Author: tearj3rker
Posted: Sun Mar 11, 2012 1:05 am
Thanks DoaQ …
But in the last video I saw by Dr. J, he said the ceiling in "opioid effect" for buprenorphine is 8-12mg, not 4mg. It seems his opinion of the ceiling level has moved closer to the SAMHSA definition recently?
I always took that graph to just be highlighting the concept of the ceiling effect for the layperson. As you said, it doesn’t give any data as to where the ceiling effect really lies. If it was a representation of real clinical data from a study it would have some kind of scale on it.
Most research indicates the ceiling for respiratory depression lies at about 4mg. Recent studies into buprenorphine for analgesia has shown the ceiling effect for analgesia is a lot higher than that – ie 7mg at least. Since Grumenthal have moved into the buprenorphine market, they’ve injected a bit of money into disproving the "4mg analgesia ceiling" myth. Because the myth would severely limit their market, esp in palliative care.
According to what I’ve read / heard so far, the present research indicates that buprenorphine has a ceiling on respiratory depression at around 4mg. One study said that the ceiling for subjective opioid effect was 8-16mg. SAMHSA have said that the ceiling for buprenorphine is between 8-16mg. Dr. J recently said that the ceiling for opioid effect was 8-12mg, though many times in the past he has said the ceiling is at 4mg. Grumenthal study said analgesia keeps increasing linearly up to 7mg.
So where does the truth lie?
And what truth do we choose to tell members on the forum?