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Opioids If I take buprenorphine while on Naltrexone would I become dependent to Bup?

spartin88

Greenlighter
Joined
Apr 30, 2015
Messages
12
Hi All,

This is my first thread and I've rarely posted but I have been using BL for years and thank everyone in advance that reads this. My question is about the interactions between buprenorphine and naltrexone and if you would become physically dependent to bupe if you took both together and stopped them together. I know that you can take them together but cannot find any information about if you would become dependent on the buprenophine like when taking it on maintenance. I have been addicted to opiates for 6 years with my doc being any pill form opiates for 4 years and then 2 years of abusing buprenorphine. In a final attempt to get extended sobriety my parents and I resorted to the Vivitrol shot. After being on the Vivitrol shot for 7 months, I caved in after 4 months and now have I have been seeing a separate doctor to get generic Subutex (Buprenorphine) because it has helped me function better and also improves my mood and energy during the limited days I can take it each month. I take it for usually 10-12 days during the month before running out as it requires a large amount to get an noticeable effects when you take it the first 3-4 days after the naltrexone injection. If I were to time it better I probably could take it for a longer time each month but I am always feeling like shit the first couple days after the shot (this has happened every month I've gotten the shot so its not related to taking the bupe) and want relief so I run through my script fast.

There is research that shows taking buprenophine and naltrexone can be more effective and provide therapeutic effects on the recovering patient such as reducing anhedonia, dysphoria, lethargy, and other post acute withdrawal related symptoms (PAWS) than just naltrexone alone, which from my own experience does nothing except act as an blocker for opiates and alcohol (though not its primary use).

The theory behind the science is that the Kappa opiod receptor goes into hyperdrive upon stopping opiates and plays a big role in regulating mood, which is part of the reason a person experiences a long drawn out period of depression, anhedonia, dysphoria, and lethargy. Since buprenorphine is a partial mu-agonist / full kappa antagonist and has a high affinity for both receptors and naltrexone is a high affinity mu-antagonist but has low affinity to the kappa receptor, the studies and research show that this combination of drugs specifically 50mg oral naltrexone and 4mg sublingual buprenorphine would still keep the mu receptor inactive while also causing the kappa receptor activity to be blocked by the Bupe. Below is the link to the research study done in 2006.

Literature states naltrexone can be stopped on its own at anytime with no negative effects. Link on the benefits of taking buprenorphine and naltrexone together vs. just naltrexone alone. http://www.gacguidelines.ca/site/GAC_Guidelines/assets/pdf/44_Gerra_2006.pdf

After 4 months and avid exercise primarily running for 2-3 miles a day doing high interval training to make sure I was activating the endogenous endorphin system through anaerobic cardio, there was barely any change in my mood, which was primarily flat or depressed, or a increase in energy levels. I had also undergone 6 consecutive ketamine infusions on the first day out of rehab. The ketamine helped tremendously at first with my energy levels being extremely high during the treatment period and for probably 2-3 weeks after. Having been used to laying around doing nothing all day I found that I had lost interest in watching tv for hours and so I would go to the gym for 2 hours or more a day sometimes 2x a day as I couldn't relax at night. I continued to get a infusion once a month as they cost $600 for an hour infusion with the highest dosage being 1.30 grams which was effective. I'll note that I had used ketamine on and off for several months before going to rehab to try to help me quit subutex and treat my depression. My tolerance was around needing .4-.8 / gram to get the trip related effects.

I am desperately wanting to take bupe with the vivitrol shot and believe it would be much more effective in helping me get back to living life instead of barely functioning and feeling lifeless like I do while on just naltrexone. My parents want me to keep getting the shot for 3 or 4 more months and give my brain more time to heal before resorting to seeing if I need to be on a buprenorphine maintenance treatment, which for me would be getting the new 6 month implant Porbuphine due to me snorting my bupe and not able to trust myself to take the medication as prescribed.

If I can show my parents any research about buprenorphine not being physically addictive if used with naltrexone they would be all for trying it and it would help me stop having to live like an addict still by going behind there backs and self medicating.
 
Naltrexone and buprenorphine together is a not terribly common medical practice, that is, discounting the presence of naloxone (a different but not dissimilar drug) Suboxone, which leads to the point here; the 4:1 ratio in Suboxone, contrary to popular belief and the promotions of the pharmcos and the beliefs even of many doctors, isn't sufficient to block the bupe entirely when i.v.'d, although most people do not like i.v. Suboxone because the ratio of antagonism to agonism gets screwy and causes some unpleasant effects. I'm going on this tangent to talk about combining opiate blockers with mixed-agonists like buprenorphine, which is to say that buprenorphine (and a few other drugs) unlike morphine or diamorphine and most classic opiates, does have effects that will at a decent dose break the blockade. You mention the κ-opioid receptors which almost certainly have a role here. So you may be onto something as for this being a way to cope with some of the negative effets of naltrexone.

However, "not being physically addictive" is unlikely. If you are experiencing effects from buprenorphine above and beyond naltrexone, then you can expect some kind of withdrawal symptoms when you cease taking the buprenorphine. In some sense you are robbing Peter to pay Paul and just delaying the inevitable, which could be said on anyone who's on a short-term taper/maintenanc with methadone or bupe with regards to the postacute withdrawal issues. So the question is really how long you intend to remain on this regime? Forever? Or as a taper of some kind? I am not experienced with buprenorphine implants so cannot speak to that.

With regards to PAWS and such, I always advise people to get their testosterone levels checked and consider supplemental testosterone, sometimes even if their levels are within what's considered clinically normal levels. Testosterone cypionate and enanthate are readily available and low doses weekly or biweekly can help a lot, not to mention with exercise and so forth.

This post or any of my communications do not constitute professional advice nor do they establish a professional relationship of any kind; I make no claim to any specific professional credentials; in person consultation is essential for any medical, psychological, substance-related or harm reduction decisions. While peer support an advice can be helpful, any content posted online, regardless of it's source, cannot, by it's very nature, substitute for an in-person relationship with a clinician who has had the opportunity to take your history in the larger context and provide professional advice with all these factors, and others, taken into account.
 
Thanks for your input. While you're probaby right about there being some sort of withdrawal involved from naltrexone and buprenorphine, I would be curious if it had the same intensity /similarity of just straight bupe withdrawal. In the only real in depth publication I found which is the link I posted it talks about how the naltrexone dose of 50 mg would almost neutralize the partial mu agonist effects caused by bupe. This is just an assumption but based on this I would think that some sort of withdrawal would be likely but then again what about if you taper the buprenorphine dose while continuing the naltrexone.

You said if you notice any effects other than what the naltrexone gives, which I can attest is nothing that it means you're getting some sort of action from the buprenorphine and this makes sense. However, what if the positive benefits you get that impact your mood or energy are indeed the antagonistic effects of the buprenorphine on the kappa receptor , which studies shows is extremely hyperactive upon opiate cessation. I would have no way to tell though if it was the mu recptor being activated at what would be a limited intesity due to bupe having bupe offset by the naltreone or if it was in fact kappa receptor being blocked that gave me those feelings I experience.

I have read bupe has a higher affinity to the MU receptor than Naltrexone but when I looked at each MOR - affinity bonding number on wiki it shows naltrexone is higher so I may be wrong on this.

As for what I want to use this combination for is that I would hope I could still allow my brain to heal and rewire itself to whatever extent it's capable of while not having to live in a constant depressive and lethargic state. Which is where I am trying to learn more about the role of the Kappa receptor during PAWS. Even if this made the recover process take longer because of the minor mu activity I would rather have that then be the way I am now. Which is pretty shitty for 7 months and limited use since I haven't touched any full opiate agonists and the vivitrol makes bupes effects much less pronounced compared to just taking bupe daily. I know I probably just repeated my original thoughts in a different way but I am just curious about if there is any way to improve mood and energy besides time and exercise during opiate abstinence. This intrigued me because maybe it is the middle ground that I'll have to take where I actually take both for an extended time or for life. I can't trust myself nor do I see a year from now being any different from relapsing back on to subutex and worst case scenario hopefully being able to live a happy fulfilling life on a low dose maintenence treatment that I finally comply with and take sublingually as directed and not try to lay doctor but I do know I'm done with full opiates agonists.
 
to anyone wanting to know-i JUST shot an 8mg subutex (white round pill marked M924) and i am on day 7 of my vivitrol shot (i previously had a shot maybe 4 months ago; my fam periodically will ask me to take one to see if i protest etc whatever it makes them feel better so i take it and usually dnt attemp to get high etc.-this time i just wanted to experiment to see what wld work to overpower). i can tell you that i got a good enough high that i was feeling nice n happy (as close to a d’d up high as you will get on this damn shot-that i can tell u). lasted about a couple hrs then tapered.i was surprised. i had hope but was def surprised at the effectiveness.not sure if wldve gotten same result if had taken sublingually. i can follow up regarding how i feel tmrw/afterwards shld anyone be curious about that. Hope i’ve helped anyone curious.
 
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