Bupe Using Suboxone like Narcan?

[Swimmingdancer]

Fascinating thread. I always thought that the theory behind using Suboxone to pull someone out of an OD is that the Sub will rip the heroin off the receptors. I don't think the naloxone is a big factor, or at least not the main one, the buprenorphine itself is a partial antagonist. Even if the bupe doesn't put/keep someone into precip withdrawals, and they experience the effects of the bupe, it is very hard to OD off bupe, especially if you have an opioid tolerance, because of bupe's ceiling effect on respiratory depression. It would be really nice to know once and for all the safety and efficacy of using Suboxone in this way.

Unfortunately, if someone has OD'd on IV heroin, I highly doubt they would be able to self-administer the Sub. People don't generally realize when they're Oding, they just go unconcious.

One thing I have seen help people in WD without Narcan is giving them oxygen. I have been pulled out of OD this way without Narcan. Might be a good idea to have some oxygen on hand to give someone while you wait for the ambulance, correct? I know one can get small portable canisters of oxygen.

I am also curious about what xburtonchic mentioned: Why does buprenorphine even cause precipitated withdrawal?

Aren't its agonist properties stronger than its antagonist properties? And why do some people get precip WDs for like 30 min and others for 12 hrs? Is it that people with a higher tolerance to opioids are more likely to get precip WD? Like the bupe puts them in WDs by ripping the prev opioid off the receptors and then the agonist properties of the bupe is not enough to replace the prior opioid? Do people who were on longer-lasting opioids get longer-lasting precip WDs? Is it like say they still have some methadone in their system, the bupe rips it off the receptors, more methadone tries to go on the receptors, bupe rips it off again and so on? Are the agonist properties of bupe longer lasting than the antagonist properties? As for why people can take some bupe, go into precip WD, then take some more a few hrs later and feel fine, is it because by the second dose their receptors are completely free and therefore there is nothing to rip off them, it's just like being free of other opioids by that point?

Sorry I know that's a ton of questions It's really interesting to me because of the huge difficulty in switching from methadone to bupe. I would awesome if it was possible to predict that someone could take bupe after methadone and only be put in precip WDs for like an hour, many people would prefer that to going through reg WD for 72 hrs+ before they could take the bupe. Or if it was possible to take another dose of bupe to end the precip WDs?

PS - If someone is that worried about reporting an OD in case they get busted (which in most places is very unlikely), they can always call 911 and tell them exactly where the person is, hide the dope, and hide when the ambulance gets there and watch from a distance to make sure everything's ok. I had someone do that to me before, and while not as safe as staying with me, it was sure a hell of a lot better than letting me die.

 

[junkieman412]

A friend of mine was oding, turning blue the whole nine. I put half a sub under his tongue and slapped the shit out of him. After about 15 minutes he snapped out of it. I was about 2 mins from the hospital it wasnt like i was counting on the sub but shit i think it worked.

 

[junkieman412]

^Look at the article I quoted two posts up... It seems that it is far from guaranteed.

it said they found her the next morning though. Face down in vomit.

 

[xburtonchic]

it said they found her the next morning though. Face down in vomit.

Yeah, she was already a goner by then... I'm assuming 8 or so hours would have passed before they gave her the bupe. Of course that's going to cause some issues, the overdose is already done and the poor girl already has brain damage... that is screwed up though. If you introduce someone to IV heroin (which I would never in hell do), you need to stay with them to make sure they're okay and nothing bad happens. You don't know how someone will react to their VERY FIRST DOSE of IV heroin... even in the smallest amount, it could be juuust enough to cause an overdose. That article pisses me off though for real...

 

[-Guido-]

You could in a pinch. One of the reasons me and my dope fiend friends would always have Suboxone stashed on us or nearby. The Suboxone contains Narcan (Naloxone).

I remember when I OD'd, the injected me with Naloxone and it in 5 seconds my eyes opened wide, my pupils dilated, my muscles tensed up, and my entire body felt like it was being dipped in liquid nitrogen. My heart rate increased, my body temperature shot up, and I got a bit anxious. I remember the EMT guy asked me "How do you feel?" With my best poker face I tried to play it off as I was fine to which I think I did good. By the time I was in the ER waiting on a gurney the Nalaxone wore off and I started to nod again, although this time I was prepared to fucking run if they opted to give me any injections.

The only problem is eventually you might need more depending on how bad the OD is, I started nodding and was fine once the Nalaxone wore off, but someone else, they might drif into unconsciousness again and require another shot.

Of all the times I overdosed, that one time was the only time they gave me Nalaxone. Every other time, they just gave me Oxygen from the tank with a mask and I was straight. I was conscious in the back of that Ambulance but I'm pretty sure that EMT wanted to ruin my fucking day...

 

[Reverend Random]

Has anyone read this Forbes article yet about why RBP switched to film and stopped producing Suboxone tabs?

I have one more question that has probably also been asked before. What is the reason that buprenorphine isn't developed as anti-OD medication besides naloxone? What would be the risk of giving a shot of bupe instead of naloxone, provided that one has ready made syringes with bupe in the same vein (ha!) as Narcan. Wouldn't this eliminate the worst withdrawal symptoms - compared to giving narcan - while still reversing one's overdose, thereby also reducing the risk of someone using again (and thus, possibly, od-ing again!).

This is not meant as an incentive to get people to use bupe by the way, I'm just curious to why this would or would not be a good idea, from a pharmacodynamic interaction point of view and why naloxone is used instead of buprenorphine. Matter of patent or is there a pharmacological explanation that I've missed?

 

[Swimmingdancer]

Has anyone read this Forbes article yet about why RBP switched to film and stopped producing Suboxone tabs?

I'm glad someone is exposing them, I'd been saying exactly that as soon as I heard the tablets were getting discontinued.

I have one more question that has probably also been asked before. What is the reason that buprenorphine isn't developed as anti-OD medication besides naloxone? What would be the risk of giving a shot of bupe instead of naloxone, provided that one has ready made syringes with bupe in the same vein (ha!) as Narcan. Wouldn't this eliminate the worst withdrawal symptoms - compared to giving narcan - while still reversing one's overdose, thereby also reducing the risk of someone using again (and thus, possibly, od-ing again!).

This is not meant as an incentive to get people to use bupe by the way, I'm just curious to why this would or would not be a good idea, from a pharmacodynamic interaction point of view and why naloxone is used instead of buprenorphine. Matter of patent or is there a pharmacological explanation that I've missed?

There is no reason to do so when naloxone works well for the purpose and there would be a number of disadvantages to using bupe in that way.
- 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 (which I think is important for HR), and that couldn't happen with bupe for obvious reasons (no one is going to use naloxone recreationally and naloxone can't harm anyone).

 

[Reverend Random]

There is no reason to do so when naloxone works well for the purpose and there would be a number of disadvantages to using bupe in that way.
- 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 (which I think is important for HR), and that couldn't happen with bupe for obvious reasons (no one is going to use naloxone recreationally and naloxone can't harm anyone).

Thanks, that makes a lot of sense. Your second point, however, I don't fully understand. Although bupe indeed lasts much longer than naloxone, wouldn't the subjective withdrawal effects be less intense, because bupe is only a partial antagonist whereas naloxone is a full antagonist? What I mean is: even by removing the other substance from your receptors, since bupe itself gives a bit of a high, wouldn't the WD be less severe?

And also, because bupe lasts longer, wouldn't that mean that the risk of OD in the _long term_ would be smaller? Given that many people who are treated with narcan are inclined to redose OR because they re-enter their state of overdose when the naloxone wears off?

I would like to stress that all this is hypothetical, because I do understand that naloxone is much safer in any occasion. I am still curious about the above points though. Thanks BL.

 

[Mass08]

bupe still gives super intense PWDs

 

[Swimmingdancer]

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.[Source]

Thanks, that makes a lot of sense. Your second point, however, I don't fully understand. Although bupe indeed lasts much longer than naloxone, wouldn't the subjective withdrawal effects be less intense, because bupe is only a partial antagonist whereas naloxone is a full antagonist? What I mean is: even by removing the other substance from your receptors, since bupe itself gives a bit of a high, wouldn't the WD be less severe?

As Mass08 said, bupe still causes severe PWD. I don't really know why exactly buprenorphine causes such bad PWD, the explanation given is always that it binds to opioid receptors with a higher affinity than (most) other opioids, removing them from the receptors, but doesn't activate receptors as strongly so one is left with a deficit, but this does not seem like a full explanation to me. It's agonist effects are obviously enough to alleviate withdrawals if the person waits a day before taking it. So it does seem weird. I'm tired and can't really focus on complex pharmacological stuff like receptor subtypes right now. What I do know is that even IF bupe did cause slightly less severe precipitated WDs than naloxone they would last for a lot longer. I don't think that's a good thing for a number of reasons.

And also, because bupe lasts longer, wouldn't that mean that the risk of OD in the _long term_ would be smaller? Given that many people who are treated with narcan are inclined to redose OR because they re-enter their state of overdose when the naloxone wears off?

You would still have the problem of redosing with bupe, in fact it would be a bigger problem with bupe IMO because with naloxone if it's given under medical supervision you are monitored to make sure you don't slip back into an OD when the naloxone wears off (and give you more if deemed necessary, although that is rare, especially with a drug with a short peak like IV heroin) and by the time you're out of the hospital the naloxone has worn off, so some of the effects of the drug can come back but by that time your blood levels are down enough that you're no longer at risk for OD. So the temptation to redose is less because you aren't feeling PWD any more. With bupe there would be a long-lasting blockade of other opioids, leading people to use ridiculous unsafe amounts in an effort to overcome the blockade, which they could potentially do, especially as the bupe starts wearing off, and OD that way. I also think it would make people less likely to seek treatment for overdoses if they knew an OD was going to be treated with something that put them in WD for a long time and blocked them from being able to use opioids to alleviate that withdrawal. If the medical community felt that naloxone did not last long enough they would be using naltrexone, a longer-lasting opioid antagonist instead of naloxone, which is not done (unless naltrexone has a lower binding affinity than naloxone or something?).

 

[Reverend Random]

Well, dimming swancer, that's about the best reply I could have expected. Thanks a lot! All those arguments against using bupe make a lot of sense to me, especially your last comments about the longer lasting effects of bupe (which might in fact create a bigger risk of OD in the long run) were things I hadn't thought of, although I am aware that when given naloxone, users should always be monitored.

Having recently returned to BL after an absence of several years, I'm so much more aware of the enormous amount of knowledge, excellent discussions and the wealth of harm reduction tips on here... I'm very appreciative. Here's an excellent dub mix in return, for whoever appreciates that stuff.

 

[chrisj946]

To answer the question.... Someone I know overdosed tonight and his friend had a 4mg sub. My friend gave him small shots of suboxone and gave CPR until my friend came out of it. He was fine.. Said he felt slightly crappy afterward but not full blown WD's. So my personal experience is that yes is does work. The friend placed some under his tongue, gave one IM injection and one IV shot that finally brought him back. This experience was enough for all of my friends to stop using..Inject in small doses until they come to.

 

[Cliffy78]

Felt like shit, profuse sweating, kept feeling like I was gonna pass out, like my brain was gonna shut off during euphoric waves. Tolerance had dropped due to not using for a few weeks. Felt like if I went to sleep I wouldn't wake up. I took 2mg suboxone sublingually waited/sweated/nodded 10 min, dosed another 2mg and started to come out of it after 5-10minutes after second sub dose. I couldn't call ambulance cause cops always come where I'm from, do it was sub or nothing and the shit actually worked!! No pwds, still buzzed the next day, slept like crazy, kept waking up with foggy head, kinda buzzed I guess. Glad I dosed the sub!! Close one...
Too much oxy, was drinking all kinds of grapefruit juice and oj for 3days prior may have helped cause od...

 

[CNSninja]

Sorry for the long post... I can't think linearly and sometimes things get verbose as I try to connect it all and make sure I get everything...

I'm not sure how valuable this information will be, since I was not actually present at the time of this occurrence, but it came from a good friend of mine and we'd always trade crazy stories about getting high while we were getting high... I have no reason not to believe the story he told me, he's never been the "storyteller" type, and I'm very familiar with that sort of person- they don't slip past me easily either. Plus I generally just trusted him, and that's a pretty rare thing in and of itself.
I wish I had been there to witness it myself because it's one of those things that people do want to know, exactly as is being asked here. He told me he was shooting dope with a few friends of ours and one of them OD'd on the dope because he was 'relatively' new and it was a new stamp...also, some might say this kid was the type who just might have a deathwish, but anyway, my friend had left over suboxone from his last attempt at sobriety, and he injected the OD-ing friend with a dose [I'm sorry, I don't recall exactly how much he said...] and he said it's most likely the very thing that saved the OD-ing guy's life.
I'm only here to say that I, for one, am under the humble impression that this is one thing that I'd say "It'll work as long as a hundred other things don't go wrong." As long as it's injected, and it's done in time.
NOW... This is the kind of thing you'd only want to do if you really, honestly had no other option. Even if your other options don't seem like options because people will get in trouble. You DO still have a choice and there's nobody on this earth who has a life with a value less than the amount of trouble any one of you could get in. So if you're in the middle of nowhere with no way to contact emergency services, I, personally, would consider it worth it, but don't take my word for it. Again, I'd stress taking the victim to the hospital, ESPECIALLY if the person who is OD'ing is breathing shallow or anything like that, any physical side effects that you don't have the equipment to deal with, this isn't the kind of thing. The naloxone 'should' bring them out of the overdose, but there are other factors like how much naloxone you have available if repeat doses are needed. Yeah, this is a thing in certain cases depending on what the person took and how much. If you fail to hit and you don't have more to try with, you're most likely not going to be able to artificially keep their lungs breathing the way they need to be, et cetera...
And if you try to inject them with naloxone and miss, you've just given them either an IM or subcutanious injection, and that's not obviously the same as IV, so if this is what you're relying on to save your friend's life, a complete strangers life, or even the life of someone you hate with your entire soul, you'd better pray to whatever god you know that you'll have a steady hand under extreme pressure, that they've got a vein good enough to hit- that won't collapse when you start pushing the plunger (it happens sometimes,) that you'll get it in the vein at all, that you'll have more if repeat injections are needed a few hours later, et cetera...


In less words, I believe this method is viable, but I believe with more of myself that taking someone to the hospital as always 100% a better idea. You don't want someone's death on your hands because you didn't want to get in trouble, and these days in some states, if you're known to be the person who handed whatever they overdosed on TO them, then you'll be facing charges brought against you for something like negligent manslaughter in certain jurisdictions.

Just take them to the hospital. It's not the doctor's job to arrest you, it's their job to save lives. Leave your shit at home and you'll be fine because being high isn't a crime as long as you're not driving that way, and as long as you're not high on meth in certain states (unless I'm mistaken...)

No life is worth counting on the words of anyone in a forum, including myself, an avid researcher with an interest in pharmacology and brains/biology, regardless of how much you trust and believe that person. I can guarantee to you with more confidence than anything else I've just said.
If it's truly life or death, then it's obviously not going to make them worse...in that case, I'd do it, but I can't tell you whether you should or not...

 

[mew4]

ive actually seen this work 1 time, altho i cant say it was 100% but a friend was overdosing and somehow another friend dissolved some suboxone in water and injected it into the dudes veins and the guy came out of it. but i wouldnt put anything above narcan, thats the only full proof way