Bupe Using Suboxone like Narcan?

[sixpartseven]

No. It would be just like having Naloxone in it. The buprenorphine is what blocks other opiates and causes precipitated withdrawal. If Naltrexone was in there instead of Naloxone, Buprenorphine would still have a higher affinity to the receptors, negating the Naltrexone just as it does the Naloxone.

 

[Free_Man**]

^^ oh ok - ... is it true that naltrexone would work if administered sublingually ? (if it wasnt taken with bupe)

where as naloxone does not work sublingually right ? (even if taken on its own)

and yeah i knew that bupe is the one with the highest affinity - i just wasnt sure if maybe naltrexone was a better competitor than than naloxone - i heard its much stronger...

 

[sixpartseven]

I really don't know the answer to that. Sorry. I'd assume it's no different in that case. What is different about Naltrexone compared to Naloxone is it's half-life and duration of effects. It's longer than it is with Naloxone.

 

[Free_Man**]

Therapeutic considerations
Pregnancy cat. Category B3 (Australia)

Legal status Schedule 4 (Australia)

Routes oral
hepatic

"It is given orally by physicians to help reduce the side effects of opiate dependence"

found this from wiki --

 

[sixpartseven]

Oral administration is different than sublingual. Oral is swallowing it. Sublingual is holding it under the tongue.

 

[Free_Man**]

Oral administration is different than sublingual. Oral is swallowing it. Sublingual is holding it under the tongue.

yeah good point . i do know that though. i just thought it was interesting that naltrexone does work orally.

shame bupe doesnt. then they would be on to a winner...

although having said that good for you guys that they dont really have a clue eh ?

 

[Captain.Heroin]

If you were to IV it, it would take longer to prepare, but would come on quicker, so it would take about 10 minutes as well, unless you have some secret method to prepping a safe shot of Suboxone in under 10 minutes.

LOL! I have a secret method! I thought it was pretty easy to prepare a shot of Suboxone in under 10 minutes. Take a pill crusher, crush some up. Dump into a spoon. Draw water up with a needle, squirt it in. Throw a cotton in and draw back (I normally took 3 minutes to let it settle because I normally wouldn't have to use a cotton that way, but in the event of an emergency I probably would've just thrown a cotton in and filtered real quickly that way to get at least most of the solution back instantly). These steps won't take more than 2-3 minutes at the very most if you know what you're doing.

I mean even when I micron filter my solution, I don't think it would take me 10 minutes to do that. I'll time myself next time if you would like me to.

It's not the best method to use to reverse an OD. You are better off calling EMS, but in a pinch or if you're extremely paranoid, it works.

You're correct; it's not the best method, please visit the ER or call 911. If this isn't an option because help is too far away (more than 30 minutes - 1 hour) then you obviously have a way to prevent an OD. It's just not desirable to use Suboxone in the event of an OD. You would have to use an astronomical amount of an opiate to OD if you had any sort of opiate tolerance, or use simply way too much as a first time user...unless you combined it with other CNS depressants.

In the event someone is ODing, and it's not just on opiates but other sedatives as well (benzodiazepines, barbiturates, alcohol, etc), giving them Suboxone may do more damage than help.

Unless you are sure the person has overdosed on opiates alone, giving them Suboxone isn't a wise choice.

Overdosing on buprenorphine is next to impossible, unless you have no tolerance.

This is very true, but overdosing on buprenorphine is definitely a possibility if you've taken a high dose of another downer like a benzo, for example. This is why getting professional help is the best route to take, as you have said.

But you are essentially correct in what you have said all together. I just think I could prep a Suboxone shot in < 3 minutes if needed.

 

[monstanoodle]

I'd just like to say that I'm glad this is being discussed. Harm reduction is the name of BL's game after all
I think it could be a good idea to ask an Opiate Replacement Therapy expert about this and try get a straight answer. Because, as already said, it sounds like it would work in theory but it would be nice to be sure and have an exact answer as it could actually save some lives either way (if it's found out to be effective or a way to make things worse - atleast it would be known and could then be suggested to be acted upon or not).
So yea, if anyone, infact a few people, could ask their personal professional about this then we could get a good answer (hopefully anyway).

All in all, a good discussion has taken place

 

[Free_Man**]

^ a good answer for what ?

 

[alloker]

I know it's already been said IVing Suboxone in the case of opiate OD would work once, but I just wanted to add another "yes." I did it to my brother once after he ODed and he came back (not feeling the best might I add). Again I'd say it's better to just call 911 in a situation like this because as Captain.Heroin said you really don't want to take a risk with someone's life; but in a pinch this will work. I think every IV drug user should know the basics of CPR, it can help out a lot in nod type situations when breathing has ceased.

 

[sixpartseven]

yeah good point . i do know that though. i just thought it was interesting that naltrexone does work orally.

shame bupe doesnt. then they would be on to a winner...

although having said that good for you guys that they dont really have a clue eh ?

Bupe - and naloxone - works orally, too, it's just the bioavailability is so low compared to sublingual (10% compared to ~35% for bupe, not sure about naloxone, but it does work orally) that it's pointless.

 

[Free_Man**]

^ Ok got ya - i knew the ba for bupe was low - not sure about naloxone either

6/7 can u clarify is it that the people who approved suboxone (the FDA ?) dont know pharmacology ? or is that they think opiate users dont know ?

i say this with refrence to it being pointless to add something like naloxone in with bupe - when we all know that bupe will kick its ass out of there...

 

[monstanoodle]

^ a good answer for what ?

Whether in emergency situations, where no other options are available, if it's safe and effective or just plain dangerous to take Buprenorphine to bring someone out of an OD. I thought that was clear to be honest

 

[Free_Man**]

Whether in emergency situations, where no other options are available, if it's safe and effective or just plain dangerous to take Buprenorphine to bring someone out of an OD. I thought that was clear to be honest

it is now lol

i would ask my GP but i dont want him to start thinking crazy stuff about me - ill ask one of our local pharmacisits if i can ...... im sure we can discover the answer to this

its interesting to me .... i mean lets say u had X ammount of heroin attached to mu receptors - and u introduced Y amount of bupe

how much of Y would you need to get rid of all of X ?

i mean whats the ratio ? is there a ratio ?

obv you would be looking to reduce opiate depression of CNS not increase it.... how would this work ? would it work at all ?

i think CH made a good point , its only worth considering , if you could be sure that opiates where the only CNS depressant in the patients system - if u added a powerful opiate , to some one who had taken a shit ton of benzos and booze and opiates and had almost stopped breathing.....

.......then its good night sweet prince.....

i still think its an interetsing question....

 

[monstanoodle]

Yea Cpt. H is a wise ol' chap indeed

When I tried to kick with Buprenorphine my specialist told me that you can break through 2mg, so I'd imagine that 4mg would be just enough to rip out the [Opiate/Opioid of choice] and replace it without it being too much.
Though I'd guess that breaking through and administering post-OD would be a different kettle of fishies altogether.

But yea we needn't ask anyone that if the person ODing has loads of other CNS depressants in the mix then it's definitely not the way to go about it. Naloxone/Naltrexone and Flumazenil, for example, would be required under the supervision of ER staff.

 

[Free_Man**]

yeah it goes without saying of course , but it would be difficult to be sure what someone had taken - unless you had been with them all day - know what im sayin man ?

i mean if there in Over dose - you aint exactly gonna get a straight answer - dont mean to be sarcastic just making a point like

 

[Eight0Eight]

I can't believe that the UK and US still haven't started distributing Narcan at needle exchanges.

I just don't see a reason why NOT to do it. As long as junkies where told that it should be used in CONJUNCTION with 999/911 then whats the problem.

I used to get it at an exchange in a different country, they didn't advertise it at all (even though it was free), and you had to ask for it especially so I don't even know if they were allowed to be distributing it. The scene was a hell of a lot safer though - there was always a vial on hand in case things went tits-up.

 

[sixpartseven]

^ Ok got ya - i knew the ba for bupe was low - not sure about naloxone either

6/7 can u clarify is it that the people who approved suboxone (the FDA ?) dont know pharmacology ? or is that they think opiate users dont know ?

i say this with refrence to it being pointless to add something like naloxone in with bupe - when we all know that bupe will kick its ass out of there...

I can't say for sure, but my personal opinion of it is that the FDA knows that most opiate users know what Naloxone is used for, and they also know that most opiate users aren't very well educated on receptor affinity, so they took advantage of that situation and put Naloxone in Suboxone, knowing it would scare the shit out of anyone who knew what Naloxone does.

It's easier to say "Naloxone will cause precipitated withdrawal when IVed" than it is to explain to everyone that Buprenorphine does the exact same thing because everyone already knows that Naloxone will do that, and saying it about Buprenorphine might even scare some people off of it who could potentially benefit from treatment with Buprenorphine.

Again, this is all just speculation, I do not know the real answer to that question. I don't think anyone really does, because to us here in OD at least, it makes absolutely no sense why they would put Naloxone in it and there is no reasonable justification for it. Any answer the FDA gave would be silly in our eyes.

I can't believe that the UK and US still haven't started distributing Narcan at needle exchanges.

Where did you get that idea? Whether an exchange hands out Narcan depends on the organization that owns it and if they choose to give it out or not. There are some sites in the US (I can't speak for the UK) that distribute Narcan.

I might be wrong, but I could swear I've heard of people here on BL getting Narcan at their exchange.

 

[Eight0Eight]

I haven't heard of it being distribute anywhere in the UK or US, unfortunately.

I might be wrong - but it certainly isn't the norm (which it should be imo).

 

[sixpartseven]

I'm pretty sure a few exchanges in New York and New Jersey distribute it, or at least, they did distribute it at some point in time.