Opioids Doctor Assitsted Withdrawal(being prescibed narcs to taper)

[Jabberwocky]

Why would you want to do that?

Lol, why not?!? I have this problem with being honest to my doctors. I am, like, on a one man crusade. It really bothers me sometimes (well, when it comes to those MDs I have come to love and respect) that their patient take advantage of them as so many often do.

So, I personally have no problem calling the rich privileged kids out on getting prescribed 24mg/day when I know for a fact they sell over 2/3 their dose. I mean, I wouldn't call out someone who really needed the money, but the few people I'm thinking about CERTAINLY don't.

Plus, well, you see... I just like being an asshole

Post plus, that look (mixed shock, disgust and HOLLY shit is this guy doing that?!) is priceless well, especially because so many seem to be CONVINCED you can't abuse suboxone... SORRY

 

[TheMiddleWay]

Here's the link to Reckitt Benckiser's press release to SAMSHA that was made last fall:

http://buprenorphine.samhsa.gov/SubutexDiscontinuation9-16-11.pdf

Lol, why not?!? I have this problem with being honest to my doctors. I am, like, on a one man crusade. It really bothers me sometimes (well, when it comes to those MDs I have come to love and respect) that their patient take advantage of them as so many often do.

So, I personally have no problem calling the rich privileged kids out on getting prescribed 24mg/day when I know for a fact they sell over 2/3 their dose. I mean, I wouldn't call out someone who really needed the money, but the few people I'm thinking about CERTAINLY don't.

Plus, well, you see... I just like being an asshole

Post plus, that look (mixed shock, disgust and HOLLY shit is this guy doing that?!) is priceless well, especially because so many seem to be CONVINCED you can't abuse suboxone... SORRY

I then.pdf missykins posted from rickett,"the mono product is more abusable." I know this if untrue as you mentioned.

I just wonder whether they know it and lie so they don't lose their honey pot of one damn expensive medicine by pushing it to CS II and minimizing the patients capable of getting it, so they act like they are actually fighting suboxone diversion.

Or are they truly incompetent?

I choose the former.

I thought at one point there was talk about banning compound medications (i.e. vicodin, percocet) when one ingredient is not responsible for the main effects. I know acetomenophin has a bit of synergy with opioids, so suboxone would be a true choice for that type of rule.

If it did target vicodin, it would make it schedule II as well since it is only III as a compounded drug (which kind of implies the acetomenophin is NOT for synergy).

 

[Jabberwocky]

Well, I would imagine that the manufacturers would know what's up, however evil that makes them, but ime many doctors who are certified to prescribe it don't have a clue.

 

[Tommyboy]

Methadone is not an option. I want to taper off of the drug that i have been using. Any thing i should say to the doc? Any tips to make this swing my way? I swear on my life all i want is to be unsick and no longer addicted, i'm not in this to get high, just not sick. That's what i've been doing for the past month and i've spent almost 2 grand in one month alone trying to taper. I CANNOT taper on my own, it is way too fucking expensive. I need my family doctor to help me out.

Has anyone had experience with this before? I started taking oxy 60's in the beginning because i had back pain. Then i just liked the high and kept doing them. Then my dad gave me a half full bottle of oxy 60's for free and told me to 'sell' them, but fuck that, i just did them all in two weeks, all IV'd. And there were 30 pills in that bottle and my tolerance wasn't even high. I was noddin 24/7. I don't even want that anymore i just want to be free.
Again, anyone have any experience with this?

Why is methadone not an option? Furthermore, why was Suboxone treatment not discussed?

Using your DOC for opiate maintenance has been researched and proven effective when administered in a clinic setting. However, they are not a good option for tapering for several reasons (no blockade effect, being able to use more on top of them, short half-life causing withdrawals to come on faster than compared to drugs with long half-lives, ability to abuse these drugs by using other ROAs, etc.).

 

[Znegative]

Why would you want to do that?

I told my suboxone doctor that I have injected suboxone before, because at the time I was thinking of going on methadone, and I used this as one of my reasons. She was shocked, but ended up believing me when I quoted the R&B suboxone package insert that basically says that naloxone is not effective in antagonizing buprenorphine.

I later brought it up again (after I stopped shooting suboxone, and took it as prescribed), when I asked for generic buprenorphine because my insurance had changed, and my family was litterally having to borrow money from friends in order to pay for my prescription. She still refused, claiming that while you can inject suboxone, that the naloxone prevents buprenorphine from being a "full agonist". I knew at this point she just did not want to prescribe it period (possibly due to liability issues, which is understandable, considering I'm an IV drug user who had admitted to shooting the suboxone), because though she may be ignorant in some aspects, she certainly knows bupe is a partial agonist, as weve talked about other partial agonists like pentazocine. (she's kind of cool in a way, because she likes to partake in conversations about all pharmaceuticals, she's one of the few psychiatrists who seems to actually care).

In a way I do think that it should be common knowledge that suboxone can be injected, plugged, sniffed etc.. The addition of naloxone is the only thing that lets R&B keep its patent on suboxone, and the way I see it, once the patent runs out again, they'll come out with a "new, less abusable formula"- just like the strips were supposed to be (yet they're actually safer to abuse!).

I can see it now: The New Suboxone Nasal Pump, or The New Suboxone IM ampule (just ont inject it into your veins!)

They should quit the bullshit. At another time when information was not so widely available, the naloxone scare tactic might have worked, and perhaps it would have even be a "good" lie. But that's not the case, end this monopoly!

 

[Missykins]

I then.pdf missykins posted from rickett,"the mono product is more abusable." I know this if untrue as you mentioned.

I just wonder whether they know it and lie so they don't lose their honey pot of one damn expensive medicine by pushing it to CS II and minimizing the patients capable of getting it, so they act like they are actually fighting suboxone diversion.

Or are they truly incompetent?

I choose the former.

As a doctor in recovery who's been treated with Suboxone and knows how these drugs work, I agree with Reckitt Benckiser's assessment and decision to cease its production. There were generic buprenorphine products available before Subutex received its patent. For a drug company to pull its product before the end of its patent, under no pressure from the FDA, was not a trivial decision.

 

[pharmaecopia]

Sorry man, I tried many different ways to quit, although tapering sounds easy it just didn't work for me or anyone I know. I only quit when I was lock in a jail cell for 2 months, it took about 1 week of absolute hell, I was coming off benzos as well, but you've been spoiling your self with all this pleasure the only way to to quit IMHO is to go to detox they will probably give you clonodine for blood presure, promethlozine for your stomach i think (sp?) and trazodone to help you sleep. Thats what they gave me in jail, but it took them 5 days so they were a little late. But then I got out of jail, relapsed and eventually quit IVing heroin, I cant say I'm completely clean but I gained 30 pounds and I'm going to an out patient rehab, which is easy to cheat on but it does help, I gotta quit atleast 3 days before my appointment so I can piss clean and look good on paper cause I am in some very deep shit with the law and need a good report.. lol... but seriously go to detox, puke, shit, and sweat it out, its the fasted and only way and it teaches you a damn lesson.

 

[TheMiddleWay]

But with such a large financial decision, did they pull it because there were other generic high dosage buprenorphine only pills (and how if under patent still?). Did they pull it so they could say they took action against the "more easily abused mono product" so they could look good and keep there more popular product out of a more restricted schedule (culling the weak to save the strong) for monetary reasons? Maybe I'm missing something.

 

[Missykins]

I told my suboxone doctor that I have injected suboxone before, because at the time I was thinking of going on methadone, and I used this as one of my reasons. She was shocked, but ended up believing me when I quoted the R&B suboxone package insert that basically says that naloxone is not effective in antagonizing buprenorphine.

From full prescribing info:

"Effect of Naloxone: Physiologic and subjective effects following acute sublingual administration of buprenorphine tablets and buprenorphine/naloxone tablets were similar at equivalent dose levels of buprenorphine. Naloxone had no clinically significant effect when administered by the sublingual route, although blood levels of the drug were measurable. Buprenorphine/naloxone, when administered sublingually to an opioid-dependent cohort, was recognized as an opioid agonist, whereas when administered intramuscularly, combinations of buprenorphine with naloxone produced opioid antagonist actions similar to naloxone. This finding suggests that the naloxone in buprenorphine/naloxone tablets may deter injection of buprenorphine/naloxone tablets by persons
with active substantial heroin or other full mu-opioid dependence.

However, clinicians should be aware that some opioid-dependent persons, particularly those with a low level of full mu- opioid physical dependence or those whose opioid physical dependence is predominantly to buprenorphine, abuse buprenorphine/naloxone combinations by the intravenous or intranasal route. In methadone-maintained patients and heroin-dependent subjects, IV administration of buprenorphine/naloxone combinations precipitated opioid withdrawal signs and symptoms and was perceived as unpleasant and dysphoric. In morphine-stabilized subjects, intravenously administered combinations of buprenorphine with naloxone produced opioid antagonist and withdrawal signs and symptoms that were ratio-dependent; the most intense withdrawal signs and symptoms were produced by 2:1 and 4:1 ratios, less intense by an 8:1 ratio."

As a clinician, I have used naloxone under emergent conditions to reverse the effects of buprenorphine and it is effective.

Why so cynical?

 

[Tommyboy]

Sorry man, I tried many different ways to quit, although tapering sounds easy it just didn't work for me or anyone I know. I only quit when I was lock in a jail cell for 2 months, it took about 1 week of absolute hell, I was coming off benzos as well, but you've been spoiling your self with all this pleasure the only way to to quit IMHO is to go to detox they will probably give you clonodine for blood presure, promethlozine for your stomach i think (sp?) and trazodone to help you sleep. Thats what they gave me in jail, but it took them 5 days so they were a little late. But then I got out of jail, relapsed and eventually quit IVing heroin, I cant say I'm completely clean but I gained 30 pounds and I'm going to an out patient rehab, which is easy to cheat on but it does help, I gotta quit atleast 3 days before my appointment so I can piss clean and look good on paper cause I am in some very deep shit with the law and need a good report.. lol... but seriously go to detox, puke, shit, and sweat it out, its the fasted and only way and it teaches you a damn lesson.

I agree. In a sick way I usually look forward to a good kick. It's like once I get through it the experience symbolizes changes and a new beginning.

But with such a large financial decision, did they pull it because there were other generic high dosage buprenorphine only pills (and how if under patent still?). Did they pull it so they could say they took action against the "more easily abused mono product" so they could look good and keep there more popular product out of a more restricted schedule (culling the weak to save the strong) for monetary reasons? Maybe I'm missing something.

I am wondering the same things. I know that there were other bupe products before subutex (temgesic for example) but the generics are the same dosages as the brand name and people are getting it in place of it, so it's definitely generic for subutex. I have been hearing a lot about generic subutex becoming harder and harder to get prescribed, and people that were prescribed it being switched to suboxone, so it seems like they did this (pull the product claiming it was easier to abuse) so that they didn't lose sales to those getting the generic subutex prescribed since they made it seem inferior to suboxone.

As a clinician, I have used naloxone under emergent conditions to reverse the effects of buprenorphine and it is effective.

At what, 10x the normal dose used to treat opiate overdose? Did you treat them for general opiate overdose, or specifically buprenorphine overdose?

 

[Missykins]

But with such a large financial decision, did they pull it because there were other generic high dosage buprenorphine only pills (and how if under patent still?). Did they pull it so they could say they took action against the "more easily abused mono product" so they could look good and keep there more popular product out of a more restricted schedule (culling the weak to save the strong) for monetary reasons? Maybe I'm missing something.

We've completely hijacked this thread, maybe as a courtesy to the OP we should splinter it.

I don't the presence of a generic on the market had anything to do with it, as those products were already in place. Both products were under the same schedule, so that had nothing to do with it. Subutex was a product with a higher potential for abuse and diversion.

 

[Missykins]

Why so much hatred towards drug companies? How do y'all intend to stay alive? Besides, many of you spend a great deal of time, energy, and money popping, snorting, shooting, or plugging their products! Gimme a break already.

Suboxone has saved many lives, and I have no shame in saying that mine is one of them. Thank God for Reckitt Benckiser, their product really helped me when I needed it, like it has many other members of this forum.

 

[TheMiddleWay]

So is it that suboxone when injected with full agonist opioid, delivers enough naloxone to stop them, but not so with buprenorphine itself (due to higher binding affinity), as naloxone is detected when administered sublingually. I've never done lt, but it seems people here don't ever feel 2mg naloxone cancel out the rest when IVed.

Edit;

Whoops we did kind of hijack the thread. I can't believe a doctor would give you hydromorphone as an admitted IV drug user, or even an addict. "oh my drug of choice is IV hydromorphone, but I want to stop, and I've already made up my mind "no" to the far less abusable options, methadone or suboxone. So please write me a prescription for x amount of hydromorphone."

This sounds insane. And if your friend really got hydromorphone, I'm guessing if he overdosed and died the doctor would go to prison.


Edit 2: I am thankful but skeptical about some things they do after developing extremely helpful drugs, to suck profit shamelessly. Extended release antibiotic that needs to be taken 1x day instead of two, new patent, useless, way more expensive, new patent. Citalopram loses patent, new drug with just one isomer... Lexapro! Any really proven benefit? Sure, more money from new patent!

 

[Tommyboy]

Why so much hatred towards drug companies? How do y'all intend to stay alive? Besides, many of you spend a great deal of time, energy, and money popping, snorting, shooting, or plugging their products! Gimme a break already.

Suboxone has saved many lives, and I have no shame in saying that mine is one of them. Thank God for Reckitt Benckiser, their product really helped me when I needed it, like it has many other members of this forum.

Here is how I see it. Subutex has saved many lives. What happens to those people though when they are no longer allowed to get the generic subutex (because it is now considered "inferior"), and cannot afford Suboxone?

As for hijacking the thread, the OP already went to the doctor and got his answer, and I'll talk to a mod about splitting this off into its own thread, so carry on.

 

[tricomb]

Why so much hatred towards drug companies? How do y'all intend to stay alive? Besides, many of you spend a great deal of time, energy, and money popping, snorting, shooting, or plugging their products! Gimme a break already.

Suboxone has saved many lives, and I have no shame in saying that mine is one of them. Thank God for Reckitt Benckiser, their product really helped me when I needed it, like it has many other members of this forum.

But if R&B hadn't demonized pure buprenorphine by calling Subutex more abusable than Suboxone, just as many people could have benefited from the much cheaper generic already available buprenorphine.

 

[Znegative]

^This was sort of my point.

Yes naloxone can reverse a buprenorphine overdose, but the ammount needed is way higher than normal. Check out This study. According to this, .8mg of naloxone produce no effect in resperitory depression caused by .2mg of buprenorphine, proving that you can shoot 2mg of suboxone no problem (2mg bupe/.5 mg naloxone)-though I don't recomend doing that.

 

[Missykins]

But if R&B hadn't demonized pure buprenorphine by calling Subutex more abusable than Suboxone, just as many people could have benefited from the much cheaper generic already available buprenorphine.

Generic buprenorphine can still be prescribed (it always has been) as part of office-based treatment, and if a registered physician and the patient choose to use generic buprenorphine in place of Suboxone, there is no restriction upon that. Subutex received its patent based upon its formulation, which was appropriate.

 

[Missykins]

^This was sort of my point.

Yes naloxone can reverse a buprenorphine overdose, but the ammount needed is way higher than normal. Check out This study. According to this, .8mg of naloxone produce no effect in resperitory depression caused by .2mg of buprenorphine, proving that you can shoot 2mg of suboxone no problem (2mg bupe/.5 mg naloxone)-though I don't recomend doing that.

This is not consistent with my clinical experience: I do not have to give supra-normal doses of naloxone to reverse its effects. Because of buprenorphine's ceiling effect, respiratory depression and bradycardia are not as common as they are in morphine unless used in combination with other drugs such as benzodiazepines. That's where people get into trouble.

 

[Jabberwocky]

Why so much hatred towards drug companies? How do y'all intend to stay alive? Besides, many of you spend a great deal of time, energy, and money popping, snorting, shooting, or plugging their products! Gimme a break already..

It's sad when doing things illegally are more cost effective than not. So thus, my dislike for drug companies is no less than that I hold for my gov't, or most of it at least (as in I don't hate all drug co's all the time). Hey, at least I'm consistent!

And to be honest, I don't give a flying fart what the package insert says (okay, yea, I say this with the on caveat being that I already know what it says ). Although the naloxone certainly must be doing something when injected, it does not stop people from getting high/feeling the effects from their bupe.

However, clinicians should be aware that some opioid-dependent persons, particularly those with a low level of full mu- opioid physical dependence or those whose opioid physical dependence is predominantly to buprenorphine, abuse buprenorphine/naloxone combinations by the intravenous or intranasal route.

I.e. why they use(d) subutex and not suboxone when transfering patients from their full agonist to their suboxone. buuuuut when there is no full agonist present in one's system, the naloxone doesn't seem to do anything (in terms of antagonizing the bupe).

WHY why did I even post in this thread... I don't even know what we're talking about any

annnd finally jus cause I like to be a dick I know you know how to edit your posts instead of double posting missy

 

[SaosinEngaged]

I'm curious as to the outcome of the OP. Tapering down with your DOC is only going to happen illicitly and the OP was unable to do that. As a result, Bupe/'Done are the only feasible options and I'd be STUNNED if the doc prescribed him hydromorphone in any form. It just doesn't work that way.

When I couldn't taper down my Oxy usage illicitly, I illicitly turned to Bupe lol. Bupe is the answer here, IMO. It just works.