In reply to Re: What is buprenorphine like? » Elizabeth, posted by MB on January 31, 2002, at 2:12:54
> They gave me an ampule and a straw and said suck the whole thing under your tongue and hold it there for as long as possible (of course, detoxing, I was salivating badly, and the buprenorphine was pretty quickly diluted...seemed like a waste). I don't know how much was in the ampule: glass bottle with a scored, breakable neck.
These ampules have 1 mL in them. It's easy to see why it would have been pretty ineffective for you, yes.
> > Have you ever experienced heroin withdrawal without buprenorphine?
>
> Yeah, but I had tons of Xanax and clonidine. I prefere benzos and clonidine when it comes to easing opiate detox (clonidine stopped the chills and the Xanax let me sleep--for a little while at least).I haven't heard many favorable things about clonidine, but it's good that it worked for you. Didn't they give you any clonidine and/or benzos the time you had the buprenorphine?
> > BTW, when the doctor in the hospital gave you the IM injection, do you know what the dose was?
>
> No I don't. Probably the same amount that was in the ampules they gave me to use sublingually.Of course it would work better, then! Silly docs.
> I'm looking in the PDR and the .3 mg ampules look like the ones they gave me.
That's the only size they come in (the solution is 0.3 mg/mL, and the ampules contain 1 mL).
> I get activated on opiates, but they also give me narcoleptic type nods. One time I was doing fine, standing in the check out line in the supermarket, and I fell asleep (standing up!!) right when the checker was reading my total. I feel like getting out and "living life" on opiates, but I do tend to nod in weird situations.
D'oh! I never had that problem on buprenorphine or any of the other opioids I've tried (e.g., hydrocodone, morphine). They're just activating for me.
> I kind of liked Stadol...I think kappa agonism is pretty strange.
How was it like and different from a regular (full agonist) opioid?
> I've never understood how a drug could be a "partial" agonist at a receptor. It seems counterintuitive to my relatively pharmacologically naive view on things that something could agonize and antagonize a receptor at the same time. How does that work?
It's a little confusing, yes. My understanding is that it works as an agonist at low concentrations and as an antagonist at high concentrations, so there's a ceiling on the intrinsic effect that it can have. (This means there is less potential for "abuse.")
-elizabeth
Posted by Elizabeth on February 2, 2002, at 10:42:00
In reply to Re: Heart and anxiety » Elizabeth, posted by Lorraine on January 31, 2002, at 10:32:40
> Elizabeth, it's Lorraine.
'Ay!
> My pdoc took my pulse last week and told me I had tachycardia and referred me to a heart doctor to wear a halter. I went home and just did some blood pressure and pulse measurements of my own and what I found was that laying down my bp was 107/67 pulse 74, then standing still at three minutes 111/87 pulse 104 and standing still at 10 minutes 116/90 pulse 113--which to me sounds a bit like POTS (postual othostatic tachycardia syndrome).
What medication(s) are you on? I believe I had a similar thing going on when I was taking MAOIs (Nardil moreso, I think), and I didn't have any real problems with it. (My pulse ran about the same as yours in the three positions, although my BP was generally lower and I tended to have some OH.)
> My pdoc thinks that I may be randomly throwing out NE to generate the tachycardia--though I think there is a standing, sitting, laying, walking component to it as well. Have you ever heard of such a thing?
In general, your cardiovascular system will adjust to things like postural changes to maintain homeostasis; when the adjustment is limited and/or slowed, you get orthostatic hypotension. I imagine what's happening with you is similar.
> For a long time, two of my primary complaints have been fatigue and anxiety. Anyway, I did try a beta blocker sometime back (propanolol) which made things worse in terms of fatigue.
Hmm. Ever taken clonidine? It's an alpha-adrenergic autoreceptor agonist and is supposed to decrease HPA axis hyperactivity (in theory). If your pdoc's theory is right, clonidine might help.
There are also beta-blockers like atenolol that are cardioselective so they won't make you tired, hopefully. I think it'd be worth trying one if you haven't. They really are much less likely to have centrally-mediated side effects than nonselective beta-blockers like propranolol.
> It has all made me wonder, whether I have adequately "ruled out" physical problems that may be contributing (or causing or interfering with treatment success by causing side effects etc).
Well, you're going to see a cardiologist now. When's your appointment? Or have you gone already (and if so, what did the cdoc say?)?
> I have never had a thorough "work-up", neurological or otherwise. Though I have been told that I have some brain lesions and that my alpha waves are low. I'm thinking of getting a full neurological work-up, MRI of head and neck area and so forth. Do you have any thoughts you'd be will to share with me on this? I so value your input.
Hmm. You did get qEEGs done; I don't know much about qEEG but it might be worthwhile for you to see a neurologist based on the results if they're really abnormal. I'm not sure how it was concluded that you have brain lesions, but MRI would show that. My idea would be to ask your pdoc to refer you to a neurologist for a consultation to find out what tests you need, if any. The neurologist should get your records (such as the qEEG reports) as well as examine you.
I hope that this is helpful. I'm interested to learn what the cdoc has to say.
best,
-elizabeth
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