Suboxone vs. Pain Meds in General

[painenduser]

Hey Old Friends,

Hi everyone, and welcome all Greenlighters! Hey guys, sorry it's been a while since I have posted. I have a lot of personal crap going on in my life and not much of it pleasant which I will save for the Dark Side forum, unless of course someone asks, then watch out! LOL So, anyway, I have a question that I have been asking myself for a while now and yet to find a good answer to. As those of you who know me, you know that I have been batting severe pain for quite sometime and probably will for the rest of my life due to my issues, however, I have run into a bit of a conundrum. You see, I have been on pretty much every pain med and have been having trouble finding one that does two things. 1. and most importantly, relieves my pain. and 2. allows me to function with out being zombified or becoming completely hyper as if I am on speed (never done speed so I use that as a euphemism). I have found one medication that fit's this bill, Opana. Problem is my Pain MGT Dr seem's to think that the dose or 30mg ER is too high for me and I have been on both long enough to know that 40mg Opana ER (btw the Opana dosages are BID). Now, last month my Dr left me in a bind, you see I see him through my hospital's charity care because I am on State Aid (ok let's face it, I can't work and SSI is being a pain in the ass and I am my lawyers have been fighting my case of almost 2 years now, but that's a topic for another thread) I am on welfare, so my Pain MGT Dr see's 25 patients a month for their clinic completely free of charge so we only get to see him once a month regardless of need, and there is no way to get any pain mgt help unless you try and make an appointment with his private practice of which will cost me $175 that I do not have and charity care will not cover that. I am also guessing due to the laws in NJ, he can only write scripts for 4 weeks at a time even if their are 5 weeks in a month because I have asked in the past about this and he says, "well you just have to try and stretch your medication out." ......... Umm easier said then done when your in serious pain! The problem is that last month he went on vacation the end of last month beginning of this month so I didn't get to see him again until the 11th of this month This means that I was about 5 days short of my meds which had I not had a good connection, I would have spent 5 days in major opiate withdrawal. My only connection was to get Subs which I used for the 5 days. They were 8x2 BID. Now here in lies my question. The sub's did a decent job at controlling my pain. Certainly not as good as the combo of Opana ER 30mg and Dilaudid 2mg QID, but it was well enough for me not to have any adverse withdrawal symptoms and I didn't get the histamine itchies as I do with my regular meds. I do not believe I have an addiction to Opiates other then the obvious medical addiction from being on them for the last 4 years, I do not misuse my medications, I don't do anything illegal with them or take them in any abusive way other then maybe take an extra or two when my pain is more severe then usual, which I am pretty sure anyone would. I guess my question is, can, would,should a Dr prescribe Sub's as an alternative to regular opiate regiment? I am assuming one down side to doing this would be when I go for my shot treatments in my back, where I am given Fentanyl and Versed IV prior to the procedure, the naloxone would render the Fentanyl useless and I have heard, but not substantiated, that naloxone can cause severe withdrawal symptoms when opiates are taken with it. Has anyone heard of Sub's being prescribed for pain mgt in person of whom do not have an opiate addiction? Is there a medication that has just the buprenorphine? As of now, I am back on my normal regiment, though it took about 2 days to get the naloxone out of my system in order to get back on Opana and dilaudid. My first couple doses did not give me any type of withdrawal symptoms as I heard it could, but they just we not very effective until about 48-72 hours post sub's. I have not yet discussed any of this with my Dr., I wanted to ask here from people who may have had some experience with such a thing. I would love to hear some advice, suggestions, etc... Just please do not give the advise that, well maybe this is the time to get off pain meds... Sorry but with the pain I am in this is just not an option, trust me, if it were, I would have explored this a long time ago. My pain is just something I live with and have for 4 years and according to my Dr's it's not likely to go away without a surgery that I am scared shittless to even consider. So I really would just love for some advice on the questions at hand. As always, I thank my friends at Blue and always look forward to your great suggestions and general conversations!

Thanks guys, Lot's of Love,

~Pain

 

[alovesupreme]

yes, there are definitely doctors in my area (USA, somewhere between the east coast and the west coast) that are beginning to prescribe bupe alone for pain management, or switch their patients on full-agonist medications over to bupe. they feel it has significantly less abuse and diversion potential (this is maybe half true), and that it's easier to wean people from. there are formulations with only bupe, no naloxone, see subutex, temgesic, etc. these are usually prescribed for pain. suboxone is typically prescribed only for opiate dependence (or if they suspect/know you have IVDU in your medical history). there are some potential issues with sub and anesthesia if you are planning to have surgeries done, but your anesthesiologist for the procedure can work it out, they just need to know beforehand so they can know to use sufficient quantities of agent to keep you under.

my girl had her gallbladder removed on suboxone, and only received suboxone for post-op pain - basically told to dose smaller amounts more frequently (maximize norbupe, minimize blocking) with total daily amount maybe two or three times her usual maintenance dose. no problem except man she was pissed when she saw the fat morphine drip the old lady next to her in the recovery room was on!! (she did use some street dope on top of the sub for the first four or five days subsequent to surgery but that was probably as much attributed just to having an excuse to do it). i'd expect most doctors would be more than happy to switch you over to bupe from stuff like oxymorphone, hydromorphone, oxycodone, etc.

 

[painenduser]

Wow......What happened to Blu? This could be the very first time that I have had a post with 186 views, and not a single reply.... Did I mess up and put this in the wrong forum? Are there some new rules around here that since I haven't been around in so long I am completely unaware of? Something is way off, this is not the Blu I used to know. I sure hope to hear something from someone soon. I hope everyone is doing well!!!!

 

[painenduser]

Wow......What happened to Blu? This could be the very first time that I have had a post with 186 views, and not a single reply.... Did I mess up and put this in the wrong forum? Are there some new rules around here that since I haven't been around in so long I am completely unaware of? Something is way off, this is not the Blu I used to know. I sure hope to hear something from someone soon. I hope everyone is doing well!!!!

HAAAHAAAHAAa Would you look at that, alovesupreme talk about timing! LOL Thanks bunch for your post. That was helpful info. I was not aware that they made meds with just the bupe. Can you or someone explain to me what exactly is the difference between Bupe and other pain relieving narcotics? Does it even count as a narcotic or opiate? I know that sounds like a damn silly question, but I am just not really sure how to ask it. The Subs and Bupe are just fairly new to me so I really don't have a good understanding about how it works. I know how the naloxone works, but not the bupe.

Thanks again bud!

 

[alovesupreme]

in brief: things like oxycodone, oxymorphone, hydromorphone, etc are "full mu agonists". you can kind of think of this as, they want to bind to the mu-opiate receptor in your brain and activate it "fully". this is generally responsible for the pain-killing effects but also the strong high that these compounds give (and dangerous respiratory depression in high doses). a chemical like bupe is what is known as a "partial mu agonist", they also bind to the mu-opiate receptor but in a sense don't activate it as strongly as full agonists do. so in essence you get [most of] the pain relief without as much potential for respiratory depression and the strong high like with traditional opiates (not that bupe can't be abused for a high in the opiate-naive, but it's nowhere as euphoric or noddy as your typical full agonist. also it has a ceiling dose of around 32 mg and interesting pharmacodynamics between itself and its major metabolite, norbupe, that tend to discourage excessive dosing aka abuse). but it is definitely a narcotic and definitely an opiate, just a bit different from the ones you may be used to.

other interesting properties of bupe are that it has a very long half-life so it lends itself easily to once-daily dosing and makes tapering off easier. also, you should know that bupe has very high _binding affinity_ to mu-opiate receptors. this is a different concept from full and partial agonism. maybe a metaphor might be, how tightly you grab the switch versus how high you're dialing it up. basically, a compound like bupe with high binding affinity will (1) "kick off" compounds from mu-receptors with lower binding affinity - even if they are "fuller" agonists and (2) prevent subsequently ingested mu-opiate agonists - again even if "fuller" agonists - with lower binding affinity from ever binding in the first place. property (1) is why you get "precipitated withdrawal" when you start using suboxone while still under the influence of a full-agonist opiate. property (2) is why you are probably finding that your usual regimen of meds is not really feeling like it usually does until 3,4,5 days after your last dose of bupe.

most mu agonists have lower binding affinity than bupe. pretty much the only compound with higher binding affinity to the mu receptor used in human medicine is fentanyl. several others are used to anesthetize large animals, but are too powerful to be accurately dosed for human use (edit: i just learned that they're starting to use sufentanil in surgical anesthesia now, but it would never be used outside a hospital setting).

now, suboxone is a combination of bupe and naloxone at a ratio of 4:1. you'll hear all kinds of silly things about the naloxone in there. the manufacturer tells you that it's to prevent it from being abused via IV (though that's not true, because bupe has _stronger binding affinity_ than naloxone!) some people will tell you it gives you headaches and makes you feel ill (i've never had this happen, but your body may vary) some people tell you this is what causes precipitated withdrawal (again, not true, it happens because the bupe has _stronger binding affinity_ and a full agonist is displaced by a partial agonist: the sudden switch from high to not-as-high feels like WDs). My personal feeling is the real reason why it is there is because, if you consume the suboxone sublingually, as directed, the naloxone _will_ act peripherally in your gut and help prevent side effects of opiate use such as constipation, which is nice if you are on a long-term regimen, say, for maintenance of opiate dependence.

i think suboxone is the nearest thing to a miracle E-Z opiate detox drug on the market today. as a pain management drug, reviews are mixed. some people find it works really well (probably people with tolerances in the low-mid end of the scale) and others say it's not so effective (so they'd rather have oxy, basically) but it's not always clear what the motivation of the respondent is (pain management, recreational value, both?)

also, note, suboxone is a branded drug so it is expensive for people without insurance. there should be generics available of both subutex and suboxone at this point in time.

another option for you may be methadone? it's also starting to show up as a PM drug, but that's a completely different discussion. methadone is cheap, cheap, cheap.