![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Rudiger on June 25, 2001, at 17:47:12
The following are excerpts from an editorial in the June 15th, 1996 issue of the journal Biological Psychiatry. The editorial outlines the (irrational) reasons buprenorphine is not used more often in cases of clinical depression that has not responded to every other available treatment.
Buprenorphine for Depression: The Un-adoptable OrphanBuprenorphine [BPN] in low (circa 0.3 mg qid) transmucosally (under the tongue or by nose drops) can be dramatically effective in cases of treatment for refractory depression. Its safety and efficacy are not secrets, yet it has received little study and currently receives little clinical use.
Early in BPN's history, Emrich et al (1982) found it a potent antidepressant in drug-refractory depressives. Sporadic supporting reports have appeared in the literature from time to time since then. Most recently, Bodkin et al (1995) reviewed the literature and reported an open trial of 10 cases to further document BPN's value as an antidepressant. When the drug works, it works quickly. Bodkin et al say they see results within several days. We have found that most patients experience benefits of an adequate dose within three hours. The only intolerable side effects are nausea and dysphoria. The effects are seen in 10% to 20% of patients and are quickly obvious....
We have personally treated five patients with BPN in whom the results were impressive. Three were more or less typical cases of depression who had failed adequate trials with various treatments, including, in one case, a thorough course of ECT. Of the two less typical patients, one was a case of panic disorder with onset in childhood and what could better be called dysthymia rather than typical depression.... All five patients were followed for several years while good results were maintained.
Given BPN's availability and demonstrated efficacy, why is it so rarely used in treating depression? Therein hangs a tale. Reckitt and Colman Pharmaceuticals, Inc. [R&C] received their NDA to market BPN as a parenteral analgesic more than a decade ago. It appears that their grand strategy was to get BPN approved as an over-the-counter analgesic. It does indeed have a remarkable safety profile. At high doses, it produces less respiratory depression and cognitive obtunding than morphine, perhaps due to its antagonist action....
Addiction and tolerance are not serious problems. Patients who abruptly stop the drug complain of fatigue, dysphoria, upset stomach, and sometimes piloerection. This pallid imitation of narcotic withdrawal is generally not associated with craving, and indeed patients do not usually associate their symptoms with having stopped the drug until they experience the relief occasioned by restarting their treatment. There are reports of the drug being abused, but then some substace abusers will abuse almost anything. We were told that San Quentin stopped using white scouring powder because substance-abusing inmates were injecting it into themselves!
One handicap BPN has had as an antidepressant was the absence of any interest in that application on the part of the manufacturer. The idea of selling BPN as an OTC analgesic was not an unreasonable one, but it did not lead R&C to pursue work on the psychotropic properties of their drug.
It appears tha BPN can be used much as methadone is used in maintaining opiate addicts. While doses of up to 32mg have been used, doses in the order of 6 to 12mg seem best. Compare this to the 0.15mg to 0.3mg doses that are effective in depression. Several studies have reported that BPN is indeed effective in treating opiate dependence, although less so than methadone (Kosten et al 1993 and Strain et al 1994). However, BPN's use in treating addicts, plus the ominous "-norphine" suffix in its name, have been even more of a deterrent to BPN's exploitation as an antidepressant than has R&C's narrow focus on its analgesic applications.
Comparing BPN with classic mu agonist opiates is unfair. BPN is a derivative of thebaine, which has partial mu agonist and kappa antagonist activities. As a partial agonist, it seems to act as a mu antagonist at higher doses, and this provides some protection against it being used in escalating doses by substance abusers. In addition, in low doses it produces minimal or no euphoria. We have a little packet of reprints to send out to pharmacists who call accusingly and question why we are prescribing such a "dangerous narcotic."...
We have continually been frustrated by the resounding lack of interest our colleagues have shown in BPN as an antidepressant. In spite of some promising pilot work, Veterans Administration workers treating post-traumatic stress disorder have declined to study BPN because so many of their clients are substance abusers, and BPN is "narcotic-like."
We discovered that someone had contracted with Cygnus, Inc. to develop a BPN patch. That was accomplished, but the contracting company dropped the project. The developed BPN patch now sits on their shelf. However, after a few cordial lunches, Cygnus indicated they would need a million dollars up front to reactivate production of the patch for a clinical trial. Small business grants are limited to $100,000 to start, so that would not get Cygnus back into the BPN patch business. Also, treatment-refractory depression does not sound like an appealing market to business types. We are not sure the market is so small, and it has been suggested that as many as 20-30% of depressed patients may be treatment-refractory. But certainly, for a single physician, patient accrual is slow. While the patent on BPN has run out, orphan drug status might allow a company to be protected against competition while it recoups its investment and more. But so far there is little interest from industry.
Academia has been similarly uninterested, but with better reason. It's too bad that substance abuse takes a hight priority than depression in congress, but then what is one to expect. And our wildest fantasy does not have the National Institutes of Mental Health approving the trial of such an oddball drug for treatment-refractory depression. In our mind's eye we can see the pink sheet: Reviewer No. 1 says: "We already know that BPN works in depression, so why do it again?", while reviewer No. 2 says: "It's too much of a long shot in these times of short money."...
Research is the art of the possible, and none of us these days can afford to espouse lost causes. But your local pharmacist can dispense BPN without a triplicate, and even supply a syringe and needle so the patient can withdraw the drug form the vial and squirt it under the tongue. You will find it in the Physician's Desk Reference under the trade name "Buprenex" injectable, 0.3mg/ml. So even if the orphan remains un-adoptable, you might want to try BPN on an occasional drug-refractory depressive, and so keep it alive, at least in the lore of those who do tertiary psychopharmacology.
Enoch Callaway
University of California-San Francisco
Tiburon, CA
References:Bodkin JL, Zornberg GL, Lucas SE, Cole JO. (1995): Buprenorphine treatment of refractory depression. Journal of Clinical Psychopharmacology, 16:49-57.
Emrich HM, Vogt P, Herz. (1982): Possible antidepressive effects of opioids: action of buprenorphine. Annals of the New York Academy of Sciences, 398:108-112.
Kosten TR, Schottenfeld R, Ziedonis D, Falcioni J. (1993): Buprenorphine versus methadone maintenance in opioid dependence. J Nerv Mental Dis 181:358-364.
Strain EC, Stitzer ML, Liebson IA, Bigelow GE. (1994): Buprenorphine vs. methadone in the treatment of opioid-dependent cocaine users. Psychopharmacology 116:401-406.
Posted by Peter S on June 26, 2001, at 21:09:14
In reply to Buprenorphine for Treatment-Resistant Depression, posted by Rudiger on June 25, 2001, at 17:47:12
I believe that Elizabeth was trying Buprenorphine for a while. I'd be interested to hear her experience and input about it. I have the original Bodkin article and I think the conclusions that they come to about the feasability of Buprenorphine seem too optimistic. But then again who knows? Maybe it is a miracle cure for a small percentage of treatment resistant patients.
> The following are excerpts from an editorial in the June 15th, 1996 issue of the journal Biological Psychiatry. The editorial outlines the (irrational) reasons buprenorphine is not used more often in cases of clinical depression that has not responded to every other available treatment.
>
>
>
>
> Buprenorphine for Depression: The Un-adoptable Orphan
>
> Buprenorphine [BPN] in low (circa 0.3 mg qid) transmucosally (under the tongue or by nose drops) can be dramatically effective in cases of treatment for refractory depression. Its safety and efficacy are not secrets, yet it has received little study and currently receives little clinical use.
>
> Early in BPN's history, Emrich et al (1982) found it a potent antidepressant in drug-refractory depressives. Sporadic supporting reports have appeared in the literature from time to time since then. Most recently, Bodkin et al (1995) reviewed the literature and reported an open trial of 10 cases to further document BPN's value as an antidepressant. When the drug works, it works quickly. Bodkin et al say they see results within several days. We have found that most patients experience benefits of an adequate dose within three hours. The only intolerable side effects are nausea and dysphoria. The effects are seen in 10% to 20% of patients and are quickly obvious....
>
> We have personally treated five patients with BPN in whom the results were impressive. Three were more or less typical cases of depression who had failed adequate trials with various treatments, including, in one case, a thorough course of ECT. Of the two less typical patients, one was a case of panic disorder with onset in childhood and what could better be called dysthymia rather than typical depression.... All five patients were followed for several years while good results were maintained.
>
> Given BPN's availability and demonstrated efficacy, why is it so rarely used in treating depression? Therein hangs a tale. Reckitt and Colman Pharmaceuticals, Inc. [R&C] received their NDA to market BPN as a parenteral analgesic more than a decade ago. It appears that their grand strategy was to get BPN approved as an over-the-counter analgesic. It does indeed have a remarkable safety profile. At high doses, it produces less respiratory depression and cognitive obtunding than morphine, perhaps due to its antagonist action....
>
> Addiction and tolerance are not serious problems. Patients who abruptly stop the drug complain of fatigue, dysphoria, upset stomach, and sometimes piloerection. This pallid imitation of narcotic withdrawal is generally not associated with craving, and indeed patients do not usually associate their symptoms with having stopped the drug until they experience the relief occasioned by restarting their treatment. There are reports of the drug being abused, but then some substace abusers will abuse almost anything. We were told that San Quentin stopped using white scouring powder because substance-abusing inmates were injecting it into themselves!
>
> One handicap BPN has had as an antidepressant was the absence of any interest in that application on the part of the manufacturer. The idea of selling BPN as an OTC analgesic was not an unreasonable one, but it did not lead R&C to pursue work on the psychotropic properties of their drug.
>
> It appears tha BPN can be used much as methadone is used in maintaining opiate addicts. While doses of up to 32mg have been used, doses in the order of 6 to 12mg seem best. Compare this to the 0.15mg to 0.3mg doses that are effective in depression. Several studies have reported that BPN is indeed effective in treating opiate dependence, although less so than methadone (Kosten et al 1993 and Strain et al 1994). However, BPN's use in treating addicts, plus the ominous "-norphine" suffix in its name, have been even more of a deterrent to BPN's exploitation as an antidepressant than has R&C's narrow focus on its analgesic applications.
>
> Comparing BPN with classic mu agonist opiates is unfair. BPN is a derivative of thebaine, which has partial mu agonist and kappa antagonist activities. As a partial agonist, it seems to act as a mu antagonist at higher doses, and this provides some protection against it being used in escalating doses by substance abusers. In addition, in low doses it produces minimal or no euphoria. We have a little packet of reprints to send out to pharmacists who call accusingly and question why we are prescribing such a "dangerous narcotic."...
>
> We have continually been frustrated by the resounding lack of interest our colleagues have shown in BPN as an antidepressant. In spite of some promising pilot work, Veterans Administration workers treating post-traumatic stress disorder have declined to study BPN because so many of their clients are substance abusers, and BPN is "narcotic-like."
>
> We discovered that someone had contracted with Cygnus, Inc. to develop a BPN patch. That was accomplished, but the contracting company dropped the project. The developed BPN patch now sits on their shelf. However, after a few cordial lunches, Cygnus indicated they would need a million dollars up front to reactivate production of the patch for a clinical trial. Small business grants are limited to $100,000 to start, so that would not get Cygnus back into the BPN patch business. Also, treatment-refractory depression does not sound like an appealing market to business types. We are not sure the market is so small, and it has been suggested that as many as 20-30% of depressed patients may be treatment-refractory. But certainly, for a single physician, patient accrual is slow. While the patent on BPN has run out, orphan drug status might allow a company to be protected against competition while it recoups its investment and more. But so far there is little interest from industry.
>
> Academia has been similarly uninterested, but with better reason. It's too bad that substance abuse takes a hight priority than depression in congress, but then what is one to expect. And our wildest fantasy does not have the National Institutes of Mental Health approving the trial of such an oddball drug for treatment-refractory depression. In our mind's eye we can see the pink sheet: Reviewer No. 1 says: "We already know that BPN works in depression, so why do it again?", while reviewer No. 2 says: "It's too much of a long shot in these times of short money."...
>
> Research is the art of the possible, and none of us these days can afford to espouse lost causes. But your local pharmacist can dispense BPN without a triplicate, and even supply a syringe and needle so the patient can withdraw the drug form the vial and squirt it under the tongue. You will find it in the Physician's Desk Reference under the trade name "Buprenex" injectable, 0.3mg/ml. So even if the orphan remains un-adoptable, you might want to try BPN on an occasional drug-refractory depressive, and so keep it alive, at least in the lore of those who do tertiary psychopharmacology.
>
>
> Enoch Callaway
> University of California-San Francisco
> Tiburon, CA
>
>
> References:
>
> Bodkin JL, Zornberg GL, Lucas SE, Cole JO. (1995): Buprenorphine treatment of refractory depression. Journal of Clinical Psychopharmacology, 16:49-57.
> Emrich HM, Vogt P, Herz. (1982): Possible antidepressive effects of opioids: action of buprenorphine. Annals of the New York Academy of Sciences, 398:108-112.
> Kosten TR, Schottenfeld R, Ziedonis D, Falcioni J. (1993): Buprenorphine versus methadone maintenance in opioid dependence. J Nerv Mental Dis 181:358-364.
> Strain EC, Stitzer ML, Liebson IA, Bigelow GE. (1994): Buprenorphine vs. methadone in the treatment of opioid-dependent cocaine users. Psychopharmacology 116:401-406.
Posted by Elizabeth on June 27, 2001, at 12:40:28
In reply to Re: Buprenorphine: Elizabeth?, posted by Peter S on June 26, 2001, at 21:09:14
First, a note to Rudiger: thanks for posting the "Unadoptable Orphan" letter. I hadn't been able to get a copy of it, and I was interested in what Calloway had to say.
> I believe that Elizabeth was trying Buprenorphine for a while.
Still am.
> I'd be interested to hear her experience and input about it.
The side effects really suck at first, but they got better with time. The only one that remains is the constipation (which I am managing with Metamucil), and even that one has gotten better. The itching and dry mouth went away.
> I have the original Bodkin article and I think the conclusions that they come to about the feasability of Buprenorphine seem too optimistic.
The conclusion was "this requires further study" (as with all medical research < g >). But who's going to fund a bigger study?
> But then again who knows? Maybe it is a miracle cure for a small percentage of treatment resistant patients.
I think it probably would work in a *large* percentage of depressives, and even a pretty decent percentage of treatment-resistant folks. The question is how many of them would be able to tolerate the side effects.
-elizabeth
Posted by Peter S on June 27, 2001, at 14:56:08
In reply to Re: Buprenorphine » Peter S, posted by Elizabeth on June 27, 2001, at 12:40:28
Hi Elizabeth,
Thanks for the reply. Actually I discussed buprenorphine with my pdoc this morning. He is of the opinion that it should be at the very bottom of the list and is very reluctant to consider it. Unfortunately I'm pretty darn near the bottom of the list right now.
Would you be so kind as to give your dosage/times per day? How long have you been taking it? Have you developed tolerance over time? Has it made a big difference in your life? Did you notice effects from it immediately?
Any info would be most appreciated!
Thanks so much.
Peter
> First, a note to Rudiger: thanks for posting the "Unadoptable Orphan" letter. I hadn't been able to get a copy of it, and I was interested in what Calloway had to say.
>
> > I believe that Elizabeth was trying Buprenorphine for a while.
>
> Still am.
>
> > I'd be interested to hear her experience and input about it.
>
> The side effects really suck at first, but they got better with time. The only one that remains is the constipation (which I am managing with Metamucil), and even that one has gotten better. The itching and dry mouth went away.
>
> > I have the original Bodkin article and I think the conclusions that they come to about the feasability of Buprenorphine seem too optimistic.
>
> The conclusion was "this requires further study" (as with all medical research < g >). But who's going to fund a bigger study?
>
> > But then again who knows? Maybe it is a miracle cure for a small percentage of treatment resistant patients.
>
> I think it probably would work in a *large* percentage of depressives, and even a pretty decent percentage of treatment-resistant folks. The question is how many of them would be able to tolerate the side effects.
>
> -elizabeth
Posted by Rudiger on June 27, 2001, at 20:36:14
In reply to Re: Buprenorphine » Peter S, posted by Elizabeth on June 27, 2001, at 12:40:28
> First, a note to Rudiger: thanks for posting the "Unadoptable Orphan" letter. I hadn't been able to get a copy of it, and I was interested in what Calloway had to say.
No prob. Thank you for making me aware of this treatment option. It has given me a little hope. A couple of years ago I had four impacted wisdom teeth taken out. The Vicodin I was prescribed, in addition to taking care of the excrutiating pain, produced a profound antidepressant effect. I had a far more productive day the day of the operation (after starting the Vicodin) than the day before! I didn't have any side-effects to speak of. Naturally my pdoc was unimpressed. Since then I've tried several combos of antidepressants with very little to show for it. There are a few things I want to try before I pursue the buprenorphine (next up is Provigil + Celexa). I don't know if my current pdoc will agree to prescribe the buprenorphine, but since I don't think he has any experience with it I'm thinking I might want to find someone else anyway.
Posted by Elizabeth on June 27, 2001, at 23:16:05
In reply to Re: Buprenorphine- Elizabeth, posted by Peter S on June 27, 2001, at 14:56:08
> Thanks for the reply. Actually I discussed buprenorphine with my pdoc this morning. He is of the opinion that it should be at the very bottom of the list and is very reluctant to consider it. Unfortunately I'm pretty darn near the bottom of the list right now.
Yeah, that's where I was at. I got lucky: my pdoc used to head a unit at McLean (he left to focus on his private practise, although he still has some teaching duties I think) and knows Dr. Bodkin. So I got referred to Dr. Bodkin for a consultation, and buprenorphine was something that came up. At the time his recommendation was that I give Nardil another try, but a couple years later (in '99) I did end up going on buprenorphine in addition to the Parnate I had already been taking. At the time I had trouble dealing with the side effects. More recently (around 6 months ago) I started taking buprenorphine again, and with some persistence I've learned to manage the side effects.
> Would you be so kind as to give your dosage/times per day?
1 mL (0.3 mg), thrice daily. That's intranasally. Sublingual doses need to be much, much higher, while intramuscular injection might not require as high a dose (I'm not sure about that, though: 1 mL IM or IV is a pretty typical dose for pain).
> How long have you been taking it? Have you developed tolerance over time?
6 months, at the same dose. Still works fine. From what I've read and heard, even people taking full agonists (morphine, oxycodone, fentanyl) as antidepressants don't need to keep increasing the dose. I really do feel that, for at least some people, these drugs do fix something that's broken.
> Has it made a big difference in your life? Did you notice effects from it immediately?
Yes, and yes. It acts sort of like a stimulant for me, but I gather that it's more commonly sedating. (I respond to all opioids, or at least all the ones I've tried, with "paradoxical" stimulation;" it's not anything unique to buprenorphine.) I have serious problems with anergia (lethargy, lack of interest, lack of motivation) and anhedonia (inability to enjoy things or feel pleasure), and the MAOIs weren't too successful at dealing with that stuff. Buprenorphine is.
-elizabeth
Posted by Elizabeth on June 27, 2001, at 23:25:17
In reply to Re: Buprenorphine-Elizabeth, posted by Rudiger on June 27, 2001, at 20:36:14
> Thank you for making me aware of this treatment option. It has given me a little hope.
I hope that my success with it can offer you a little more hope. I'm glad to hear that other people are thinking of trying it. It would be nice if it became an accepted treatment for depression.
> A couple of years ago I had four impacted wisdom teeth taken out. The Vicodin I was prescribed, in addition to taking care of the excrutiating pain, produced a profound antidepressant effect.
That's how I discovered it too: I got Vicodin ES (7.5 mg of hydrocodone/tablet) when I had my wisdom teeth out. (I only had two, and they weren't impacted, so it wasn't really all that painful. Good thing, because hydrocodone really isn't all that strong an analgesic.)
> I had a far more productive day the day of the operation (after starting the Vicodin) than the day before!
Yeah, I remember that too! I had general anaesthesia for the procedure, and after it wore off the nurse who assisted the oral surgeon gave me a Vicodin ES. I started feeling *fine* -- this was 1995, right at the start of my descent into the blackest depression I've ever had.
> I didn't have any side-effects to speak of.
Lucky!
> There are a few things I want to try before I pursue the buprenorphine (next up is Provigil + Celexa).
I tried Provigil briefly. I had some trouble with agitation, but I was also on Parnate at the time. Why Celexa, though?
> I don't know if my current pdoc will agree to prescribe the buprenorphine, but since I don't think he has any experience with it I'm thinking I might want to find someone else anyway.
What part of the country do you live in?
-elizabeth
Posted by Rudiger on June 28, 2001, at 11:22:37
In reply to Re: Buprenorphine » Rudiger, posted by Elizabeth on June 27, 2001, at 23:25:17
>
> I hope that my success with it can offer you a little more hope.It does. Definitely.
>
> That's how I discovered it too: I got Vicodin ES (7.5 mg of hydrocodone/tablet) when I had my wisdom teeth out. (I only had two, and they weren't impacted, so it wasn't really all that painful.
I think mine only had 5mg of hydrocodone. The Vocodin actually ran out before the pain did. I spent a few extra days in agony because I wanted to avoid any chance of getting "addicted." Not that the surgeon ever mentioned that I might need more.
> Yeah, I remember that too! I had general anaesthesia for the procedure, and after it wore off the nurse who assisted the oral surgeon gave me a Vicodin ES. I started feeling *fine*
I had to wait about six hours for my Vicodin because I was in a study-ouch. What I won't do for science. Ok, it also saved me an enormous amount of money.
>
> I tried Provigil briefly. I had some trouble with agitation, but I was also on Parnate at the time. Why Celexa, though?
I've been on it for awhile. I had to stay on it for the duration of a depression study I'm currently in.
>
> What part of the country do you live in?The middle part. Upper Midwest to be more precise. Any thoughts?
Posted by Elizabeth on June 29, 2001, at 19:18:07
In reply to Re: Buprenorphine-Elizabeth, posted by Rudiger on June 28, 2001, at 11:22:37
> > What part of the country do you live in?
>
> The middle part. Upper Midwest to be more precise. Any thoughts?I can't talk long, but one word: Chicago.
-elizabeth
Posted by Pacha on June 30, 2001, at 5:33:53
In reply to Re: Buprenorphine-Elizabeth » Rudiger, posted by Elizabeth on June 29, 2001, at 19:18:07
Elizabeth is it ok to take asprin/paracetamol for mild headakes that bup is giving me ?
I can defently feel the mood improving effects. But to be honest the side effects (sickness, sedation, spaced out) are outweighing the benefits. I'm going to give it a couple of weeks before i decide whether to continue or stop.
Posted by Elizabeth on June 30, 2001, at 18:05:37
In reply to Re: Buprenorphine » Elizabeth , posted by Pacha on June 30, 2001, at 5:33:53
> Elizabeth is it ok to take asprin/paracetamol for mild headakes that bup is giving me ?
Sure. The headaches are probably caused by increased intracranial pressure and should go away within a few days. (Great pain killer, huh? < g >)
> I can defently feel the mood improving effects. But to be honest the side effects (sickness, sedation, spaced out) are outweighing the benefits. I'm going to give it a couple of weeks before i decide whether to continue or stop.
What dose are you taking and how long have you been taking it? I suggest decreasing it by half. Obviously, you should talk to your doctor before doing such a thing, if possible.
-elizabeth
Posted by Pacha on July 1, 2001, at 5:59:15
In reply to Re: Buprenorphine side effects » Pacha, posted by Elizabeth on June 30, 2001, at 18:05:37
Thanks for replying Elizabeth, i really appericate it. Your the only person i can talk to about bup.I've started to realise that i only really get the side effects when i wake up (having not taken bup for 18+ hours). I hope these aren't withdrawl or anything. I'm quite worried that i only feel normal while on bup now.
Its my fourth day on bup, i started at only quater a tablet increasing to 1/2 tab a day.
I think i will go to my doc tomorrow to explain that i've been self medication with bup, and ask if he will supervise me. I really hope he won't yell at me about opiates blah blah, and get me on some useless SSRI.
cheers
pacha
Posted by Elizabeth on July 1, 2001, at 14:44:31
In reply to Re: Buprenorphine » Elizabeth, posted by Pacha on July 1, 2001, at 5:59:15
> Thanks for replying Elizabeth, i really appericate it. Your the only person i can talk to about bup.
Well, sure.
> I've started to realise that i only really get the side effects when i wake up (having not taken bup for 18+ hours). I hope these aren't withdrawl or anything. I'm quite worried that i only feel normal while on bup now.
What dosing schedule are you on? It sounded from what you said like you are taking it only once a day. For opiate addiction, the dosing schedule is different than for depression or pain (like methadone, addicts take it once a day, first thing in the morning -- often in a very large dose). For depression or pain, all the references I've seen (plus personal experience) say that it should be taken every 6 hours or so (three times a day).
The symptoms you listed sounded to me like side effects, not withdrawal symptoms. Buprenorphine withdrawal symptoms are pretty mild (from people's complaints, I'd expect Paxil withdrawal to be much worse), but are qualitatively similar to heroin withdrawal: shakiness, chills, hypersensitivity, anergia, mild diarrhea, etc.
> Its my fourth day on bup, i started at only quater a tablet increasing to 1/2 tab a day.
Umm...that doesn't help. (I take the liquid formulation -- we don't have Subutex/Temgesic in the USA.) What strength are the tablets? If you're in a country where it's used mainly for opiate dependence, the lowest strength tablets might be hard to tolerate for an opiate-naive person.
Regardless, maybe you should think about going back to taking 1/4 tab and/or splitting the daily dose in half or thirds.
> I think i will go to my doc tomorrow to explain that i've been self medication with bup, and ask if he will supervise me.
I didn't realise that that was what you
> I really hope he won't yell at me about opiates blah blah, and get me on some useless SSRI.
Me too. Buprenorphine is *not* a typical opioid. Although hydrocodone, oxycodone, morphine, etc. all have antidepressant effects, they just don't feel the same. It's not just that they're stronger or something -- oral morphine is actually pretty weak -- they just don't feel like the same thing.
-elizabeth
Posted by Pacha on July 2, 2001, at 4:54:29
In reply to Re: Buprenorphine » Elizabeth, posted by Pacha on July 1, 2001, at 5:59:15
i've got the 0.2mg sublingal
i went to see the doctor today, she didn't have a clue. She said i'd might as well be taking heroin.
I argued a good case for myself, showing the case studies, said i tried alot of other worthless ad's. Said nothing has worked better than this stuff, and if addiction is the price for a normal life, then so be it.... etc..So i asked to be refered to a specialist.
I still don't think there's much chance i'll get bup on prescription.
Posted by Elizabeth on July 3, 2001, at 15:05:52
In reply to Re: Buprenorphine » Elizabeth , posted by Pacha on July 2, 2001, at 4:54:29
> i've got the 0.2mg sublingal
That's not much, but then, the sublingual formulation is almost exclusively used for addiction (addicts need much higher doses, like up to 16 mg).
Try 0.1 mg, that's all I can think of.
> i went to see the doctor today, she didn't have a clue. She said i'd might as well be taking heroin.
She's *so* wrong. If nothing else, the risk of any serious consequences of ODing on buprenorphine is very small.
Here's a link to Bodkin et al.'s article. It discusses the safety and low abuse potential of buprenorphine, among other things:
http://balder.prohosting.com/~adhpage/bupe.html
> I argued a good case for myself, showing the case studies, said i tried alot of other worthless ad's. Said nothing has worked better than this stuff, and if addiction is the price for a normal life, then so be it.... etc..
People who are truly "addicted" don't lead normal lives. Thing is, you're unlikely to get addicted to buprenorphine (although the risk is increased by using it without a doctor's supervision).
> So i asked to be refered to a specialist.
That was smart. What sort of specialist?
> I still don't think there's much chance i'll get bup on prescription.
Good luck to you, anyway. What country are you in? (I think I might have asked you this before but I don't recall the answer.)
-elizabeth
Posted by sbaartman on December 1, 2003, at 5:39:17
In reply to Re: Buprenorphine side effects » Pacha, posted by Elizabeth on June 30, 2001, at 18:05:37
Ok hope I get response, because I do not know what is happening to me. I was put on buprenorphine treatment for about the fourth time now. I have started to use again for about a month. but now when I try to return to the treatment I get severe nausea or more of a gal attack that does not seem to go away. I have tried to keep the hold as long as possible from my last heroin shot. And the last time was as much as 15 hours. Every time this happens I get so weak that I cannot even function probably after taking the bupe. WHAT IS HAPPENING?
Posted by justawebpage on February 17, 2004, at 13:04:10
In reply to Re: Buprenorphine » Rudiger, posted by Elizabeth on June 27, 2001, at 23:25:17
I have untreatable depression for 10 years now. I have noticed that all the post here are over 1 year old. Is there anyone taking Buprenorphine for depression now? If so how has it worked and what does it cost for depression dosages?
Posted by Tony P on February 19, 2004, at 1:46:35
In reply to Re: Buprenorphine, posted by justawebpage on February 17, 2004, at 13:04:10
Buprenorphine may have just dropped off the map, as some drugs do. Here in BC Canada, it's not even on the Schedule any more.
I agree with a previous post - the name was probably against its use right from the start. Meprobamate is almost unavailable because it got a bad rap for addiction potential, while the benzodiazepines, which can be even worse for withdrawal, are still the DOC for many ailments.
Tony P
> I have untreatable depression for 10 years now. I have noticed that all the post here are over 1 year old. Is there anyone taking Buprenorphine for depression now? If so how has it worked and what does it cost for depression dosages?
This is the end of the thread.
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