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Dr. Bob is Robert Hsiung, MD,
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Posted by reefer on January 4, 2006, at 17:47:40
In reply to Re: buprenorphine WEEK 7 » ed_uk, posted by pseudoname on January 4, 2006, at 10:26:03
> > Opiophobes often talk of people becoming apathetic on opioids.
>
This is true for all of the full agonists. In this bupe is very different. It makes me motivated to do things to, and a lot of people report this.> Somebody posted that she reacts to tramadol (Ultram®) like it's an amphetamine. It makes her run around cleaning her house and so on. I haven't had that experience yet.
>
Tramadol has potent effects on NA, and this is why some people become speedy on it. It is a very weak opioid, different studies give different info but it's inbetween 1/10 and 1/100 the potency of codeine(which is about 1/10 or less the potency of morphine).
Posted by Declan on January 5, 2006, at 2:05:03
In reply to Re: buprenorphine WEEK 7, posted by reefer on January 4, 2006, at 17:47:40
I think if opiate doses are not excessive, and if the opiate is not too toxic (methadone) then motivation will likely be increased. I have heard it said of bupe, but maybe this is by comparison to methadone, that it is very clear mentally and not depressing. But I did some gardening on codeine, and I talked to strangers in the street on morphine (over the years). These positive motivating effects definately diminish over time, part of which I put down to methadone's toxicity, and partly to changes in oneself, maybe opiate receptors.
Declan
Posted by pseudoname on January 5, 2006, at 9:32:39
In reply to Re: buprenorphine WEEK 7, posted by Declan on January 5, 2006, at 2:05:03
I'm going to experiment with increasing my buprenorphine dose slightly (like from 3 mg/day to 4.5) to see if the "motivation" angle might improve more.
Despite these improvements:
•general mood
•activity level
•I brush my teeth every day now, no problem (big change)
•I feel I "have to" do stuff (which is an improvement over complete lethargy/disinterest),...there's a lot of room for further improvement. I'm not *doing* the stuff I feel I have to do.
Since there's no guidelines and I'm "a pioneer" like Ed says, ;-) I need to experiment.
Posted by York on January 5, 2006, at 13:12:02
In reply to buprenorphine WEEK 7 » ed_uk, posted by pseudoname on January 2, 2006, at 20:34:06
I have had refractory depression for 20 years and have tried avery SSRI available. I found info on the internet about Bupe and wanted to try it. No MD would give it to me. I went to visit family in TX and decided to go to Mexico and get some Temgesic 0.2mg SL. I got 2 weeks worth and that was the best 2 weeks of my life. I felt emotions that I never experienced before. From happy, sad, mad, balanced, and so many more. I have always had anxiety and that is usually my only emotion. I was able to make decisions based on real emotions and not by anxiety.
Anyway, fast forward 2 months. Went to 5 different MD's and all turned me down. I finally went to a MD who is Suboxone certified and told him I was a Vicodin addict. He gave me Suboxone 8mg's x 30 pills. With the Temgesic I was taking 0.3mg every 4 hours with a total daily doe of 1.2 mgs. I am not doing as good on the Suboxone but still 50% better than usual. I find it hard to cut the pills in small doses. I could be taking from 0.2 to 0.7 mg at a time. Sometimes I feel very good and at other times feel like my old self.
A couple of question.
1- I know the Suboxone is not pure Bupe because it has Naloxone in it and as long as it is taking SL the Naloxone "should" have no affect. What are your feeling on this?
2- Do you have any suggestions on what I should do to try and get the dosages more accurate as far as splitting the pills?I no this is the medicine for me at this time. Hopefully there will be other meds made in the future that will be easier to take or not addicting but after years of horrible depression/anxiety and tons of diffeent meds, I know this works for me.
Posted by reefer on January 5, 2006, at 13:17:54
In reply to opioid motivation » Declan, posted by pseudoname on January 5, 2006, at 9:32:39
> I'm going to experiment with increasing my buprenorphine dose slightly (like from 3 mg/day to 4.5) to see if the "motivation" angle might improve more.
>
For me taking 8 mg s.c inj. makes no difference at all compared to taking 4 mg s.c inj. I would very much like to try going much much higher. Like between 16 and 32 mg i just can't afford to waste my expensive hard to obtain Subutex. There is something that seems to work VERY much better than upping the dose. And that is spreading the dose as much as possible. Taking 4 mg in the morning will make me fine for 3 - 4 hours, just like 1 mg will. But taking 1 mg every 4 hours is a whole other story. This will make me feel fine pretty much all day long. So same total dose spread out is a whole other story than all at once. And this makes me think i really would like to get the patches instead. Since they release a low, stable and constant dose during the entire time it is working: between 72 hours and 7 days depending on the patch if i understand this correctly. I'm not sure if the patches deliver enough though. I think the 40 mg 72 hour patches delivered 70ug per hour. That is 280ug parenteral bupe during 4 hours. Should equal around 400ug SL. And the dose i like best is 0.5 mg every 4 hours. So this might very well be near perfect. There is also the possibility to add another patch if a higher dose would be needed.Anyway until i can get my hands on patches i will try and make a nose spray which i will administer every hour. I will report on how that works.
Posted by pseudoname on January 5, 2006, at 14:39:32
In reply to Re: buprenorphine WEEK 7, posted by York on January 5, 2006, at 13:12:02
Hey, York. Nice to meet you.
I'm very sorry you had such a hard time getting a buprenorphine prescription. I found that a lot of docs were absolutely misinformed about the law. My own doc said she only went along with it (after I corrected her about the law) because she figured I wouldn't sue her if I got addicted.
> 2- Do you have any suggestions on what I should do to try and get the dosages more accurate as far as splitting the pills?
See Larry Hoover's brilliant suggestion:
http://www.dr-bob.org/babble/subs/20051106/msgs/580668.html
It worked for me. Later in that same thread I post a couple tips for doing it that way.(Gotta run right now. Hope to comment on your other question later.)
Posted by reefer on January 7, 2006, at 8:30:50
In reply to Re: opioid motivation, posted by reefer on January 5, 2006, at 13:17:54
Ok i went to the pharmacy and obtained a nasal decongestion spray that had a real pump. Not that crap that you squeeze the entire bottle and end up with a different dose everytime. I emptied it by spraying it out in the air and i counted the times it took to empty it. It was about 100 pushes on the pump to empty it, the bottle said 10 ml. I then took a syringe with a needle on it and pushed it through the plastic on the top side of the little plastic "can" and sprayed in water a couple of times which i sprayed out until i figured it was cleaned out from the oxymetazoline solution. I then proceded to fill it with 8 ml of water and counted the times it took to empty it. About 80 pushes. So now i had a pretty accurate dosage calculated. I dissolved 8 mg Subutex in 8ml of water and injected it into the nasal spray bottle. And if i'm counting this right i get 0.1 mg per push or at least very close to that. I haven't started using it yet, i will wait until my blood levels fall to a lower level. Then i will try to take one spray per nostril every 60 minutes, which will make a total dose of about 2 - 3 mg per day depending on how long i sleep. I will keep you posted on my little experiment. If anyone is interested?
Posted by ed_uk on January 7, 2006, at 12:50:25
In reply to Re: Buprenorphine nasal spray!, posted by reefer on January 7, 2006, at 8:30:50
I'm interested :) Keep us updated.
Ed
Posted by reefer on January 7, 2006, at 17:04:19
In reply to Re: Buprenorphine nasal spray! » reefer, posted by ed_uk on January 7, 2006, at 12:50:25
> I'm interested :) Keep us updated.
>
> EdHi Ed! This article might be of interest:
Do they mean 5% dextrose in a water solution? Another thing i've noticed when dissolving Subutex tablets in cold water is that some of it remains undissolved(fillers). And it is easy to filter most of that out by just sucking it(the solution) up through a ball of cotton. So i'm thinking, maybe first filtering out the crap and then adding Dextrose would be a good idea. Because i think i read in another article that the bioavailability of pure intranasal bupe hcl solution was 50% compared to i.v. Increasing that up to 80 - 90% by just adding dextrose would be excellent.
The other constituents of a Subutex SL tablet:
Lactosemonohydrate 191,8 mg, mannitol 120 mg, cornstarch, Povidone, waterfree ascorbic acid, sodiumcitrate, magnesiumstearate.
Posted by Iansf on January 7, 2006, at 19:18:19
In reply to Re: Buprenorphine nasal spray!, posted by reefer on January 7, 2006, at 8:30:50
> Ok i went to the pharmacy and obtained a nasal decongestion spray that had a real pump. Not that crap that you squeeze the entire bottle and end up with a different dose everytime. I emptied it by spraying it out in the air and i counted the times it took to empty it. It was about 100 pushes on the pump to empty it, the bottle said 10 ml. I then took a syringe with a needle on it and pushed it through the plastic on the top side of the little plastic "can" and sprayed in water a couple of times which i sprayed out until i figured it was cleaned out from the oxymetazoline solution. I then proceded to fill it with 8 ml of water and counted the times it took to empty it. About 80 pushes. So now i had a pretty accurate dosage calculated. I dissolved 8 mg Subutex in 8ml of water and injected it into the nasal spray bottle. And if i'm counting this right i get 0.1 mg per push or at least very close to that. I haven't started using it yet, i will wait until my blood levels fall to a lower level. Then i will try to take one spray per nostril every 60 minutes, which will make a total dose of about 2 - 3 mg per day depending on how long i sleep. I will keep you posted on my little experiment. If anyone is interested?>
>
>
Wow, I'm really impressed. I can't imagine myself even thinking up such an approach, let alone following through with it. I wonder if there are other meds that could be administered this way, and if it might prove more beneficial than ingesting them. Like MAO inhibitors - might this not be an even better, and safer, route than the patch for getting an MAOI into your system? Might this technique reduce the amount of a med needed to attain effect - and reduce the number or severity of side effects as a result?
Posted by ed_uk on January 8, 2006, at 10:10:30
In reply to Re: Buprenorphine nasal spray!, posted by reefer on January 7, 2006, at 17:04:19
Hi Reefer!
>Do they mean 5% dextrose in a water solution?
Yes
Ed
Posted by reese7194 on January 9, 2006, at 8:54:47
In reply to Re: Buprenorphine nasal spray! » reefer, posted by ed_uk on January 8, 2006, at 10:10:30
hello everyone, i haven't had a chance to read all the posts. i remember years ago trying to find a doc who try buprenex here in nyc. that was when it was schedule five and all that b.s.
finally after going through hell i was finally put on opiods. i am curious if anyone has been on buprenex for an extended period of time and how there tolerance is.
the one side effect i have found with opiods is what i would call...it kind of does in a way what the stereotype of what lithium of anti-psychotics are supposed to do. it can / does dry my brain out. so it's not so wild and creatiive. which is good and terrible.
maybe i am just jaded and tired and this is the reason. it's hard to tell. i go on and off them quite a bit. curious what other people have noticed. thanks
reese
Posted by pseudoname on January 9, 2006, at 17:19:19
In reply to opioid motivation » Declan, posted by pseudoname on January 5, 2006, at 9:32:39
I've been on buprenorphine (Subutex) 3 mg/day for about 7 weeks for depression.
Last night, I had trouble breathing when I lay down to go to bed. It was as if I couldn't get enough oxygen through my nose, but there was no pain. So I breathed through my mouth. No better!
Every time I lay down this started over. Then it started happening while I was sitting up straight. Then it started happening whenever I THOUGHT about the subject of breathing and I got butterflies all through my abdomen, like a panic attack. (Which I've never had before.)
I figured it was asthma, which I've never had.
I got ZERO sleep last night. At 4:00 AM I took a walk; I was okay. Then I played a computer game and got absorbed in it and.... no breathing problems! Today troubled respiration came & went whenever I though about it & forgot about it. At one point I could only avoid what felt like suffocation by distracting myself playing with my cel phone's menus.
I went to my G.P. today about it, who listened to my chest & my heart & my history (all fine), read my blood O2 level (98%), ordered chest X-ray (not yet seen), etc. His determination? It's not asthma, not heart attack, not infection. It's probably due to the BUPRENORPHINE!
Bupe, like other opioids, *can* cause respiratory depression in overdose. (If you got too much opioids, you'd need to be on a ventilator till they were out of your system. I'm pretty sure there's no antidote.) He thinks it's likely that I may be sensitive to opioids, and that the bupe is screwing with various respiration control centers in my brain even at the low doses I'm taking.
So his advice: No more bupe until this is resolved and I speak again to my pdoc (who prescribed it).
My reaction: NOOOO!!!
Bupe is the ONLY antidepressant that has EVER worked for me. I've had hopeful outlooks on it that I have never had in all of my adult life! I care about other people as human beings now! My "How-are-you?"s are SINCERE on bupe!
It is not perfect and I need to learn more about maximizing its good effects (which are not constant but seem to be spreading), but it is as close as I've ever been to a miracle drug.
I can't lose it now. I *can't*.
Acute respiratory problems, however, are TERRIBLE. They are actually worse than depression. I cannot afford to keep having them. I'm really not looking forward to tonight since I'm still affected by this morning's bupe and I still have trouble breathing every time I think about it.
The G.P. offered no advice about tonight other than to try sleeping propped up with pillows and go to an E.R. if it gets dangerously bad.
I left a message with my pdoc, but it's not her style to return calls promptly. I see her next week Tuesday (8 days from now).
Posted by reefer on January 9, 2006, at 18:18:50
In reply to BAD NEWS!, posted by pseudoname on January 9, 2006, at 17:19:19
> I went to my G.P. today about it, who listened to my chest & my heart & my history (all fine), read my blood O2 level (98%), ordered chest X-ray (not yet seen), etc. His determination? It's not asthma, not heart attack, not infection. It's probably due to the BUPRENORPHINE!
>He might be right it's the buprenorphine. But he is wrong saying it's respiratory depression.
A little citing from an article on bupe:
Even high doses of buprenorphine--as much as 100 times the dose at which it produces analgesia--do not produce dangerous respiratory effects. "Respiratory depression caused by buprenorphine is not of clinical concern," says Segal, "which makes it an extremely attractive treatment alternative."
I can't diagnose you. But i would bet on that what happened to you was not respiratory depression. But it might very well be related to the buprenorphine.
Posted by pseudoname on January 9, 2006, at 19:00:55
In reply to Re: BAD NEWS!, posted by reefer on January 9, 2006, at 18:18:50
Thanks, reefer.
I Googled from your quote & got the article.
I think I agree with your analysis. The G.P. was just going by what his pocket PDA of drugs said, so he wants me to see my pdoc about it. But the pdoc doesn't know anything about buprenorphine either!! Sigh.
I was not expecting this complication.
Posted by reese7194 on January 9, 2006, at 19:27:40
In reply to Thanks re respiratory problem » reefer, posted by pseudoname on January 9, 2006, at 19:00:55
i am sure this won't help and i'm sure you have thought about it but i figured i should mention it anyway. have you ever had any anxiety attacks before? if by chance you haven't. you are very lucky. because that could be what it is. in a way i hope it is that. because that would makes things a lot easier to deal with because it would have no connection to the buprenorphine.
Posted by reefer on January 9, 2006, at 20:54:44
In reply to Re: Thanks re respiratory problem, posted by reese7194 on January 9, 2006, at 19:27:40
I didn't want to say it at first but i also strongly believe it's anxiety. I actually had a couple of panic attacks during the first months of my bupe use. I cannot say for sure there is a connection to it. I had the attacks before using buprenorphine also but they were under control and reappeard during buprenorphine use. Then they dissapeard again. I must ask, do you have some trouble with sleep from bupe? I did in the beginning and i think that the anxiety was secondary to my loss of restful sleep cause as soon as i got good sleep again i didn't have any more attacks. But it might or might not be related. I can't really say. Just a thought.
Posted by pseudoname on January 9, 2006, at 21:52:03
In reply to Re: Thanks re respiratory problem, posted by reefer on January 9, 2006, at 20:54:44
> i am sure this won't help
Reese, I disagree with you already ;-)
(These exchanges are a lot of help. I'm lost at sea.)> [anxiety attacks] could be what it is.
It clearly has a psychological component. If I even START to turn my inner cognitive eye toward ideas connected to breathing, then suddenly I can't get air and my abdomen goes all squirelly like someone gave me a shot of epi.
Just now my BP was 140/93 (pulse 60), when my guts felt like an adrenaline surge. It was 124/80 at the doc's today. 118/78 last month.
> in a way i hope it is that [anxiety attacks].
> because it would have no connection to the buprenorphineMaybe. Bupe (I'm making wild guesses) might be setting me up somehow for the anxiety attacks. My brain is changing a *lot* lately, take my word for it. I suppose this could be a bad side-effect. If it is, maybe it's temporary...
Maybe I could take the bupe (for depression) AND PAXIL or something like that (for the anxiety)?
I'll be off the bupe for the next couple days. If the problem clearly goes away, that will make the bupe look guilty.
> have you ever had any anxiety attacks before?
Nope, never. Lucky me.
The part of this that was like (or was) a panic attack was horrible. Worse than depression.
I'll check back in tomorrow. Hopefully, I'll be WELL-RESTED!
Posted by reese7194 on January 9, 2006, at 22:02:31
In reply to anxiety » reese7194 » reefer, posted by pseudoname on January 9, 2006, at 21:52:03
okay. look this is the deal. if you have been on this stuff for seven weeks you have a tremendous amount of pressure going on in your head every minute if not every second within that every minute which is stating in blaring letters
"AM I STILL FEELING BETTER!!!!"
"IS THIS GOING TO GO AWAY!!!"
all sorts of f*cking sh*t like this plus whatever usually goes on. but just because you are feeling better.......that alone to me is the most obvious thing that is going on. come on man. how can there not be a complete and utter sense of terror. i'm not sure what your age is or how long you have been on meds and all that crap and it doesn't really matter.
but i think the idea of taking something like paxil is definetly the wrong direction. if anything i would just try to realize that it is possibly, and i say posssibly, anxiety. if this turns out to be it.
be grateful. because i think that is a pretty healthy reaction to feeling possibly better. because you don't know what is going to happen when you wake up each day. will it look the same. will it look like it did yesterday or like it did a few months back.
worse comes to worse have your doc give you some klonipin or something. and please don't worry that you are taking a benzo and an opiod antogonist it is not a big deal unless of course you have a history of abuse.... which i'm guessing you don't.
i hope that helps.
i'm glad it's helping.
Posted by Declan on January 10, 2006, at 0:29:52
In reply to Re: anxiety, posted by reese7194 on January 9, 2006, at 22:02:31
I'll bet it wasn't respiratory depression. If it was that you would have got it much earlier, and anyway (in my experience) respiratory depression is never a (subjective) problem to the person who is experiencing it.
I'd still be thinking of something like asthma, which comes in many shapes and sizes. If you had some Ventolin handy when it was happening...........Hey, let me tell you, this is it....I know 2 people who switched from methadone to bupe who ended up in hospital with asthma attacks. Whatever you call them, I'll bet that's it.
Declan
Posted by pseudoname on January 10, 2006, at 10:01:36
In reply to Re: anxiety, posted by reese7194 on January 9, 2006, at 22:02:31
Good morning! I slept well last night and got up without breathing problems. I couldn't even trigger them by pinching my nose. :D
> if you have been on this stuff for seven weeks you have a tremendous amount of pressure going on in your head every minute if not every second [...]
Well, you have hit on it.
I left out of my posts yesterday (and I didn't get a CHANCE to tell the doc) that because the buprenorphine has been working and I've been relieved from depression for the first time in DECADES...
I have a $h*+load of new pressures. In fact, earlier in the evening of the breathing problems, I was going through some of the most stressful hours of my life. This has happened a lot in recent weeks as I feel more hopeful and energetic and turn my attention to financial and personal problems that I've been letting slide for years.
My life is still in crisis, but I can't ignore the problems anymore like I did when depressed.
Hours before the breathing problems began, I was at crisis-level stress. I was thinking, "Even if I'm not depressed, I can't solve these problems! I'm doomed!"
THEN I thought of an old friend / businessman that I could ask for advice, and waves of relief went through me. I started thinking, "Hey, maybe this *can* be solved ....er, somehow."
THEN the breathing problems started.
I know, LOL: people are saying, "Why didn't you mention this before?!"
Posted by reese7194 on January 10, 2006, at 10:28:12
In reply to Re: anxiety » reese7194, posted by pseudoname on January 10, 2006, at 10:01:36
no man that makes sense that you wouldn't say anything. if you would have said something i wouldn't have thought of it possibly being anxiety. anxiety is the sneaky sh*t that you can't be to aware of hopefully. it's like the car keys that are in front of your face but you can't see them. you know?
it's just cool that you are feeling okay. and it's hard not to feel like or beat yourself up for having possibly something new to be upset about.
you know
Posted by pseudoname on January 10, 2006, at 10:53:52
In reply to Asthma, bupe, and respiratory depression, posted by Declan on January 10, 2006, at 0:29:52
> I know 2 people who switched from methadone to bupe who ended up in hospital with asthma attacks
That is very interesting.
I left out of my posts that Friday & Saturday I had experimented going by increasing my dose from 3 mg/day to 5 mg/day. Then back to 3 mg Sunday. Then the breathing problem was Sunday night.
ALSO: Because of my depression, my house has not been cleaned in years. It is an asthmatic horror with all the dust!
But the doc said the trouble I described just didn't fit asthma. He said my problem was not environmentally triggered and my O2 levels were fine. I didn't 100% understand his confidence, but he pretty much ruled out asthma. Also, I have had no problem quickly filling my lungs even when very panicked, if that matters. But as you say, asthma comes in many shapes & sizes.
> If you had some Ventolin handy when it was happening..........
I was hoping the doc would just give me an inhaler to try. What could it have hurt? Maybe I can borrow one.
With asthma in mind, yesterday morning (before the doc visit) I also washed all my bed linens, blankets, & pillows, started cleaning my room, and changed the furnace filter.
I'm thinking now that my problem is anxiety-related, but I'm not ruling anything out.
My dusty house may be putting my breathing right on the edge of asthma-like irritation. Maybe that's why *breathing* and not, say, chest pain, is where my anxiety is expressed? THAT makes a lot of sense to me.
Posted by reefer on January 10, 2006, at 12:59:48
In reply to Re: Asthma bupe » Declan, posted by pseudoname on January 10, 2006, at 10:53:52
> > If you had some Ventolin handy when it was happening..........
>
> I was hoping the doc would just give me an inhaler to try. What could it have hurt? Maybe I can borrow one.
>
Do NOT use an inhaler. As far as i know they are beta-adrenergic agonists. And that's like anxiety in a bottle. Since the doc checked your 02 blood levels and they were normal he was correct in ruling out asthma. If you get an inhaler, use it first after trying an anti anxiety med like a benzo.> With asthma in mind, yesterday morning (before the doc visit) I also washed all my bed linens, blankets, & pillows, started cleaning my room, and changed the furnace filter.
>
Good, at least you wont get buried in dust!> I'm thinking now that my problem is anxiety-related, but I'm not ruling anything out.
>
Get some Xanax, or Klonopin wafers. Because they are quick acting. As soon as you feel the breathing problems come on you(if they do), take 0.25 - 0.5 mg and lay down and do some kind of relaxion training. If after 30 minutes you feel fine then you can be pretty sure it is anxiety related.Also remember that while you are now taking a bupe holiday you might feel more depressed. If that happens use small "rescue" doses of bupe.
Posted by ed_uk on January 10, 2006, at 15:16:03
In reply to BAD NEWS!, posted by pseudoname on January 9, 2006, at 17:19:19
Hi PN :)
>Last night, I had trouble breathing when I lay down to go to bed. It was as if I couldn't get enough oxygen through my nose, but there was no pain. So I breathed through my mouth. No better!
Sounds like panic-anxiety.
>Then it started happening whenever I THOUGHT about the subject of breathing
This is practically diagnostic of anxiety. If you were suffering from acute asthma you would be continually breathless, it wouldn't disappear on distraction.
>respiratory depression
It wasn't respiratory depression. No doubt about it. Your symptoms don't even vaguely resemble respiratory depression!
>It's probably due to the BUPRENORPHINE!
If bupe was gonna cause panic-like symptoms it would probably have occured before now. Perhaps the dose reduction from 5mg to 3mg triggered anxiety? Your docs will inevitably be ultra-cautious because using bupe to treat depression is so unusual.
>If you got too much opioids, you'd need to be on a ventilator till they were out of your system. I'm pretty sure there's no antidote.
There is an antidote. It's called naloxone (Narcan). You won't need it though :)
>I can't lose it now. I *can't*.
You could try a sedative antihistamine to help you sleep. Atarax (max 100mg per dose) might help, you could take it as a single dose in the evening. You need to focus on the fact that however much is feels like you can't breathe, you CAN breathe. In fact, you were probably hyperventilating! Anxiety will never stop you from breathing, despite how awful it feels. Keep this in mind. It will reduce your anxiety and hence your breathlessness.
Love
Ed
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