In case anyone is not familiar with Suboxone, it is actually the buprenorphine causing the precipitated withdrawal as it is a μ opioid partial agonist and an antagonist of the κ and δ receptors, and its very strong receptor affinity, receptor activation/antagonist profile, duration of action and LADME profile are the causes.
The naloxone, since it is very poorly absorbed via non-injection routes of administration, is there to keep people from grinding up and shooting Suboxone, just like is done with Talwin NX (pentazocine) Valoron N (tilidate) and I believe some oral forms of Polamidone (levomethadone), and is why there is atropine in diphenoxylate and difenoxin tablets in the United States and at one time was in morphine and other drugs too.
Hyoscine is/was used for this reason as well as potentiation expecially for neuropathic pain. Also known as scopolamine, it was, presumably for both reason, in old formulations of injectable Physeptone (racaemic methadone) as well as the original formula of Percodan and an obscure propoxyphene product about the same time, as well as an old Meptid forumulation (meptazinol) . .. I believe the first potentiation pharmaceutical was Schlesinger's Analgesic Solution 115+ years ago,, which had 10 mg of ethylmorphine, ²⁹⁄₈₁₀ grains of hyoscine, and was available with and without the C-Jam. It could be taken orally or dropped into the eye if there was a problem like conjunctivitis there.
The hyoscine doses are higher than the atropine adulteration of the anti-diarrhoeal drugs mentioned above, which is 2.5 per cent of the usual therapeutic dose of atropine per dosing unit. There is no atropine in loperamide preparations sold in the United States in that any form of atropine went on prescription on 1. January 1993 in the United States, when there was also weeping, wailing, and gnashing of teeth about the disappearance of Donnagel PG, which was paregoric, tincture of belladonna, and attapulgite/kaolin (the inert but helpful thing in Kaopectate along with pectin) and it is probably not in there elsewhere because many national laws and regulations forbid that kind of addition of a substance for something other than the labelled use.
Willian S Burroughs wrote in 1952 or so from Tangier that he got six ampoules of methadone with hyoscine when he couldn't get Eukodol (injectable oxycodone) or M for some reason, and he shot up all of them at once, and went into an anticholinergic delirium, stripped naked, ran around, was yelling and knocking over furniture &c, and of course had no memory of it all.
Of course, hyoscine and other belladonna alkaloid salts, and other anticholinergics and narcotics do in fact go together, witness B & O Supprettes, which have both opium and belladonna in them, the sacred pharmaceutical Scophedal and the old Twilight Sleep protocol for childbirth and injuries and office procedures. Mixing narcotics with belladonna alkaloids and other strong anticholinergics must be done very carefully as there are additive and synergistic anticholinergic effects with 4-phenylpiperidine opioids and others with anticholinergic effects.
Anticholinergic delirium is one of the more serious results, and worsening of amnesia and the potential of severe constipation and even paralytic ileus are there. In my own case, careful dosing allowed me to get quite a bang out of dihydrocodeine and/or codeine plus hyoscyamine, the levo enantiomer of atropine used for intestinal troubles . . . I was at that time prescribed those two medications plus Bentyl (dicycloverine) and a small amount of oral morphine for the very worst cases.
To this day, codeine is officially something like a third-line treatment for intractable IBS and similar afflictions. Whole opium products are even more helpful as there are the additional 50+ alkaloids, other active ingredients, and oils, waxes, resins, chlorophyll, and other unabsorbed but very useful and healthy things that can calm the digestive tract and have many other beneficial effects. Like much old techniques and inconvenient pharmacology truths, this is written in textbooks and references to this day but the information is forgotten and even outright suppressed as with anything having to do with Op, Weed, Bolivian Marching Powder, naturally occurring DMT, all that . . .
