Bupe Using Suboxone like Narcan?

[overone]

Reversing overdose w/Suboxone is possible.

Personally, I have never eperienced first hand an attempt to reverse an opiate overdose with the use of suboxone, but I am a Bio major with minor in Chem. The idea to me is sound. In my opinion what would occur is that with a dose of suboxone (naloxone), it would react on the u-opioid receptors knocking off the full agonist opiate. The idea that mixing the two opiates, i.e. heroin and beprenorphine would only exacerbate the overdose situation, doesn't hold water. Being that opiates have smaller binding affinities than buprenorphine does.

Here is the conclusion of a case study of this exact subject performed jointly at U. of M. and at John Hopkins:

CASE REPORT
A case of heroin overdose reversed by sublingually administered buprenorphine/naloxone (Suboxone®)

Christopher Welsh, Susan G. Sherman & Karin E. Tobin. Department of Psychiatry, Division of Alcohol and Drug Abuse, University of Maryland School of Medicine, Baltimore, MD, USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

Correspondence to Christopher Welsh, Department of Psychiatry, Division of Alcohol and Drug Abuse, University of Maryland School of Medicine, 22 S. Greene Street, Box 349,
P-1-H-10, Baltimore, MD 21201, USA. E-mail: [email protected]
Copyright Journal compilation © 2008 Society for the Study of Addiction

ABSTRACT
Background
Opioid overdose is a major source of morbidity and mortality in injection drug users in the United States and many other countries.

Case description
A case is described in which buprenorphine/naloxone (Suboxone®) was administered sublingually to reverse a heroin overdose.

Conclusions
Sublingually administered buprenorphine/naloxone might be used as a means to reverse opioid overdose.

--------------------------------------------------------------------------------

Submitted 17 January 2008; initial review completed 3 March 2008; final version accepted 19 March 2008

 

[cj]

^^^
exactly what I figured. I also think the whole you might OD them on bupe is crap I have seen people get inducted on 16mgs by doctors who seem to have no fear of them ODing if you have even a moderate tolerance which most addicts do then its very diffucult to OD. If shit came to shit I would try it as well as call 911 its not gonna hurt IMO. Only problem is gonna be if they do die you may get into some shit legally but im no lawyer so im not sure. Harm reduction wise we prolly shouldnt advocate this though.

 

[OscarTheOptimist]

Suboxone is dangerous to give to an OD victim, the best way is to call the ambulance if the person is non responsive or has blue lips. A paremedic told me, that all the myths about putting ice in their pants are jus myths, they also said that if they don't respond to a slap in the face, they need to go to the ER.

 

[Georgie25]

Personally, I have never eperienced first hand an attempt to reverse an opiate overdose with the use of suboxone, but I am a Bio major with minor in Chem. The idea to me is sound. In my opinion what would occur is that with a dose of suboxone (naloxone), it would react on the u-opioid receptors knocking off the full agonist opiate. The idea that mixing the two opiates, i.e. heroin and beprenorphine would only exacerbate the overdose situation, doesn't hold water. Being that opiates have smaller binding affinities than buprenorphine does.

Here is the conclusion of a case study of this exact subject performed jointly at U. of M. and at John Hopkins:

CASE REPORT
A case of heroin overdose reversed by sublingually administered buprenorphine/naloxone (Suboxone®)

Christopher Welsh, Susan G. Sherman & Karin E. Tobin. Department of Psychiatry, Division of Alcohol and Drug Abuse, University of Maryland School of Medicine, Baltimore, MD, USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

Correspondence to Christopher Welsh, Department of Psychiatry, Division of Alcohol and Drug Abuse, University of Maryland School of Medicine, 22 S. Greene Street, Box 349,
P-1-H-10, Baltimore, MD 21201, USA. E-mail: [email protected]
Copyright Journal compilation © 2008 Society for the Study of Addiction

ABSTRACT
Background
Opioid overdose is a major source of morbidity and mortality in injection drug users in the United States and many other countries.

Case description
A case is described in which buprenorphine/naloxone (Suboxone®) was administered sublingually to reverse a heroin overdose.

Conclusions
Sublingually administered buprenorphine/naloxone might be used as a means to reverse opioid overdose.

--------------------------------------------------------------------------------

Submitted 17 January 2008; initial review completed 3 March 2008; final version accepted 19 March 2008

What's up with this case study? Doesn't give much information at all!

I would think giving an overdose person a sublingual dose of suboxone would be difficult, no? Being as it would take at least 5-10 minutes for it to dissolve under the tongue, let alone the person would likely be drooling it out the whole time anyway. Also, isn't the naloxone inert in suboxone? Since it's affinity is 4:1 it's pretty much the Bupe that's doing the work, not the naloxone.

 

[SkagKush]

^ haha.... ya that study is like huh......

im curious if this could actually work, i understand why it could....but also why it wouldnt.....so i dunno

 

[AllOverItPDX]

So I just did this about 2-3 months ago with my generic subutex (buprenorphine 8mg). I was at a friends apartment and his other buddy was over who ALWAYS went into the bathroom to shoot his shit. Well he had been in the bathroom for over 20 mins and when we knocked there was no answer. We knocked the door down and he was unconcious on the bathroom floor. We tried slapping him and yelling at him and putting him under a cold shower but nothing was waking him up.
Finally my buddy told me to grab one of my bupes and a rig. So I grabbed some bupe ( I think it was 3-4 mg but not sure) and broke it down and drew it up in the needle. My buddy hit him with it and within a minute he was back to life, but very groggy. He had no recollection of what happened and was pissed that we killed his high, like any good junkie

My buddy and I were amazed that it happened but now I ALWAYS keep a bupe on me when I'm shooting dope just in case something goes wrong. Before this happened I was skeptical but now seeing it with my own eyes I know that it does work and is definetely worth the try I mean what's the worst that could happen? It cant get much worse that it is at that point.

Would love to hear some more successful stories of people being brought out of an OD with bupe. Even though this thread is a bit old I think it is one of the more important threads on bluelight...

 

[gms]

same thing happened to me thought i was going to die...i've taken suboxen too early before but never IV only under the tongue it seemed to me that shooting it made it one million times worse i dunno if its cuz it hits u instantly or what but man i'd be careful if your sick and than want to shoot it...awful awful awful

 

[Fire&Water]

"^^It's the buprenorphine (agonist-antagonist) that causes the withdrawals, not the naloxone. This has been discussed to death. "
From my experiences, I don't believe that to be the truth.

"What kind of an ass-backwards clinic would give someone ONE shot of buprenorphine in the morning? That sets people up to turn to heroin at night. "
In Baltimore about ten years ago, this was a standard practice. Ideally, they wanted to give you one at night as well, but if work prevented you from coming back, they would just double dose you. Other outpatient places that give you the pills only dose you once.

"I have never heard what you're talking about, care to shed some light on what you're talking about, or are you just trolling OD for the hell of it?"
I am new here and do not want to get in any pissing matches. I don't know you, nor you me, but dubbing yourself Capt. Heroin does not automatically make you the foremost authority on dope. I know alot of shit, but the most important thing I know is that I don't know everything.

Here's the deal- I've certainly been around the block a few times. Back in 2000, I was living in Baltimore, which as most people know has a serious heroin problem. They also have one of the best research hospitals in the US - Johns Hopkins. As a result, they are often the first to get advances in opiate treatment.
I am originally a NYC kid and did my share of dope up there. Untill living in Balt, the only thing I had ever heard of for opiate withdrawel was methadone. Then about ten years ago, while living in Balt, people told me about a new treatment for getting off dope. There were and still are clinics where they dispense all kinds of symptom relieving pills in a giant blister pack the size of a piece of legal paper - everything from Celebrex to things for sleep, GI disorder, cramping etc. On the top are 3 Subutex (oblong, white with a cross on them). They tell you to not take anything 24 hours prior to coming in. They do not let you go home with the Subutex, and you take it in front of the nurse. They pop out all the Subutex and lock them up, but you can leave with the other stuff. At Hopkins Bayview (inpatient), they give you Suboxone which is the first place I ever saw that.
In the old days, they would give you an intramuscular (sp?) shot.
I have never had the Subutex or straight Bupe put me in WDs. I have been to each of the above mentioned types of detox once each. Once, after leaving the clinic with the blister pack, I stopped and copped on my way home (stupid, I know). It was called "Red Line". Later that afternoon, I ran into a friend of mine and she told me that she copped Red Line and it was fire. I told her that I got it and it sucked. That is when I realized the bupenorphine had blocked the dope. I have experienced that once or twice after that. It is my belief, through my personal experiences, that the bupenorphine blocks opiates from getting in, the naloxone will pull them out of you. I shot a piece of a Suboxone one time and it wasn't pleasant. I am glad I never tried a whole one. I have friends who have and instantly regretted it.
Another thing I have noticed is that Suboxone seems to have more of an adverse effect on people on methadone. In detoxes and on the street, the only people I have met who have had real bad adverse reactions to Suboxone were on methadone.

BTW- as far as the daily dose of bupe turning people to heroin at night, I would guess that if the person went to the clinic with serious intentions of quitting, they would most likely not go cop at night. The dosage they give you is plenty to keep the WDs away.

As far as trolling OD for the hell of it is concerned - I basically troll the ENTIRE internet for the hell of it. I'm not a professional web surfer, although it would be nice if somebody paid me for it... lol

Peace.

"the only people I have met who have had real bad adverse reactions to Suboxone/(Subutex) were on methadone".
Do not tread lightly, this sentence is pure gold...

 

[jazz hands]

Check out this thread I started on Suboxone for opiate overdose:

http://www.bluelight.ru/vb/threads/...-Girl-With-Heroin-(Tried-to-revive-w-Suboxone

 

[volksgeist666]

Ive always wondered the same thing. I would never gamble someones life on this, but if EMS ws slow, I would crush Suboxone and IM while waiting.

 

[Mudvayne]

so what you're asking is if you're with someone who is overdosing, and you have a suboxone, and you give it to them will it reverse their overdose?
YES
i've saved 4 peoples lives using this same exact situation.. after watching them fall out i would put an 8 mg sub strip under their tongue and EVERY time within ~10 minutes they would come completely out of the overdose, it's really something that a lot of addicts should know about if you run into a situation where you see someone ODing and you have the sub on hand
it works wonders honestly and i've saved lives doing it
(sorry i only really read the OP and am posting based on that, but it DOES work) going from the blue lips and gasping for air to completely normal in just a very short ammount of time
i wish more addicts knew about this, but i think you need to use suboxone and not subutex

 

[jazz hands]

^Look at the article I quoted two posts up... It seems that it is far from guaranteed.

 

[effie]

I find this whole thread very interesting and have thought about what to do in an emergency quite a lot.. my conclusions:

If there is an emergency -

1 - Call 911/999/whatever the emergency services number is for your area. Right away. ALWAYS. No excuses if you have access to a phone or you can run to find one - call them!

2 - Administer naloxone/Narcan if you have it after calling the emergency services (or have someone do it at the same time if there is more than one of you present to help out). This is because you don't want to be fussing around taking ages fumbling with the naloxone before the ambulance has been summonded - an overdose situation can be very scary and it is easy to go to pieces. Ideally you should have been trained in how to use it, but there are very few places that will do that. IV administration is fastest obviously but IM works too and may be easier than trying to hit a vein in the panic of an emergency situation. If you miss, don't worry, subcut works too only the onset of action is a little slower. It is no substitute for calling the emergency services - it is very short acting and the person will require ongoing medical care and attention, or they will slip back into an overdose - plus there may be damage from the period of time without oxygen. Unfortunately not many people will have access to naloxone so this step often won't be possible.

3 - If for some reason you can't do 1 or 2 (you're in the middle of nowhere with no phone signal, you're a dick, etc) then yes buprenorphine (Subutex/Suboxone) could work and is definitely better than doing nothing. Again IV would be ideal under perfect circumstances but it may well be too tricky in an OD situation IMO (especially given that you are prepping a pill) - IM is risking an abscess but has a much better bioavailability than sublingual, but again prepping a shot is probably too tricky in this situation.. so if in doubt crush it up and shove it under the tongue like sixpartseven did. The ROA that would be best would depend on the individual situation, how calm you are and how skilled you are at prepping FAST I think. Under the tongue is probably going to be the most practical for most people, realistically.

Giving buprenorphine this way is better than doing nothing and if enough buprenorphine makes it to the opioid receptors it will rip the heroin off and reverse the OD. It does of course have partial agonist action but buprenorphine overdose is rare and there is a ceiling for respiratory depression. Nb: It doesn't matter if it is Suboxone or Subutex - it is the buprenorphine that will help, not the added naloxone, which does absolutely nothing even when IVd, as mentioned earlier in the thread.

The dilemma is what to do if you have called 911/999/whatever, you have no naloxone, but you do have buprenorphine. Do you wait and let the paramedics administer naloxone or do you give buprenorphine? It is better to treat the overdose as quickly as possible, so if there is going to be a delay (you can check this with the telephone operator) then I would definitely give it, personally...

However - if you do give it and somehow the person then manages to OD on buprenorphine, naloxone will not work to bring them back as it cant rip the buprenorphine off the receptors. It is unlikely that this would happen, given that you probably aren't going to get that much bupe into them and the ceiling effect on respiratory depression that I mentioned, but it would still concern me and usually ambulances are at the scene of an OD pretty damn fast, so if the paramedics are only a minute or so away I would leave it to the professionals.

Also, learn CPR. Please. Everyone should know this, but especially friends of people who shoot opiates. Far, far better to do CPR while you wait for the ambulance than to waste time messing around trying to crush up some buprenorphine and leave the person starved of oxygen until the paramedics arrive.

 

[Tommyboy]

Ah, this was probably the first thread I ever started on BL. It definitely is an interesting topic.

 

[effie]

It is. It's such a fine line between HR and potentially causing harm.. still not entirely sure what the answer is, haha, despite my long post. I guess the key thing is to always call an ambulance, whatever else you do!

 

[jazz hands]

Also, learn CPR. Please. Everyone should know this, but especially friends of people who shoot opiates. Far, far better to do CPR while you wait for the ambulance than to waste time messing around trying to crush up some buprenorphine and leave the person starved of oxygen until the paramedics arrive.

QFT-- The air that is provided by compressions alone ventilate the upper airways sufficiently to keep a person alive for awhile. The key is circulating fresh air through the throat. CPR while getting real medical attention is unquestionably the way to go, unless you have Narcan and know how to administer it (I believe it is available in some areas for this purpose.)

 

[madonit]

im not sure that injecting some body with bupe in any form subutex or suboxone while there are overdoseing off a full agonist is a good idea. In some people it may work like narcan but in others it may end up working the other way as an agonist thus induceing a more deadly overdose to treat by ambulance/paramedics. I suppose it depends on many factors but call 999 911 or 112 first ! also the naloxone in suboxone does not prevent them from being misused by people previously on subutex i have a good friend who used to regualy inject his subutex. when most uk scripts was changed to suboxone in last 12 months he was put on them and tried injecting them and found they give him the same high as injecting subutex. supposidly still enjoyable but maybe a little less potent with naloxone but abuse proof yeah right ok pharmacutical companies if you say so lmfao silly !!!

 

[xburtonchic]

I've had to use Suboxone twice for this reason (on other people, though... I've never personally overdosed myself.) I've only seen two people overdose, and both times the only thing I had available was Suboxone. I do have Narcan, but unfortunately not on me those two times.

Both times I just wrenched their jaw open and shoved Suboxone under their tongue. They both woke up about 5-10 minutes later, having absolutely NO clue that just moments before they were turning blue and on the verge of brain damage from lack of oxygen, or worse. The strange thing is that neither of them had any precipitated withdrawal. The first time it happened, he did say that he was having brain zaps and that he just felt extremely fatigued and lethargic... but that might be because I may have used too much Suboxone. I gave him 4 mg, whereas with the second person, I only gave him 2 mg... and he had NO adverse effects. So from those experiences, I would say that in the case of an overdose Suboxone can definitely be the difference between life and death... it certainly was for those two guys. I hope I am never put in that situation again... but if I am (God forbid, that shit is scary and I don't want bad things happening to anyone regardless) then as a general rule of thumb, I would administer 2 mg sublingually... wait a couple of minutes, and if they still weren't waking up, adminster another 2 mg... and so on and so forth.

I know Suboxone only has a ridiculously small amount of Naloxone in it, but apparantly that's all it takes to bring someone out of an overdose. The first guy WAS pissed off at me though, since he wasn't able to get high anymore that night from having the Subs in his system...

 

[Tommyboy]

^ It's not the naloxone that reverses the overdose in this case, it's the actual buprenorphine. Anyway, I would still call the paramedics after giving it to them, or give it to them and drive them to the hospital if you live within 5-10 minutes of one, because if it doesn't work then you are fucked since you just wasted some precious time trying to bring them back on your own. If you are that worried about police or whatever then you can always just give the intersection closest to you, and if they don't come out of the OD then you can flag down the paramedics and have them come to the house, but if they do come out of it just tell the paramedics that the person came to and ran off and you didn't know who they were.

 

[xburtonchic]

Yeah, I read through this whole thread after posting and gathered that it's actually the bupe... that's very interesting indeed. Like someone else said, I never would have even thought to use it if it didn't say "Naloxone" on the bottle! Honestly, the cops have been the LAST thing on my mind when I've been thrown into that situation. My main focus is waking up the person who is overdosing. If CPR doesn't work, it's on to Suboxone. There's several reasons I chose that route both times, mainly because I knew I would have been unable to get either of them to hospitals on time. Both times, I was in cities completely unfamiliar to me and the people overdosing couldn't tell me where the closest hospital was... obviously. Another reason is that I feel like I need to DO something... I'm always too scared to leave them alone/stop CPR while I run down the street to find out where I am, or drive around the city until I find a hospital. I'm way too terrified of driving someone around while they're seizing anyways for fear of the jolts of the car making it worse. IDK it just always seemed to me that it would take too much time and then it would be too late. The first time, I DID call 911, since I wasn't 100% the Suboxone would even work... but the bitch ass dispatcher refused to trace my location! I had no idea where I was... in a parking lot somewhere... let alone know what streets I was on. I told her the closest businesses to me, that it was an emergency and that she was wasting time, that how hard is it to just trace my location because I KNOW dispatchers are capable of it even when you use a cell phone. She either wouldn't or couldn't do it though, and finally ended up hanging up on me... it was pretty clear she didn't give a fuck either way whether another junkie lived or died. Didn't even waste my time going through that the second time it happened... too great of a chance of just wasting more time, and by then I knew for a fact that Suboxone would work. (I'd been with them both all day, so I knew that all they had OD'ed on was heroin. If it had been anything else I don't think I'd know what the hell to do honestly... maybe flag someone down and ask them to help get the ambulance over while I continue CPR? Actually... I don't know why I didn't think of that in the first place...)

Moral of the story though: Suboxone can work to reverse a heroin OD, and it doesn't even always cause precipitated withdrawal. I assume that part has to do with the person's tolerance level, how long they've been using, their metabolism, and a number of other factors, however.

What I don't understand though, is WHY precipitated withdrawal even happens...? I mean. If the buprenoprhine has a higher affinity than the opiate you last ingested, and it then knocks that opiate off the receptors... why does it not simply replace it? And why would taking another Suboxone a few hours later not get a person out of precipitated withdrawal? To me, it seems like it should in theory be the exact same thing as waiting until the opiates leave the receptors on their own... can someone explain the physiology/pharmacology behind this please?

EDIT: Just want to add that, yes, I completely 100% agree that you should get the person medical help if you're able to. Even if it works, everybody is different, so I don't think it's ever really a good idea to rely on Suboxone/CPR alone, except for in emergencies (like when you don't have the time to wait because they're already turning blue, or dispatchers are giving you problems *cough*, or you have no idea where the hell a hospital would be, or you're too scared to start the car while they're overdosing, or whatever.) You should ALWAYS try to get professional medical help in conjuction with, or as a replacement of (if you can), simply giving the person Suboxone and praying that it's enough...

P.S. What kind of fucked up person bails out when their friend is overdosing and doesn't even attempt to help? WTF? Just stash the fucking drugs and paraphernilia somewhere the cops can't look if you're that paranoid, or better yet, throw it away!!! Personally, I never wanted to use dope for the rest of the day after seeing those overdoses anyway... both times, I was so terrified that I would just hold off until the withdrawals started kicking in. That being said, I've never heard of anyone doing that to someone and I hope for their sake (and the person who's life is on the line's sake of course) that I never do! Damn dude, some junkies can be incredibly soulless fucked up people...