Maps, Directions, and Place Reviews
Subutex vs. Suboxone
The manufacturer recommends starting with Subutex because it does not have the Naloxone component. Naloxone has side effects which could be severe enough to encourage the patient to stop taking the medication completely. Naloxone is not needed unless the patient has a propensity to inject drugs. Unfortunately, some doctors are adamant about using Suboxone. If that is the case with the patient, find a doctor that doesn't insist on Suboxone but will use Subutex instead. Even better, when the patient calls to make his first appointment, ask the nurse at the office if Subutex is prescribed. If the nurse says no, then hang up and call another doctor. Do not take more medication than you need to detox.
Also, try and move consistently down off of Sub as quickly as possible. Listen to your body. If you have been addicted for several years, it may take a longer time than if the addiction is shorter in time. It's possible to detox in a month but the patient must be highly motivated and follow a strict plan.
Some patients remain at the highest levels for extended periods of time. That is not necessary and should be avoided.
One example of a taper schedule is:
Starting at 12mg, then: 10mg-2 weeks 8mg- 3 weeks 6mg- 3 weeks 4mg- 4 weeks 3mg- 4 weeks 2mg- 4 weeks 1mg- 4 weeks .5mg-4 weeks .5mg every other day 6 weeks
Total- 35 weeks
However, keep in mind that the taper schedule will be different for everyone.
Lastly, it's often difficult to determine what the equivalence of Sub vs. the drug of choice of the patient. One tool can be found at: http://www.medcalc.com/narcotics.html. This is a good tool but it is certainly not a perfect tool. Even doctors have a hard time making this determination. For example, 10 tablets of Vicodin is about 100 mg. of hydrocodone. That translates to about 8 mgs. of Sub. Even though Sub. has a long half-life, it's also a good idea to split the Sub. dose so that the active chemical stays relatively stable throughout the day. Anyone contemplating using this med to escape narcotics, feel free to contact my Talk Page for additional help. Jtpaladin 16:34, 11 April 2007 (UTC)
OK just one comment for anyone who reads the otherwise ox comment above. Ten tablets of Vicodin would not be 100 mg of hydrocodone. It would be 50 mg. If it was Vicodin ES it would be 75 miligrams of hydrdrocodone. 10 tablets for 100 mg would be Vicodin HP (which is pretty uncommon) or another formulation of Hydrocodone/APAP.
Inpatient rehabilitation section?!
Is it just me that's deeply uncomfortable with this section in particular? A huge amount of unreferenced stuff, and frankly I've got no idea where some of it's come from or why it's in an article on subutex / suboxone / buprenorphine.
Feels to me like this could do with a lot of work, some decent and brutal editing, and a fair few more references. If there's anything I can add / reference then I'll have a peek later (particularly around detox treatments / pro-social networks in recovery) but tbh I feel there's a whole lot of stuff in here that's on the wrong page and is - frankly - largely irrelevant with a somewhat ideological hue.
A couple of the other sections strike me as a wee bit flabby / unreferenced n all, but hey. I'll have another look later, and if I can't suggest anything more constructive or make any positive additions / contributions I'll butt out completely, ha.
81.2.126.58 09:24, 13 June 2007 (UTC)Geoff
This information contained about the induction dosing is particularly necessary to an article on buprenorphine as it has a very unique initial dosing phase. The section could definitely stand to be re-written; however, I do not see most of it as irrelevant.
Perhaps if Wikipedia had an entry on "Opioid Treatment Programs" then the rest of the information contained in this section outside of the induction dosing in an inpatient setting could simply be linked to? But there is no such article.
Lucida.ann 21:14, 27 August 2007 (UTC)
Edit for Suboxone page
I just wanted to let you guys know that Suboxone isnt intended to have an orange flavor. In the actual drug form from R-B its listed as having a lemon-lime flavor. If anyone wants a picture from the brochure for proof let me know. kylewmackey@gmail.com --Preceding unsigned comment added by 67.189.252.63 (talk) 01:15, 2 October 2007 (UTC)
Being someone who takes this medication, I can say that until someone told me it was supposed to be lemon lime, I would have said it tasted like orange tang. The color of the tablet probably is enough to suggest that any citrus flavor be interpreted as orange. 66.41.0.174 (talk) 20:32, 28 November 2007 (UTC)
Updated Suboxone information under "preparations" - and comment about subsequent section lengths
11 December 2007 - London
Hello
I have added the most relevant studies around Suboxone's effects in human subjects when it is injected, as well as the best available evidence about Suboxone's potential for abuse/black market in the community (Finland only!).
In my view the following sections around buprenorphine-based detox are way too long. It would be better for Wikipedia if we instead cited external sources or guidelines around detox - these do after all vary substantially by country, as do the methods of proving opioid dependence treatment using buprenorphine-based products.
Cheers
193.130.97.35 (talk) 10:38, 11 December 2007 (UTC)
Parochial USA content makes this article confusing.
It would be useful for the reader (myself included) to seperate out the parochial USA content from the main theory and research. The USA specific information interupts the article and considerably lengthens passages. more consise information would be helpful with perhaps seperate sections for USA issues which are only specific to 1% of the global population. It would be great if someone with appropriate detailed knowledge could attempt to edit accordingly! HDTomlinson (talk) 03:38, 7 January 2008 (UTC)H.D.Tomlinson (UK)
Major changes needed
Hey Wikipedians. I just marked this article as {{cleanup-rewrite}} because, frankly, the quality of the article is terrible. This should probably be a task for WikiProject Pharmacology to take on with full force and extreme prejudice. Random bold and strike-out? Sentence fragments and run-ons? This is not how Wikipedia operates. I urge anyone who can work on this to do so, even if you can improve only one section. --Animated Cascade talk 06:20, 5 April 2008 (UTC)
suboxone and use during pregnancy
Suboxone is a pregnancy category C1. Which means it should only be used with EXTREME caution during pregnancy.2Basically this means that only if the benefits outweigh the risks on the mother and fetus. Suboxone use during pregnancy may cause the newborn to undergo withdrawal symptoms immediately after birth. The child may have to be weened off of the medication to prevent severe DT's and other side effects that come with the withdrawal symptoms. This may take weeks or months to completely rehabilitate the child.
references: 1. www.suboxone.com 2.clinical pharmacology edition 8 pg 7 dislpay 1.3 Lpn2008 (talk) --Preceding comment was added at 20:43, 16 July 2008 (UTC)
Recreational use
Buprenorphine is a popular recreational drug (typically used by opioid users) in Sweden. I would add something about this, but I'm having a hard time finding sources and articles that are not in swedish. It is also a popular recreational drug in the United States, as well, especially among users of heroin on the east coast. It is typically used in between "dry periods" when there is no heroin for sale in the area or city, so the users can stave away the withdrawals for a few days until they get their dope back. This is also a very common practice in New York, Chicago, California, and especially in Philadelphia. Philadelphia is notorious for patients who get Buprenorphine prescriptions and then proceed to sell them right afterwards for profit. ? MqaTalk ? 15:24, 5 August 2008 (UTC)
Article accuracy
Please forgive me for this unsusual approach. I am new to contributing to wikipidia and it is a whole other all gamae. I know this is not a forum. However, the reason I am addessing this issue in this way is simply this. Many of the post are accuate or have innaccurate details. I have looked at this page and hope it would conform to to feder quidlines. I ama physician no longer in practice who did early researh on the drug based upon he work of Kostin and Kleber in 1984 when at NDIA. I was certified by ASAM.For your interest, in addicitonto be being proven affective for opiod deto it was found effectivefor cocaine detox. However, he thought of placeingan opiod naive patiet on another drug wthich would habbituate him was deemed medically poor judement and was rejected by the original researcher.
NB: I AM NOT AT THIS TIME EDITING ANYTHING IN THIS ENTIR SUBJECT. The reasn is that while there is accurate writing in the entire article there are inaccurae things as well. Additionally,it is not focused and gets side tracked. Editing this would be a lot for me because I would have to return to original source, personal communications. That said I need the editor's advice on this subject. Do you want an exhaustive desciption, history, use,formulations, use in other coutnries, all indications includin detox, the history of how its use in detox was discovered, some detaiels of opiod addiction and he mechanism of thretment.
There are tons of articles on the entire subject which themselves are fairly coheren that do not cover all the topics here.
PLEASE BE CLEAR I AM NOT COMMENTING ON HE POST BELOW ME. I have nothing to single out about it at the moment. Just cheating on the forum aspects. I don't know why you don't have this sourcess and article need discuss.---- --Preceding unsigned comment added by Tetrasect (talk o contribs) 16:21, 3 November 2008 (UTC)
Conflicting statements about overdose reversal via naloxone
under the head Pharmacology and Pharmakinetics it says:
"Buprenorphine also has very high binding affinity for the ? receptor such that opioid receptor antagonists (e.g. naloxone) only partially reverse its effects."
and then under Adverse effects it says:
"Moreover, former doubts on the antagonisation of the respiratory effects by naloxone have been disproved: Buprenorphine effects can be antogonised with a continuous infusion of naloxone.[18]"
are these statements conflicting?Azrayl (talk) 01:04, 16 December 2008 (UTC)
Desperately needs a new intro
Specialists have rewritten this thing so many times the intro is nonsensical medicalese. We need a straightfoward, lawyman-friendly introduction. As written, this would only make sense to a specialist, and a specialist's first place to read up on it wouldn't be Wiki (I hope). --Preceding unsigned comment added by 208.226.153.24 (talk) 17:01, 3 September 2009 (UTC)
Well said. Needs new intro, but that concern, it seems to me, is secondary to wider concerns about the article as a whole. I have grave concerns about the article's content. Isn't the action and efficacy of this drug along with (for goodness sakes!) advice to readers about taking it or withdrawing from it best left to professionals at sites such as www.mayoclinic.com? It strikes me that the article and others like it are dangerous and place wikipedia in the highly inappropriate position of dispensing medical advice. 24.17.54.220 (talk) 17:54, 17 October 2009 (UTC)simonelf@hotmail.com
4 Alternate two-dimensional (2D) Buprenorphine images from one given.
Drawn differently from the wikipedia image but in the same 2D style:
a jpg o a gif o another jpg o a png (all different images, just naming them by image type even though not the same in different formats)
Someone might find these interesting. Regards, Nagelfar (talk) 13:50, 20 October 2009 (UTC)
Buprenorphine vs. Methadone
Please reduce the Buprenorphine vs. Methadone section. There is too much cross analysis and too little conclusiveness for it to be granted a paragraph under an article such as this. Either move the Buprenorphine vs. Methadone section into its own article, the article regarding opiate addiction or be prepared to leave a less analytical conclusion. --78.86.159.199 (talk) 18:22, 16 August 2008 (UTC)
Also, most of it sounds like original research and/or totally made up bullshit. For instance, the part that states shooting up buprenorphine is easier than methadone. There isn't any reasons given besides methadone is a liquid. This actually makes it easy to shoot up methadone. They only add water when you dose methadone at the clinic. How was someone going to shoot up at the clinic anyways? Either way, that's just an example of the completely subjective rubbish that makes up this paragraph. Offense to anyone who wrote this, you are making Wikipedia rubbish. 173.24.227.245 (talk) 03:08, 10 April 2009 (UTC)
Methadone should be much more difficult to inject, for various reasons. Even though is is a concentrated liquid, a dose of even just 20 mg would be 20 ml which is quite a bit of liquid to inject. The solution itself is more a syrup. It contains dyes, flavoring and other additives that do not belong in the bodies' circulatory system. Adding water to it would make it less thick, but would result in a lot more liquid to inject as well. As for Buprenorphine versus methadone for the treatment of opioid withdrawal and addiction; this really depends on the drug(s) of abuse, severity and length of use. I have had this explained to me by a drug counselor. Buprenorphine is better suited to individuals who have perhaps been abusing prescription opioid drugs like hydrocodone (Vicodin, Lorcet, Lortab) or oxycodone at lower dosages (Percocet, Endocet, lower dosage OxyContin), perhaps even insufflation of small amounts of heroin and for a limited period of time. For instance, somebody who has been using less than or around 30 mg of oxycodone a day for less than six months and whose lifestyle has not yet been significantly disturbed (ie, they still hold a job, care for the family and have a strong support network). In scenarios such as that, outpatient treatment with buprenorphine in an office-based setting is typically sufficient at eliminating withdrawal, reducing cravings and getting the user on the road to recovery. In the case of the intravenous heroin user, who injects more than a few bags of heroin a day and has been doing so for over six months the need for treatment with methadone in an in-patient setting becomes greater. It may be more difficult for the heroin addict to abstain from using for the 24-36 hours required before buprenorphine can be administered. Methadone is also a full agonist, it is more sedating and capable of providing the addict with a greater sense of well being. For these reasons it may more sufficiently alleviate craving. Like buprenorphine it is also capable of blocking the effects of other opioids, but for methadone the blocking dose is attained more gradually. A person who is on methadone may switch to buprenorphine. In order to do this their dose of methadone must be 30 mg or less and they cannot dose for 48 hours. --Preceding unsigned comment added by 71.162.73.145 (talk) 18:12, 7 January 2010 (UTC)
Carfentanil, potency vs. binding affinity.
"Use in persons physically dependent on full-agonist opioids while not already in withdrawal will trigger an extremely intense form of opioid withdrawal, - called "precipitated withdrawal" or "precipitated withdrawal syndrome" - that cannot be reversed by high doses of any other opioid (except for the possibility carfentanil or dihydroetorphine, which are not licensed for use in humans and are active in the hundreds of nanogrammes)"
The relative potency of a chemical (by weight) has nothing to do with the binding affinity of the medication in question, and there's no reason to believe that even such potent opioids would reverse the precipitated withdrawal. Furthermore the statement isn't sourced at all. Considering it's under the label of "pharmacology" one would think the editor posting such nonsense would be aware of the fact that potency and binding affinity ARE NOT THE SAME THING.
Bupe has a notoriously high binding affinity. It binds to the opiate receptors more strongly than even naloxone, which, incidentally, is what Vets and scientists use to bring large animals out of the sedation caused by extremely potent opioids such as carfentanil. If naloxone will reverse carfentanil, yet bupe can't be displaced by naloxone, then it stands to reason that carfentanil cannot "fight through" the bupe, to put it in layman's terms.
IF potency were the only thing you needed, then a (much) larger dose of whatever opioid you're addicted to would relieve the symptoms, since full mu-agonists have no ceiling to their effects.
Having misleading, incorrect, and to be frank, possibly dangerous information in this article is shameful. If, indeed, precipitated withdrawal brought on by buprenorphine CAN be overcome with these medicines, then put it back in, and source it. Until then I suggest it be removed asap. I'll remove it myself in a few days if no one complains, or sources it. --Preceding unsigned comment added by 98.19.171.137 (talk) 17:22, 21 April 2010 (UTC)
Bioavailability: 31% (sublingual, from ethanolic solution)?
from what research I've done on Buprenorphine and bio availability this statement is infact wrong and i have seen this on the page for a long time now.I would like to see where this information came from. Im not a pharmacologist but my research says that buprenorphine sublingual ethanol solution actually increases the bio availability to 50-70%. where did the information about the low bio availability of ethanol mixed with buprenorphine come from? and same thing goes for the sublingual high dose tablet, I do not believe that the bio availability is 50-60%. infact a high dose tablet without ethanol is about 30-40%. I cant believe you would put this information out there without any facts or data. I was using those statistics for my own suboxone use and im sure other people are to. Do you realize how much buprenorphine is wasted without adding ethanol to the buprenorphine. Thanks for throwing my money down the toilet. I dont know how to remove bad and stupid data but the whole bio availability part should be removed until a source is show. I would love to help with the bio avail part myself. --Preceding unsigned comment added by Paulination (talk o contribs) 23:34, 2 June 2010 (UTC)
Translation?
I've just done a light copy edit. Does anyone understand this and, if so, could you please make it clearer?
Typically, the first day dosage is no more than 8 mg or it may precipitate withdrawals as antagonistic effects overwhelm agonistic effects, after which initial daily dose totals around 8-16 mg of either Suboxone or Subutex.
Does it mean daily dose after the first is around 8-16? Anthony (talk) 05:40, 13 August 2010 (UTC)
"Withdrawal Danger ?"
To me this sounds like cases where doctors have overprescribed buprenorphine, and some one is taking upwards of 16mg a day, which is insane. I went from a huge heroin habit, to several hundred milligrams of oxycodone, and started on 4mg of subutex a day. Very few doctors even remotely understand this drug, yet somehow went through all the work to become licensed to prescribe it.
After Working with lots of folks who have taken or are still taking buprenorphine, and being an addict myself who takes buprenorphine. "extreme acute withdrawal" is not something I have EVER witnessed or felt-first hand with buprenorphine. www.heroin-detox.com is not a reference/citation. Unless there is a real source for this date, this should be removed. Azrayl (talk) 18:13, 1 July 2008 (UTC)
Had exactly the same situation described on top of the section,no one needs 16 mg. a day or even 8,but that is what usualy prescribed. After 2 years of about 3-4 mg. a day of subutex I decided to stop taking it at once,was amazed to have almost no withdrawal,could function normaly and sleep. --Preceding unsigned comment added by 84.108.77.177 (talk) 09:52, 17 March 2011 (UTC)
Commercial preparations
It says no human studies have been done on the effectiveness of intravenous buprenorphine/naloxone preparations but in the manufacturer's prescribing information it talks about studies done with IM injections of buprenorphine/naloxone? I'll double check the insert, but I'm pretty sure it's all there.
Effect of Naloxone: "...whereas administered intramuscularly, combinations of buprenorphine with naloxone produced opioid antagonist actions similar to naloxone."
to print these results in an insert they would have to have observed these effects in humans, correct? Azrayl 02:09, 18 September 2007 (UTC)
There are several generics of the buprenorphine hydrochloride 0.3 mg/mL solution (Buprenex); I suggest mentioning these in this section. Off the top of my head I can think of generics marketed by Bedford Laboratories (in 1 mL vials) and Hospira (in cartridges for use with their Carpuject system, http://www.hospira.com/Products/carpujectsyringesystem.aspx). (Buprenex comes in 1 mL ampoules.) 174.111.242.35 (talk) 16:43, 21 March 2011 (UTC)
New to Suboxone
I have been struggling with Hydrocodone addiction for 20 years, spent 2 and 1/2 of those years in prison as a result of my addiction, and suffered most of the consequences other addicts experience...yet I still found myself wrapped up in the vicious cycle again after over 2 years of clean time. Just last week I finally got the nerve to confide in my doctor, parole officer, and family that I was back on the pills. I stopped the Hydrocodone at 2am last Sunday morning, saw my doctor on Monday morning and took my first dose of Suboxone right away. The 1/2 of the sublingual strip did little or nothing to help my withdrawls and I was given the other 1/2 45min. later. I felt immediate relief, even felt that familiar euphoric feeling...maybe stronger than hydro had given me in years. I told my doctor of this feeling and he was not concerned. I had to see him the following day for my second dose and again reminded him of the 'high' feeling I was experiencing. He was still not concerned and sent me home with a week's worth of Suboxone (1 8mg-2mg strip/day). I remember very little of those first 4 days and barely was able to function, even slurred my words and was clumsy. I decided yesterday to not take any at all and did just fine...no withdrawls, no cravings. My doctor is now insisting I take at least 1/2 strip per day until I see him next week, but I really have no desire to continue. Why take something that makes me feel 'higher' than the drug I am attempting to stay away from? It seems ludicrious!!!! --Preceding unsigned comment added by 97.87.179.5 (talk) 10:49, 23 April 2011 (UTC)
Street Reports
I've got a street report that the president was kidnapped by aliens. Should we include that in Wikipedia too? Please remove this. Not only is it completely without source, a "street report" wouldn't be a reliable source anyways. Thanks.12.207.120.160 (talk) 09:50, 18 August 2008 (UTC)
something's wacky here, needs to be fixed
from the "dependence treatment" section:
"In the United States, a special federal waiver is required to prescribe Subutex and Suboxone for opioid addiction treatment on an outpatient basis. However, if the doctor meets none of the other clarifications, an 8-hour course is all that is required)."
"clarifications?" huh?
This is poorly stated - Subutex and Suboxone are both ONLY prescribed for opioid addiction, for which a dr. must have a DATA2000 waiver this would also allow them to prescribe methadone. However, unlike methadone, an additional 8-hour course is required before being approved to prescribe Suboxone/Subutex.
TIP-40 is a publication detailing Suboxone/Subutex use, clinical guidelines, and legal specifics. A copy should be linked to. I'll see about adding that.
This is actually incorrect. As a patient of back surgery I have been put on Subutex for back pain. It works incredibly well. Aftre being on the pure agonists I find Subutex to be an excellent pain killer. My pain mgmt. doctor uses his regular DEA # to prescribe this for me. He said that his DEA # begins with a Z, may be an X but i think a Z, when he prescribes for opiate dependency. He uses his normal DEA # for regular pain mgmt. when scripting for subutex. --Preceding unsigned comment added by 68.84.119.213 (talk) 18:16, 15 May 2008 (UTC) 66.41.0.174 (talk) 20:30, 28 November 2007 (UTC)
I also receive Subutex for the treatment of pain. My dr did have to go for special certification to be able to prescribe this. I take 2 (2mg) sublingual tabs 4 times a day. I see him once a month but he has given me 1 refill at times if he was not able to see me before my month's supply would run out. He does also use it for opoid addiction but that is not the only thing he uses it for. --Preceding unsigned comment added by SettleDownKim (talk o contribs) 16:53, 31 March 2009 (UTC) Source of Buprenorphine
The introduction to the article states "Buprenorphine is a synthetic Bentley compound derived from an alkaloid of the plant Papaver somniferum (the opium poppy), known as thebaine." The linked article, Thebaine, says that while it is "[a] minor constituent of opium" thebaine is extracted for commercial use from Papaver bracteatum (the Iranian poppy).
Johhtfd (talk) 15:37, 20 July 2011 (UTC)
New Generic Formulation of Subutex?
Recently returned from pharmacy, only to find that my generic buprenorphine (Subutex) pills had shrunk! They are the 8mg version, produced by a company I'm not familiar with, "HI-TECH." I am about to look into the company, since I've NEVER heard of them...and I've heard of lots of pharm manufacturers before. I had never heard about a version made by them either. Is it possible they removed the binders completely? Because they are SMALL. I'm trying to think of a good comparison...maybe the size of a generic Klonopin? The pink, slightly rounded ones. Possibly a bit smaller. It seems that whatever the case, either less binders or whatever else it could be, that it assists in letting more of the medication get absorbed through the prescribed sublingual method. This seems experientially to be because less pill causes less saliva buildup, making it less likely more of the medication gets swallowed (where even less of it gets absorbed). Just wanted to put this out these and see if anyone has any experience with them, or has seen them (or the manufacturer) before. 70.44.100.103 (talk) 22:38, 27 August 2011 (UTC)
Removed section
I have removed the following text from the article because it doesn't have enough context for the reader to understand it (suboxone films are not even defined, for example), and it is vague, poorly written and not well supported by the reference. If anyone wants to fix it up and put it back, please feel free. -- Ed (Edgar181) 14:40, 9 March 2011 (UTC)
Suboxone Flavor
it's the most god awful lemon lime i've ever tasted. the taste of it makes me want to puke more than the opiate content. 65.210.123.70 (talk) 21:08, 6 June 2008 (UTC)
HAHAHHAH... ok im not laughing at you, im laughing with you, im got some in my mouth right now.
-
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- Kyle that "god awful" taste making you want to "puke" is the naloxone, it is orally active and there is a population that react to it strongly. you may only have a slight response enough to mean that you cave in to the pressure to force people to take suboxone when subutex would give them a far superior control and stability of neg opioid symptoms.
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my experience, is that use of opioids shut down your endogenous endorphine production and people who still retain endorphin production (not considering up/down regulation of receptors) ((not most by any means) individuals (perhaps over 10%)) have a strong aversive reaction to the naloxone orally or otherwise!! this is the truth no matter how many times 'addiction experts' and the shillitary assert that it doesnot cause any problems orally ! bs. to these i say, ive been given the chance to trial suboxone in a formulation that was designed to appear to be bupe, as part of the original trials showing it was equivalent. here in australia i have participated in two such trials years apart with suboxone designed to look like subutex and with the newer strips which are suboxone only!, both times i observed that the conductors of the study completely unethically used discretion to invalidate people that had a bad reaction to subOXONE due to the nalOXONE, which only a cruel and sadistic or completely ignorant bastard would give to people with opioid dependancy. I had severely disrupted sleep for a month which did not stabilise (on one occasion i was sick with pneumonia in hospital and could not be given any analgesic because of the buprenorphine blockade yet the naloxone made my pain and suffering significantly worse, i took it completely correctly and did not misuse anything anywhere around the duration (not within months), i also transitioned from real pure bupe to the sadistic shite suboxone which is purely about power and control, it does not stop diversion anyway. this may seem contradictory but what i am saying, but read carefully; it causes a mild to strong aversive reaction in me and others no matter how it is taken, people can belt it up and it is so-so, aleviates serious withdrawal but replaces it with a naloxone sickness. i know because ive spoken to many people that would still use suboxone iv if that was all they could access and they were withdrawing badly, it doesnot cause precipitated withdrawal (in years ive only seen that once, although it looked quite unpleasant the person has to literally still have heroin in their system, ie has taken the two within hours to get precipitated withdrawal and this one case happened with just buprenorphine too, so in that case it was not due to naloxone anyway because it was not present!!!!ffs).
(the pituitary gland where beta-endorphine is produced always together with ACTH as a cleavage product of POMC, requires cysteine and excess glutamate (which the "opioid inactive" enantomer affects, which is why methadone has a worse withdrawal than just about any other opioid because it is half a glutamatergic drug (in germany they use only the single therapeutic enantomer but everywhere else is no regulation and methadone could easily be adulterated with a higher than 50% amount of the inactive enantomer which would account for experience that some formulations, or dispensations, of methadone have widely different potency and quality).
causes cysteine depletion and strongly contributes to the endogenous endorphine shutdown) This page is full of inaccurate information and unfortunately there is no consensus with many incorrect and biased claims pushed even by the so called authorities including manufacturers and other bodies with an interest in the Freshly Patented suboxone which justifies $10+ a day dosing here in australia for something that costs cents. of course the patents on buprenorphine have elapsed but there is just too much money to be made for the truth to stand up to.
the strategy is to transition to only dispensing the strips using automated retinal scanning machines, this way it will not be possible to get subutex prescribed and their long term income will be guaranteed. of course if you are PREGENANT subOXONE cannot be taken which pretty much blows the claim that the naloxone is not orally obsorbed out of the water. in fact around 10% absorbs so on 32mg of bupe a day that means 8mg of naloxone and so approx 0.8mg of naloxone into the brain, which explains the experience of naloxone effects YES EVEN WHEN TAKEN ORALLY! -- Preceding unsigned comment added by 220.101.100.14 (talk) 14:13, 26 April 2012 (UTC)
In the UK Suboxone has the flavour of oranges, and is more unpleasant than the 'neutral' though bitter taste of Subutex. -- Preceding unsigned comment added by 86.181.36.210 (talk) 09:29, 22 April 2012 (UTC)
Lots and lots of changes made
Hello everyone....
Came across this page tonight and found it riddled with errors of all sorts, including that NA hadn't made a statement regarding maintenance therapy and that buprenorphine is PREFERABLE over methadone during pregnancy!!! (Which I'm going to guess anyone reading this knows is totally not true.)
I added and changed A LOT, and I will be adding in the remaining associated links, etc., for the information I changed/added.
--Lisamarie (talk) 07:35, 26 January 2008 (UTC)
Are you sure you dont mean simply that there is more experience with methadone during pregnancy, i personally disagree, i think methadone is wreaking havok on the unborn childs neural development, buprenorphine may well be safer in this regard, but lets do a literature survey. thx -- Preceding unsigned comment added by 220.101.100.14 (talk) 14:33, 26 April 2012 (UTC)
Use for pain relief?
This article doesn't mention much about the use of this drug for pain relief, even though as it says it is much more potent by weight than morphine. I found some discussion of this here [2] and it does sound like there is some use of the drug. I am perplexed, because given the level of prescription drug addiction, I would think that it would make sense to use an anti-addictive medication as the first-line opiate for relief of moderate pain. What is the problem with it? Wnt (talk) 01:36, 27 October 2008 (UTC)
Metabolism
I think we need to have section about Buprenorphine's metabolism, both in-vivo and in-vitro. It is not sufficient to say that buprenorphine's metabolite is nor-bupe, although the pharmaco-dynamics of OH-bupe and OH-nor-bupe haven't been elucidated. Here is a study on the in-vitro metabolism: http://dmd.aspetjournals.org/cgi/content/full/33/5/689
If someone wants to get this started, I'll collect the references for you. A lot of the data I find is very contradicting with other data from trials. There are studies indicating in-vitro buprenorphine and nor-buprenorphine are both also CYP 3A4 and 2D6 (??) inhibitors. Aj1976 (talk) 02:24, 1 December 2008 (UTC)
Patent status
Does anyone have a source pointing to the patent status of this drug? --Preceding unsigned comment added by 24.206.182.80 (talk) 02:06, 21 July 2009 (UTC)
buprenorphine as antidepressant - legality [section 2.3.1]
Use of buprenorphine or other opioids to treat depression is not a legal "grey area." At least in the US, off-label prescription is legal. Quite simple, no "grey area" whatsoever. Now, whether physicians are willing to do it is another matter, but there is nothing illegal about it. 174.111.242.35 (talk) 08:48, 19 June 2011 (UTC)
Added more in-depth history....WITH REFERENCES!
I added a more in-depth explanation of how buprenorphine came to be. It's the first paragraph in the history section. It looks horribly juxtaposed once the second paragraph comes in with its lack of references and incorrect information. I'd do more to fix it myself but I just don't have the time. My two references contain an amazingly detailed account of the history of buprenorphine. If somebody wants to pickup the history after 1982 and how it came to be in the US, these two links will help: http://onlinelibrary.wiley.com/doi/10.1111/j.1749-6632.2011.06352.x/full#ss4 http://rzbl04.biblio.etc.tu-bs.de:8080/docportal/servlets/MCRFileNodeServlet/DocPortal_derivate_00001868/NIDA179.pdf (around page 17, John Lewis' In Search of the Holy Grail)
Tunafizzle (talk) 20:37, 5 August 2012 (UTC)
Opioid dependence section
This section needs a lot of work and sources. It is written from a mainly U.S POV and includes information that is best covered in other articles. It's also long winded and I'm sure it could be largely edited while retaining the core information. I've done some work but it needs more. Coinmanj (talk) 01:06, 21 August 2012 (UTC)
The thriving black market for suboxone speaks volumes about how hard life can be for addicts in this country
- Doctors and dealers battle for addicts salon.com Aug 22, 2012. Nemissimo (talk) 17:33, 22 August 2012 (UTC)
Contraindications
The only reference for this section is a dead link. There are also some claims which seen dubious to me, particularly the equivalence of 2 mg buprenorphine with 80 mg morphine. That doesn't sound right. The whole paragraph needs a reference and some of it may have to be removed.Rose bartram (talk) 16:35, 15 December 2010 (UTC)
Wow, this link's been dead since 2010? There's no question 2mg of Suboxone is on a whole different level than 80mg of morphine. And if it's buprenorphine without naloxone a naive person could easily use this wrong information to overdose. I just marked it dead, I think I'll just delete this sentence and link to Opioid_comparison. I think that's the more responsible thing to do, especially considering how long this link's been dead -- I can't believe it's stayed up for so long. Pfoot (talk) 19:58, 6 September 2012 (UTC)
ASAM
ASAM -American Society of Addiction Medicine does NOT have a low status. These physicians are in need and they pay them extremely well, given their rarity and need. That was clearly a personal opinion considering ASAM specialists to be in low regard. -- Preceding unsigned comment added by 152.130.6.194 (talk) 08:12, 25 December 2012 (UTC)
Suboxone Withdrawal
I agree with everyone about suboxone withdrawal, although perhaps more vehemently - I personally went through it. There isn't a lot of substantiation on this from traditional sources -- most of what's on the Web comes from message boards. although there is an entry on Livestrong. (I'm naturally suspicious, but the manufacturer may have something to do with this.) The withdrawal varies in severity, but it exists, and for this article to be complete, it needs to address it. JSFarman (talk) 23:52, 11 March 2013 (UTC)
After reading the article, I thought it would be helpful if there were more information about withdrawal from Suboxone. There is currecntly a lot of discussion by users in various online communities regarding the claims that withdrawal from Suboxone is milder as reported by both the manufacturer and literature (that is, milder than the opioid one was dependent on before Suboxone treatment. While withdrawal symptoms are subjective, some users' experiences of Suboxone withdrawal are not consistent with the word "milder" and it would be nice to see some new research here or at least a mention of the problem. --The preceding unsigned comment was added by 72.200.68.198 (talk) 09:52, 18 March 2007 (UTC).
I fully agree. The subjective reports vary so wildly for buprenorphine withdrawal. I think the word "milder" is not the right word to use. It might be mild for a percentage of people coming off, but a lot of the cases I've seen indicate that the withdrawals can be really bad. Aj1976 (talk) 02:28, 1 December 2008 (UTC)
Without question there is a lot of misinformation about this subject floating around and perhaps that should be a focus within this subtopic here. Having experienced Suboxone withdrawals personally on a few occasions, I can tell you it is an opiate/opioid withdrawal, the severity of which depends mostly on how much the user has been taking and for how long. One thing prescribers and manufacturers like to avoid is the length of the withdrawal period. This drug has an extremely long half-life which results in a long, drawn out withdrawal period (e.g. three weeks as opposed to the 36 - 72 hours for dilaudid, on average). As any addict will tell you, withdrawal is withdrawal and it is terrible no matter how "mild" so the duration of a full-on, get it on, suboxone DT is beyond what almost anyone can withstand. Which fully explains the recidivism rate for long term maintenance patients who have had their regimens discontinued.
shortage of parenteral buprenorphine 0.3mg/mL soln followed by massive cost increase
Recently a lengthy shortage of buprenorphine injectable, during which it was impossible to get it (at least for retail pharmacists - if any was available, hospitals got first dibs), ended after lasting a very long time. I had been getting it from a compounding pharmacist. Although the patent has been expired for some time, and prior to the shortage, there were several generics available in the US, now the only brand you can get at a retail pharmacy is Reckitt Benckiser's Buprenex, the original brand-name product. Before the patent expired, the retail price of Buprenex was about $300-400/month; now, it's about $1000 for the same quantity. Can anyone tell me:
TIA to anyone who can help answer my questions. Mia229 (talk) 20:48, 4 January 2013 (UTC)
Buprenorphine page should be separate from Suboxone page
I know that things like hydrocodone and vicodin are not generally given separate pages, being that they differ in one active ingredient. But they both server the same purpose - pain relief.
Also, Suboxone is buprenorphine and naloxone at a ratio of 4:1. Suboxone is actually two drugs in one. -- Preceding unsigned comment added by 108.176.105.38 (talk) 09:00, 15 October 2013 (UTC)
In the case of Suboxone, its use is different than the use of either of its components alone. It is used for opioid addiction treatment, not pain relief. I think separate articles would go a long way in making this information more accessible. Especially given the general dislike the 12-step proponents seem to have of this drug, and lack of neutrality the article tends to display. (on and off as differing camps edit the article back and forth.)
66.41.0.174 (talk) 20:38, 28 November 2007 (UTC)
QUESTION=HOW LONG IS BUPRENORPHINE IN YOUR SYSTEM? --Preceding unsigned comment added by 71.234.226.18
(talk) 05:18, 27 January 2008 (UTC)
Speaking of differing camps editing the page, the segment before last, "Ending treatment of Suboxone/Subutex," is incredibly biased and makes reference to the fact that addiction is comprised of "especially spiritual" aspects of one's personality. This is ridiculous, subjective, and should be removed. The entire section about ending treatment is worded as though from a single person's perspective and is all conjecture and totally subjective. Should be removed. 72.188.184.3 (talk) 19:26, 12 December 2010 (UTC)
when can a talk page be cleaned up
the article has been tidied up a good bit, how about this talk page? -- Preceding unsigned comment added by Tunafizzle (talk o contribs) 04:27, 3 July 2014 (UTC)
Looks much much better, thanks.Tunafizzle (talk) 01:20, 24 July 2014 (UTC)
Biased argument on binding affinity and marking
This section seems to be written in a hostile tone and seems to try to force an opinion on the topic rather than just presenting facts. It should be rewritten or deleted. -- Preceding unsigned comment added by 130.132.173.197 (talk) 20:15, 30 September 2014 (UTC)
MOR agonist with DOR antagonism
How common is this among opioids? Even Bupe's active metabolite Nor-bupe doesn't have this (straight across full agonism). For example thiobromadol is a mu-agonist that is equally potent as a delta-antagonist. Is buprenorphine notable as being in a similarly exclusive category with that drug as an unusual case worth mentioning? Nagelfar (talk) 22:25, 30 September 2015 (UTC)
Conflicting affinity information?
I don't understand these things that well so maybe I just don't get it but in the section Suboxone and naloxone theres a phrase "Published data clearly shows the Ki or binding affinity of buprenorphine is higher (0.2157 nM) than naloxones (1.1518 nM)." Cited source seems to deal with MOR affinities. Later in the articles Pharmacodynamics section the Ki value for MOR is 1.5 nM. Is there a conflict or am I missing something.--Custoo (talk) 12:42, 15 October 2014 (UTC)
i'm confused by this, too. on the page, it states that the Ki (affinity for receptor) rating for the mu receptor to be ~1.5, but in this section it states ~0.2. further confusing is when the naloxone page is brought up, the Ki rating for naloxone doesn't match any of these values. -- Preceding unsigned comment added by 198.49.6.225 (talk) 05:14, 27 May 2016 (UTC)
Carfent.. again ... and again
Hello friend, you didn't sign the preceding comment. It's cool to be a stickler for sourcing, just remember, when you point a finger, there are always three fingers pointed back at you, and there is a long tradition on the Internet of being harder on others than we are on ourselves. Be of clean hands before making demands.
I'm not 100% sure what you're saying here, but it appears that you're stating that PWDs cannot be overcome with a bolus of one's drug-of-choice. This is not entirely accurate. Fentanyl and even "lowly" hydrocodone can certainly overcome a bupe block, but it's entirely dependent on how much bupe was taken vs. how much hydrocodone is taken. Bupe patients need emergency pain relief in the ER from time to time, and ER doctors can and do overcome the bupe block by using relatively massive doses of another opiate. This also, obviously, would relieve any PWDs the patient might be experiencing.
The following link is probably not sufficient basis for a encyclopedic source, but it does address real-world, actual situations in which bupe blocks are overcome by very high doses of other opiates.
http://suboxonetalkzone.com/emergency-pain-relief-while-on-suboxone/
With regards to binding affinity, the reason bupe causes PWDs is because it has a higher binding affinity than the drug(s) that it displaces. This being the case, it stands to reason that bupe would be similarly be displaced by any drug with a higher binding affinity than itself ... given in sufficient quantity. Given in a quantity much higher than bupe itself, bupe PWDs could also be overcome by taking an opiate with lower binding affinity. Binding affinity and ED is only comparable in 1:1 ratios. A (usually much) higher quantity of a drug with a lower binding affinity can and does displace drugs with a higher binding affinity, which succumbs to a constant barrage of the "weaker" drug attempting to displace it. 10x the dose of a drug with a Ki of 2, can overcome the antagonism of a drug with a Ki of 1. It all depends and there are many other factors at play besides Ki. Yuno Aye Feltersnatch (talk) 18:40, 10 June 2016 (UTC)
Causes physical addiction/withdrawl
This fact is probably something that readers of the article would want to know. A recent edit deleted the fact https://en.wikipedia.org/w/index.php?title=Buprenorphine&diff=prev&oldid=723869251, (it was not cited), and maybe it should be obvious that this is a physically addictive drug with physical withdrawal effects, so I added a bit in adverse effects and I think that the obvious needs to be stated at least somewhere in this article.TeeVeeed (talk) 15:38, 25 June 2016 (UTC)
OK-so I went back and added a ref to the drug's page that states that it directly CAUSES a physical dependence. The history section implied that it does not after the old deletion, and actually implied that what researchers were originally looking-for, (a non-addictive opiate)- is what this is when that is false and not even supported by the warning labels currently on the drug. The fact that this drug is physically addictive--(produces withdrawal symptoms upon discontinuation) WAS part of this article, and that fact has been removed at least two times now.
"SUBOXONE Film contains buprenorphine, an opioid that can cause physical dependence with chronic use. Physical dependence is not the same as addiction. Your doctor can tell you more about the difference between physical dependence and drug addiction. Do not stop taking SUBOXONE Film suddenly without talking to your doctor. You could become sick with uncomfortable withdrawal symptoms because yo..."--from the manufacturer's website
I don't want to get into an argument about physical dependence vs addiction. Feel free to change my words in article, but physical dependence and discontinuation syndrome--whatever you want to call it, needs to be included, and especially following a statement that implies that this is not "addictive"--when many people consider a physical dependence to be a physical addiction, we don't want to mislead by semantics here.
This could be really confusing because Suboxone can cause precipitated withdrawal upon initial use from an opiate-user's regular narcotic, so "withdrawal"-is a known adverse event but it also causes physical dependence and withdrawal if used without other drugs-when used as prescribed,(as-in a long-term maintenance program on Suboxone), and we don't want to imply or say that it doesn't.TeeVeeed (talk) 21:39, 25 June 2016 (UTC)
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