A person wrote about feeling sick after taking Suboxone, thinking that naloxone is to blame and frustrated that her physician would not prescribe Subutex, She asks, can naloxone make me sick?
I first read your blog last week as I was going through the despair and misery of withdrawal from Percocet, and considered suicide. I didn’t want to die, or create anymore suffering for my family; I just didn’t see any options or hope. Your well written words (I thank you deeply) about the hell of withdrawal got my attention & brought me to tears. I continued to read, found out about Suboxone, which led me to message boards from others like me. For the first time I felt hopeful. I found a doctor and made an appt, and after the initial, office administered dose I found myself feeling the best I had in years– no withdrawal and no physical pain – wow! At the 2hr follow-up I told (the doctor) that my pain was completely gone, which she disputed, saying it’s not prescribed for pain. What I know now is that she had given me Subutex in the office, and a Suboxone prescription to take home!!I filled the prescription, took the ½ pill dose, and within minutes my stomach hurt/gnawed, and I developed a very strange headache and mild to moderate chest pain. By the evening I’d vomited and the headache worsened. By next morning I had the worst headache ever and started vomiting large amounts of bile, all of which continued throughout the day. My doc insisted I show up for the follow up appt. that day, even though I was too sick to hold my head up. She insisted I was sick from withdrawal
To date I’m taking 3 Excedrin for migraine within an hour of every Suboxone dose as I get a bad headache every time. I also wake up with a moderate headache every day. The last few days I’ve noticed I don’t feel emotions, joy, or happiness. I feel depressed & don’t care about things that would typically give me happy goose bumps – my grandkids, my dogs, sunsets.
I asked the sub doc to put me on Subutex which she refused to do. I explained that if someone was this ill from BP or diabetes meds, and there were other options, it would be unethical to not help the patient. I spend $180 for medication that makes me ill- every day.
I’ve spent the day trying to find a doc who will prescribe Subutex, with no success. Ironically, a few years ago my own doc recommended this drug for my back/leg pain. I don’t know what to do. I can’t stay on Suboxone or go off. Do you have any suggestions?
My answer:
I hope that your weekend is going OK. I have a few thoughts about your situation, but I don’t know how much help they will be, as ultimately you are dependent on the prescribing doc. But maybe we will find something that will help.
It sounds like you have a pretty good understanding about buprenorphine and Suboxone, but there are a couple areas that need clarification. For most people- more than 95% of people in my estimation—there is no difference in the subjective experience from taking Suboxone vs. Subutex. The active drug, buprenorphine, is present in both, and the naloxone that is present in Suboxone has no significant effect. The ceiling effect of Suboxone is due to buprenorphine; naloxone plays no role in that effect. Both Suboxone and Subutex can be used for pain, and both can be used for ‘induction.’ There are some misguided physicians out there who think that Subutex is a better choice for induction, thinking that naloxone will cause withdrawal during the induction process—but those doctors are wrong. Both Suboxone and Subutex cause precipitated withdrawal, which comes from buprenorphine, not naloxone.
Naloxone does not pass through the mucous membranes lining the oral cavity, and instead ends up being swallowed, and taken up into the portal vein from the proximal small intestine. In MOST people, naloxone is then rapidly destroyed by the liver before getting into the systemic circulation. In a FEW people, though, naloxone causes side effects. Side effects are of two basic types. The first type is an allergic reaction to naloxone, causing flushing, wheezing, and perhaps nausea, vomiting, and/or rash. Allergic reactions can occur from very small amounts of a substance, and so people can have allergic reactions to naloxone even when the drug is essentially cleared by the liver and too little remains to cause symptoms of withdrawal.
A second type of reaction is more common in my experience, and that is where the naloxone is not destroyed well be the liver and instead gets into the systemic circulation and then to the brain and spinal cord, where it blocks the opiate effects of buprenorphine. In this case the person would have typical symptoms of withdrawal, including headache, depression, anxiety, restlessness, pain, diarrhea, and nausea. Naloxone is not a long-lasting medication, so I would expect the withdrawal-type symptoms to last only for 30 minutes or less.
As I mentioned, naloxone is usually destroyed very efficiently by the liver before reaching the systemic circulation, a process called ‘first pass metabolism.’. There are many medications that interfere with liver enzymes, although I do not know of specific inhibitors of the enzymes that destroy naloxone. In other cases, people have a genetic background that results in reduced metabolism of certain substances including naloxone. Your symptoms occur shortly after each dose, which is what we would expect in a person who is not fully metabolizing naloxone.
I do not know why your physician is refusing to prescribe Subutex, but it sounds as if she is concerned about diversion. In my opinion, concern in this instance is misguided. Yes, there is a diversion problem with buprenorphine, but there is not a difference between Suboxone and Subutex in this regard—i.e. BOTH are diverted. Studies suggest that buprenorphine is not generally diverted for the purpose of ‘partying’ or getting high, but rather is taken by addicts who are trying to treat themselves to get off opiates, or who need something to carry them over when heroin or oxycodone are not around. In either case, the presence of naloxone does nothing to reduce diversion. As you likely know, naloxone only prevents against intravenous use of Suboxone—a type of diversion that accounts for a very small percentage of cases.
You are welcome to share this with your physician. Unfortunately there are some thin-skinned doctors out there though, so be careful that you do not get yourself kicked out of treatment! I have a couple other suggestions that might be safer. First, you are welcome to send me a list of medications you are taking, and I will check to see if any of them are inhibitors of the liver enzymes that metabolize naloxone. Prozac, for example, is a potent inhibitor of one group of enzymes, and therefore can affect the half-life of a number of medications.
A second thing you can do has been described in earlier posts. The idea is to absorb the buprenorphine without absorbing the naloxone. Since naloxone is taken up only at the intestine, the key is to avoid swallowing the naloxone. Start with a dry mouth. Put the tablet in your mouth and bite it into pieces to get it dissolved in a small volume of saliva. Then use your tongue like a paint brush, and spread the concentrated saliva over the mucous membranes in your mouth for about 10 minutes. After ten minutes spit out the saliva, which contains the bulk of the naloxone. Be sure to avoid eating or drinking for about 10 more minutes, as you don’t want to rinse away the buprenorphine that is attached to the surfaces in your mouth. This method of dosing seems to be more efficient than placing a tablet under the tongue, and allows more control over the absorption of naloxone. I’ve had a number of patients who initially felt that their dose of buprenorphine was too low, who then felt better dosing this way. And I have had a few patients who believed they were getting headaches from naloxone, who had fewer headaches after dosing this way and spitting out the naloxone.
One final thought. I did not address your comments about joy, happiness, passion, or depression because it is usually not a good idea for us addicts to focus on whether we are adequately ‘feeling’ those things. Opiate addicts tend to spend too much time looking ‘inward,’ thinking about how they feel. One goal with treatment is to get them thinking about things OUT THERE in the world, rather than about how they are feeling ‘inside’ (Don’t confuse this point, though, with ‘feelings work.’ Addicts tend to have a hard time identifying feelings and recognizing the nuances between one feeling and the next, and there is much to be gained in working on identifying and recognizing feelings during group or one on one psychotherapy. This work is to be distinguished from the self-obsessed search for happiness that many of us addicts get wrapped up in from time to time). Once a person decides he/she is not feeling ‘passion,’ the absence of passion becomes a self-fulfilling prophecy. The same holds for feeling sad, lonely, or depressed. I do not have an explanation for why Suboxone vs. Subutex would result in a lack of happiness or passion, except perhaps by causing low level withdrawal symptoms that affect mood. I SUSPECT that those feelings are more ‘psychological’ than anything else. I also do not know why your symptoms on Suboxone last all day long, although I suppose it is possible that for some reason your body metabolizes naloxone extremely poorly, causing it to sicken you for the entire period of time between doses.
If the ‘spitting technique’ works, that is one more bit of data that you can take to your physician. Hopefully, if that is the case, she will have a change of heart.
24 Comments
jsday187 · December 27, 2010 at 1:48 pm
The original poster describes a similar experience to mine. Suboxone and NOT Subutex makes me feel wildly sick for an hour after i take it. This sick is nothing AT ALL like withdrawals. It feels like the flu without the fever. Almost indescribable stomach and body convulsions/tremors, headache and nausea/vomiting as well as severe depression.
Once again only on Suboxone does this happen. Not surprisingly Naloxone’s length of effect is about an hour.
Luckily I found a few ways that prevent this from happening with Suboxone.
The first is the way you described in your post: chewing, allow time to absorb, then spit out the saliva.
The second way, if you can transcend past the stigma, is far, far, FAR, I REPEAT *FAR* more effective and preferable: Nasal insufflation. In other words you crush up the Suboxone and snort it. The lines need to be very tiny, the snorting straw properly angled and snorted over a long enough time (i.e. 4mins) to prevent any large amount from dripping down you throat.
I find that a 2mg Suboxone is equally effective as 4 maybe even 6mg, as far as withdrawal relief, done this way. If any amount does drip down your throat do not swallow it and instead hold it in your mouth (ie alternate the saliva it is in between your cheeks, gums under your tongue) for 5-10 minutes and then spit out.
Also the adverse effects felt from using Suboxone the way you’re “supposed” to are negligible and usually non-existent.
I cannot believe they have not produced a Nasal Spray formulation of Suboxone.
I am even considering getting some nasal spray, a syringe with a small gauge detachable needle and some sterile saline water and making my own Suboxone nasal spray. Obviously the nasal spray bottle’s contents will be disposed of(maybe not though i will check then test if using the spray as a solvent, instead of the straight saline, works as well or better). The syringe will be for drawing up a dissolved solution of Suboxone/Saline and then, after attaching the small gauge needle, squirting the solution into the tiny hole on the nasal spray bottle. The saline will be used as a solvent to dissolve the pill, unless I decide that the nasal spray works just as well for the same purpose. Most likely I will empty nearly all the spray out and refill with just enough Suboxone solution to be finished insufflating after about 5-10 sprays. If this method is better than insufflation of dry Suboxone powder I will post again and share the experience.
Why they mix Naloxone with Buprenorphine is pretty much a mystery to me.
It is a total lie that injecting Suboxone causes precipitated withdrawals. A person who has been using Suboxone for any reasonable amount of time can inject it as is with only a short lasting feeling of withdrawal (at most 10-20mins) before the Buprenorphine overtakes it completely. (I’m sure anyone who has abused opiates before knows what injecting them feels like when you are in withdrawals in comparison to when you are not, in terms of which is more satisfying, which for most is the first scenario). Not only that but Suboxone can only really be abused this way a short while before using it by any method does not produce a “high” at all with continued daily use. And the same goes for continued daily use of Subutex as well, as in injecting it will only produce a “high” for a limited number of days.
So what is Naloxone’s real purpose? I suspect it may have been added to obtain a lower scheduling etc. among some other possible reasons I’m not too sure about.
Please, please PLEASE DO NOT use what I have said for the purpose of ABUSING Suboxone. What I have written is meant to be used with the EXACT SAME amount of Suboxone you take daily already, NOT A MILLIGRAM MORE.
In my opinion it should not matter at all what method is used to consume a medication as long as you are not doing it that way for the purpose of abuse and also as long as it is sterile and safe(which is not too hard if you take time to do it with care, using common sense).
Hope this post has been helpful or at least a little informative and also please remember that this is only my experience and what worked for me,(as well as a few other people I know too I guess) you may not get the same results. Better off not using any addictive drugs in the first place if it can be avoided.
Happy Holidays!
Jeffrey Junig MD PhD · April 1, 2017 at 8:55 pm
Interesting. You sure are angry, no doubt about that. I could just keep telling you that you have an illness or side effect, and have you come back for more tests and more appointments… but instead I suggested that you increase the happiness in your life in other ways, through hobbies, exercise, and relationships, WITHOUT sitting in a waiting room and looking for answers from doctors. And that advice makes you angry?
Medications, including psych medications, rarely provide the whole answer– and never provide the things you are looking for, like ‘interest in life.’ You actually wrote that ‘When i can get hole (sic) of some opiates (meaning that when i can increase my dopamine) or subutex, i feel like a completely new — and much happier person’.
Welcome to the club!
You seem to want a doctor to validate an opinion that makes no sense. You may as well call the weatherman and complain that the sun wasn’t out today! I cannot change reality. About 3% of a dose of naloxone is absorbed through mucous membranes, far too little to do anything to your quality of life. And even if it did, somehow, affect your quality of life, naloxone is metabolized very quickly, so the ‘naloxone-based misery’ would be gone, and you’d be left with just your normal anger and misery. When I used to give naloxone in the OR (many, many times) it had to be repeated every 10 minutes or so, because that’s how long it lasts.
It is difficult to share my experiences gained from speaking with dozens of people about buprenorphine medications every day for 12 years. After the first few thousand discussions, several things become apparent. I try to share what I’ve learned from those impressions here. Every now and then someone comes along (you) and disagrees. That’s fine- but I’ll never understand why you took the time to get all worked up, rather than just move on to another blog. You won’t like this either– but someone with that much anger is not likely to feel very happy. I know you are convinced that naloxone is making you ‘this way’– but I would encourage you to have an open mind on that. Angry people tend to be… angry people. Work on the anger, and I bet the naloxone won’t bother you near as much!
As for Hippocrates, I’m not doing you any harm, Renee. I write this blog for free; you’re completely free to ignore what I write, and find a doctor who will take your money, blame the meds, and make money off your misery.
One more thing– you wrote that YOU can’t imagine anything more insulting than MY blog post?
heaven41 · July 3, 2017 at 5:54 pm
Hello ,doc i just have a question for u ok here goes i recently just switched to from methadone to suboxone and i was on a very high dose like 110 but i came down to 20 by coming down 5 mil a week well anyway i started suboxone i was only given 1 8 milagram strip which the first one i had to take in front of the doctore and it made me so sick i thought i was gona die ,but this suboxone doctore i dont think he knows what he is doing he writes 1 8milagram strip a day for all the people he sees anyway ive been hving some bad times with this suboxone i keep taking it but sometimes it feels like i havent took anything and other times i feel like im getting the flu my legs ache could it be i havent took enough or what i dont understand this stuff and any help would be great,also i was on meathadone for 2 years could it be beacause of that i dont know i just really want this to work for me.
Jeffrey Junig MD PhD · July 4, 2017 at 2:52 pm
You don’t mention a couple things that would help with my answer. But a couple points… it is hard to transfer from methadone do buprenorphine. To avoid precipitated withdrawal (PW), you want all opioid agonists to be gone before starting buprenorphine. For oxycodone or heroin, waiting 24 hours works well. But for methadone, you need to stop anywhere from 4-7 days before taking buprenorphine, or you will probably get severe PW. Some people change from methadone to a shorter-acting opioid for a week or two, and then stop that for 24 hours before taking buprenorphine. Note that fentanyl is ALSO a long-acting med if taken regularly, because it builds up in fatty tissue and takes days to weeks to get metabolized by the liver.
So length of time off methadone is important. Also, you want your methadone dose to be 40 mg or less before transferring, i.e. you want your body to be USED to 40 mg of methadone per day, to make sure your tolerance is low enough.
No matter what happens, if you DO have PW, there is only one solution— keep taking buprenorphine as scheduled. The best thing is to INCREASE the buprenorphine dose quickly if PW develops, i.e. to take 16 mg each day. But if you can’t get the doc to prescribe that, take the 8 mg, and keep it in your mouth as long as possible. DO NOT TAKE OXYCODONE OR METHADONE! That will only prolong your misery at this point. PW never lasts very long; it will be 50% gone afte 24 hours, and almost all gone after 48 hours.
One last comment– note that when buprenorphine is working properly, you will feel like ‘you didn’t take anything’ You won’t be sick, but you also won’t ‘feel’ anything from opioids. And a reminder– please use the forum. YOu’ll get TONS of good responses there.
heaven41 · July 3, 2017 at 6:07 pm
Hello doc i just have a question for you,or maybe you could help me with this ok i just startred suboxone im on 8milagrams once a day thats all my doctore will wright is 1 a day foreveryone but anyway i switched from meathadone to suboxone but it seems like every time i take it it kind of feels like i have the flu my whole body aches i dont think its withdraw i dont know do u think maybe i need a higher dose or what.thank you any help would be great .
Jeffrey Junig MD PhD · July 4, 2017 at 2:56 pm
You will gradually adjust and do better if you keep takign what is ordered. You are probably having mild ‘PW’ that will pass after a few days. But yes, it will pass more quickly on a higher dose of buprenorphine, say abou 16 mg per day.
ray · April 20, 2017 at 7:23 am
Hi,
I have been struggling with addiction for many years 30+. I just started suboxone 3 months ago to help with sever PAWS, i take .5mg yea a quarter of a pill. The side effects of 1 mg were unbearable, everything you described x10, headaches were the worst. I dropped down to .5mg and it became tolerable. Please note i have a high tolerance to opiates.
My doctor could not explain how 1mg could make me so sick and .5 was perfect.
I agree with you about how the medication takes all the enjoyment of life away but the Dr. is right about addicts and and how we or I are constantly focused on how we feel. Weather its a runny nose or a pain in my back, anxiety or depression i blame it on the meds and it is always on my mind.
I don’t think there is an easy solution, its a hit and miss thing, i will just keep trying until i hit the right balance, i have been in it to long to give up now.
Good Luck Ray
JEFF · June 3, 2017 at 4:26 am
I began taking Generic Buprenorphine in March 2017 and now am on Suboxone. I couldn’t afford Subutex or Generic Bup I should say. I was prescribed 16mg a day, which I couldn’t take – I began becoming VERY Depressed and now 3 months later I am the same way and I too am down to .5mg a day and Barely can tolerate this. The Only reason I continue to take this is because it does help a little with pain, but nothing like a higher dose which the side effects just outweigh any pain benefit – feeling drunk, dizzy, faint, itchy all over, numbness and tinglenes in arms and legs, feels like I am quivering — No not withdrawals. I was on Methadone for 15 years of stability and feeling fine, doc wanted me off. I was taking for pain and now I can recall why — .5mg of suboxone just doesn’t cut it for my pain whatsoever, so exercise makes me feel so much worse. How do I truly get my dopamine levels up? I am still having almost every side effect I have researched on Suboxone but Doc refuses to put me back on Norco or Methadone. The pain in my lower back is now constant and just cannot ignore even by laying down most of the day and when I do something I absolute Love like going fishing, it is just too much to bear. What can I do. Also: A major side effect is NO sex drive and I was already taking testosterone and now the testosterone has no effect. I don’t mean to sound whiny as I am a very tough person – I am truly suffering from long term pain that was controlled in a stable (no side effect) manner and now it’s not. I know that Bup works very well seemingly from reading hundreds of testimonies but for me the side effects are very serious – especially the dizziness and headaches – just as described from first person. P.S. I am also finding myself becoming a “Natural” angry and depressed person – which is not me.
I know that Nektar Pharmaceuticals is coming out with an Opiate Drug that is supposed to be Non-Addicting due to the Large Molecular size which crosses the BBB much slower but yet Phase II and Phase III trials prove that it works well for Chronic Lower Back Pain — I hope this isn’t a fluke and that I could be a candidate for this medication. I believe if I can exercise without the long lasting pain effects then I could get my life back I had just a short year ago.
I sincerely wish that I didn’t suffer from the side effects of Suboxone because it was just as powerful if not more than Methadone for pain.
Ms Marti · July 17, 2017 at 3:48 pm
Hi I tried Suboxon for the first time last week after waiting 24hr since my last oxycodone dosage I was so sick after i took the 8mg strip I wanted 2hr then redosed another 8mg then waited 2hr and took 16mg point is it only made me sicker each time i took it then when i went to the doctor the next day it did not show up in my blood only my urin. Do have any answer as to why I get so sick from it??
Jeffrey Junig MD PhD · July 18, 2017 at 7:03 am
When you say sick, you mean withdrawal? People on very low doses of opioids will get nauseated from buprenorphine (from too great of an effect). The part about not being in blood is not unusual; urine is a much more sensitive way to test for buprenorphine because it is concentrated in the urine. But 24 hours is usually plenty of time after stopping oxycodone. Were you on any other opioids? And was the oxycodone swallowed, snorted, or injected? Swallowed meds take much longer to leave the body….
Beyond those things, your case is very unusual. Usually the withdrawal maxes out after 8 mg of Suboxone, and additional doses don’t make the person sicker. Let me know if your doc figures it out!
Science Diva · July 25, 2017 at 10:56 pm
Hello Doc! Thank you for taking the time to answer everyone’s questions and run this forum–for free. It is greatly appreciated. I have 4 college science-related degrees, and despite all that, I find myself an addict (step 1). I have been taking Subutex for 5 years (suboxone broke me out in a rash). It’s been okay, never failed a drug test, followed guidelines, etc., but I am having a really rough time getting below 2 mg. I have horrible withdrawal symptoms, not cravings just physical (mostly stomach issues). I also have had dull pain radiating on my left side under my rib cage (and sometimes under my right). I have a hard time differentiating between stomach and liver pain. I was told my liver enzymes are upper range normal with a fatty liver. I’m also started to experience migraines, which I’ve never had. Ambien is the only other thing I’m prescribed, and it strangely helps with the headaches (could be the causation. “the problem and cure could be one in the same”)
I want to be done with this. I work–a lot, and this has prohibited that from happening. Any advice on treatment programs that help to get you off Subutex? Can it be taken indefinitely? I read about medical induction–interested but scared. What medications should I ask to help get passed the “end” — not that addiction ever ends.
Thanks,
Science Diva
Lbarn20@aol.com
Jeffrey Junig MD PhD · July 26, 2017 at 8:16 am
Be sure to check out the forum- there are always many people there who are tapering, and you’ll find all sorts of ideas. Because of the shape of the dose/response curve, that last 2 mg is where all of the work is… Keep in mind that reducing any opioid dose by 5-10% each week is generally tolerable. I have people use the film and dose twice per day, then I have them reduce one of those doses by 10%. Then 2 weeks later, reduce the other dose by 10%. Keep working back and forth, trimming each dose by another 10% every 2 weeks– and the withdrawal will be tolerable.
The only med that I’ve found helpful is clonidine, at night, to help with sleep. Benzos reduce the misery of withdrawal too, of course– but there are many considerations before using them. Some people claim that gabapentin is helpful, but I haven’t been impressed by the response of my patients. I strongly recommend avoiding opioids, even weak, ‘natural’ opioids like Kratom. Yes, you can blunt withdrawal with Kratom, but doing so works against the point of what most people are doing on buprenorphine– i.e. trying to avoid or stop using opioid agonists.
Yes– many patients express a desire to simply stay on buprenorphine, and in my opinion that should be a valid option. We keep people on much heavier, more costly medications for lesser reasons! We can easily put addiction into remission in many people, eliminating the harm completely. Why don’t we?!
Mike · October 12, 2017 at 2:03 pm
In the past I detoxes off suboxone over a 3.5 day period, left rehab even though they wanted me there for like a year, and lasted over 3 years completely clean. A few months ago I relapsed and decided to get help. What’s strange is every time i take my suboxone I’m sick for 30 to 60 minutes with no other opiates in my system. To get into the drug I can wait 24 hours but then sent into withdrawal after taking the suboxone for another 24. This is havoc on my body. I’m just trying to do the right thing and I feel like either allergic or getting a severe adverse reaction to the naloxone in the suboxone. I even thought it was the packaging or coating on the generic brand zubsolv so I traded some for the name brand subs.im struggling so hard to get on this medicine. Why you ask? I’ve cleared 48 hours twice to get onto it and failed. Just this week I cleared 72 hours to get into it and I also failed. It’s not a lack of will power it’s just because I got work and other obligations. Has anyone else had this much trouble getting onto these meds? Or once on the Suboxone are you getting adverse reactions. Is there any alternative for me? Help !!!☹️
Jelz · November 15, 2017 at 1:59 pm
This seems to be a bit of an older thread but I cannot help but relate. I was wondering if you might think my case is similar as well and what might be the best way to address it?
This is my second time in treatment. The first was a year ago and I was taking 4.2 mg of Bunavail. I had some unwanted sides like extreme fatigue and nodding while driving. With a script of Concerta…those went away.
However, this time (about 5 months after ending that first treatment) I have started again after having unfortunately relapsed. This time I have been put on 6mg of Suboxone. I have been struggling with unwanted sides since Induction which was 5 weeks ago. This time I had the nodding and fatigue but it’s cleared up for the most part on it’s own. However…none of the others have.
I have been struggling with nausea and vomiting the worst. Also headaches, blurred vision, body aches, muscle spasms, and a just overall ill feeling. The only medications I take are the Suboxone, Zofran as needed, and Ibuprofin as needed.
It’s really interefering with my ability to function each day. I cannot drive or I get extremely sick. And if I’m too active I’m getting sick. and if I eat I’m getting sick.
I do not understand what changed?
I was put on the Naltrexone pills? I believe (or was that naloxone?) when ending my Bunavail tx to help do a rapid detox before being put on the Vivitrol shot. Those things shredded my stomach and once on the shot I was sick the entire month.
I can’t really think of what other information would be helpful. But thank you for what you do and if you manage to get a chance to respond…thank you.
Jenny · March 30, 2018 at 11:28 am
You stated “As you likely know, naloxone only prevents against intravenous use of Suboxone” I just wanted to inform you that is 100% inaccurate, naloxone does NOT prevent intravenous use of Suboxone. I know many people who IV Suboxone on a daily basis.
Jeffrey Junig MD PhD · April 2, 2018 at 7:36 pm
Not sure how I worded it, but if you’ve ever read anything I’ve written then you know my thoughts on that issue. I’ve written entire posts about the false narrative about naloxone– i.e. that it does not block the effects of buprenorphine beyond a small extent (there are studies showing that after IV use, people receiving the combination product have lower ‘liking scores’ than people receiving buprenorphine alone, but the difference is not large enough, from my perspective on the study, to be important).
In my reply to you I was referring to something else entirely– whether naloxone causes prolonged side effects or is the mechanism for the ‘cap’– which it is not. My answer was to point out that naloxone doesn’t cause the cap on buprenorphine; that the cap comes from buprenorphine alone.
So you’re sort of twisting my words to make a point that doesn’t need to be made.
Beyond all that… your ‘many people who IV Suboxone on a daily basis’ are all idiots. Take a fraction of what you’ve spent on heroin over the year and spend it on yourself. Get a doctor– someone who has studied and learned how to help people addicted to opioids– and let him/her help show you a way to a better life. Sometimes I just want to say ‘YOU’RE PUTTING CRAP DIRECTLY INTO YOUR CIRCULATION!’ And the CRAP is just talking about the chemicals, not all the bacteria, yeast, and skin fragments from everyone else that dipped into the same spoon.
Injecting Suboxone… seriously?!
Michelle · May 6, 2018 at 8:57 am
So here is my issue…. I’ve been on suboxone for 6 years and have relapsed maybe a couple times for an extended period of time within those years but I did have 2 and a half years of consistent and continually clean time as well. The side effect I have experienced have been from the beginning till now… growing up I was taught to not cry about every time you have a stomach ache and there have actually been times I refused to go to the er or doctor when I should have and ended up hospitalized for several days because I let it get worse.. a learned behavior from my father.. so I don’t like running to a doctor every time I feel sick or anxious to fix my problems.. I exercise on an every day basis eat extremely healthy and sleep at least 6-7 hours a day.. I take suboxone twice a day because I take it for pain.. the side effects I experience tend to last a little bit more than 1 hour after taking the subxone and I’ve always had a very unusual reaction to certain medications.. idk if this helps at all but when I was 7 I was given demorall with anesthesia when I was going into a minor surgery and I almost died and needed 7 different stimulants (I believe they were stimulants but I’m not positive I was very very young) to wake me up and they actually brought my parents in to say goodbye. I was told that this isn’t a normal reaction but I really didn’t think anything of it but figured I’d mention it.. anyway my side effects include dizzyness, feeling fatigued, excessive sweating, swelling of hands neck and face, (that one is actually rare but has happened and scared me half to death) chest pain, pain in the upper right abdomin, difficulty breathing and feeling like I can’t take a full deep breathe, multiple rashes mainly on neck chest but have had them in many different places, my throat has felt like it was closing before, nausea, flushed in the morning right after taking suboxone, daily depression and anxiety that have made it hard to even take the train to work because it is so bad in the morning, muscle spasms, and blurry vision… I understand that sounds like a lot but some just come and go while others are a daily constant.. the reason I think suboxone is the issue is because Last time I went to rehab I actually detoxed with methadone instead of suboxone and did not feel any of these side effects.. I was so much happier and at first I thought it must be the methadone and then when I tapered off of the methadone i STILL felt happy even with being kinda sick still… because Of the really bad back pain I have after being in 5 car accidents I needed to go on pain management with suboxone and when I started taking it again alll of these symptoms came back and I don’t think I ever noticed how bad these symptoms really were cause I spent several years with these and then having almost a month without them I truly realized that these things that I would dismiss and ignore and push through were not ok.. right now what is really getting to me is the incredible anxiety I have depression chest pains and not being able to catch my breathe.. the rashes on my neck are really bad and the excessive sweating is hard to deal with..in multiple blogs I’ve read that someone may feel a couple of these symptoms but not all of them.. honestly I think I could handle a couple of them in the morning but all of these things are affecting my ability to function sometimes and I’m taking care of my mother so not functioning is not an option.
I feel like I’ve given this medication ALOT of time and have always taken it properly and have been on numerous different doses and nothing is changing.. some of these symptoms are genuinely frightening especially when my hands feet neck and face swell up to double the size or when I’m trying my hardest to breathe And can’t get that deep breathe I need… when I first said something about them to my doctor he said just wait and see if it continues and when I told him it was continuing he’s change my dose and then another 2 months of waiting and it just continues that way with no improvment.. my issue is that when you go to your doctor and say a medications making you feel all around not right they don’t dismiss you the way i feel doctors have done to me especially when the reactions I’m havin are not little symptoms, they try a new medication.. and I don’t want to go on benzos again I want to be on as little medication as possible and I don’t understand why if you can’t get high on subutex that it would be so harmful to try… any improvement ya know.. idk if you know or have experienced this before Idk if you can help but I figured it was worth a try
Jeffrey Junig MD PhD · May 21, 2018 at 7:38 pm
I don’t have an explanation for those side effects. But any one of them would typically be a reason to transfer a patient to something other than buprenorphine. It sounds like you want your doc to give you plain buprenorphine, instead of a combination tablet? The problem is that there is no logic behind the issue. Understand that people on the outside of any science or specialty can’t sometimes see the reasons for things- but that doesn’t mean that the reasons don’t exist. I don’t mean to be patronizing; I just don’t have a good way to explain my point. Narcan from Suboxone is only in your body in very tiny amounts, for a short length of time. It is such a safe medication that it is now handed out to people without a prescription in many states, and encouraged for use by people with no medical training. I just cannot imagine how having naloxone in your body for 20 minutes can cause the things you describe, other than you having repeated anaphylactic reactions – and that is not likely because those reactions are often fatal.
I get the impression that you speak in dramatic terms– like by saying your head doubles in size. That just is not possible, because your head has a skull that CAN’T change size. Yes, you may get some soft-tissue swelling– but nowhere near ‘double’ in size. Likewise the comments about not being able to breathe… if a doctor hears a person talking in those terms, he/she is going to immediately disregard much of what you’re saying.
To answer your question, no, buprenorphine is not that harmful. It is essentially the exact same medication as Suboxone or Zubsolv as long as you don’t inject the medications.
I recommend going through the things you wrote and carefully evaluating them, and think whether you could be exaggerating. Then when you see your doc, try to be accurate with your descriptions. Don’t say your head ‘doubles in size’. Say it ‘looks like your head is larger’, or ‘there is swelling on my face’. If you feel some tightness when you breathe don’t say ‘I’m suffocating’, say ‘It feels harder to breathe’. I don’t know if the doc will prescribe buprenorphine, but it may help with the communication between the two of you.
Pam · June 19, 2018 at 6:37 pm
I would just like to quickly share my experience with the difference taking Subutex versus Suboxone. I started taking 2 of the 8mg/2mg (bup/naloxone) a day exactly one year ago today. I had been in a pain management clinic for 20+ years with doctors prescribing me way way too many and too strong of opiates. I felt it destroying my life and my joy so I decided to try Suboxone. I went through some horrible PW’s but survived. For awhile after surviving the rough part, I thought and truly believed that my life was about to start a new chapter…my best chapter yet! I had traded in taking 6-7 strong opiates a day down to 1-2 Suboxones a day so no longer would medications control my life on a daily basis. I spent 11 months gradually feeling worse but still better than being controlled by pain pills. I would have 3-4 good days to every 14 bad ones. I kept thinking tomorrow would be a better day. I was fatigued, slept for days at a time and then would not be able to sleep, I would have muscle jerking throughout my body that were so big I would drop things or fall. It honestly looked, I know, like I was having convulsions and they’d come out of nowywith no warning. I thought it was from the gabapentin they put me on to replace the benzos I had always been prescribed for my anxiety. I also went from a size 3 to plus size clothing with no changes in my diet, etc. only meds had changed. Also, I kept going to my PCP begging him to help find out why I kept feeling like I was sick with the flu or worse…why I’d go days without leaving my apartment because I just couldn’t do anything. Lethargy like I’d remembered from having mono years ago…had blood tests but found nothing or no real signs of my symptoms and note that I’m a very positive and optimistic person. A month ago my Suboxone doctor decided to switch me to Subutex because she knew a small percentage of people were effected by naloxone. Honestly we were really trying to figure out my weight gain cause it was causing my physical symptoms ( rheumatoid and bad back problems related to childhood injury).
So I’ve been on the Subutex…NO naloxone… for a month. Not only have I lost 10 1/2 lbs., the muscle jerks have completely stopped, I no longer feel bad all of the time, I’ve been out and about being the spontaneous person I used to be and SOO HAPPY!! I had no idea any of these symptoms could be related to naloxone so it’s not like I had it in my head that it was the root of all my issues. My jaw dropped when my doctor said she was switching me because she is a very strict by the book doctor…she’s VERY good! I was really only expecting that maybe I’d lose some of the weight… MASSIVE SWELLING. I never dreamed all the other yuck I was dealing with would diminish as well. SO I don’t think Drs should ever say the words that a certain Med doesn’t have certain side effects and then state the reasons why they couldn’t because as small of the amount of naloxone I was getting daily, whether quickly leaving my body or not, 100% positively caused these side effects on me which TREMENDOUSLY affected my quality of life. EACH OF US, INDIVIDUALLY, have completely different genes, DNA, etc so you can never rule out things just because scientific studies SAY so and that’s how ‘you’ learned it to be. LISTEN TO PATIENTS….PEOPLE.
WE are supposed to immediately trust you all from the second we meet you. We are supposed to trust you enough to take your word and put medications you doctors say we are to take BUT as patients, WE HAVE TO EARN DOCTORS TRUST and it takes way too long to not be treated as ‘pill seekers’ ‘must be addicts’… Yes it’s an epidemic BUT there are still lots of people in need of genuine help so therefore desperately needing to be trusted equally…at least until one shows the obvious nature of chasing a fix!
Thank God my dr who only just told me she has always been a doc that prescribes Suboxone and NEVER subutex…that she took a shot with me in hopes of positive change and WOW I feel like me again which is a first in 20+ years for me. God bless.
Chris · July 18, 2018 at 1:24 pm
I see Dr. J only answers certain questions. The naloxone blocks endorphins, therefore causing major depression in some. Me being one of them. Everyone has different brains. I’d like to see Dr J answer this last question. We know he’s not gonna because this person is totally correct. And calling someone an idiot on here. You’re the idiot.
Jeffrey Junig MD PhD · July 26, 2018 at 5:04 pm
Dude, check your insecurity at the door! I work at two offices and find time to answer questions here when I can- which means I may be gone for a few months. I would only skip a question if it was so ridiculous that I feared simply reading it would create more ignorance than knowledge. Frankly, this question is borderline.
Yes, naloxone theoretically blocks endorphins. But there is no evidence that naloxone therefore causes ‘major depression in some’. If you post a reference, I’ll read it – meaning a scientific article, not someone claiming it to be so. If I saw a study making that conclusion, I would have many questions for the author. How do you know that ‘endorphins’ were blocked in your test subjects (the people who supposedly had naloxone-induced depression)? Which endorphins were blocked? In which parts of the brain? And how did you measure that blockade – brain biopsies? Wouldn’t THAT be likely to cause depression? How did you control for that?
And I would ask why naloxone, a drug that is metabolized within 30 minutes, have such an effect? Why would some degree of receptor blocking for less than an hour per day result in major depressive disorder? If it DOES cause MDD, why doesn’t it do it to everybody? Why only a few people, if it is a direct chemical effect?
Beyond your question, you do understand that I am not some naloxone profiteer, right?
Jennifer · October 18, 2018 at 7:14 pm
Ok so I’m not a medical doctor and I don’t have a degree. But so many of these sympotms people are explaining sounds like my symptoms from over active thyroid disease/ graves. I was put on methimazole to suppress my thyroid from over producing. Well I have noticed since then I have gotten on subs the 8 mg strips .And since I have had major problems. Ie my tongue swelling under Neath and burning when I take my med. naseu vomiting also some pretty serious stuff liek when I am sleeping I wake up many times throughout the night with my heart very fast (which I’m use to from thyroid disease) but I feel like I am shakomh internally but husband has said it doesn’t look like I am shaking .It’s like I am waking up in a state of severe confusion and shaking on the inside my eyes everything. And gasping for air. I have no clue what is going on but it is really starting to scare me .Also the tongue swelling underneath and burning from the film. I take 8 mg name brand Suboxone film 10 mg methimazole 80 mg propanolol and 2 300 mg neurotin a day .Do you know what may be causing this? Also I have taken films for a very long time and the burning and swelling in my saliva gland just started in the last couple weeks. Thank you very much for any help.
Mandy · December 21, 2018 at 1:07 pm
I have to just say i have hepatitis C and I’ve taken Subutex for 2 1/2 years for a combination of pain & addiction treatment and there is a HUGE difference between the two. I took suboxone before, trying it on three separate occasions before I finally went to a doctor and each time I suffered horribly, migraines, nausea, vomiting, stomach cramping and dizziness/light-headedness. The Subutex has never caused me to experience any of those symptoms so I can only surmise it’s the naloxone as that is the only difference between the two.
Jeffrey Junig MD PhD · December 31, 2018 at 1:11 pm
Mandy, I appreciate your comments. There is 2 mg of naloxone in the 8 mg Suboxone film, as you probably know. A standard ampule of naloxone contains 0.4 mg of the drug. Naloxone has a short half-life, and is usually metabolized within and hour or two.
I believe you. I just don’t know how to explain why you have such a reaction, and most people don’t.