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Re: Suboxone???? Is it only for Opiates or an Ad Too?

Posted by undopaminergic on May 27, 2008, at 18:52:52

In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too? undopaminergic, posted by okydoky on May 27, 2008, at 10:28:29

> "preferably Subutex rather than Suboxone "
>
> Can you give me a reason that my doctor will accept?
>

Generally, it is thought that the naloxone in Suboxone is poorly bioavailable when the tablet is used sublingually as intended, and that it will have no effect. However, some people claim to have hypersensitivity reactions to it, and I'm also concerned that it may have subtle effects that may interfer with either the buprenorphine or with the endogenous opioid system. It's also possible that the naloxone may be beneficial and perhaps lessen side effects. It would be nice if you could compare Subutex and Suboxone side by side to determine whether there's a difference at all.

The naloxone is mainly only added to deter abusers from injecting it, as it is an opioid antagonist that will precipitate a withdrawal syndrome in some individuals and under some circumstances. However, unless you have a history of selling or injecting your opiate medications, there's no reason why Suboxone should be prescribed in preference to Subutex. I recommend trying both, side by side, in an attempt to detect subtle differences.

>
> I was thining what a pain it is going to be as my doc does not prescribe Suboxone but was going to send me elsewhere for it.
>

Some doctors mistakenly believe that they need a special permission (called a "waiver") to prescribe Subutex or Suboxone. The waiver is only needed when Suboxone/Subutex is prescribed for addicts as a substitution therapy - that is, as a replacement for heroin or other opioids (that the addict is usually obtaining illegally). It is perfectly acceptable to prescribe Subutex/Suboxone in place of any other opiate for the treatment of pain, depression, or other medical uses other than substitution therapy. Here is a letter from the DEA clarifying the rules:
http://www.naabt.org/links/DEA_Bup_for_pain_letter.pdf

>
> He wants to try other opiates besides oxycontin because he thinks I will get better pain management. He is not set on Suboxone. So are ther any other ones that you think might not interfeir with the Amineptine? I really do not like changing. I tried hydromorphone and could not breath and have a bottle of Anvinza if I choose to try it.
>

There are numerous options to choose from, and most of them are unlikely to interfer with amineptine. It may be prudent to avoid pethidine/meperidine, however, as it has actions on the monoamine system - the same site of action that amineptine and methylphenidate also target.

If you experience a tendency to reduced breathing, it is probable that you are starting the medication at a dose too high. Most people quickly become tolerant to the respiratory depressant effects of opiates at the doses they are familiar with - as well as lower doses, and only a large overdose will depress breathing.

People react differently to different opioids, and some find that morphine has fewer side-effects than buprenorphine, while others experience the opposite. Some find that methadone causes less impairment than morphine or buprenorphine.

You may also wish to investigate dextromethorphan (DXM) and memantine, as they usually interact favourably with opiates, and may allow the dose to be reduced.


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