Buprenorphine and Naloxone (Suboxone) Pharmacology
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- čas přidán 13. 07. 2024
- Hi! This video is about the rationale behind combining buprenorphine with naloxone. I explain why the route of administration of the drug product influences the effect the user will experience.
Suboxone is positively changing my life in every way. I do NOT miss that constant obsession with when I could have my prescription filled and the utter dread of having to face withdrawal. These two awful factors are 110 percent gone from my life now.
Hi! I am so glad to hear it has helped you! The only addiction I have had is with food, so I can't really imagine how difficult it can be for people with an addictive brain chemistry.
Happy for you ! I was the same way until I got onto buprenorphine
@@AVW_Dr.Dr. Yet you think you know about drugs you have never taken. and dont know first hand.
I have been on Suboxone for opiate addition for about 6 months, I still have to go to the pharmacist 3 times a week. I lied to my doctor and said I had to travel for 6 days and got takeaways for them 6 days. I waited 36 hours, then went on a huge Oxycontin binge. By the end of it I was in chronic withdrawals, I felt like dying, but I had to wait at least 24 hours before I took Suboxone, so I didn't go into precipitated withdrawal. Them 24 hours were torture. After I took the Suboxone, I was feeling "normal" within the hour. I promise you I won't be doing that again...
Most doctors that deal with "replacement therapy" aren't going to judge you for being an addict. I've worked in rehab centers and with psychiatrists and I can tell you that a lot of people in the field are in it for the right reasons... sometimes due to personal experience. Always be honest with your doctor and if you aren't getting the answer you wish for, go see a different doctor. Repeat the process. If you end up with the same result, which I highly doubt, then the problem might lie with you. Honesty is the best way to move forward. If Suboxone isn't reducing the potential harm you pose to yourself, there are other options such as Methadone, or possibly getting approval for a full lawn 28-day rehab with aftercare. Doctors take an oath, that basically states, that the health of the patient in front of them comes first no matter what. Cause no harm and relieve the symptoms. If you were lying to your doctor it's because you want to get high. Any doctor that is prescribing Suboxone has either been in the game themselves or has someone they love/loved go through the same thing you have which is why they are so passionate about what they do. I am in recovery myself and was smooth sailing up until covid hit and a virus that has a 0.74% chance of general hospitalization, took the front seat to a disorder (addiction) that has over a 50% death rate. If you can't tell your doctor that you need to get high and are going to go score and you need help getting the monkey off your back, then either you need to step up to the plate and advocate for yourself, or you need to find a doctor that will prescribe you something safe that will keep you from killing yourself and giving you another day to possibly find recovery and get past the addiction.
Box one is a fantastic chronic pain treatment as well. You don't have to be an addict to need it. I was on hydrocodone for years but 2 times my pill count was off and I was put under a microscope and treated like a criminal. Suboxone is much less stigma ridden due to 1x a day application. It's a Godsend for some chronic sufferers!
A good explanation. Thank you
You're welcome!
They don't tell you how bad the withdrawal is when you taper off suboxone. On it for 10 years and even after a very slow taper, it's still months of agony
Thank you for sharing your experience. Do you mind sharing exactly how you tapered off?
Buprinotphrine is used for chronic pain
It’s not helping nearly as much as Hydro did. I wish I could go back.
Suboxone has saved me and I can not thank whoever introduced it to the world enough
May I ask how long you've been on it?
You realize there may come a day that you'll have to so through the same hell to stop taking that as you would any other op.
@@Lady-Carmakazi Facts
@@Lady-Carmakazi you don't have to come off of it because it's a disease
Just like any other you need to educate yourself someone that
Is an alcoholic has to have alcohol
And some people take medicine
To not Drink alcohol
High blood pressure is a disease
Diabetes is a disease heart disease is a disease and so is addiction if one doctor won't write it there's always going to be another one
Buprenorphine is a weak partial agonist at the mu receptors.
Wich means it only tickles the receptors. Sufficiently to remove the withdrawals and craving. But not sufficiently to cause euphoria
Suboxone saved my life.
I heard it is atleast 10% active on the opioid receptors in the stomach and brain when swallowed
So basically buprenorphine is a safer drug that methadone and other opiates, and opioid, because it has a lower ceiling which gives it a lesser chance at overdose, I tell you tho the withdrawal is almost as bad as methadone. So if you take suboxone or subutex, or any of those buprenorphine medicines, if you don't want to have withdrawels ,wheen off of it before too long because it is addictive, and here lately I've seen them using it for pain ,"not suboxone" but other kinds like belbuca, and suboxone for methamphetamine addiction.
I always advise that any medication should be stopped as gradually as possible. In my case, I was taking a capsule with beads in it, and when I wanted to wean off it I actually lowered the number of beads I was taking each week (daily dosing). For strips why not reduce it by about 10% each week, or every every 2 weeks, by cutting the strip. Allergies are an exception to the rule about gradual discontinuation. If someone develops a severe allergy to anything it needs to be discontinued immediately of course. None of this is medical advice, but just for information purposes.
i've been on buprenorphine for 12yrs and now it has stopped producing the euphoric effect and i don't know why. i questioned the manufacturers about ingredient change but they denied it. what the hell can it be.
Hello. That is a long time for that change to occur now. Have you started taking any other medications, or had any weight changes?
I been on strips for two years and my insurance quit paying for the strips and only will pay for the tablets. I don’t feel like I did on the strips. It’s like the tablets aren’t as strong. I let it dissolve under my tongue until it’s completely gone. Do you spit the rest out or swallow it? The taste makes me sick.
You don't spit it out. You try to keep it under the tongue as long as you can, but then you swallow it. I imagine the strips are easier to keep in place due to sticking to the cheek.
Try placing an orange TicTack (or 2) under your tongue at the same time. It will be much more pleasant. And if you really have trouble swallowing potato chips will absorb the off taste very nicely! I hope you try this. I have been on Suboxone for 2 years. I prefer the tablet. There are different strengths as well. I started out at 2mg/.5mg Naloxone.
I always spit Suboxone out as not to get any a Naloxone in me. I used to sweat on Suboxone, but Subutex I don't.
Try putting an orange Tic Tac in at the same time. It covers the bitterness. I swallow the remainder. Sometimes it's necessary to have a handful of salty potato chips. It really absorbs that horrible taste quickly.! I take 1 1/2 tablets because I don't want to pay for strips.
Hi! Loved your video. I’ve been on suboxone for about a year and been addicted to opioids (H and F by inj it) for maybe 6 years. Question. I was always told to dissolve under the tongue. I have also heard about dissolving inside of cheek. Is that way not preferred ? Or the same ? Thank you for your time !!
Hi and thanks! The package insert does not specify if one method of administration is preferred over the other. That is directly from the manufacturer. The key is to allow the film to fully dissolve, and alternating sides of the tongue or cheek if you need another film to achieve the prescribed dose. I am sorry to hear you are, or were, addicted to opioids. That is clearly something that needs to be addressed by a specialist, and I hope you get the help you need.
@@AVW_Dr.Dr. thank you your so kind. Does under the tongue work any better or the same as using your cheek ? Under the tongue is sublingual right ? So is the cheek an ok method to use ? Sorry about all the questions. I appreciate your time. And I do go to an online Suboxone clinic thankfully where it is monitored and random drug tests are taken. I still struggle everyday of course 🙏. Thanks again
@@emilydisalvo4769 under the tongue is sublingual yes. It should not be much different from the cheek.
@@emilydisalvo4769 Are you using suboxone films or suboxone tablets?
@@ryanthomasyee hi. Films
What happens if someone snorted it? I hear friends all the time and that's only way they use it?
Since naloxone is normally used intranasally for opioid overdose reversal, snorting suboxone would certainly make the naloxone more bioavailable, and would oppose the buprenorphine more strongly than if used sublingually. I would expect snorted suboxone to give less euphoria, and likely oppose other opioids in the system as well. Now, the answer would be very different for something with just buprenorphine, and no naloxone.
Another thing I know people that shoot up the suboxone strips and swear they get high and they keep doing it so it's either true or it's in their heeads, but I have never shot anything I snorted lots and lots of oxys,percocets and any pain meds really.
Hi, I can say it helped for 4 days then on the 5th day, my body, every muscle it feels like I've been hit by a mac truck. I'm not understanding why. I stopped taking it 3 days ago and I didn't have the soreness and pain in my muscles. I started back yesterday and today I hurt worse than I did on the 5th day. My pain management Dr. Says ,it will go away. This isn't going away only worse
When I switched from methadone to suboxone, I had a lot of muscle pain/soreness for 2.5 weeks after the last dose of methadone. It went away eventually.
I must say I am not aware of this as a side effect. At least not a common occurrence. Moving from a stronger opioid to this would be a very likely cause, as mentioned by okiM.
Has anyone found this to be more addictive than Kratom?
I'm a recovering alcoholic and addict. Predominantly Alcohol and Benzodiazepams and periods of a year of liquid/pills morphine,Percocets and hydrocodone. Most of my friends or at least acquaintances we're addicted to heroin. So while I had seizures from alcohol/benzo withdrawal. I haven't in 6yrs felt opiate withdrawal. The only time I ever truly felt the hell of opiate withdrawal was taking morphine pills daily. Once I ran out after a year, I literally couldn't feel any emotions for about 8 months. It was so scary. I started like a fool to take kratom. Only to find I got drunk on it. 45 Grams a day. I reached out and the doctor prescribed me buprenorphine-nalox 2-0 5mg. I'm honestly scared I'll become more addicted to it than kratom..idk I'm in a bad dream and just want to wake up.
I don't have any experience taking opioids or kratom (opioid-like activity), other than for an endoscopy. Withdrawal from alcohol/benzos can be fatal, while that from opioids is described as very uncomfortable, but not fatal. The only thing I will add in response to your question is that kratom has not been tested in a clinical trial for toxicity, and there are no safeguards to ensure you are getting kratom without added opioids or other illicit drugs. Suboxone has that advantage, and the fact that the partial agonist function should limit the maximum activity. I am not a physician, and of course, not your physician even if I were. So, I wont make any recommendations, but I wish you the best.
Yes it's highly addictive
@AVW_Dr.Dr. It's the dehydration that's most dangerous. When people stop taking things abruptly they will sweat, puke, get diarrhea. Yes it can be deadly. Need to taper
None of this shit is anything but uncomfortable. God got this if you let him
How is it going on Suboxone?
I'm sure the doctor gave you the addiction vs. dependency anology. In medicine, addiciton is a series of behaviors surrounding a substance or activity. People with depression don't usually have this concern about taking an antidepressant, even though they come with physiological dependency and a withdrawal syndrome if you stop taking them, especially suddenly.
If you're not puking your guts out from the taste/smell of Kratom, running into seizures, spending your money, alienating your relationships, growing more isolated, and not having to think about how you plan to dose, get your supply, how to hide it, etc. Then I guess sure, your trading substances. One was a supercar that was speeding down the highway, getting into accidents, endangering your life and others. The other is a Gremlin. it doesn't go very fast, and even if you tried to drive the same way with it, it's not thrilling or nearly as dangerous.
Hope you're doing well.
There a difference between the pills and strips??
Hi. There are no significant differences. Both have buprenorphine and naloxone.
Both taste terrible to me. The film feels slimy under my tongue and to swallow after dissolving requires potato chips. With the tablet, I take it with an orange TicTac and it seems fine then. So I now prefer the tablet...
Wouldn’t the Nalaxone block the effect of the buprenorphine ?
That's a great question. It's not supposed to be absorbed from the oral mucosa as much as buprenorphine, but the reality is naloxone's half life is too short to serve a purpose in this formulation, which is supposed to be to prevent abuse through injection.
I understand your thinking behind why injection should not work for euphoric effects, but I promise you with dissolving innothing but water and injecting, you get a minor heightened euphoric effect vs taking it sublingually. I would highly discourage this way, as it will destroy your veins and lead to possible infections.
Brian, thanks for sharing your experience. The information I presented is from the package insert, but whether or not there are exceptions I'm not aware. It's possible the buprenorphine is more soluble in water than the naloxone. Did you filter it after dissolving it?
@@mjames7674 if there weren't enough naloxone to counteract the buprenorphine when given by injection the combination would be pointless. I'm not saying people aren't experiencing what you said, but it's a little surprising. Thank you for sharing this information. And yes I've heard of many people destroying their veins with this.
I'm also curious what you mean about bioavailability. If you're injecting it you have 100% bioavailability unless you leave fail to get it all in the syringe. That would depend a lot on what it's dissolved in and how is filtered.
I made a long reply to this but has for some reason been deleted... Did you get a chance to read it?
@@mjames7674 I did read it. My reply was to it. Not sure how it got deleted. I was able to read even after I couldn't find it here. I saw it on CZcams studio where I can edit my videos
@@AVW_Dr.Dr. Hey, I was just curious, you don't know of any way that I could help my veins heal, do you? Is it even possible for them to heal back to or close to back to their original state before I damaged them?
WHAT ABOUT USE FOR CHRONIC PAIN INSTEAD OF OPIATES?
Suboxone contains an opiate, but depending on the severity of pain it may not be strong enough to be adequate. Same goes for subutex.
@@AVW_Dr.Dr. thank you. was watching a youtube video with a local pain management/addiction doc who says he has been using it for chronic pain with great results. looking for options bc been on long term opiates for chronic pain r/t failed back surgeries.
Unfortunately, it doesn’t help with chronic pain despite the pharmacology indicating that it should & its 💯 an opiate.
PLEASE think twice before taking even very low doses for chronic pain because it occupies so many mu receptors & for such a long time (days), that if you need another opioid in that time (& you will), it won’t work! It’s also highly addictive. Even people with no history of drug abuse suffer from debilitating withdrawal effects for an extremely long period of time when they decide to stop taking it. You can’t just stop, you’ve got to taper down & it takes weeks during which time other opiates won’t work.
Stick to more commonly prescribed pain meds (all opiates with extreme caution), non steroidal anti inflammatories, nerve pain meds, buy your own TENS machine (inexpensive), use heat, massage & all those other tactics you’d probs already be aware of.
Very best of luck, chronic pain’s the pits - I suffer from it too ❤❤❤
@@maclardy Did you try it? they are talking about placing a spinal stimulator now
@@spike7703 yes, I’ve tried it at varying doses for a long time but only tried the sublingual films. Unfortunately, it had no effect on my chronic back pain & debilitating sciatica & when I was on it, I wasn’t allowed to have anything other than Advil for pain 😵💫😵💫😵💫. I had my TENS machine going flat out & have permanently scarred my back from using hot water bottles but both those things worked while suboxone didn’t.
How to stop this tablet I want to leave him plz tell me the right path I taking 3 tablets per day
If it is prescribed then speak to your doctor. But either way, tapering off the medication slowly is always the best plan. The slower the better. Lowering the dose by 0.25 tablets a week is even reasonable. 2.75 one week, 2.5 next week, 2.25 next week, etc.
@@AVW_Dr.Dr. thankx docter
Bro i used to know this taper schedule so I NEVer w/d and take breaks every 2 days and now I’m jUs fUkdddd you could Be my Doc?? I can pay you 💰to fwm and lmk wtfff to do about this since I can’t go to the gov idk if your a Social worker hope not anyways PLEASE 🥺 LOLLL PLEASE TELL ME AND OTHERS HOW TO TAKE THE sAme DOSE TO GET OFF EVENTUALLY PLEASE JUST NOTE A TAPER
Naloxone gives me headaches theres no point in having the Naloxone ii can't compete with the buprenorphine
You make a good point. I'll be making a video explaining why the formulation is not serving its intended purpose.
What if it's crushed and sniffed, or snorted via nostrils??
Keep in mind naloxone is used intranasally to reverse opioid toxicity. Therefore, snorting it would block the effects of buprenorphine.
@@AVW_Dr.Dr. Hi Doc. It would seem that adsorption via the nasal passages would be the same. If not better nonetheless, there's no argument with you, I'm sure that you know best. I bring up this issue, because of the ancients and how they used these passages for such, the nose, anal, for ingesting. Why are these areas left out?
@@4gripp do you mean why was it left out of the video? I know that anal administration of certain substances via smoke was common in India some time ago.
@@AVW_Dr.Dr. No sir, left out of ingestion of some medications in general. I have an idea/invention for a new way for back surgeries that take place. I've been searching for someone in your field that may give feedback, and or partnership. It deals with preventative back-pain post procedure, and procedures.
@@4gripp feel free to share your idea. I always enjoy thinking of inventions, but never act on them.
I used to know this Bs comment on CZcams that said smh I needa go back to plain bupe Atmm
HOW DOES IT WORK? BY DRASTICALLY RAISING THE PH LEVELS IN YOUR MOUTH TILL YOUR TEETH GET THESE PIN HOLES THAT THEN OPEN UP. LOST ALL MY TEETH. IM ON DISABILITY, MY FAMILY HAS A $40K+ DENTAL BILL, SUB CLINICS GASLIGHT PATIENTS AND DONT VOLUNTEER THE FDA WARNING!!
I've never heard of this.
Now, do you volunteer the FDA warning on Suboxone for tooth rot? Or do you just say Suboxone is totally safe?
Shall I spit it out ? After resolving it under my Tongue 👅 ???
I’m desperate to know
Plz someone ??
Hello. There are good instructions here: www.mayoclinic.org/drugs-supplements/buprenorphine-naloxone-oromucosal-route-sublingual-route/proper-use/drg-20074097
@@AVW_Dr.Dr.
Can’t thank you enough sir
I’m honoured that you took your valuable time to reply
Love you sir
From London England 🏴
DON'T SPIT IT OUT. You have to swallow it after letting it sit in your mouth for a good while. And yes i take suboxone and know personally. The instructions will prob say to spit it out which is faulty. Yes it's absorbed sublingually but you still get affect from swallowing it. It won't do crap if you spit it out.
Just saying you can absolutely inject or snort suboxone also you can go from sub and get high off any opiate the issue arrises when you do suboxone too early before the real opiate has cleared from the brain receptors
Thanks for commenting. I am afraid this comment will get flagged, but I didn't want to remove it myself. I do appreciate the information, being naive to opioids myself other than for an endoscopy.
@@AVW_Dr.Dr. no worries sir thank you for the educational content as well as your commitment to open conversation if it gets flagged no biggie you've earned my respect not deleting this yourself....all of your information was excellent I just wanted to add some information from personal experience!
Glory to Ukraine!
Yes sir! Ukraine is an inspiration to the world.
Suboxone is being used in chronic pain treatment. Because of its working ability to occupy the receptor for up to 36 hours, it is invaluable as opposed to taking say hydrocodone 3x a day. Hydrocodone has a short half life and the tendency to take more on a bad pain day (which turns you into a criminal) is a constant issue with regulations under a pain contract. I am now a 2 year patient treated with Suboxone and it works wonderfully! It feels like a constant in the relief level. This has been a Godsend! My goal is to not feel any high, merely have a level of pain that makes life liveable. I was first told that Suboxone was being used to help get addicts off Methadone. That was scary. My Dr. talked me into a 14 day trial and now Suboxone is my window to a life that still has pain but it is at a level that I can bear. I suffer from a 13+ mm subluxation L1 - L2 and without medication, I cannot even get out of bed! I never take this gift for granted. It allows me to live, not just exist in pain.
I resent having politicians get between my Dr. and my Healthcare. I am honest and he does not enable at all! That is a relationship I work hard to keep on a high trust level. Thanks Doc! You make my life sane!!!
Hi and thanks for your input! I also have a lumbar subluxation, but it's not usually debilitating. However, when it first started it was horrible. Stabbing pain that made me break out into a full sweat. I think that happens less now because of an unconscious avoidance of certain movements. I haven't used opioids for it, but naproxen is sometimes essential.
@@AVW_Dr.Dr. I took NSAIDS until I developed an internal gastric bleed that put me in the ICU for 3 days and up onto Med Surg floor for 5 days of monitoring. It was a near death experience. Somehow my brain woke me from sleeping, I was gasping for air but could not get oxygen in my system. It woke my wife and she called the ambulance. Had I not awakened when I did, by morning I would have bleed out. Without medication I have excruciating pain. The insurance companies still call it elective surgery to have 4 to 5 fusions. I have issues with bowel motility and sometimes cannot control my bladder. I was told by the Dr. it is likely that my subluxation could cause need for colostomy and possibly a feeding tube at some point. I just try to live each day and not be an ass to people even though on a good day even with Suboxone I still have constant pain, muscle weakness, loss of sensation in my legs especially. I understand that people who have never lived with constant pain cannot comprehend what it is like. I am physically retired and just try to be the best person I can be for my situation.
That sounds nice, but I don't know anybody taking Suboxone every 1 1/2 or every 2 days unfortunately. Most people take it multiple times a day.