I may be talkin outta my ass here, so forgive me if that is the case but...
I always thought the benefit of Suboxone (although with Subutex I realize this doesn't hold true), is that the Naloxone, while having less affinity than the buprenorphine, does help to limit abuse and OD potential. Using more of it, or using it in conjunction with other opiates doesn't get you higher or give you a rush(??). I'm guessing that bupe alone must have a long half-life... thus the ability for Subutex to be effective as well.
I also thought the idea behind Methadone was that it had a long half-life, so once a morning treatment "held" opiate abusers till their next visit.
I don't quite understand the HM pellet option. It seems like continuous use of a short acting opioid wouldn't really be an effective long term solution. How is it any different that allowing doctors to prescribe whatever they want for opioid dependency? I mean, why wouldn't Heroin addicts think this is just a way to get even higher??
I'm all in favor of a generic bupe option. I know the price would help many many addicts.
just curious
-DISCO
The Naloxone in Suboxone was an appeasement to political interests involved in the drug treatment industry. It has absolutely, 100% no impact on the ability of someone to overdose on Buprenorphine, to inject crushed up Suboxone tablets, or to precipitate withdrawal.
The entire purpose of Naloxone in Suboxone is, according to Reckitt-Benckiser,
discourage intravenous abuse of Suboxone tablets. Meaning, the rumours and myths concerning what will happen to you if you inject Suboxone are the entire purpose. There is no physiological consequence from the Naloxone in Suboxone when it comes to abusing Suboxone via injection, insufflation, etc to get high. There is some evidence that certan side effects are specific to Suboxone when it is
taken as directed sublingually, specifically headaches.
Methadone was chosen as a Heroin/Morphine alternative for opioid maintenance for a number of reasons. The long half-life is simply one of many reasons why it was chosen and backed by political and medical interests.
There are a large number of opioid addicts who do not accept or fail at Methadone and Buprenorphine maintenance programs. There are many opioid addicts who maintain on Methadone or Buprenorphine despite numerous problems with these programs because, in many countries, these are the only options. Because of the political situations in certain countries (like the US), it is very unlikely that, in the shortterm, we will get even a pilot IV opioid maintenance program like those in the UK, Holland, Switzerland, etc.
The Hydromorphone subcutaneous depot pellet is an
extended release product. Once a month, or every 3 months or every 6 months, the addict/patient has the pellet removed and a new one put in. Because it will be released very slowly over a long period of time, the short half-life of Hydromorphone is irrelevant. Currently, many other countries use extended release Hydromorphone tablets (Jurnista, HydromorphContin) as an alternative to Methadone maintenance for opioid addicts.
Methadone has a number of disturbing side effects, and in many patients these side effects are far too bothersome to attempt going higher in dose to reach a dosage level that adequately covers and controls cravings.
Hydromorphone has a much, much more preferable side effect profile compared to Methadone. There is a good foundation of literature and studies on the use of XR Hydromorphone in opioid addicts who have tried and failed or are currently on and don't like MMT.
Sedation, severe constipation (leading to vomiting, impacted bowel, anal fissures/tearing, passing blood, etc), inability to feel or react to emotional stimuli, excessive sweating, uncomfortable 'overheating' (feeling like your bodies thermostat is fucked up), etc are common problems and side effects for long term MMT patients. These problems are not present or are substantially less severe with XR Hydromorphone.
In an XR form, there is no 'high' from Hydromorphone. In a depot pellet form, there would be no change in plasma/blood concentration as drastic as there is with a once-a-day dose with Methadone. Just a constant medication level until it is time for a replacement pellet.
This also serves another beneficial purpose to those trying to detox. By removing the conscious act of dosing with an opioid medication, the opioid dependancy becomes a more or less unsconscious issue. Without having to dose, and without drastic changes in blood/plasma levels, the life of a person with a HM depot pellet resembles the life of someone not dependant on opioids, and with the constant blood/plasma levels, the person would not feel the ups and downs of opioid dependancy related to a dosing schedule.
However. The Hydromorphone depot pellet is simply one tool in the toolbox. It should not take the place of Methadone or Buprenorphine, and it should not stop the push for full prescribing rights for doctors treating opioid addicts. Meaning, all opioid medications and formulations, instant release and extended release, syrup, tablet, dispersible, injectable, everything should be in the table for physicians treating addicts.
Longterm IV Diamorphine maintenance, oral Morphine, IV Methadone, sublingual Buprenorphine, subcutaneous depot pellet Hydromorphone, oral Methadone, IV Hydromorphone, oral Dihydrocodeine, and so on, absolutely everything should be allowed if a physician believes it is the right path for their patient.
Like I said, there is a large percentage of opioid addicts who have failed numerous treatment modalities- cold turkey, 12 step, symptomatic medications (Clonidine, Benzo's, Ibuprofen, etc), Methadone maintenance, Buprenorphine maintenance, etc. These addicts require other options, whether temporary, longterm or for the rest of their lives. The HM pellet is just another option.
