What is the purpose of buprenorphine?

Buprenorphine Post
deegee
Posts: 137

Postby deegee » Fri Jul 10, 2015 6:15 am

I think that this discussion isn't going to work on a forum such as this. Aside from your own anecdotal evidence, I'd be curious what other evidence exists. I think that your explanations above are in agreement with what I said (perhaps I stated it un-clearly though)
I do not believe that buprenorphine suppresses psychological cravings. I think that psychological cravings are the likeliest reason for relapse.
I will avoid ad hominim attacks, easy as they would be, as I believe you all have good intentions, but let's just agree to disagree.
I also listen to my patients. I also have treated thousands of patients and my patients are also wonderful and love me.

Dave
Posts: 187

Postby Dave » Fri Jul 10, 2015 6:15 am

Kevin, I agree with you that bupe does suppress cravings. I also tell patients who have occasional thoughts of getting high that this is normal and different from physical cravings. I think there are two kinds of cravings, the physical from not getting enough bupe and the psychological, which can occur in anyone who has ever enjoyed being high on drugs. I tell them that by thinking rationally and refusing to go back to a worse way of living, they can deal with the psychological cravings, which become less frequent the longer they are from the old way of life. Psychological cravings usually arise when they see others using drugs or when they are under stress. It is important they learn the difference and other ways of dealing with stress than taking a pill or injection. It is also why they need to avoid old friends who are still misusing drugs.

MChaplin
Posts: 183

Postby MChaplin » Fri Jul 10, 2015 6:15 am

I agree with Kevin- I think that what distinquishes buprenorphine from methadone and naltrexone is that it stops cravings more effectively- it stops withdrawal for sure- and it blocks the euphoric effect of other opioids and it stops cravings- does that mean that our patients will never think of using again? of course not, but it does mean that they are not constantly feeling driven to get high. Do many of them still need to learn how to cope with intensely negative (or intensely positive) feelings without turning to the great off button that exogenous agonist opioids provide? of course they do- but on buprenorphine, they have the opportunity to learn- without it, the craving takes over and becomes unbearable. How do I know this? Because I listen as carefully as I can to the experiences which my patients share with me. If buprenorphine didn't suppress cravings, it would be naltrexone. It is a partial agonist- to the opiate experienced brain, it affords little to no euphoria except sometimes on initiation or at time of dose increase but in the majority of patients, it does stop wdrl and cravings. It just does. When I am concerned that it is being used "inappropriately" to cope with the least little bump in the road, I remind patients that ideally the total dose should be taken in the am- and not prn- as in, i don't feel good, so i think i will take a little bit of my film now. prn use of bup is a form of addictive thinking- that is when something doesn't feel right, i can change it by using a substance. once daily dosing encourages people to deal with life on life's terms. However, I have found increasing the daily dose very effective when clients are taking it as prescribed and still experiencing cravings throughout the day...caveat being that there is little to no benefit once the "ceiling" is reached. In those cases, i advise patients that they are going to have to find other ways of coping with the cravings or switch to methadone.

drpasser
Posts: 1404

Postby drpasser » Fri Jul 10, 2015 6:15 am

I completely disagree that the expectations of suppressing cravings leads to inappropriate use of bupe.

You are just wrong; or else, I have been wrong in my successful txs of over 1000 OBOT pts over the past ten years.

What you said, IMO, is dogmatic and not good advice. You can do it how you want of course. That's not how I do it.

Sorry. But I hate to see falicies perpetuated on this site. I am sure, I have failed to convince you that monitoring for and addressing cravings is the name pf the game in this business.

Best,
Kevin

deegee
Posts: 137

Postby deegee » Fri Jul 10, 2015 6:15 am

Yeah, well I do agree with all the above, but

I was kind of looking for what buprenorphine itself is expected to do as a medication. The above posts describe a very pretty picture of recovery and patients dedicated to such.
I was hoping for something else.
In my opinion, buprenorphine eliminates any withdrawal/dopesick feelings, allowing patients to feel relatively normal. This allows the patient to pursue the other arms of a full recovery program.
I do not expect it to suppress cravings. As a matter of fact, the expectation thereof usually leads to inappropriate use of buprenorphine when patients feel anxiety or stress, something for which it is not intended to be used.
I do believe that it occupies mu receptors so that if and when a patient "slips", there will be no positive reinforcement.

kcairns
Posts: 571

Postby kcairns » Fri Jul 10, 2015 6:15 am

Purpose of buprenorphine....Yes to above...and also to allow a hope-abandoned Addict to receive the message that "i am now me with individualized life joy and duty fulfillment and opioid-craving-killing capacity built strongly into me,and, having got this message i may become able to hang up the suboxone phone as i go forth"... (ever aware suboxone and counselling cant prevent all cravings w/o the person's effective input, but suboxone can at right doses prevent od).letting go of the unvital including many prescription drugs.free of burden of all that is less than who you are....go forth...in a world where all is interconnected,; sure of the fundamental goodness within you ,free of believing you need what you do not lack,.disallowing the less important from controlling you.not wasting ourselves on what is less than we already are..not needing to meet some Buddha coming down the road, nor to travel the yellow brick road needing to find -- "I am Oz the great and powerful....who are you ?? and what do you seek from me?"...but calmly certain of the answer to Oz' vital question - "who are you?? ...and that answer being " I am me, all that I am , and among all else I am the one most vital person in keeping myself ok" . The saying that "If you see the Buddha coming down the road, kill him" tells u to kill all neediness-born hope for outside rescue...for no meaning that comes only from outside us is real ... any Buddha we see outside us is impermanent and thus inferior to the Buddha within us ... "the Tao we can see is not the real Tao"...and from Black Elk, All that is transcendent above this Creation is also imminent in the least part of it and in each of us..

MChaplin
Posts: 183

Postby MChaplin » Fri Jul 10, 2015 6:15 am

I would add improving quality of life...

Dave
Posts: 187

Postby Dave » Fri Jul 10, 2015 6:15 am

Yes, all of the above is correct. Building self-confidence is very important too since so many have been put down by pharmacists and anyone else who knows their affliction. A sign of love from the physician is much appreciated by this group. Suspicion and scorn are negative attitudes in treatment, and should be avoided if possible. Vocational guidance is important as well because so many are either unemployed or in low-paying jobs. Depression is common, and I recently saw my first case of major depressive disorder in one woman I have been seeing a long time. Other degrees of depression, anxiety, and panic disorder are fairly common too. A doctor who appears to be nothing more than a legal pill dispenser is a major negative for these people who are is great need for support and someone to talk to. I have seen smiles come to faces that seldom showed any sign of hope in the past. I have been told by many that they had just been drifting along with nothing to look forward to. These are lost waifs looking for something to hold on to, for some reason to go on living -- so give it to them, and not just a prescription.

klsloan
Posts: 17

Postby klsloan » Fri Jul 10, 2015 6:15 am

How about "all of the above"? Each individual may need more of one component or another, but all are important in allowing individuals the best possible chance at building sober, "legit" lifestyles and lives.

drpasser
Posts: 1404

Postby drpasser » Fri Jul 10, 2015 6:15 am

Preventing deaths, seems like a good, primary reason, right?

A person dies every 15 minutes-24/7 in our country.

What a terrible disease.!


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