Author: tearj3rker
Posted: Tue Feb 21, 2012 9:03 pm
| cire113 wrote: |
| God This isnt ROCKET science people..
BUPRENOROPHINE has stronger affinity the receptors than NALAXONE… You get INSTANT withdrawals from the BUPRENORPHINE knocking off the opiate receptors…NOT Nalaxone….. YOU CAN shoot SUBOXONE and not GO into instant withdrawal as long as there arent other opiates in your system… It aint complicated people… I thought this was general knowledge |
Many YEARS ago… I shot Subutex literally the next morning after having heroin. And I had zero precipitated withdrawals and enjoyed it.
About 2 years ago I shot Suboxone over 24 hours after using heroin, and I was SICK. Really sick.
Can anyone explain that since the bupe displaces the naloxone anyway?
When only Subutex was prescribed here, a lot of who were still using heroin were injecting it ‘to get them by’. As long as they were careful and waited til they were hanging out before having it, they were okay. Since Suboxone’s been phased in, it’s virtually impossible to do that. People have to wait a lot longer after gear before they shoot Suboxone, to the point it’s just unviable.
Most of the people here shooting their pills still preferred using heroin and would keep using it when they could. Since Suboxone’s replaced Subutex, it’s made the practice a lot harder. Shooting Subutex was BIG problem in my city and many people would spit out their supervised dose (we get supervised / clinic dosing) after they left, all spitty and dirty, and go home to inject it. That is VERY rare these days. So Suboxone has made an impact.
That being said, myself and these pill shooters were all still using heroin at least occasionally.
I can quote some studies that may shed some light. ‘The Sponsor’ refers to RB.
| Quote: |
| Study CR92/111 involved the administration of sublingual buprenorphine solution at a dose of 4 mg then 8 mg daily to opioid-dependent subjects until Day 8. This was followed by “challenges� on Days 9, 10 and 11, in which subjects received, in random order, single doses of buprenorphine 8 mg + placebo, buprenorphine 8 mg + naloxone 4 mg and buprenorphine 8 mg + naloxone 8 mg, each given as a sublingual solution. On Day 12, subjects received a single intravenous dose of buprenorphine 8 mg + naloxone 4 mg. Withdrawal symptoms were assessed using a subject-rated 21-item questionnaire, a subject-rated visual analogue scale (VAS), and an observer-rated VAS. The investigators found no significant difference between the sublingual treatments and the intravenous challenge for any of the withdrawal measures. In summary, this study does not support the sponsor’s claim. On the contrary, it indicates that subjects who regularly take Suboxone will not experience significant withdrawal if they inject their usual dose (suggesting that the presence of naloxone in the product is not a deterrent to patients injecting their own medication). The study provides no information as to whether the naloxone content of Suboxone will produce withdrawal if injected by users who are dependent on other opioids. |
So for people JUST taking Suboxone, no significant withdrawal with IV.
| Quote: |
| Study CR93/005 enrolled 13 subjects who used heroin at least once daily and were opiate-dependent according to the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) criteria. The subjects underwent an initial screening in which they were given a single intravenous dose of naloxone 0.4 mg. Three subjects were excluded from further participation because they had no withdrawal symptoms (VAS rating 0). Five subjects were excluded from further participation in the study because their withdrawal symptoms were too severe (VAS ratings of 60-100). Five subjects continued in the study and received, at intervals of ≥ 5 days, single intravenous doses of buprenorphine 0.4 mg + naloxone 0.4 mg, buprenorphine 0.4 mg, naloxone 0.4 mg, and placebo. In these subjects, the agonist and antagonist effects of buprenorphine 0.4 mg were only minimally different to placebo. Naloxone 0.4 mg produced typical withdrawal effects. The 1:1 combination of buprenorphine 0.4 mg + naloxone 0.4 mg acted predominantly as an antagonist, and was perceived as dysphoric and unpleasant by all 5 subjects. Overall, this study provides only partial support for the sponsor’s claim. Naloxone 0.4 mg (less than the 0.425 mg remaining in a Suboxone 2/0.5 mg soluble film at expiry) is clearly capable of producing withdrawal symptoms – and thus acting as a deterrent to abuse – in the majority of opioid-dependent persons when injected alone or in combination with an equal amount of buprenorphine. However, 3/13 subjects (23%) failed to experience withdrawal after injection of 0.4 mg naloxone during the screening period, even though they were daily heroin users who fulfilled DSM-III-R criteria for opiate addiction. The buprenorphine:naloxone 1:1 combination would presumably have also failed to produce withdrawal symptoms in these 3 subjects, had they continued in the study. Furthermore, the study does not provide any information regarding the effect of injecting buprenorphine and naloxone in a ratio of 4:1 (as present in fresh Suboxone soluble films and tablets), or a higher ratio (as present in stored Suboxone soluble films), or at higher doses. |
So for people already opioid dependent, addition of naloxone to buprenorphine significantly increases withdrawal effects.
Real world applications? IMO if everyone was being given Subutex instead of Suboxone, there would be a lot more IV / intra-nasal abuse going on. Mostly because it would allow more full-agonist users to resort to IV buprenorphine when they needed to. It’d also allow people who now inject their Sub to switch to and from agonists more easily.
The kinds of people I knew who were injecting the Subutex preferred, and were still injecting agonists. Suboxone cut that option out for them. The rate of IV Sub abuse where I’m from has reduced a LOT since Suboxone came along because of that.