Talk:Buprenorphine

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[edit] Buprenorphine page should be separate from Suboxone page

I know that things like hydrocodone and vicodin are not generally given separate pages, being that they differ in one active ingredient. But they both server the same purpose - pain relief.

In the case of Suboxone, its use is different than the use of either of its components alone. It is used for opioid addiction treatment, not pain relief. I think separate articles would go a long way in making this information more accessible. Especially given the general dislike the 12-step proponents seem to have of this drug, and lack of neutrality the article tends to display. (on and off as differing camps edit the article back and forth.)

66.41.0.174 (talk) 20:38, 28 November 2007 (UTC)

                    QUESTION=HOW LONG IS BUPRENORPHINE IN YOUR SYSTEM?  —Preceding unsigned comment added by 71.234.226.18 (talk) 05:18, 27 January 2008 (UTC)

[edit] Suboxone Withdrawal

After reading the article, I thought it would be helpful if there were more information about withdrawal from Suboxone. There is currecntly a lot of discussion by users in various online communities regarding the claims that withdrawal from Suboxone is milder as reported by both the manufacturer and literature (that is, milder than the opioid one was dependent on before Suboxone treatment. While withdrawal symptoms are subjective, some users' experiences of Suboxone withdrawal are not consistent with the word "milder" and it would be nice to see some new research here or at least a mention of the problem. —The preceding unsigned comment was added by 72.200.68.198 (talk) 09:52, 18 March 2007 (UTC).

[edit] Subutex vs. Suboxone

The manufacturer recommends starting with Subutex because it does not have the Naloxone component. Naloxone has side effects which could be severe enough to encourage the patient to stop taking the medication completely. Naloxone is not needed unless the patient has a propensity to inject drugs. Unfortunately, some doctors are adamant about using Suboxone. If that is the case with the patient, find a doctor that doesn't insist on Suboxone but will use Subutex instead. Even better, when the patient calls to make his first appointment, ask the nurse at the office if Subutex is prescribed. If the nurse says no, then hang up and call another doctor. Do not take more medication than you need to detox.

Also, try and move consistently down off of Sub as quickly as possible. Listen to your body. If you have been addicted for several years, it may take a longer time than if the addiction is shorter in time. It's possible to detox in a month but the patient must be highly motivated and follow a strict plan.

Some patients remain at the highest levels for extended periods of time. That is not necessary and should be avoided.

One example of a taper schedule is:

Starting at 12mg, then: 10mg-2 weeks 8mg- 3 weeks 6mg- 3 weeks 4mg- 4 weeks 3mg- 4 weeks 2mg- 4 weeks 1mg- 4 weeks .5mg-4 weeks .5mg every other day 6 weeks

Total- 35 weeks

However, keep in mind that the taper schedule will be different for everyone.

Lastly, it's often difficult to determine what the equivalence of Sub vs. the drug of choice of the patient. One tool can be found at: http://www.medcalc.com/narcotics.html. This is a good tool but it is certainly not a perfect tool. Even doctors have a hard time making this determination. For example, 10 tablets of Vicodin is about 100 mg. of hydrocodone. That translates to about 8 mgs. of Sub. Even though Sub. has a long half-life, it's also a good idea to split the Sub. dose so that the active chemical stays relatively stable throughout the day. Anyone contemplating using this med to escape narcotics, feel free to contact my Talk Page for additional help. Jtpaladin 16:34, 11 April 2007 (UTC)

OK just one comment for anyone who reads the otherwise ox comment above. Ten tablets of Vicodin would not be 100 mg of hydrocodone. It would be 50 mg. If it was Vicodin ES it would be 75 miligrams of hydrdrocodone. 10 tablets for 100 mg would be Vicodin HP (which is pretty uncommon) or another formulation of Hydrocodone/APAP.

[edit] something's wacky here, needs to be fixed

from the "dependence treatment" section:

"In the United States, a special federal waiver is required to prescribe Subutex and Suboxone for opioid addiction treatment on an outpatient basis. However, if the doctor meets none of the other clarifications, an 8-hour course is all that is required)."

"clarifications?" huh?

This is poorly stated - Subutex and Suboxone are both ONLY prescribed for opioid addiction, for which a dr. must have a DATA2000 waiver this would also allow them to prescribe methadone. However, unlike methadone, an additional 8-hour course is required before being approved to prescribe Suboxone/Subutex.

TIP-40 is a publication detailing Suboxone/Subutex use, clinical guidelines, and legal specifics. A copy should be linked to. I'll see about adding that.

This is actually incorrect. As a patient of back surgery I have been put on Subutex for back pain. It works incredibly well. Aftre being on the pure agonists I find Subutex to be an excellent pain killer. My pain mgmt. doctor uses his regular DEA # to prescribe this for me. He said that his DEA # begins with a Z, may be an X but i think a Z, when he prescribes for opiate dependency. He uses his normal DEA # for regular pain mgmt. when scripting for subutex. —Preceding unsigned comment added by 68.84.119.213 (talk) 18:16, 15 May 2008 (UTC) 66.41.0.174 (talk) 20:30, 28 November 2007 (UTC)

[edit] Inpatient rehabilitation section?!

Is it just me that's deeply uncomfortable with this section in particular? A huge amount of unreferenced stuff, and frankly I've got no idea where some of it's come from or why it's in an article on subutex / suboxone / buprenorphine.

Feels to me like this could do with a lot of work, some decent and brutal editing, and a fair few more references. If there's anything I can add / reference then I'll have a peek later (particularly around detox treatments / pro-social networks in recovery) but tbh I feel there's a whole lot of stuff in here that's on the wrong page and is - frankly - largely irrelevant with a somewhat ideological hue.

A couple of the other sections strike me as a wee bit flabby / unreferenced n all, but hey. I'll have another look later, and if I can't suggest anything more constructive or make any positive additions / contributions I'll butt out completely, ha.

81.2.126.58 09:24, 13 June 2007 (UTC)Geoff

This information contained about the induction dosing is particularly necessary to an article on buprenorphine as it has a very unique initial dosing phase. The section could definitely stand to be re-written; however, I do not see most of it as irrelevant.

Perhaps if Wikipedia had an entry on "Opioid Treatment Programs" then the rest of the information contained in this section outside of the induction dosing in an inpatient setting could simply be linked to? But there is no such article.

Lucida.ann 21:14, 27 August 2007 (UTC)

[edit] Commercial preparations

It says no human studies have been done on the effectiveness of intravenous buprenorphine/naloxone preparations but in the manufacturer's prescribing information it talks about studies done with IM injections of buprenorphine/naloxone? I'll double check the insert, but I'm pretty sure it's all there.

Effect of Naloxone: "...whereas administered intramuscarlarly, combinations of buprenorphine with naloxone produced opioid antagonist actions similar to naloxone."

to print these results in an insert they would have to have observed these effects in humans, correct? Azrayl 02:09, 18 September 2007 (UTC)

I'm not sure I understand. Intravenous is not the same as intramuscular. --Galaxiaad 03:15, 18 September 2007 (UTC)

Oh I am sorry, I was reading intravenous as intramuscular, so the article is correct that there has not been (official) human studies observing intravenous bupe/naloxone preparations. Azrayl 17:25, 18 September 2007 (UTC)

[edit] Edit for Suboxone page

I just wanted to let you guys know that Suboxone isnt intended to have an orange flavor. In the actual drug form from R-B its listed as having a lemon-lime flavor. If anyone wants a picture from the brochure for proof let me know. kylewmackey@gmail.com —Preceding unsigned comment added by 67.189.252.63 (talk) 01:15, 2 October 2007 (UTC)

Being someone who takes this medication, I can say that until someone told me it was supposed to be lemon lime, I would have said it tasted like orange tang. The color of the tablet probably is enough to suggest that any citrus flavor be interpreted as orange. 66.41.0.174 (talk) 20:32, 28 November 2007 (UTC)

[edit] Suboxone Flavor

clip::

SUBOXONE is an uncoated hexagonal orange tablet intended for sublingual administration. It is available in two dosage strengths, 2mg buprenorphine with 0.5mg naloxone, and 8mg buprenorphine with 2mg naloxone free bases. Each tablet also contains lactose, mannitol, cornstarch, povidone K30, citric acid, sodium citrate, FD&C Yellow No.6 color, magnesium stearate, and the tablets also contain Acesulfame K sweetener and a lemon / lime flavor.

From
http://www.rxlist.com/cgi/generic/suboxone.htm67.189.252.63 18:06, 2 October 2007 (UTC)Kyle Mackey

it's the most god awful lemon lime i've ever tasted. the taste of it makes me want to puke more than the opiate content. 65.210.123.70 (talk) 21:08, 6 June 2008 (UTC)

[edit] Updated Suboxone information under "preparations" - and comment about subsequent section lengths

11 December 2007 - London

Hello

I have added the most relevant studies around Suboxone's effects in human subjects when it is injected, as well as the best available evidence about Suboxone's potential for abuse/black market in the community (Finland only!).

In my view the following sections around buprenorphine-based detox are way too long. It would be better for Wikipedia if we instead cited external sources or guidelines around detox - these do after all vary substantially by country, as do the methods of proving opioid dependence treatment using buprenorphine-based products.

Cheers

193.130.97.35 (talk) 10:38, 11 December 2007 (UTC)

[edit] Parochial USA content makes this article confusing.

It would be useful for the reader (myself included) to seperate out the parochial USA content from the main theory and research. The USA specific information interupts the article and considerably lengthens passages. more consise information would be helpful with perhaps seperate sections for USA issues which are only specific to 1% of the global population. It would be great if someone with appropriate detailed knowledge could attempt to edit accordingly! HDTomlinson (talk) 03:38, 7 January 2008 (UTC)H.D.Tomlinson (UK)

[edit] Lots and lots of changes made

Hello everyone....

Came across this page tonight and found it riddled with errors of all sorts, including that NA hadn't made a statement regarding maintenance therapy and that buprenorphine is PREFERABLE over methadone during pregnancy!!! (Which I'm going to guess anyone reading this knows is totally not true.)

I added and changed A LOT, and I will be adding in the remaining associated links, etc., for the information I changed/added.

--Lisamarie (talk) 07:35, 26 January 2008 (UTC)

[edit] Major changes needed

Hey Wikipedians. I just marked this article as {{cleanup-rewrite}} because, frankly, the quality of the article is terrible. This should probably be a task for WikiProject Pharmacology to take on with full force and extreme prejudice. Random bold and strike-out? Sentence fragments and run-ons? This is not how Wikipedia operates. I urge anyone who can work on this to do so, even if you can improve only one section. --Animated Cascade ^talk 06:20, 5 April 2008 (UTC)