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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Tom Twilight on November 22, 2006, at 16:23:00
Hi all
I just took 0.4mg of Buprenorphine
All I can say is Wow!
Anxiety and Social Anxiety disapeared, so did depression.
I didn't feel druged and Monged out like a benzoNow I know that Bupe is an Opiate, and that it should be used as a first med, but I have tried a lot of drugs including MAOIs and nothing seems to work.
What I really want to know is does anyone have any experience with Bupe, has anyone been taking it long term?
Does tollerance build up?
Can it be prevented?
Posted by Declan on November 22, 2006, at 17:09:41
In reply to Buprenorphine-Advice Please, posted by Tom Twilight on November 22, 2006, at 16:23:00
Pseudoname said tolerance was not an issue for him. He has lots of posts about it, somewhere or other, but recently.
Posted by blueberry on November 22, 2006, at 18:55:06
In reply to Buprenorphine-Advice Please, posted by Tom Twilight on November 22, 2006, at 16:23:00
Buprenorphine treatment of refractory depression.Bodkin JA, Zornberg GL, Lukas SE, Cole JO.
McLean Hospital, Consolidated Department of Psychiatry, Harvard Medical School, Belmont, MA 02178, USA.Opiates were used to treat major depression until the mid-1950s. The advent of opioids with mixed agonist-antagonist or partial agonist activity, with reduced dependence and abuse liabilities, has made possible the reevaluation of opioids for this indication. This is of potential importance for the population of depressed patients who are unresponsive to or intolerant of conventional antidepressant agents. Ten subjects with treatment-refractory, unipolar, nonpsychotic, major depression were treated with the opioid partial agonist buprenorphine in an open-label study. Three subjects were unable to tolerate more than two doses because of side effects including malaise, nausea, and dysphoria. The remaining seven completed 4 to 6 weeks of treatment and as a group showed clinically striking improvement in both subjective and objective measures of depression. Much of this improvement was observed by the end of 1 week of treatment and persisted throughout the trial. Four subjects achieved complete remission of symptoms by the end of the trial (Hamilton Rating Scale for Depression scores < or = 6), two were moderately improved, and one deteriorated. These findings suggest a possible role for buprenorphine in treating refractory depression.
PMID: 7714228 [PubMed - indexed for MEDLINE]
Posted by Phillipa on November 22, 2006, at 21:22:21
In reply to Re: Buprenorphine-Advice Please, posted by blueberry on November 22, 2006, at 18:55:06
Yeah and when I told my doc when I broke my arm and took l percocet at bedtime for the pain that I was laughing again he looked at me and said they are addicting what are you nuts? Love Phillipa
Posted by Declan on November 23, 2006, at 1:03:12
In reply to Re: Buprenorphine-Advice Please, posted by blueberry on November 22, 2006, at 18:55:06
Yes, well that's progress for you. Good old tincture of opium.
Posted by yxibow on November 23, 2006, at 4:41:01
In reply to Buprenorphine-Advice Please, posted by Tom Twilight on November 22, 2006, at 16:23:00
> Hi all
>
> I just took 0.4mg of Buprenorphine
>
> All I can say is Wow!
>
> Anxiety and Social Anxiety disapeared, so did depression.
> I didn't feel druged and Monged out like a benzo
>
> Now I know that Bupe is an Opiate, and that it should be used as a first med, but I have tried a lot of drugs including MAOIs and nothing seems to work.
>
> What I really want to know is does anyone have any experience with Bupe, has anyone been taking it long term?
> Does tollerance build up?
> Can it be prevented?Tolerance is a possibility and even a probability with any opiate given enough time. It is a C-III agent and is used primarily for withdrawal from other opiates.
Since opiates are not a standard practice of care for psychiatry in the US, most psychiatrists would shy away from any prescribing of them because they can have their license revoked and be federally prosecuted for misuse of narcotics.
Whether they were used "in the old days" in psychiatry may be true, but so were people given insulin and had holes drilled in their heads. Its not to say that there may be future consideration of mu-receptor modulation but the trials I can imagine would be very restricted
"Wow" is probably the response that anybody would have to a midrange opiate -- percocet may be a nice reward for wisdom tooth extraction as I can attest but not for the psychiatrist who is out of a job.-- Jay
Posted by blueberry on November 23, 2006, at 7:16:41
In reply to Buprenorphine-Advice Please, posted by Tom Twilight on November 22, 2006, at 16:23:00
When was the last time you heard someone say, "I started on 20mg prozac 4 years ago and I am still doing great on the same dose"? Probably never. More likely it is something like, "20mg prozac worked sort of for a little while and then I had to go to 40mg and when that stopped working I went to 60mg and now 4 years later it doesn't seem to hardly work at all anymore."
Why do they single out the benzos and opiates for tolerance issues, when in fact every single psychiatric med I can think of is equally guilty? The only exception might be lithium or a rare situation.
Posted by Phillipa on November 23, 2006, at 18:37:01
In reply to Re: Buprenorphine-Advice Please » blueberry, posted by Declan on November 23, 2006, at 1:03:12
Declan than I'm from the good old days as when my ex and I got home from Acapulco and his dysentary was so bad the Er gave him tincture of opium. Worked well. Love Phillipa
Posted by Phillipa on November 23, 2006, at 18:45:47
In reply to Re: Buprenorphine-Advice Please » Tom Twilight, posted by yxibow on November 23, 2006, at 4:41:01
They have a clinic inpatient in Charlotte that treats with bupenorphine. And my understanding from the website I visited that's it's not against the law to use it for other uses that getting off other drugs just written permission. Of course the site could be wrong? Love Phillipa
Posted by yxibow on November 23, 2006, at 20:02:07
In reply to Re: Buprenorphine-Advice Please, posted by blueberry on November 23, 2006, at 7:16:41
> When was the last time you heard someone say, "I started on 20mg prozac 4 years ago and I am still doing great on the same dose"? Probably never. More likely it is something like, "20mg prozac worked sort of for a little while and then I had to go to 40mg and when that stopped working I went to 60mg and now 4 years later it doesn't seem to hardly work at all anymore."
>
> Why do they single out the benzos and opiates for tolerance issues, when in fact every single psychiatric med I can think of is equally guilty? The only exception might be lithium or a rare situation.
An SSRI "not working" because its "pooped out" is not the same as the real dangers of respiratory depression definately from barbiturates, somewhat benzodiazepines, and especially hardcore opiates.
They're singled out because they're frequent drugs of diversion. Generic prozac is not a drug you see sold frequently on the street corner. But high abuse of Oxycontin and forged prescriptions for Xanax and diversion of Valium are things that are unfortunately out there.
That doesn't mean that benzodiazepines shouldn't be used for what they are meant for -- anxiety, hypnotic, antispasmotic, and antiepileptic applications. They're especially abhorred it seems in England.I think the trust between one and a competent psychopharmacologist should be enough to obtain benzodiazepines for what they are best used for -- anxiolytics that are far less dangerous than barbiturates or opiates.
And I agree, they are singled out and there are doctors who won't prescribe them, including a past one I had in college who would use propranolol instead of benzodiazepines. That can be dangerous in itself if one stops a beta blocker midway and doesn't taper, blood pressure becomes misregulated.
But doctors also are concerned for themselves, and malpractice, and so essentially some CYA (cover your *ss) and don't prescribe benzodiazepines all that often when in fact a modest dose of a long acting benzodiazepine like Valium is actually probably one of the safest psychiatric drugs out there just because of their near 50 year history. Tolerance and habituation of course can still develop, but its this concept that one will become addicted to benzodiazepines is more than an issue of semantics.
-- Jay
Posted by med_empowered on November 23, 2006, at 20:24:43
In reply to Re: Buprenorphine-Advice Please » blueberry, posted by yxibow on November 23, 2006, at 20:02:07
You can look up docs licensed to RX buprenorphine. My understanding of the situation is that they take some sort of class/training, and they're good to go. If a doc sees fit, s/he can RX for something other than opiate withdrawal...they just need to practice good patient management and avoid over-prescribing, etc. It doesn't seem to be that big a deal--its just unorthodox.
Anyway, I did a search for docs in 50mi radius of me, and a couple shrinks popped up, and some of them seemed to be in private practice...my guess is a number of those docs are using it "off-label" in select cases.
Posted by notfred on November 24, 2006, at 1:30:37
In reply to Re: Buprenorphine-Advice Please, posted by med_empowered on November 23, 2006, at 20:24:43
Docs only have to take the class if using bupe for addiction/withdrawal. Any doc can prescribe it off label without taking the class.
Posted by notfred on November 24, 2006, at 1:34:12
In reply to Re: Buprenorphine-Advice Please, posted by notfred on November 24, 2006, at 1:30:37
Posted by Tom Twilight on November 24, 2006, at 4:23:33
In reply to Re: Buprenorphine-Advice Please, posted by notfred on November 24, 2006, at 1:34:12
This debate is very interesting regarding the US prescribing rules
Unfortunatly I live in the UK were the rules are probably harsher!
Recently some UK addiction Docs were fired for being to "Liberal" in their prescribing
They probably weren't being that liberal by US standards!
Posted by ronaldo on November 24, 2006, at 10:26:27
In reply to Buprenorphine-Advice Please, posted by Tom Twilight on November 22, 2006, at 16:23:00
> Hi all
>
> I just took 0.4mg of Buprenorphine
>
> All I can say is Wow!
>
> Anxiety and Social Anxiety disapeared, so did depression.
> I didn't feel druged and Monged out like a benzo
>
> Now I know that Bupe is an Opiate, and that it should be used as a first med, but I have tried a lot of drugs including MAOIs and nothing seems to work.
>
> What I really want to know is does anyone have any experience with Bupe, has anyone been taking it long term?
> Does tollerance build up?
> Can it be prevented?Hi
My wife has been taking 200mcg (0.2mg ?) for several years for pain control. I haven't heard her complaining that it gets weaker with time and as far as I know she has not had to increase the dose. It seems they prescribe more for depression but 0.4mg does sound like a hefty dose to me.
...ronaldo
Posted by notfred on November 24, 2006, at 16:35:59
In reply to Re: Buprenorphine-UK rules?, posted by Tom Twilight on November 24, 2006, at 4:23:33
Ed_uk should be able to fill you in on the UK rules.
He is a wonderful resource.
Posted by Phillipa on November 24, 2006, at 19:10:45
In reply to Re: Buprenorphine-UK rules? (Ask Ed), posted by notfred on November 24, 2006, at 16:35:59
Yes he is and usually he works half day on Saturdays which is tomorrow here. And if not then Sunday he usually posts. Love Phillipa
Posted by JerryPharmStudent on November 25, 2006, at 0:43:45
In reply to Re: Buprenorphine-Advice Please, posted by med_empowered on November 23, 2006, at 20:24:43
> You can look up docs licensed to RX buprenorphine. My understanding of the situation is that they take some sort of class/training, and they're good to go. If a doc sees fit, s/he can RX for something other than opiate withdrawal...they just need to practice good patient management and avoid over-prescribing, etc. It doesn't seem to be that big a deal--its just unorthodox.
>
> Anyway, I did a search for docs in 50mi radius of me, and a couple shrinks popped up, and some of them seemed to be in private practice...my guess is a number of those docs are using it "off-label" in select cases.how does one do this search??? I'm in desparate need of a med change - my life is depending on it - and I respond very well to opiates.
Please let me know.
thanks
Jerry
Posted by ed_uk on November 25, 2006, at 14:25:13
In reply to Re: Buprenorphine-UK rules? (Ask Ed), posted by notfred on November 24, 2006, at 16:35:59
Aww thanks!
Buprenorphine is available under four different brand names in the UK.....
1. Temgesic 0.2mg and 0.4mg sublingual tablets, which are approved for relief of moderate to severe pain. A Temgesic injection is also available.
2. Subutex 0.4mg, 2mg and 8mg sublingual tablets, which are approved for the treatment of opioid dependence.
3. Transtec 35mcg/hour, 52.5mcg/hour and 70mcg/hour patches, which are changed twice a week (every 3 to 4 days). Transtec is approved for use as an analgesic.
4. Butrans 5mcg/hour, 10mcg/hour and 20mcg/hour patches. The patch is changed every seven days. Butrans is used as an analgesic. Note that the dose is very low compared with other buprenorphine formulations.
In the UK, doctors do not require a special license to prescribe buprenorphine. Also, doctors have the legal right to prescribe buprenorphine for what ever condition that want to prescribe it for. In practice however, it is only prescribed for pain control and opioid dependence. If a doctor was to prescribe buprenorphine for the relief of depression (which would be extremely rare), it would probably be best for them to prescribe Temgesic, Transtec or Butrans because anyone receiving Subutex would be assumed to be opioid dependent! Temgesic (which has been around forever), has aquired a reputation in some areas for recreational use - if the aim is to treat chronic depression, I think it might be best to try Butrans or Transtec first. As a sidenote, all buprenorphine formulations are schedule 3 controlled drugs in the UK.
Regards
Ed
Posted by ed_uk on November 25, 2006, at 14:26:15
In reply to Re: Buprenorphine-Advice Please » med_empowered, posted by JerryPharmStudent on November 25, 2006, at 0:43:45
Hi Jerry
Will the doc who prescribed the hydrocodone allow you to switch to bupe?
Ed
Posted by Tom Twilight on November 25, 2006, at 15:31:49
In reply to Re: Buprenorphine-Advice Please » JerryPharmStudent, posted by ed_uk on November 25, 2006, at 14:26:15
Sorry to change the subject slightly
I just wonder how bad Bupe withdrawals actually are?
I keep getting conflicting opinions on this one!
Posted by JerryPharmStudent on November 25, 2006, at 19:03:11
In reply to Re: Buprenorphine-Advice Please » JerryPharmStudent, posted by ed_uk on November 25, 2006, at 14:26:15
> Hi Jerry
>
> Will the doc who prescribed the hydrocodone allow you to switch to bupe?
>
> EdGood question - and I'm afriad to ask him. See, when I was prescribed the hydrocodone I was seeing specialists at the University of Minnesota Medical School - and they werent afriad to try offlabel treatments. Now, I am living back home in IL in a small town with one Psychiatrist. He is only continuing my hydro Rx because the docs at U of M sent him my records. He said to me that he has never seen anyone else on an opiate for depression - but would keep me on it if it worked. He also said that his malpractice insurance goes way up when he Rx's meds like hydrocodone. But - why should that be MY concern??? Which is better for the patient - Rx''ing a med that would help them greatly or keeping them on a blunt SSRI only to keep his inurance costs down - you know??
Perhaps if I had enough research to show him he would switch me. Howver, I risk being taken off the hydro if I even mention that it's not working as well as another med like bupe could.
What to do????
Posted by Phillipa on November 25, 2006, at 19:48:01
In reply to Re: Buprenorphine-Advice Please » ed_uk, posted by JerryPharmStudent on November 25, 2006, at 19:03:11
Are you saying the hydrocodon isn't working you want to try Bupe? I'd say google and others here and see what studies you can come up with. They can prescribe bupe.Love Phillipa
Posted by Declan on November 25, 2006, at 22:47:37
In reply to Bupe Withdrawals-Just how bad are they?, posted by Tom Twilight on November 25, 2006, at 15:31:49
For long term opiate addicted patients a bupe withdrawal (from presumably the lowest level) means a couple of weeks dragging yourself around and lying on the couch. So I've heard. But I've heard very different things too. Is this because the opiate thing is so politicised? I suspect so.
This is the end of the thread.
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