[strad64]

Robert, I would appreciate whatever info or response you might be able to provide on a couple of problems.

My wife started Suboxone a month ago, 4 mg/day, which helped her get past the w/drawal problems from a 4-year hydro addiction, but she is now experiencing some problems with the Suboxone. We're in our late 50s, and needless to say I am very proud of her.

First, what pain relief is available to patients on Suboxone? Can Ultram be used? OTCs like Advil and Tylenol aren't doing anything for her. She had used Ultram (Tramadol) in the past with success before her hydro habit, has not used it for several years now, and we are wondering whether Ultram, which is described as a "synthetic opiod", can be used while on Suboxone without triggering the withdrawal problems that opiods would produce. Her doctor did some quick research when she started treatment and found that Ultram binds to the same receptors as opiods, but he can't predict the effect if she tried Ultram after having started Suboxone. I can't blame him for being cautious, but the pain problems are resurfacing and becoming a real problem for her. It's easy to forget that legitimate chronic pain issues are often at the root of many addictions, and although Suboxone is also a pain med, it apparently doesn't offer the same pain relief as hydro. (I'll save questions about emergency surgery and anesthesia for another day.)

Second, we are trying to decide whether a switch to Subutex would be worthwhile. Prior to her addiction to hydro, she had been successfully treated for depression for nearly 15 years with a combination of Imipramine and Xanax, the latter of which has been prescribed for her (averaging 3mg/day) for nearly 20 years for anxiety. When she became addicted to hydro, the depression, or symptoms of depression, increased as the addiction continued. Obviously, there is some sorting out to be done once she has more time behind her being off of the hydro. But in the short time she's been on Suboxone, she has expressed many of the same comments that I see from people on this forum who have said that Subutex made a huge difference for them, i.e., that after switching to Subutex they no longer felt inert or "not themselves", etc., as they had while on Suboxone. Unfortunately, it's difficult to distinguish between those feelings and the symptoms of depression. Obviously, before even considering the possibility of changing her depression meds, which have worked so well for so long, the question of Subutex seemed worth exploring. I saw an earlier post in this forum which referenced "a book" which said that the Naloxone in Suboxone blocks endorphins, but the post didn't contain any reference to the book. It's difficult to believe that the Naloxone alone (given its stated purpose) is responsible for the difference, but what else could it be? I'm neither a doctor nor a chemist. The evidence in this forum for a difference between the two may be anecdotal, but it seems to be fairly widespread, and this drug is new enough, relatively, that testing may not yet have accounted for it.

Anyway, sorry for the lengthy post and thank you for whatever advice you might offer. By the way, your post on 12/08 on Suboxone/Subutex Therapy was very helpful, and helped her decide to try Suboxone. And if anyone else cares to reply, I'd of course appreciate that as well. This forum is a great source of info on personal experiences.

Thanks.

[Robert_325]

She should NOT take ultram while on subs. It does affect the same receptors as hydrocodone and it would be a mistake to do that.

About 15% of people react to the naloxone in suboxone. If she is one of those people subutex would make a world of difference in all aspects of how she feels. I would try that first, as it certainly won't compromise her recovery by using subutex and it may help. I'm very happy to hear she is taking only 4mg. That's great, but if she is feeling poorly on such a small dose it's very likely the naloxone as you've mentioned.

Make the switch to subutex and then we'll see how her pain is affected. It may improve if she is in fact reacting to the naloxone. Let's hold off making any other decisions until after she makes the switch. Stay in touch. God bless.

[strad64]

Thanks very much for the quick response.

[Robert_325]

Let me know how the subutex works. Then we'll start working on the taper down and off. It will get better for her! Have faith. God bless.

[strad64]

Her Dr has advised that his FDA certification for Suboxone does not include Subutex, which strikes me as odd, but in all events we will need to look elsewhere for another Dr who can prescribe it. I would love to find some credible documentary support for the switch to Subutex, because I suspect that most Drs will respond, as her Dr just did this afternoon, with the automatic reply that "Naloxone isn't even absorbed by the body" or otherwise write it off as a product of the patient's imagination. I have a lot of respect (and gratitude) for the medical profession, but I can't count the number of times in our lifetime that we've had to beg, plead with and cajole a Dr for a change in treatment that ultimately proved to have positive results.

In the meantime, she is considering a shot at tapering on the 4-day/25% reduction formula.

A thrill a minute. I wonder what other people do in their spare time ....

Thanks again.

[Robert_325]

Here is the link for the DATA 2000. This explains the laws pertaining to drs and their patients using buprenorphine.

I hear the same thing about naloxone from drs all the time. They say I'm crazy about the naloxone. There have been "lots" of hundreds of people on subs post on these forums. I guarantee you that about 15% of the people passing through here react to the naloxone. Doesn't matter what the dr says he's wrong. God bless.

http://buprenorphine.samhsa.gov/