![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by psychobot5000 on April 2, 2011, at 15:30:35
Question: is it possible buprenorphine/suboxone is MORE likely to produce tolerance and a negative rebound in mood than other opiates?
The reason I ask is that it clearly does, for me, while I have never observed this effect with other opioid medications. Suboxone, which I understand has a roughly thirty hour half-life, typically improves my mood for the first part (say, six or eight hours) of the first day, before leveling off. By the second day after a single dose of .5mg (particularly the second half of the second day), when the blood levels are presumably dropping, my mood is lower than it would otherwise be. Third day can be bad, too, but by the fourth things are more or less back to normal. Moral of the story: for me, taking suboxone comes back to bite me in the face.
However, I've never noticed such an opioid-induced depression when taking, say, regular pain pills. Is it possible the very high-occupancy of receptors of suboxone makes its rebound effects on mood MORE pronounced than traditional opioids? Seems counterintuitive, but I thought I'd ask. I'd like to know whether it's a safe bet that I should stay away from regular opioids--which would be too bad. Sometimes they seem helpful for mood and cognition, without any observed negative effects on mood, though I've only ever used them sparingly and in limited quantities.
Thanks,
Psychbot
Posted by mtdewcmu on April 2, 2011, at 16:20:29
In reply to Opiates and tolerance--could suboxone be worse?, posted by psychobot5000 on April 2, 2011, at 15:30:35
> Question: is it possible buprenorphine/suboxone is MORE likely to produce tolerance and a negative rebound in mood than other opiates?
>
> The reason I ask is that it clearly does, for me, while I have never observed this effect with other opioid medications. Suboxone, which I understand has a roughly thirty hour half-life, typically improves my mood for the first part (say, six or eight hours) of the first day, before leveling off. By the second day after a single dose of .5mg (particularly the second half of the second day), when the blood levels are presumably dropping, my mood is lower than it would otherwise be. Third day can be bad, too, but by the fourth things are more or less back to normal. Moral of the story: for me, taking suboxone comes back to bite me in the face.
>
> However, I've never noticed such an opioid-induced depression when taking, say, regular pain pills. Is it possible the very high-occupancy of receptors of suboxone makes its rebound effects on mood MORE pronounced than traditional opioids? Seems counterintuitive, but I thought I'd ask. I'd like to know whether it's a safe bet that I should stay away from regular opioids--which would be too bad. Sometimes they seem helpful for mood and cognition, without any observed negative effects on mood, though I've only ever used them sparingly and in limited quantities.
>
> Thanks,
> PsychbotMost pills have a half-life of about 4 hours. The longer you're on opioids, the worse the eventual withdrawal will be. There are a number of variables in play, but the simplest explanation is that buprenorphine just lasts longer.
Posted by mtdewcmu on April 2, 2011, at 16:40:24
In reply to Opiates and tolerance--could suboxone be worse?, posted by psychobot5000 on April 2, 2011, at 15:30:35
>I'd like to know whether it's a safe bet that I should stay away from regular opioids--which would be too bad. Sometimes they seem helpful for mood and cognition, without any observed negative effects on mood, though I've only ever used them sparingly and in limited quantities.
The history of people trying to self-administer opioids for their depression is not an encouraging one.
Posted by psychobot5000 on April 2, 2011, at 16:50:11
In reply to Re: Opiates and tolerance--could suboxone be worse?, posted by mtdewcmu on April 2, 2011, at 16:20:29
> > Question: is it possible buprenorphine/suboxone is MORE likely to produce tolerance and a negative rebound in mood than other opiates?
> >
> > The reason I ask is that it clearly does, for me, while I have never observed this effect with other opioid medications. Suboxone, which I understand has a roughly thirty hour half-life, typically improves my mood for the first part (say, six or eight hours) of the first day, before leveling off. By the second day after a single dose of .5mg (particularly the second half of the second day), when the blood levels are presumably dropping, my mood is lower than it would otherwise be. Third day can be bad, too, but by the fourth things are more or less back to normal. Moral of the story: for me, taking suboxone comes back to bite me in the face.
> >
> > However, I've never noticed such an opioid-induced depression when taking, say, regular pain pills. Is it possible the very high-occupancy of receptors of suboxone makes its rebound effects on mood MORE pronounced than traditional opioids? Seems counterintuitive, but I thought I'd ask. I'd like to know whether it's a safe bet that I should stay away from regular opioids--which would be too bad. Sometimes they seem helpful for mood and cognition, without any observed negative effects on mood, though I've only ever used them sparingly and in limited quantities.
> >
> > Thanks,
> > Psychbot
>
> Most pills have a half-life of about 4 hours. The longer you're on opioids, the worse the eventual withdrawal will be. There are a number of variables in play, but the simplest explanation is that buprenorphine just lasts longer.I did think of that, naturally. Occam's razor, it's probably right. Nevertheless, I wonder whether an alternate explanation is possible. I've been on pain pills for a few days after surgery, and don't remember any lowness in my mood afterward.
Posted by mtdewcmu on April 2, 2011, at 17:31:57
In reply to Re: Opiates and tolerance--could suboxone be worse? » mtdewcmu, posted by psychobot5000 on April 2, 2011, at 16:50:11
> > > Question: is it possible buprenorphine/suboxone is MORE likely to produce tolerance and a negative rebound in mood than other opiates?
> > >
> > > The reason I ask is that it clearly does, for me, while I have never observed this effect with other opioid medications. Suboxone, which I understand has a roughly thirty hour half-life, typically improves my mood for the first part (say, six or eight hours) of the first day, before leveling off. By the second day after a single dose of .5mg (particularly the second half of the second day), when the blood levels are presumably dropping, my mood is lower than it would otherwise be. Third day can be bad, too, but by the fourth things are more or less back to normal. Moral of the story: for me, taking suboxone comes back to bite me in the face.
> > >
> > > However, I've never noticed such an opioid-induced depression when taking, say, regular pain pills. Is it possible the very high-occupancy of receptors of suboxone makes its rebound effects on mood MORE pronounced than traditional opioids? Seems counterintuitive, but I thought I'd ask. I'd like to know whether it's a safe bet that I should stay away from regular opioids--which would be too bad. Sometimes they seem helpful for mood and cognition, without any observed negative effects on mood, though I've only ever used them sparingly and in limited quantities.
> > >
> > > Thanks,
> > > Psychbot
> >
> > Most pills have a half-life of about 4 hours. The longer you're on opioids, the worse the eventual withdrawal will be. There are a number of variables in play, but the simplest explanation is that buprenorphine just lasts longer.
>
> I did think of that, naturally. Occam's razor, it's probably right. Nevertheless, I wonder whether an alternate explanation is possible. I've been on pain pills for a few days after surgery, and don't remember any lowness in my mood afterward.
>
>When you initially take opioids, it takes a long time to get withdrawal. You become sensitized to withdrawal up to a point as you take more and more opioids. So you may get more withdrawal from the same amount of opioids now than you did then.
Hydrocodone feels more intoxicating than buprenorphine, so you may have taken a much stronger dose of bupe (in terms of mu activation) even though it didn't feel stronger.
The steadier blood levels of bupe may lead to more withdrawal over time than the spikier blood levels you get from repeatedly taking vicodin (if you integrate the area under the curve). Plus, your blood level of vicodin would drop a lot while you sleep, whereas with bupe, you are still racking up withdrawal.
There could be some pharmacological difference in withdrawal liability between the chemicals, but these three principles explain a lot.
Posted by bleauberry on April 3, 2011, at 4:08:22
In reply to Opiates and tolerance--could suboxone be worse?, posted by psychobot5000 on April 2, 2011, at 15:30:35
To prevent opioid tolerance, take LDN with it. LDN is usually 1.5mg to 4.5mg. For your puproses, that is way too much. For opioid management we're talking ultra low dose....1/10th mg to 1/4mg. No one knows why. Theory is at that dose the receptors involved in euphoria and pain are still open and working, but the ones involved with dysphoria and tolerance are temporarily blocked. This is very new information, purely anecdotal, that I accidentally stumbled on when doing more LDN research. I came across several different forums where heroine addicts were taking ultra low dose naltrexone with their heroine because they got higher, no tolerance, and no withdrawal. Can't tell you how I know, but it works the same way with cannabis.
Forget suboxone. Don't need it. LDN.
Posted by psychobot5000 on April 3, 2011, at 12:48:38
In reply to Re: Opiates and tolerance--could suboxone be worse?, posted by bleauberry on April 3, 2011, at 4:08:22
> To prevent opioid tolerance, take LDN with it. LDN is usually 1.5mg to 4.5mg. For your puproses, that is way too much. For opioid management we're talking ultra low dose....1/10th mg to 1/4mg. No one knows why. Theory is at that dose the receptors involved in euphoria and pain are still open and working, but the ones involved with dysphoria and tolerance are temporarily blocked. This is very new information, purely anecdotal, that I accidentally stumbled on when doing more LDN research. I came across several different forums where heroine addicts were taking ultra low dose naltrexone with their heroine because they got higher, no tolerance, and no withdrawal. Can't tell you how I know, but it works the same way with cannabis.
>
> Forget suboxone. Don't need it. LDN.Forgive my ignorance, but what is LDN?
Psychbot
Posted by psychobot5000 on April 3, 2011, at 13:53:09
In reply to Re: Opiates and tolerance--could suboxone be worse? » bleauberry, posted by psychobot5000 on April 3, 2011, at 12:48:38
Oh, Low Dose Naltrexone. Got it.
Posted by floatingbridge on April 7, 2011, at 1:32:39
In reply to Re: Opiates and tolerance--could suboxone be worse?, posted by bleauberry on April 3, 2011, at 4:08:22
BB,
My gp said that if I initiated LDN therapy while taking any norco, I'd precipitate immediate withdrawal. So your saying .1-.25mg for pain treatment maintenance?
And suboxone, isn't that bound with naltrexone?
Sorry. I find this so confusing. Not your answer--opoids and pain management.
> To prevent opioid tolerance, take LDN with it. LDN is usually 1.5mg to 4.5mg. For your puproses, that is way too much. For opioid management we're talking ultra low dose....1/10th mg to 1/4mg. No one knows why. Theory is at that dose the receptors involved in euphoria and pain are still open and working, but the ones involved with dysphoria and tolerance are temporarily blocked. This is very new information, purely anecdotal, that I accidentally stumbled on when doing more LDN research. I came across several different forums where heroine addicts were taking ultra
low dose naltrexone with their heroine because they got higher, no tolerance, and no withdrawal. Can't tell you how I know, but it works the same way with cannabis.
>
> Forget suboxone. Don't need it. LDN.
Posted by psychobot5000 on April 7, 2011, at 10:24:39
In reply to Re: Opiates and tolerance--could suboxone be worse?, posted by floatingbridge on April 7, 2011, at 1:32:39
It seems they actually want you to take .001mg of Naltrexone, from what I read--so it's not regular LDN, rather, it's ULTRA low dose naltrexone. Apparently this is enough to do something about tolerance. Who knows if it works.
I think suboxone is bonded to some other opioid antagonist, i.e. not naltrexone but nalaxone.
If there's a source that recommends the higher dose--1 tenth of a miligram to a quarter, I'd like to hear about that; obviously, it's important to get the right dose.
Psychbot
> BB,
>
> My gp said that if I initiated LDN therapy while taking any norco, I'd precipitate immediate withdrawal. So your saying .1-.25mg for pain treatment maintenance?
>
> And suboxone, isn't that bound with naltrexone?
>
> Sorry. I find this so confusing. Not your answer--opoids and pain management.
>
>
>
> > To prevent opioid tolerance, take LDN with it. LDN is usually 1.5mg to 4.5mg. For your puproses, that is way too much. For opioid management we're talking ultra low dose....1/10th mg to 1/4mg. No one knows why. Theory is at that dose the receptors involved in euphoria and pain are still open and working, but the ones involved with dysphoria and tolerance are temporarily blocked. This is very new information, purely anecdotal, that I accidentally stumbled on when doing more LDN research. I came across several different forums where heroine addicts were taking ultra
> low dose naltrexone with their heroine because they got higher, no tolerance, and no withdrawal. Can't tell you how I know, but it works the same way with cannabis.
> >
> > Forget suboxone. Don't need it. LDN.
>
>
Posted by mtdewcmu on April 7, 2011, at 14:05:51
In reply to Re: Opiates and tolerance--could suboxone be worse? » floatingbridge, posted by psychobot5000 on April 7, 2011, at 10:24:39
> It seems they actually want you to take .001mg of Naltrexone, from what I read--so it's not regular LDN, rather, it's ULTRA low dose naltrexone. Apparently this is enough to do something about tolerance. Who knows if it works.
>
> I think suboxone is bonded to some other opioid antagonist, i.e. not naltrexone but nalaxone.
>
> If there's a source that recommends the higher dose--1 tenth of a miligram to a quarter, I'd like to hear about that; obviously, it's important to get the right dose.
>
> Psychbot
>
> > BB,
> >
> > My gp said that if I initiated LDN therapy while taking any norco, I'd precipitate immediate withdrawal. So your saying .1-.25mg for pain treatment maintenance?
> >
> > And suboxone, isn't that bound with naltrexone?
> >
> > Sorry. I find this so confusing. Not your answer--opoids and pain management.
> >
> >
> >
> > > To prevent opioid tolerance, take LDN with it. LDN is usually 1.5mg to 4.5mg. For your puproses, that is way too much. For opioid management we're talking ultra low dose....1/10th mg to 1/4mg. No one knows why. Theory is at that dose the receptors involved in euphoria and pain are still open and working, but the ones involved with dysphoria and tolerance are temporarily blocked. This is very new information, purely anecdotal, that I accidentally stumbled on when doing more LDN research. I came across several different forums where heroine addicts were taking ultra
> > low dose naltrexone with their heroine because they got higher, no tolerance, and no withdrawal. Can't tell you how I know, but it works the same way with cannabis.
> > >
> > > Forget suboxone. Don't need it. LDN.
> >
> >
>
>Suboxone is mixed with naloxone, which is supposed to only be active when injected. Naltrexone is active orally. Buprenorphine bonds so tightly to the opioid receptor that naloxone/naltrexone don't affect it as much, but buprenorphine itself acts as an antagonist to other opioids.
I read about LDN a few years ago and the claims that it eliminated opioid tolerance. That sounds a bit too good to be true, however, and the fact that I haven't heard much about it since tells me that it doesn't work.
Posted by psychobot5000 on April 7, 2011, at 15:41:20
In reply to Re: Opiates and tolerance--could suboxone be worse?, posted by mtdewcmu on April 7, 2011, at 14:05:51
> > It seems they actually want you to take .001mg of Naltrexone, from what I read--so it's not regular LDN, rather, it's ULTRA low dose naltrexone. Apparently this is enough to do something about tolerance. Who knows if it works.
> >
> > I think suboxone is bonded to some other opioid antagonist, i.e. not naltrexone but nalaxone.
> >
> > If there's a source that recommends the higher dose--1 tenth of a miligram to a quarter, I'd like to hear about that; obviously, it's important to get the right dose.
> >
> > Psychbot
> >
> > > BB,
> > >
> > > My gp said that if I initiated LDN therapy while taking any norco, I'd precipitate immediate withdrawal. So your saying .1-.25mg for pain treatment maintenance?
> > >
> > > And suboxone, isn't that bound with naltrexone?
> > >
> > > Sorry. I find this so confusing. Not your answer--opoids and pain management.
> > >
> > >
> > >
> > > > To prevent opioid tolerance, take LDN with it. LDN is usually 1.5mg to 4.5mg. For your puproses, that is way too much. For opioid management we're talking ultra low dose....1/10th mg to 1/4mg. No one knows why. Theory is at that dose the receptors involved in euphoria and pain are still open and working, but the ones involved with dysphoria and tolerance are temporarily blocked. This is very new information, purely anecdotal, that I accidentally stumbled on when doing more LDN research. I came across several different forums where heroine addicts were taking ultra
> > > low dose naltrexone with their heroine because they got higher, no tolerance, and no withdrawal. Can't tell you how I know, but it works the same way with cannabis.
> > > >
> > > > Forget suboxone. Don't need it. LDN.
> > >
> > >
> >
> >
>
> Suboxone is mixed with naloxone, which is supposed to only be active when injected. Naltrexone is active orally. Buprenorphine bonds so tightly to the opioid receptor that naloxone/naltrexone don't affect it as much, but buprenorphine itself acts as an antagonist to other opioids.
>
> I read about LDN a few years ago and the claims that it eliminated opioid tolerance. That sounds a bit too good to be true, however, and the fact that I haven't heard much about it since tells me that it doesn't work.There have been some studies out that purport to support the idea, and there are a bunch of (from what I can tell) opiate users/abusers out there on the internet posting stories who seem to claim it worked for them--partially, if not completely.
Posted by mtdewcmu on April 7, 2011, at 20:52:21
In reply to Re: Opiates and tolerance--could suboxone be worse?, posted by psychobot5000 on April 7, 2011, at 15:41:20
> There have been some studies out that purport to support the idea, and there are a bunch of (from what I can tell) opiate users/abusers out there on the internet posting stories who seem to claim it worked for them--partially, if not completely.
>
>
>How recent are those posts? And do they say they've been doing it successfully for a while, or are those descriptions of one or two trials? The placebo effect can account for a few apparent successes.
Posted by mtdewcmu on April 7, 2011, at 20:56:00
In reply to Re: Opiates and tolerance--could suboxone be worse?, posted by psychobot5000 on April 7, 2011, at 15:41:20
> There have been some studies out that purport to support the idea, and there are a bunch of (from what I can tell) opiate users/abusers out there on the internet posting stories who seem to claim it worked for them--partially, if not completely.
>Also, I worked at a hospital up until a year ago, and I never heard anything about LDN being used. You would think that a magical cure for opioid tolerance would be taking the pain-control world by storm.
Posted by psychobot5000 on April 7, 2011, at 21:12:44
In reply to Re: Opiates and tolerance--could suboxone be worse?, posted by mtdewcmu on April 7, 2011, at 20:52:21
>
> > There have been some studies out that purport to support the idea, and there are a bunch of (from what I can tell) opiate users/abusers out there on the internet posting stories who seem to claim it worked for them--partially, if not completely.
> >
> >
> >
>
> How recent are those posts? And do they say they've been doing it successfully for a while, or are those descriptions of one or two trials? The placebo effect can account for a few apparent successes.I'd say one or two trials, but I haven't looked into it thoroughly.
Posted by sigismund on April 8, 2011, at 3:06:07
In reply to Re: Opiates and tolerance--could suboxone be worse?, posted by mtdewcmu on April 7, 2011, at 20:56:00
>You would think that a magical cure for opioid tolerance would be taking the pain-control world by storm.
If you had opiate intoxication without tolerance or addiction there would be illicit euphoria unpunished by reality.
Sounds unacceptable to me.
Never underestimate envy.
Posted by floatingbridge on April 13, 2011, at 5:48:41
In reply to Re: Opiates and tolerance--could suboxone be worse? » mtdewcmu, posted by sigismund on April 8, 2011, at 3:06:07
Lol :)
> If you had opiate intoxication without tolerance or addiction there would be illicit euphoria unpunished by reality.
>
> Sounds unacceptable to me.
>
> Never underestimate envy.
Posted by Lisalisa110 on September 24, 2011, at 18:24:58
In reply to Re: Opiates and tolerance--could suboxone be worse?, posted by psychobot5000 on April 7, 2011, at 15:41:20
I am here to say so far I am living proof that Suboxone works 6/24mg strips. November 2011 will be 1 year opiod free. Percocet to be exact. 7.5/325 mg. Got myself up to about 10 tabs a day by the time I surrendered. I am doing very well. Little by little I see and feel glimmers of a real person again. It just keeps getting better. Yes there's ups & downs, who does not have them. That's life. Only difference is now I participate. Finding Suboxone treatment has been a miracle for me. I was ready to end my life. Letters written and all"....... And then, it happened. I learned about Suboxone and finally realized there is away to be finished with opiates, my percocet. Just wanted to share that in case anyone else looks for Suboxone. I'd be glad to share. That's the best medicine of all.
Posted by Lisalisa110 on September 24, 2011, at 18:39:41
In reply to Re: Opiates and tolerance--could suboxone be worse?, posted by Lisalisa110 on September 24, 2011, at 18:24:58
Here's a great link to Suboxone.
Posted by Chairman_MAO on September 29, 2011, at 18:12:41
In reply to Opiates and tolerance--could suboxone be worse?, posted by psychobot5000 on April 2, 2011, at 15:30:35
I haven't read the whole thread, but here's your solution: take it _four times per day_. The drug has complex pharmacodynamics. Forget about the terminal elimination half-life in this context.
And why only .5mg? The general rule is to use the least amount of drug possible, of course, and 0.3mg qid has been used in psychiatry.
Word on the street is 4mg qid is much better--and just for kicks, before you escalate the dose, get a prescription for memantine if you want the most robust effect possible.
"Suboxone, which I understand has a roughly thirty hour half-life, typically improves my mood for the first part (say, six or eight hours) of the first day, before leveling off [...]"
See? You answered your own question. I'm zonked right now, but I could explain this in more detail at another time if you're interested.
Posted by psychobot5000 on September 29, 2011, at 18:16:56
In reply to Re: Opiates and tolerance--could suboxone be worse? » psychobot5000, posted by Chairman_MAO on September 29, 2011, at 18:12:41
> I haven't read the whole thread, but here's your solution: take it _four times per day_. The drug has complex pharmacodynamics. Forget about the terminal elimination half-life in this context.
>
> And why only .5mg? The general rule is to use the least amount of drug possible, of course, and 0.3mg qid has been used in psychiatry.
>
> Word on the street is 4mg qid is much better--and just for kicks, before you escalate the dose, get a prescription for memantine if you want the most robust effect possible.
>
> "Suboxone, which I understand has a roughly thirty hour half-life, typically improves my mood for the first part (say, six or eight hours) of the first day, before leveling off [...]"
>
> See? You answered your own question. I'm zonked right now, but I could explain this in more detail at another time if you're interested.Hey,
Thanks, but I doubt I'll ever use that medication, again. Interesting post, though.
Posted by Chairman_MAO on September 29, 2011, at 18:31:11
In reply to Opiates and tolerance--could suboxone be worse?, posted by psychobot5000 on April 2, 2011, at 15:30:35
http://www.2ndchance.info/painBuprenorphinepkinsert.pdf
See how they administer it every four to six hours for pain? Well, if you want optimal results, go with the monograph. I doubt you'll be disappointed.
Posted by Chairman_MAO on September 29, 2011, at 18:32:55
In reply to Re: Opiates and tolerance--could suboxone be worse?, posted by psychobot5000 on September 29, 2011, at 18:16:56
Oh, OK. Didn't see your followup before my last post.
Just in case you do decide to use it again, you'll know what to do. ;-)
I understand that they want people to be compliant and that taking a pill four times daily can be a pain, but it's just so much better ...
Posted by psychobot5000 on September 30, 2011, at 0:34:39
In reply to Re: Opiates and tolerance--could suboxone be worse? » psychobot5000, posted by Chairman_MAO on September 29, 2011, at 18:32:55
> Oh, OK. Didn't see your followup before my last post.
>
> Just in case you do decide to use it again, you'll know what to do. ;-)
>
> I understand that they want people to be compliant and that taking a pill four times daily can be a pain, but it's just so much better ...Hey, no, it's much appreciated, and I take stomach medicine plenty of times a day, so it's no big deal. It's just that the benefit to side-effects ratio wasn't very favorable for me with that medicine. Never did that much for me, and I felt kind of stoned. Some other meds are much cleaner, at least for me.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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