New Findings About Buprenorphine

Be sure to take a look at ‘buprenorphine news’ halfway down in the right column–  there are new things popping up lately about buprenorphine.  The top two studies are particularly interesting;  the first looked at patients wearing low-dose buprenorphine patches (yes, they are coming folks!) in pain patients to see if the patients took less medication ‘on the side’– I see many problems with such a study, since patients will take ‘side medications’ for different reasons, and people on buprenorphine, being blocked, would need to take very large doses of other narcotics to get any effect toward reducing their pain.  If the study shows that people with the patch take on average higher doses of side meds, what does that mean?  I wouldn’t interpret it to mean that people on buprenorphine are more likely to abuse pain medications.
The other study is even more interesting– or confusing.  People were given very high doses of buprenorphine– up to 99 mg per day! (in fact, the top doses were 99.9 mg– suggesting to me that the patients were using some automated delivery system that ‘locked out’ at 100 mg).  I have read that buprenorphine becomes a pure antagonist at those doses– I have no personal experiences with the drug in myself or in patients to verify that fact, but I have read it in several different sources of information that are generally science-based and reliable.  So… what gives?   I have no idea.  I will post more info as I find it.
The new use of buprenorphine for the treatment of opiate dependence has been quite a phenomenon, and continues to be a Godsend for many people.  But the most exciting thing about the introduction of Suboxone in my opinion is that it provides clear evidence for other pharmaceutical manufacturers that there is money to be made in the development of medications for treating addictions.  The field of addiction has always been second class to more ‘respectable’ diseases;  money is spent by the Federal Government on treatment programs and on research through NIDA, NIH, etc… but there has not been a great deal of commercial interest in treating addiction, and it takes commercial interest to innovate, to develop medications, and to get the medications through the FDA approval process.

I finished medical school in 1988– I remember the first calcium-channel blockers, verapamil and nifedipine.  They were a new class of medication, and a new treatment for high blood pressure;  over time a number of other calcium-channel blockers were developed, and more uses for the medications were found.  The same process has occurred over and over for other classes of medications– we have ‘selective’ or ‘nonselective’ beta blockers;  we have 1st, 2nd, 3rd generations of cephalosporins; we went from H-2 blockers like tagamet and zantac to the improved medication pepcid, and then to the pump inhibitors like prilosec and the improved medications, protonix and nexium…  Not to get into the whole debate over the prices for pharmaceuticals, but the money paid for new meds goes to the development of better meds, and hopefully the success of Suboxone will push the big US companies to develop better and better treatments for opiate dependence.  Maybe in a few years we will look back at Suboxone as we now look back at propranolol;  maybe a person will be able to choose between ‘generic Suboxone’ at Walmart pharmacies for $4 per month, or ‘Junigoxone’ (note to self– maybe THIS is how I monetize the blog– companies recognize the immense power of the brand, ‘Suboxone Talk Zone’, and get into a bidding war for the right to use my name…  that’s the ticket!), a form of buprenorphine that doesn’t cause ‘sweats’ and can be instantly removed when surgery is necessary.
On that topic, one last thing…  I really do think that there will be a way to prevent and even reverse opiate tolerance at some point in the relatively near future.  One product, morphidex, got as far as human testing a few years ago;  unfortunately it was found to be less effective in humans than the animal studies suggested.  But in time such a medication will be available, and I often wonder what the medication will do to the use of narcotics, to the treatment of chronic pain, to heroin addiction…  an optimist can see great things for humanity from the development of such a medication.  But I can also see huge risks and problems that would come with it.  For the opiate addicts reading this (who else would read this?), would you be able to avoid narcotics if you could take them without ever becoming tolerant, and without ever having withdrawal?  If they still caused the obsession, and still demanded more and more of your attention– they still feel good, and taking more feels ‘more good’– but you never ran the dose up and ran out of money, and never worried about getting sick– what would your life be like?  Or maybe I should say, what WILL your life be like?