Suboxone and opiate overdose

[whippa craka]

Say somebody witnesses a heroin/oxycodone overdose. If the overdoser had a suboxone strip placed under his/her toungue would it help or hurt his situation? Save the persons life? Or Kill them?

I figure any response is good for harm reduction.

 

[tentram]

there have been people who've been brought back with suboxoine (nalaxone in it), having it stuck under their tongue; from a couple isolated accounts here on bluelight over the years.

by no means should this be promoted as a safe and practical measure to be used when an overdose has occurred. calling the appropriate emergency contacts immediately is imperative to save the persons life. relying on the buprenorphine is too risky itself and a possibility it may increase the chance of being a fatal overdose.

 

[whippa craka]

I agree. I was just thinking of this one day, as suboxone is becoming more and more available every day and had a friend overdose.

Opiate users often will have access to Suboxone. Opiate users overdose. Suboxone = Life Saver? I figure if there were responsible individuals who knew this information, there's lives that could have been saved. Is there any kind of documentation or higher input anybody has?

From what I know bupe has higher affinity then most opiates, including heroin (i'de have to double check), but obviously I am not assuming that means it would help. If it is beneficial, when isn't it? What if theres benzo's in their system, does it suddenly become not worth it? All questions are food for thought but I can imagine only a handful of people have practiced resuscitating someone with suboxone.

 

[Swimmingdancer]

I doubt sublingual administration would be fast enough to save anyone with a serious life-threatening OD, like someone who has OD'd on a fast-acting drug like IV heroin. This topic has been discussed many times already and there are many disadvantages and risks to using buprenorphine or Suboxone in an attempt to reverse an OD.

There is a whole huge thread on this subject in OD. Using Suboxone like Narcan?

Whippa craka - if the person has taken benzos giving them bupe could do more harm than good. That's one of the problems, you can rarely be certain what drugs someone has taken.

 

[Pagey]

Seems unlikely. I'm sure there have been cases where it worked but I wouldn't count on it, especially if the suboxone was given orally...there would be more of a chance if it was injected.
I think it's just smart for any strong opiate user to keep Naloxone handy. That's what they would inject you with were you to call an ambulance. I can get it at needle exchanges and it's saved my life a couple times. Really worth having around. If you don't though, the best thing is really to get an ambulance.

 

[SteeleyJ]

It's possible but you needto consider the legal ramifications here aswell.... if someone is overdosing and you gave them more drugs ( even for a good cause ) you might be held responsible by uninformed people for giving sub ( more drugs in thier eyes ) instead of calling paramedics.

 

[vajeeh]

This legit situation happened about four years ago with me and three friends. I was driving back from Baltimore, and we all did our shots after stopping in a parking lot somewhere. My friend in the front seat had a bit of a lower tolerance than the rest of us, but did the same amount as we did. After getting back onto the road, within maybe 3-5 minutes, he had increasing difficulty staying awake, with breathing, etc. He went completely out. I was on the highway and I had to keep driving, thinking they would be able to wake him up at any moment.

We all started screaming at him, we poured water over his head, the guy behind me starting twisting his nipples, smacking him, flicking him in the nuts(...), but nothing seemed to work. I asked if my friend in the backseat had his sub script with him and he did, and I said we should put it under his tongue. The guys in the backseat managed to place it in his mouth, we presume under his tongue although you can't say for certain. We held his head tilted back a bit, both opening his airway and preventing the suboxone from moving too much. After a moment he started to breathe, but with difficulty, and he went from full-on out to an extremely deep nod (His breathing started to regulate, however eradicate, but we could tell oxygen was now being exchanged) but he was still unconscious, sorta like sleeping. he stayed like this for about 20 minutes, slowing his breathing progressively regulated and he eventually came to and woke up, however he started getting ill. He was pissed that he was now extremely dopesick and kicked into withdrawals, and he was mad at us for the rest of the day. Go figure.

 

[tentram]

ungrateful prick. he's so lucky to be alive having read that. i'm glad he got a few flick to the nuts in this case

sounds as if it mightn't necessarily had been the bupe which brought him back, perhaps he just came through. and as time has gone on and more bupe entering his system it's stripped the heroin from him and leaving him sick. who really knows, there's not a definitive way to find out unfortunately. he's just lucky to be alive and not another OD victim.

 

[Swimmingdancer]

A couple of my posts from the thread I linked above in case people aren't bothering to read that thread:

It's interesting, there are some case reports about people using Suboxone to reverse heroin overdoses. It's funny because the researchers writing up these reports don't actually know as much about buprenorphine as we do here on BL, for example one said when someone was injected with Suboxone that it must have been the naloxone in the Suboxone that reversed the overdose, which I disagree with because buprenorphine has a higher binding affinity than naloxone. They did make similar conclusions to mine about why it would be unsafe to administer bupe in an OD:

Although IV injection of Suboxone was technically a misuse of the medication, the lay responder’s actions successfully reversed the overdose and likely saved the victim’s life. However, given the risks of IV administration of buprenorphine/naloxone sublingual tablets, we do not advocate for such an approach to be used by other drug users or their acquaintances. Indeed, IV administration of buprenorphine/naloxone introduced more opioids to the victim’s body and put the victim at risk for complications from the non-sterile injection of a medication that is intended for sublingual administration. Additionally, if the overdose victim had been under the influence of any other central nervous system depressants, such as benzodiazepines, the addition of buprenorphine to the patient’s system could have exacerbated the overdose event.

- Because it is a partial agonist that adds in additional risks like having it add to the respiratory depression (you can never be sure what drug(s) someone has taken and naloxone is safe regardless whereas bupe is not), or overdosing on the bupe itself.
- Precipitated withdrawal from bupe would be much longer-lasting than with naloxone. Naloxone has a short duration of action.
- Increasingly in some places naloxone is available outside the medical profession.

Also obviously given someone bupe is no substitute for real medical attention and it is very important to call an ambulance. I do not recommend treating ODs with bupe.

 

[BlueHues]

Naloxone is really only active IV....Bupe itself is a partial antagonis itself and could potentially push whatever full agonist the person is ODing on off the receptors and bring them out of it...

I know, for myself, that in the midst of a full-blown habit, bupe on it's own would probably bring me out of it....considering the fact that, when I was prescribed subutex(straight bupe) and I took it 20 hours after my last dose of heroin, it induced withdrawal.....

But the fact that suboxone is not designed to be used this way, makes it iffy....

Buoe on its own won't induce withdrawal in all opioid users, and with the 8mg of bupe competing with the 2mg naloxone, who really knows?

But if somebody was straight falling out, that 2mg naloxone might be the only thing that would save them in an overdose event, so who can really say? What if the nearest ambulance was 20 minutes away...they could be dead or irreversibly brain-damaged by then....It's a tough call definitely, but I wouldn't completely rule it out in an emergency....

 

[Swimmingdancer]

What if the nearest ambulance was 20 minutes away...they could be dead or irreversibly brain-damaged by then....

This is the only time I would consider using it to treat an OD.

 

[Bob Loblaw]

I've known several people--myself included--who have had this done successfully. It's certainly not the best thing to do though.

 

[BlueHues]

Yeah, for sure....If somebody is legitimately ODing, I would never consider it an alternative for calling the paramedics.....Once your brain stops getting oxygen, there's not that much time....

I've brought a few people out of it with CPR, but even in that short time of doing chest compressions, they could have ODd....I just didnt want the cops to show up was the thing....which is why, a lot of states have laws that if you call 911 for somebody ODing, you cant be arrested for drug possession....

 

[SaosinEngaged]

Using Suboxone to reverse an OD should be your worst case scenario. In other words, an ambulance is a long way out or you live far away from a hospital and you don't think you or your friend will make it, or some other such scenario where it may be something of a last resort.

If the option or ability to call an ambulance/get to the hospital presents itself, that should always be prioritized.

 

[killacaine4209]

Narcan (Naloxone) is a junkies best friend, though I've seen stone cold junkies actually hurt the folks that saved their miserable lives because the shot was wasted. Bad craziness, indeed. I don't think suboxone would help an overdose but hell, stranger things have happened........