suboxone

[denthemenis]

was wondering if anyone has an experience or has taken suboxone for pain and if so was there any major side effects. POR this should be right up your alley (not being a smart ass) as you are very knowledgeable when it comes to questions of this nature. Any info would be helpful. I can read about it all day on the internet but answers are all from a pharmacological aspect.

[POR]

why would you ask about suboxone as opposed to subutex ?

Since buprenorphine is substantially more potent on a per mg basis than morphine and, as a partial mu receptor agonist as opposed to morphines full mu agonist action, it has much less side effects than other opiates. To date all the patients I have seen succesfully transferred to buprenorphine have stated they feel much more awake, less drugged up and less constipation problems than when on ocycontin, duragesic, morphine etc. It has definite clinical advantages also I imagine it's use will slowly become more widespread. It is abusable though.

Suboxone for pain management is a controversial subject and best left as being not recommended. It is done in certain circumstances but there is no advantage to it's use otherwise.

Someone was arguing here a few months that it's never used for pain and that may be true for all practical purposes but there are addiction specialists in the pain management field who will use it on rare and special occasions. I have not seen any formal write-ups on it but it is talked about at pain seminars I've attended. I've used it for pain but again, it was a special circumstance.

[denthemenis]

Reason I'm asking is that I am on Suboxone and am nauseous and at time it's very difficult to keep anything in my stomach even with compazine (both types).
I was concerned about the previous meds I was on (Vicodin ES, M.S. Contin) due to the dosage having to be raised and then raised again.

I am sort of health conscious in a way. I do at time get tired of taking pills including psych meds and at times will just stop everything and remove myself from the world. I have been getting better in that respect but pain and depression is a horse of a different color.

The suboxone I don't seem to care for very much. I do not at all like the side effects. It screws with my vision at times and haven't been able to drive because of it. Like right now I am having to take a break because the screen is getting blurry (a double vision kinda thing) my pain level is also not so good and my legs have been killing me today. Like a roller coaster. I really wish there was a way to get a new spine. Very very depressing situation especially when you add the other factors into the mix.

[POR]

that's unfortunate. Is it because you have only recently been started on the suboxone or tritated up too quickly ? Because it is so much stronger, patients generally stay at 2 mg for a week or two and go up 2 mg per week till effect.

MS contin and Vicodin are poor choices for long term pain management since they are so short acting. Vicodin also contains acetominophen which recently has shown adverse health effects with low dose long term use.

The fact that your doses had to be raised in itself is not a real concern, the correct dose is wahtever it takes to get the pain controlled so the patient can function. For instance I saw a patient today who takes 800 mg of oxcycontin, that ten 80 mg pills, every 12 hours and is fine, works and is in school. He didn't get their in a few weeks though.

Since side effects of opiates are dose related, the general rule is to lower the dose for awhile till patient tolerates it and start back up slowly.

But why suboxone and not subutex ?

[denthemenis]

they are the 8mg-2mg. dosage is 3 which I was nervous and quite frankly scared to take after reading info that said suboxone can cause death, so I stayed at two. Have been on since last Wednesday. Maybe dose is too low? too high?. Maybe I should have just stuck with what I was taking prior to this.

I have been on some sort of opiate since I had first injured my spine in 98 and i'm not to keen on the idea of taking handfuls of pills. I am scared to death of becoming an addict per say and I don't like the idea of becoming opiate dependent but then again but I guess the same could happen with suboxone.

I did call the suboxone helpline that was listed on the pamphlet but let me tell ya it was no help at all. They will not answer your questions whatsoever. I thought since the pamphlet said to call with questions or concerns I would find the answers I was looking for since they are in fact the manufacture boy was I sadly mistaken. I am honestly thinking of sending a complaint to the Joint Commission as this is just wrong.

To me 800mg of Oxycontin seems insane and deadly but i'm not doctor or pharmacologist.

To answere your question as to why suboxone. My sister was addicted to vicodin and I saw what is was doing to her life and got to thinking was I like this? am I going to become this? not only that but I am concerned about my psychological condition as I struggle every day and I thought I read somewhere that high doses and prolonged use of opiates also add to a psychological condition.


Back to my sister. I saw what a change suboxone has made for her. She seems allot more happy definitely more pleasant to be around and much happier. So I though to myself what do I have to loose and now I know my stomach contents a little weight and some sleep. Hopefully things will get better with time.

It's not just physical symptoms of pain and suffering it is very much mental. I then read you earlier post and started reading about Depression and Pain Comorbidity and found this issue to be a bigger problem than I thought.

I feel very much hopeless at times thinking that things are never going to get better. I never thought a spine surgery would take to where I am today. It's not only a physical and psychological problem anymore. You now have to add politics the BWC, Industrial Commission, MCO and the slew of other problems associated with it as I have mentioned in my other posts. I think I have gotten away from the topic here.

I went to suboxone also because after hearing and seeing what it has done for people I thought it might help me with my pain condition and it seemed to have promise of a better future if you can make sense to that. I'm not sure that I can as the side effects suck. I never really knew subutex was different from suboxone till now. Could I be better off with subutex?

All I know is that I want this pain to be under control so that I can start doing more to help my psych condition and possibly one day get back to the normal life which was lost somewhere in all of this and last but not least I would like to get back to work I'm hoping within the next year or so but only time will tell because as of right now I am a little anti-social and a very angry person as you might have noticed in other posts so since I am in some what of a manic state now I better apologize to you now or it will never happen. The world and yes the system is already dysfunctional enough and I think this is a great place to get away from that at times .

Nuff said 4 now

[POR]

ok. I see the problem, and it's a dual one. No fault of yours though.

Let me first talk about opiates for chronic non-malignant pain. Some years back a national consensus that pain was an under appreciated and under treated problem of many legitimate patients led to a further realization that physicians were afraid of undue scrutiny or prosecution in prescribing opiates.

New guidelines where issued, states published new pain assessment mandates for hospitilized patients, handbooks for physicians and medical societies etc encouraged a better appreciation for the disability and suffering pain causes in patients , encouraging the ethical treatment of pain without fear of harrassment. Since then there has been a surge or tidal wave in the prescibing of opiates for all manner of pain and, while a backlash is surely coming, patients have unquestionably been helped as a result. Goof patient education is part of that prescribinbg recommendation.

As a consequence, more opiates are on the streets, opiate adiction has risen, opiate related crime has increased and most of the market comes from diversion out of physician offices, not pharmacy hold ups. This has led to greater public awareness of the problems of opiates and also alot of misinformation and mistaken assumptions.

Here are some facts;
Regular use of opiates leads to dose tolerance in most people.

Regular use of opiates causes a true physcial dependance to the opiates so that stoppping intake results in the typical withdrawal symptoms which is like having a very bad cold for a week, skin crawling, sweats, chills, cravings, muscle cramps, diarrhea and general misery. This is the same reaction for heroin or morphine or oxycontin, or fentanyl etc. An opiate is an opiate is an opiate.

Dependance does not equal addiction.
Dependance is a physical definition which means the body requires opiates to maintain a sense of well being and health. It is necessary to maintain function. Addiction on the other hand means that the person engages in illegal and harmful activity as a means to obtain more opiate even when they know their actions are harmful. Think of it this way; An opiate-dependant person has improved funtion, an opiate addict does not.

Opiates have side effects and those side effects are dose dependent. These include nausea and vomiting, especially when first introduced, itching, headache, mental impairment and constipation. Generally the body gets used to the dose and it all settles down but not always, lowering the dose can ameliorate the side effects. Too rapid an increase in dosing can increase the side efects. Each patient is different in what they can handle.

And the most important concept of all is that there is no ceiling effect to opiate dosing. The rationale in exposing a patient to the potential problems of long term use of opiates is to increase the patients function and/or to ease suffering. This means that one should treat to effect; ie. the pain is lowered and function improves. That means that the physcians should use whatever dosage of opiate meets that goal. No ceiling effect means that there is no physicla limit to the dosage other than side effect managemnt. We all know that too much tylenol can kill you or that too much aspirin is harmful and many other medications may be toxic to other systems at certain dosage levels. This is not the case with pure opiates. There is no toxic effect to any of the bodies systems, death due to overdose is by means of respiratory center depression, a side effect but not a toxic effect on a system.

So, as a long winded means of getting back to your post.:

"Im scared to death of becoming an addict per say and I don't like the idea of becoming opiate dependent but then again but I guess the same could happen with suboxone."

Pain patients do not become addicted. ( I wont go into pseudo-addiction here) So that was a misplaced fear your doctor should have discussed with you ahead of time. BTW - even patients wiht substance abuse problems can be treated for pain effectively - another topic.

Long term opiate use does diminish certain hormones in the body and depression can result. A qualified pain specialist will be aware of this and working with you on that problem, and yes, anti-depressants are rendered ineffective for the most part when this occurs.


"To me 800mg of Oxycontin seems insane and deadly but i'm not doctor or pharmacologist."
Yes - it would likely kill you - but again, no ceiling effect. The number simply does not matter. He has been on opiates for over 12 years and this is the controlling dose with no increases in over three years now. THis is part physicians get wrong.

"I went to suboxone also because after hearing and seeing what it has done for people I thought it might help me with my pain condition and it seemed to have promise of a better future if you can make sense to that "

No. Suboxone is expressly not for treatment of opiate dependence in patients who suffer from chronic pain unlees there is a need for that patient to be off all opiates entirely. While it can work there is simply no reason to use it instead of Subutex or the buprenorphine patch or injection as a means to tret chronic pain wiht less overall side effects that other opiates which have full mu receptor agonsit activity.

In other words, you have attested that you have had a number of spine surgeries that have not only not relieved your condition but have left you with chronic debilitating pain. Assuming this to be the case, it is possible to improve function and be off all opiates through a multi-disciplinary pain program if such were available to you but in Ohio there are very few. The chronic pain program at the Cleveland Clinic is among the best in the state for example. Unfortunately, not all patients can live with chronic pain condition opiate free. Therefore implantable pumps have been developed and they work very well when they do work because the doses are about a tenth.

So, it's laudable to attempt to live your life without opiates if you can manage. If not, then opiates are a lifesaver when used correctly as part of an overall pain management program. Suboxone would not be the best choice becasue of the nalaxone component but it does prevent injecting the medication as a means to get high. Are you comfotable with the pain mangement tereatment you are receiving ? Is it the best progrma available to you. Could it be done better ?

I apologize for the length, a new record, but it seemed better to put pain medication use in some greater context as it is not like prescribing an antibiotic. Maybe it would be less distracting to other readers if you used the private message function for more questions .

As to your side efects now, staying at the lower dose for awhile till they begin to subside as you are doing is a good choice. Go slow.

good luck

[denthemenis]

ok. I see the problem, and it's a dual one. No fault of yours though.

Let me first talk about opiates for chronic non-malignant pain. Some years back a national consensus that pain was an under appreciated and under treated problem of many legitimate patients led to a further realization that physicians were afraid of undue scrutiny or prosecution in prescribing opiates.

New guidelines where issued, states published new pain assessment mandates for hospitilized patients, handbooks for physicians and medical societies etc encouraged a better appreciation for the disability and suffering pain causes in patients , encouraging the ethical treatment of pain without fear of harrassment. Since then there has been a surge or tidal wave in the prescibing of opiates for all manner of pain and, while a backlash is surely coming, patients have unquestionably been helped as a result. Goof patient education is part of that prescribinbg recommendation.

As a consequence, more opiates are on the streets, opiate adiction has risen, opiate related crime has increased and most of the market comes from diversion out of physician offices, not pharmacy hold ups. This has led to greater public awareness of the problems of opiates and also alot of misinformation and mistaken assumptions.

Here are some facts;
Regular use of opiates leads to dose tolerance in most people.

Regular use of opiates causes a true physcial dependance to the opiates so that stoppping intake results in the typical withdrawal symptoms which is like having a very bad cold for a week, skin crawling, sweats, chills, cravings, muscle cramps, diarrhea and general misery. This is the same reaction for heroin or morphine or oxycontin, or fentanyl etc. An opiate is an opiate is an opiate.

Dependance does not equal addiction.
Dependance is a physical definition which means the body requires opiates to maintain a sense of well being and health. It is necessary to maintain function. Addiction on the other hand means that the person engages in illegal and harmful activity as a means to obtain more opiate even when they know their actions are harmful. Think of it this way; An opiate-dependant person has improved funtion, an opiate addict does not.

Opiates have side effects and those side effects are dose dependent. These include nausea and vomiting, especially when first introduced, itching, headache, mental impairment and constipation. Generally the body gets used to the dose and it all settles down but not always, lowering the dose can ameliorate the side effects. Too rapid an increase in dosing can increase the side efects. Each patient is different in what they can handle.

And the most important concept of all is that there is no ceiling effect to opiate dosing. The rationale in exposing a patient to the potential problems of long term use of opiates is to increase the patients function and/or to ease suffering. This means that one should treat to effect; ie. the pain is lowered and function improves. That means that the physcians should use whatever dosage of opiate meets that goal. No ceiling effect means that there is no physicla limit to the dosage other than side effect managemnt. We all know that too much tylenol can kill you or that too much aspirin is harmful and many other medications may be toxic to other systems at certain dosage levels. This is not the case with pure opiates. There is no toxic effect to any of the bodies systems, death due to overdose is by means of respiratory center depression, a side effect but not a toxic effect on a system.

So, as a long winded means of getting back to your post.:

"Im scared to death of becoming an addict per say and I don't like the idea of becoming opiate dependent but then again but I guess the same could happen with suboxone."

Pain patients do not become addicted. ( I wont go into pseudo-addiction here) So that was a misplaced fear your doctor should have discussed with you ahead of time. BTW - even patients wiht substance abuse problems can be treated for pain effectively - another topic.

Long term opiate use does diminish certain hormones in the body and depression can result. A qualified pain specialist will be aware of this and working with you on that problem, and yes, anti-depressants are rendered ineffective for the most part when this occurs.


"To me 800mg of Oxycontin seems insane and deadly but i'm not doctor or pharmacologist."
Yes - it would likely kill you - but again, no ceiling effect. The number simply does not matter. He has been on opiates for over 12 years and this is the controlling dose with no increases in over three years now. THis is part physicians get wrong.

"I went to suboxone also because after hearing and seeing what it has done for people I thought it might help me with my pain condition and it seemed to have promise of a better future if you can make sense to that "

No. Suboxone is expressly not for treatment of opiate dependence in patients who suffer from chronic pain unlees there is a need for that patient to be off all opiates entirely. While it can work there is simply no reason to use it instead of Subutex or the buprenorphine patch or injection as a means to tret chronic pain wiht less overall side effects that other opiates which have full mu receptor agonsit activity.

In other words, you have attested that you have had a number of spine surgeries that have not only not relieved your condition but have left you with chronic debilitating pain. Assuming this to be the case, it is possible to improve function and be off all opiates through a multi-disciplinary pain program if such were available to you but in Ohio there are very few. The chronic pain program at the Cleveland Clinic is among the best in the state for example. Unfortunately, not all patients can live with chronic pain condition opiate free. Therefore implantable pumps have been developed and they work very well when they do work because the doses are about a tenth.

So, it's laudable to attempt to live your life without opiates if you can manage. If not, then opiates are a lifesaver when used correctly as part of an overall pain management program. Suboxone would not be the best choice becasue of the nalaxone component but it does prevent injecting the medication as a means to get high. Are you comfotable with the pain mangement tereatment you are receiving ? Is it the best progrma available to you. Could it be done better ?

I apologize for the length, a new record, but it seemed better to put pain medication use in some greater context as it is not like prescribing an antibiotic. Maybe it would be less distracting to other readers if you used the private message function for more questions .

As to your side efects now, staying at the lower dose for awhile till they begin to subside as you are doing is a good choice. Go slow.

good luck

Did you get the message I sent?

[JohnMaggio]

People do abuse Suboxone - it is even sold on the streets. It has the potential to get people high if taking enough - I have seen people do this. It however used in a taper down setting (Subutex can be used the same way, better success with Suboxone) it has tremendous benefits. Eliminating the “kicking feeling”, the detox feeling, and enabling the user to feel normal while being in the detox time frame.

I myself was in a treatment facility where they offered a 7 day step-down Subutex program. Two doses a day until the last day. Tapering down each dose.

I took it for 6 days and on day 7 my body feeling was bearable.
https://www.choicepointhealth.com/su...tment-program/