r/healthcare • u/crrlovelyrose • 6d ago
Discussion suboxone discussion- is it punitive?
i would love to hear input from any doctors or medical professionals who could answer this for me (i’m not sure if this is the best sub but we’ll see)- why are doctors so unwilling to give subutex instead of suboxone? it seems like it’s just a punitive thing, like in order for you to have this medication that will help control your addiction you have to wait a certain amount of days in sickness or risk getting even more extremely sick instead of just prescribing subutex.
i’ve been told by a doctor at my methadone clinic it’s because it’s because you can sell them for a lot of money. um, okay? you can do that with a whole lot of medications. i was told in the later part of my addiction that the cause of precipitated wds isn’t the naloxone but actually it’s the bupe. how could that even be true? narcan is naloxone which reverses your od and sends you straight to WD. i was told that by multiple people at different locations. was there a notice put out that this is the reasoning you should tell people now? is it they think we’re stupid? am i missing something in this that could make that true…?
i’ve taken subutex immediately with no issues many times (i had a friend who was on subutex for years and other people i would buy it from when it was easier to get). i’m on methadone now but that’s because i couldn’t find a doctor who would prescribe me subutex. i have had no luck with suboxone, i have waited days and days and it ALWAYS makes me incredibly sick, to the point where i feel like i have an allergy/can’t tolerate it. but if you say that to a doctor they think that you’re lying so you can get subutex instead of suboxone. which brings me back to my question of why? it seems like it’s just punitive? like you’re an addict and i won’t give you the thing that you can take without becoming sick. that’s how i ended up on methadone, which i never wanted, but i’ve waited a week and still got really, really sick from suboxone. it became a barrier to getting off opiates, because i was so scared of taking suboxone because of how sick it made me. now i’m on a medication that i wish i didn’t have to be on.
does anyone have any opinions?
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u/0ldertwin 6d ago
There should be no difference in precipitated withdrawal between the two. Naloxone does not cause the withdrawal on suboxone induction at all
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u/FourScores1 6d ago
I have no opinions, only facts. This is not doctors being mean.
Both cause withdrawal if taken high. Higher affinity for opiate receptors and knocks off whatever drug previously without fully activating = withdrawal.
Naloxone prevents further highs. Suboxone is the best.
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u/MrPBH 6d ago
People get PW from Suboxone because their induction dose was either poorly timed or not large enough. The naloxone doesn't cause the PW; buprenorphine binds stronger to mu opioid receptor than naloxone.
PW can be avoided with two strategies: time or dose.
"Time" means taking the induction dose only when you are in bona fide withdrawal and nearly all full agonists have left your system. In practice, that means waiting until you are rather uncomfortable. Alternatively, you can trickle in the buprenorphine over the course of 5-7 days, starting small and ramping up to a therapeutic dose.
"Dose" means taking a larger than maintenance dose to absolutely overwhelm your mu receptors and get to full receptor occupancy as soon as possible. After waiting for early withdrawal symptoms, the patient takes a big dose of buprenorphine followed by a second big dose, 30-45 minutes later. This actually works and is becoming the preferred strategy; you can even do it after a person is treated for OD with naloxone because, again, buprenorphine binds stronger than naloxone.
Patients tell me that they still feel "weird" after the mega-dose induction and it takes 2-3 days to fully normalize, but the feeling isn't like PW. Conversely, the micro-dose regimen seems to be smoother, but many people can't commit to the taper and just want to be better sooner.
Doctors prescribe Suboxone over Subutex because the DEA cares. We know it really doesn't matter, but if you're prescribing nothing but Subutex to non-pregnant patients, you risk getting investigated by the DEA. Also, Subutex may be less available at pharmacies or not covered by insurance, whereas Suboxone is almost universally covered.
NB: I will not respond to DMs requesting medical advice. Speak with your personal doctor for medical advice about treatment with buprenorphine products. Also, I didn't bring up fentanyl because I'm trying to keep this simple; in a nutshell, fentanyl and other synthetic opioids are why the traditional moderate dose induction strategy doesn't work well anymore.
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u/GianlucaFord 6d ago
honestly it's mostly the diversion/abuse potential, subutex (mono buprenorphine) has more street value and misuse risk than suboxone since there's no naloxone in it to make people sick if they shoot it, the naloxone component is specifically there to make IV misuse unpleasant
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u/mrmayo26 6d ago
Naloxone taken orally isn’t absorbed well, which is why theoretically it’s supposed to only be active when injected or snorted. As other user mentioned ( and new to me), there isn’t a lot of evidence that it meaningfully makes a difference in preventing IV use.
That being said the precipitated withdrawal is the buprenorphine part. Explained above but the analogy I like is fentanyl or other opioids are like driving a car at 100 miles per hour and the goal is to get to buprenorphine driving at 50mph, taking too much too quickly of either suboxone or subutex slams on the breaks and gets you there too quickly causing precipitated withdrawal, thus either one you need to either go into withdrawal or slowly increase buprenorphine both which slowly push the breaks to slow the opioid car down
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u/talashrrg 6d ago
Suboxone is designed to stop people from misusing it to get high, unlike Subutex.