Morphine & Buprenorphine

[Toodlepip]

I’ve taken morphine for roughly 8+ years. I once had zomorph & oramorph replaced with a high strength Buprenorphine patch. The first day on it was a living hell. The withdrawal symptoms were awful. I left work early that day shaking, sweeting etc. I told my GP a Lie, I said my pain wasn’t under control wearing the patch. God forbid if I was seen as a druggie/another addiction problem patient of which has become standard across the medical profession these days

Is this normal to experience bad withdrawal symptoms when morphine is replaced with a Buprenorphine patch.

 

[Jabberwocky]

It depends on two things - were you in withdrawal when starting buprenorphine or maybe had some precipitated withdrawals, or you simply had high tolerance that buprenorphine couldn't "cover" and you were withdrawing until your tolerance fell to a level that buprenorphine could cover. Also, patches take time to release buprenorphine and buprenorphine builds up in the system, so there is that to consider.

 

[Toodlepip]

Wow…….. I never expected all those question or maybe factors as to why I suffered so badly

I cannot remember the strength of the patch but I know I felt whoozy
Having a major tolerance to opiates maybe the patch wasn’t strong enough.
Feeling how I did would this be unusual.

Basically the synthetic & natural opiate when you swop one for the other you wouldn’t notice the difference. I had been opiates 20 years, codeine since my teens then morphine 8 years ago.

 

[Jabberwocky]

I would suggest that you look up buprenorphine and its interaction with other opioids. In a short gist - buprenorphine is a partial agonist at the mu opioid receptors (most important regarding your question) and it doesn't "turn on" the receptors fully. That is the reason it has a plateau regarding strength/maximum potency, and I would lie if I was to tell you that I am sure what it is. But from what I have read it is as potent as (max) ~150mg oral morphine. Buprenorphine also has a high affinity for mu opioid receptors and will displace most other opioids from the receptors. High affinity means that it is pulled to the receptor stronger than other opioids. You can visualize the receptor as a "metallic cup" and buprenorphine as "a magnet which that metallic cup is drawing to itself". In this analogy, buprenorphine will fill the surface of the cup (receptor) and will displace all other opioids that are being drawn to a receptor or are at the moment filling the receptor. Because morphine turns the receptor "full on" and buprenorphine does not, when buprenorphine displaces morphine from receptors opioid effects are reduced...and thus leading to instant withdrawal. I hope I am painting a coherent picture here.

That is why it is important for a person to already be in withdrawal when switching from morphine to buprenorphine. It also means that even the biggest effective doses of buprenorphine will not suffice if a person has a tolerance higher than 200mg of oral morphine and the person will have to endure some withdrawal in the process of crossing over from morphine to buprenorphine. I don't know what strength of morphine or patches you were using but if the higher dose of morphine was used and patches were not sufficiently strong you will have withdrawal while switching.

I hope I have made some sense. I am not a doctor or a pharmacist and my knowledge is bound by my internet browsing skills and personal experience. But yes, buprenorphine is not a simple opioid that is for sure.

 

[Noctthis]

I had a similar experience when i was switched to the buprenorphine patches the main reason for it in my case is that the patches take three days to properly get into your bloodstream so if you switch straight from the morphine to the buprenorphine you essentially go three days with nothing

 

[Toodlepip]

That was so so interesting and after reading your post twice I’m still trying to get my head around the biology of it all.

This is how I’ve always understood what opiates do. Please correct me if I’m wrong. In order for me to understand properly i need information in more simple English. Yes I’m blonde lol and proud to be dizzy ha ha

So………. Adeles Brain Master class lol. (Drum Roll please

A normal brain that is unaffected by Medical negilance e.g Over prescribing without regular patients reviews. The brain is able to create a chemical naturally called endorphine. This feeds the receptors. The results is a stable happy normal person.

When a doctor over prescribes opiates. The chemical that supplies the receptors has relied on Morphine for the happy feeling. No more does the brain need to make/supply endorphines. With a regular dose it isn’t long before a dependency starts due to a doctor.

A brain experincing withdrawal has basically Forgotten how to make endorphines. The brain cannot function nor cope,
Reducing very slowly and done the right way shouldn’t feel any withdrawal. To produce this natural chemical again your brain must heal slowly. Any withdrawal will cause patient to fail

This is my knowledge. I understand that whilst wearing the patch any opiates taken orally Will be useles.


I was taking over 200mg of morphine at the time of replacing my medication.

Thinking about how I did it I’m quite sure when my 12 hour extended release medication had run out after 12 hours I applied the patch.

There was no withdrawal. 1 hour after wearing it I felt drunk. 5 hours later I was sweating, runny nose, unable to function. I guess I should of entered a more of withdrawal before applying it. My 12 hour slow release is visible in my stoma pouch after 4 to 5 hours.
My appointment with the pain team is due. I’m dreading it if they stop my zomorph, it’s become my life.

I currently take 60mg Zomorph x2 a day. That’s it. What strength would you recommend for me

 

[Toodlepip]

I had a similar experience when i was switched to the buprenorphine patches the main reason for it in my case is that the patches take three days to properly get into your bloodstream so if you switch straight from the morphine to the buprenorphine you essentially go three days with nothing

For that reason I would avoid it like the plague. I am terrified of even the slightest withdrawal feeling. It’s like a phobia now. I am unable to behave in a safe manner due to desperately wanting that yucky feeling to end.

I have maybe experienced bad symptoms in the past, a GP who didn’t care at all for my mental health. I have a new doctor now so maybe discussing my situation with her she may help me. My big worry is not putting me on the correct dosage if I go onto patches. I don’t want to suffer Like before.

I have no more patience with my pain, sometimes it just gets too much, especially when a doctor has more care for his monthly targets to meet in removing people off opiates

 

[Xorkoth]

If you're dependent on another opiate, you have to be in full withdrawal before you take buprenorphine, because it kicks all other opioids of the receptors instantly, and is itself only a partial agonist, so it causes what is known as precipitated withdrawal (PWD). I can't believe your doctor wouldn't have known that or told you not to start the bupe right away. So irresponsible and/or ignorant.

 

[Jabberwocky]

To produce this natural chemical again your brain must heal slowly. Any withdrawal will cause patient to fail

To answer your post simply - kind of. Not to go into details (that in reality, I don't understand fully as opioids affect much more than one system in the body) I would only add that withdrawal is a necessary part of the process of "healing". Lack of exogenous opioids starts the withdrawal as the opioid tone is reduced in the body. The body starts to adapt and tries to reach new homeostasis and until homeostasis is reached we feel physical withdrawal. Higher the tolerance (amount of exogenous opioids needed for regular functioning) more body needs to adapt when opioids are stopped and thus more intense the withdrawal is. If we keep it simple that will suffice. ,

Edit - I can't make any recommendation about the strength or type of medications you should take. That would be very irresponsible. I am very sorry that you are going through all this. I hope you find a solution that makes your life easier. Please inform us of your progress.