Question about Subutex for someone who really really really knows :)

[Plumber101010]

In closing, it might behoove you Plumer to approach others with some humility when dealing with subjects like this one, hopefully this thread can slide down the front page now. Merry Christmas everyone..

Humility doesn't normally apply when somebody comes right out and tells you, you are WRONG about something. Where is the humility advice to that poster? There were many other ways that one can go about voicing their opinion on something without coming out with a flashing neon sign and using tough and abruff terminology. When I post something that I know to be correct, and somebody comes along and says WRONG, which means youre a dummy, humility takes a backseat in my opinion. Especially about subject matter that is so readily available, subject matter that 99.99999 percent of everyone everywhere would agree with me on, well, it's very hard to remain humble!

To be honest I am somewhat in shock and awe that this subject matter is still even being debated. I just can't believe that somebody would disagree with my statement, when I / we were asked what was the difference between the two and why the change.

To disagree with my reply, that it was added to prevent IV abuse, and in such a demeaning way, telling me I was WRONG, when it's such an open and shut case, was such a clear cut issue, well, I just don't understand it myself and still do not.

If you Google an answer to that question you will be hard pushed, in fact it would take deep research, to get over the first couple million replies that it was added to prevent IV abuse. As I say, why anyone would disagree with my answer will have me shaking my head for quite sometime.

 

[Jekyl Anhydride]

Getting back to your original question these people had to be put on Naltrexone first to induce W/D before they could be switched to Buprenorphine/ naloxone. Switching directly to Bupe/ Nalox would result in irreversible W/D due to the lower efficacy of Bupe.

Another was the concern that if a direct methadone to buprenorphine transfer is initiated, significant withdrawal would result due to buprenorphine being a partial agonist but at the same time having the highest affinity for the Mu receptors. Therefore, the withdrawal would not be able to be reversed by the addition of other opioids, which could potentially cause a higher treatment dropout rate

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719550/

 

[Plumber101010]

Getting back to your original question these people had to be put on Naltrexone first to induce W/D before they could be switched to Buprenorphine/ naloxone. Switching directly to Bupe/ Nalox would result in irreversible W/D due to the lower efficacy of Bupe.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719550/

That's new to me and I thought that was the whole purpose of waiting 24 hours or so? So are you saying that doctors are prescribing that to people to put them into immediate withdrawal so they don't have to wait or detox for 24 hours? If so that's very interesting. And brings up a variable I guess I never really thought of. Why bother detoxing, just shoot a dose of Narcan up your nose than do a Subutex or Suboxone? Am I reading what you're writing correctly?

 

[JessFR]

The first couple million replies can still be wrong. It wouldn't be the first time I'd discovered something that everyone believed to be true but was definitely false.

I'm not interested in proof that comes in the form of "I'm an expert so I know". I am VERY interested in proof that explains the reason it works. If it does. If I see that then I'll start believing it. For now all I have is evidence which says it's bullshit in the form of a logical deduction based on other things we know are true. Which is far more compelling than any number of "its true cause I said so".

Aside from that, the idea of putting people on an antagonist and switching them immediately to buprenorphine is an interesting concept.

Though plumber, and before I say this I want to say that this isn't personal, I just think perhaps you don't understand this well enough to give a better answer, which combined with your insistence that what you say is true makes it quite frustrating.

But that you are giving any consideration to a concept that involves giving someone naloxone or naltrexone and then giving them buprenorphine to make for a faster induction process, if I'm reading write and that's what is being suggested.

Such a suggestion is in direct logical contradiction to the other suggestion which is that naloxone is added to subuxone to reduce abuse.

In order for buprenorphine to be able to work after an antagonist is in your system it has to displace it. And if it does that it also means such an antagonist is not going to be very effective as an abuse deterrent beyond psychological ignorance.

No matter if you give the antagonist first then buprenorphine, or the two together. It's logically either going to displace the antagonist or not. It can't be both in different scenarios. Such is a suggestion born of exactly the ignorance me and others are suggesting is responsible for a mistaken believe that it works to deter abuse.

 

[Keif' Richards]

Hey guys, it would seem that we're devolving into a bit of a circle jerk here. I'm not overly preoccupied with who is right and who is wrong in situations like this. The safety of the user is always the most important aspect of what we do. We all have pride and nobody wants to be proven wrong, but in the end, it can be better to just leave things as they are in favor of unity among members of the forum. Perhaps Naloxone was added for legitimate, ethical reasons, perhaps not. We can have discussions about the social ills of the pharmaceutical industry, but in the end, it's not very important for our purposes.

I am going to go ahead and close this. I think that we've covered virtually any and every point possible regarding the how/why of the Naloxone component of Suboxone. Nobody can prove the intent of any party here, but in the end, we know that the addition of Naloxone to Buprenorphine has little, if any ultimate effect on the user. Right or wrong at this point, I don't think we're doing anybody any good by continuing to argue it.