Author: Ironic
Posted: Mon Oct 31, 2011 3:36 pm
| Diary of a Quitter wrote: |
| The pain-medication question for Suboxone patients gets tricky, not just because of the Sub patients higher tolerance for opioid medications, but because of buprenorphine’s high affinity for opiate receptors. At a dose of 16mgs/day, a Sub/bupe patient basically has NO open/available opiate receptors for another full-agonist opioid medication to latch onto and activate.
Dr. Junig has explained this somewhere and I will try to find it later, but the gist of it is that whatever opioid medications are circulating in your bloodstream will be constantly in the process of "attaching" and "detaching" from your opiate receptors. Buprenorphine is unique in that it is a partial-agonist with a very high affinity for the opiate receptor. This means that while it only partially stimulates the receptor, it "bonds" very strongly with the receptor and basically out-competes most other full-agonist opioids at the receptor, never even giving them a chance to latch on and do their thing. At the same time, the fact that bupe is a partial agonist means that its analgesic effect is nowhere near as strong as an equivalent dose of morphine. Same is true for other effects like respiratory depression. There are possibly certain opioid medications that can "out compete" buprenorphine at the receptors and thereby provide some measure of pain relief to Suboxone patients in an emergency situation. I believe Fentanyl is one, dilaudid may be another. Whether this works or not likely varies from person to person. I passed a kidney stone when I was on 4mgs of Sub daily and a 4cc shot of IV dilaudid effectively killed the pain, but it wore off more quickly than what I’d experienced in similar situations in the past. Other people report being not as lucky. So, long story short is that if you are on a higher-end dose of bupe (like 16mgs or possibly even 8mgs) it might not matter how much of a full-agonist opioid you take, you may feel little-to-no effect from it. This is why Sub patients are encouraged to stop their medication at least a few days before surgery – in which case their tolerance will still be high, but they will be more likely to get some pain relief from full agonists. |
YES YES YES YES YES
Thank you.
I am NOT trying to pick on anyone. I am trying to make sure that people understand that there is no free lunch. Doctors will usually start people on a (too) high dose of Suboxone and not taper them on any schedule. Being on these high doses of Sub for months or years is NOT the same as being on a lower dose. At a lower doses (4 mg and under), there are many less concerns. You can still probably (your chances improve the lower you go) get pain relief from a full-agonist in a medical emergency. I have also heard that 4 mg is the dose at which your brain begins the process of downregulating the extra opiate receptors you have, which means it is healing. I would love to see concrete evidence of this.
Many people don’t even think about what they would do in a medical emergency until they are in the hospital screaming in pain, with no relief possible.
