Dearest Dr. Sub,
I was told that suboxone would help with my pain which is nerve related so I got off opiates and tried the sub back in August. Some people, have said it helps. Seems IMO that nerve related injuries is not relieved by sub? Do you agree ?
Suboxone contains the active medication buprenorphine. There is a great deal of emotion around this and other sites over Suboxone; I encourage you to listen primarily to medical professionals, as some of the other opinions have taken on zealotry that is more likely to cloud judgment than buprenorphine!
Realize first that Suboxone contains nothing new; the two medications have been used by doctors for over 30 years. I used buprenorphine to treat labor pain as an anesthesiologist during the 1990's; it was an excellent medication for pain then, until largely replaced by labor epidurals. It is active intravenously in microgram doses; when taken orally it is subject to 'first pass metabolism' at the liver, and so it must be taken 'trans-mucosally' or through the lining of the oral cavity.
It is often combined with naloxone and taken in a medication called 'Suboxone'; it is also available as 'Subutex', in a form without the naloxone. The two medications are indistinguishable when taken properly.
Buprenorphine is a mu agonist, meaning that it works at the exact sites that other narcotic pain relievers work. Nerve pain in general responds poorly to narcotics, and anti-convulsant medication may be a better choice... but sometimes an opiate is required even for nerve pain. In those cases, high doses are often used.
Buprenorphine has caused a great deal of excitement in the pain treatment community; it causes much less craving subjectively, and the long half-life results in less behavioral conditioning, a positive from an addiction standpoint. The ceiling effect discourages abuse as well. Most importantly, though, it causes less obsession, which in turn causes personality effects with stronger opiates like oxycodone.
As someone who has treated chronic pain for over 15 years, I can guarantee that most of the 'amateur doctoring advice' over Suboxone on the internet is simply wrong; I encourage you to seek health advice from someone with actual experience in treating chronic pain. In addiction, every sober addict tends to feel expert in addiction-- even after only a couple years off pills themselves. Be careful who you listen to.
Regarding buprenorphine, you don't have to take my word for it; go to clinicaltrials.gov and search under buprenorphine; you will be witness to the future of pain control.
I will stand by my prior comments. As I mentioned in the note that was removed, Suboxone consists of buprenorphine and naloxone-- two of the more well-known medications in medicine, as both have been used clinically for over 30 years. There are no significant cognitive effects from Suboxone; I have many patients from various professional communities (doctors, attorneys, writers, and a stockbroker, specifically) who are grateful for the LACK of sedation or cognitive slowing, especially compared to opiate agonists.
As for safety, Buprenorphine was a favorite for control of pain during labor until the epidural became more commonly used; I have a number of papers from studies of the use of Suboxone or buprenorphine during pregnancy, breast-feeding, and delivery, and in all of them buprenorphine comes out looking better than agonists such as methadone.
As far as comments like 'Sub caused me to have more pain'-- that is simply silly. The analgesic potency of buprenorphine is about equal to 60 mg of oxycodone, or 30 mg of methadone. Tolerance develops to the analgesic effects, but tolerance develops to ALL opiates, so that will be an issue with any opiate treatment.
Again, I don't get the zealotry here-- I have meetings throughout the midwest with more and more pain clinics who are changing over entirely to buprenorphine from opiate agonists. That kind of response rarely happens in medicine to a new medication, or in this case a new use for a medication. There will soon be implants (probuphine), skin patches, monthly injections... the excitement over buprenorphine should speak for itself-- but then, people would have to have their ears open!
I feel that its the fact that people get stuck on suboxone for months or longer just like people who get "stuck" taking methadone for years or for the rest of thier live. The fact that the withdrawals when trying to come off are very severe probably much worse then if they just quit the opiates cold turkey. My addiction docter wanted me to use subxone for about 10 days on a taper from 16mg 3 days to 8mgs 3 days to 4mgs 3 days and off...He said he doesnt want people on it long term because of how hard it is to come off, but hew wants the ease into withdrawals to be easier and if the person needs more time and the drops are too severe then he will slow it down and he uses suboxone for every person who comes in for thier opiate addictions. I just dont see the use in it long term, if usually the main reason for people to start with suboxone is because they want to get clean, your going to have to go through with withdrawals at one point.
Oh and i never took the suboxone, i was also contemplating methadone, but in the end i just went cold turkey and i thought it was the best choice, to just get it over with. I also know the rate for an addict to relapse and use again going cold turkey is much high then someone using suboxone, but youll have to face withdrawals at some time.
Also my docter now wants me to use Naltrexone for a month or two, he believes that it can actually speed up PAWS, to that amount of time, instead of possibly up to 2 years as it can last that long. I am a little scepticle, i know its a opiate blocker and that not alot of research has yet been done to determine that it can do something like that yet. Also with my withdrawals come back when i start using it since it blocks out the receptors, even if im around 10-14 days clean or more? Im just not sure i want to even bother, but hes trying to convince me...
It is pretty hard for many of us "lay people" to fully sort this out. You dont understand zealotry against sub - but then you gush over the "future of pain control" in an almost zealous manner. Maybe we are on the verge of space age progress with pain control... but as long as the meds get both (all three?) groups so polarized, I certainly dont see how a consensus will be reached. And that compounds any problems the meds have.....its hard enough when everyone agrees about something... And this stuff is pretty new - - so the development of patches and implants and other forms of dose so rapidly is also confusing. It is not an easy question to find an answer to .........
we have emailed before about the use of suboxone. I hear various opinions, not just from patients but individuals who are not necessarily experts, but they call themselves experts. One person is a physician who has treated chronic pain for over twenty yrs but has no experience yet with suboxone. he has heard, however, that it is not as difficult a taper as full mu agonists. Whether this is true or not, I dont know and certainly will vary on the individual just like any other drug is to withdraw from. You had told me that once you are on suboxone it is very difficult to get off of it but I have heard that a slow taper is relatively painless and not difficult to stop if the pain is finally relieved at some point and doesnt need the drug anymore. Not looking for any answers here, just posting a comment.
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