Home | E-Book Store | www.PersonalConsult.com | www.USMoldPhysician.com
Free Books | Testimonials
*Suboxone contains buprenorphine and naloxone. The naloxone is poorly absorbed when used as directed under the tongue—it is put in Suboxone to discourage intravenous use.
*At higher doses the effect of buprenorphine on a key pain receptor levels off, and it can even start to act like an anti-opioid
*Because you cannot keep increasing it to decrease pain, you will reach a point of no more pain relief.
*The good side of this is you cannot accidentally take too much. This is not a real issue with careful use of opioids used chronically and raised slowly in pain care under a doctor's supervision, but is a concern and risk if a new and aggressive increased dose is taken and/or mixed with other drugs like alcohol or sedatives in a careless manner. An excess increased dose with or without mixing with other drugs can cause respiratory depression. This does kill people.
*This "ceiling effect" gives you a safety benefit.
*Also, since high doses do not offer a high or any additional benefit or euphoria, it is less likely to cause a physical dependence.
*Since it is made to be a detox agent and lasts in the body for some days at a low dose, only mild withdrawal symptoms happen as a trend if you suddenly stop.
*You can use it to come off of all your opioids of any type or if you think you will relapse than you can use as a legal maintenance that allows you to go to work, school or take care of your family. You can have a life.
*If you use an opioid the same day you start Suboxone or if you recently used a very long lasting opioid, you might develop a mild withdrawal syndrome. So it is best to start feeling some initial withdrawal feelings before you start it. Yet after that initial mild withdrawal, you want to use a dose high enough to completely end ALL WITHDRAWAL SYMPTOMS. If you have a pain problem, you might try gently increasing your dose or trying two slightly different doses every other day to see which is better.
*If you feel profoundly ill after taking Suboxone, which is not common, we suggest a trip to the emergency room for at least a 12-24 hour evaluation. Many things can cause this rare event and these include some stealth infections that we will be publishing about soon, and some errors in prescribing or an allergic reaction.
Buprenorphine: a primer for emergency physicians.
The recent approval of office-based treatment for opioid addiction and US Food and Drug Administration approval of buprenorphine will expand treatment options for opioid addiction. Buprenorphine is classified as a partial micro opioid agonist and a weak kappa antagonist. It has a high affinity for the micro receptor, with slow dissociation resulting in a long duration of action and an analgesic potency 25 to 40 times more potent than morphine. At higher doses, its agonist effects plateau and it begins to behave more like an antagonist, limiting the maximal analgesic effect and respiratory depression. This "ceiling effect" confers a high safety profile clinically, a low level of physical dependence, and only mild withdrawal symptoms on cessation after prolonged administration. Suboxone contains a mixture of buprenorphine and naloxone. The naloxone is poorly absorbed sublingually and is designed to discourage intravenous use. Subutex, buprenorphine only, will also be available primarily as an initial test dose. Clinicians will be using this drug for detoxification or for maintenance of opioid addiction. Patients with recent illicit opioid use may develop a mild precipitated withdrawal syndrome with the induction of buprenorphine. Acute buprenorphine intoxication may present with some diffuse mild mental status changes, mild to minimal respiratory depression, small but not pinpoint pupils, and relatively normal vital signs. Naloxone may improve respiratory depression but will have limited effect on other symptoms. Patients with significant symptoms related to buprenorphine should be admitted to the hospital for observation because symptoms will persist for 12 to 24 hours.
Sporer KA. Annals of Emergency Medicine. 2004;43:580-4.
[Underlining, enlargement and shifting the reference presentation by Dr. Schaller. He thanks Dr. Sporer for his research].
