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Pharmacy/Quest. Ab. Buprenorphine


Dr. Ghooi,

Thank you for your time.

I can go straight from opiates (addiction) to Subutex, without going into full withdrawal (or ANY withdrawal). I've heard some say that one "MIGHT" be able do the same with Suboxone, some say, though, that the Naloxone in Suboxone is what would make me sick, if I tried to do that (begin without being in withdrawal), with Suboxone. Is this correct?

*[If it IS correct, if I have to go into withdrawal ANYWAY (ar. 15-20 10mg Vicoden/day), why not just go ahead & IMMEDIATELY start the Suboxone? If I DO go into withdrawal, I would have, anyway, had I waited to take it until I WAS in "Full Withdrawal"! That makes no sense to me.]

But a lot of doctors & people have said that I must be in "full withdrawal" to get on Subutex, too. That may be true for some, but like I said, not for me. I've gotten off of painkillers twice by just going straight into Subutex, (without waiting to go into withdrawal). Again - the Subutex did NOT precipitate a sickness / or withdrawal symptoms.

The problem with Subutex is:
1) Suboxone is more readily prescribed now.
2) I've heard that the Naloxone is very bad for your teeth  (Is that correct, or a fallacy?)

I do NOT crush/inject/sell the Subutex, but the doctors don't want to prescribe Subutex anymore - only Suboxone.

So, seeing that Subutex does not put me into a withdrawal, is it the Naloxone that makes people actually get sick, if opiates are still in their system?

(I am not on Heroin. Exclusively pain pills - no Oxycontin or Dilaudid - only Hydrocodone / Vicoden).

Thank you VERY much for your help!

PS - I've had severe, treatment-resistant MDD for many years. After an injury a few years ago, I noticed that Hydrocodone was the ONLY thing that I had EVER TAKEN (of prob. 50+ meds) to completely relieve my depression. It doesn't make me "high" or sleepy - no matter how many I take. The COST of getting them & the tolerance are the problems. Could it be, though, that my brain just doesn't PRODUCE its' own opiates? I've even had Ketamine injections - worked for a few days only.

Thank you!

Your question challenges all that I have learnt so far. Ok so lets get the issues sorted out:
Subutex is buprenorphine
Subuxone is buprenrophine plus naloxone
While  buprnorphine is an opoid analgesic,  naloxone is an opoid antagonist.
As a result subutex can replace morphine but suboxone cannot.
In fact use of subuxone is likely to cause withdrawal in a person dependent on morphine.
(I use the name morphine as a representative for all opioids.)
It is in the nature of these drugs to produce benefit for a short  time only.
However I am a pharmacologist and not a de-addiction specialist, I cna advice on  the basis of my experience but now my experience is limited to treating terminal cases with morphine SO I think you should seek advice of a de-addiction  specialist.
All the best.
Ravi Ghooi


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Dr. Ravindra Bhaskar Ghooi


I can provide information on drugs and medicines, their actions, uses, interactions and adverse effects. To avoid confusion, generic names of medicines may please be provided. I am a pharmacologist, having worked on animal and human pharmacology, and presently I am the Dean of Bilcare Research Academy, where we teach courses on clinical research. We dont work on saturdays and sundays, hence questions reachng me on these days will be replied on Monday, please bear with me.

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