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Unread 09-29-2006, 11:47 PM   #1
Suture
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Default The function of the Naloxone found in Suboxone

I’ve been noticing some confusion on this site about Naloxone.
  • First, it is very important to understand that the naloxone present in Suboxone, but not Subutex, is only there to prevent misuse by injection. It serves no other purpose.
  • Secondly, only a miniscule amount gets into the blood when taken sublingually. With the exception of a very small percentage of individuals who are hypersensitive to it (some on this site), that amount of naloxone has no perceivable effect and is considered clinically insignificant.
  • Third, Debate about the effects and pros/cons of Naloxone or Subtx vs. Subxn is irrelevant since naloxone is not introduced to the blood stream in significant quantities.

As mentioned in a post here some people are hypersensitive to naloxone, lactose, and even the cornstarch also found in the tablets. These people might have any variety of reactions, but this is very very rare and happens in less than .1% of the population. It however is no less real to those people despite its rarity and I don't want to minimize their expirience. Some have reported nausea, and mild withdrawal-like symptoms. It’s very important to understand only about 1 in 1000 people report such a reaction.

The ONLY reason the naloxone is there is to prevent people from shooting their Suboxone. Naloxone, although clinically insignificant when taken sublingually, becomes clinically significant when injected into the blood and can precipitate a withdrawal syndrome in opioid dependent people. This prevents people from crushing, dissolving and shooting their Suboxone.

Most people will not notice any difference between the two medications. In some countries where only Subutex is available, it has become a widely abused drug. To prevent that from happening in the US and to assure buprenorphine is not removed from the market, docs are encouraged to use Suboxone whenever possible.

Here are some facts from the FDA about this:

Physiologic and subjective effects following acute sublingual administration of SUBOXONE and SUBUTEX tablets were similar at equivalent dose levels of buprenorphine…the SUBOXONE formulation, had no clinically significant effect when administered by the sublingual route…. Naloxone did not affect the pharmacokinetics of buprenorphine and both SUBUTEX and SUBOXONE deliver similar plasma concentrations of buprenorphine…. The effects of 16mg SUBOXONE were similar to those produced by 16mg SUBUTEX (buprenorphine alone).”
(source FDA) http://www.fda.gov/cder/foi/label/2002/20732lbl.pdf

Important term:
bioavailability: The ability of a drug to enter the body. Example: Naloxone has poor bioavailability when taken sublingually (under the tongue)

Buprenorphine/naloxone:
There have been reports from several countries of misuse of buprenorphine by injection. Because of this buprenorphine misuse, a sublingual tablet form containing naloxone has been developed for the U.S. market to decrease the potential for misuse of the combination product via the injection route. Sublingual naloxone has relatively low bioavailability (Preston et al. 1990), while sublingual buprenorphine has good bioavailability. (Both naloxone and buprenorphine have poor GI bioavailability.) Thus, if a tablet containing buprenorphine plus naloxone is taken as directed—sublingually—the patient will experience a predominant buprenorphine effect. However, if an opioid-dependent individual dissolves and injects the combination tablet, then the antagonistic effect of naloxone predominates because of its high parenteral bioavailability (Stoller et al. 2001). Under such circumstances, the individual should experience a precipitated withdrawal syndrome. This should decrease the likelihood of misuse of the combination tablet by the injection route.
(Source: naabt glossary)
Commonly patients experience a variety of symptoms during induction especially if they transition from methadone or OxyContins. These symptoms usually dissipate on their own. If a patient is convinced their symptoms are the result of the naloxone (or something else) and they switch to Subutex they could easily misinterpret that the end of symptoms was the result of the change in medication, when actually the symptoms would have disappeared anyways. The placebo effect should not be discounted either, sometimes a change will have an effect if it is believed it should. That doesn’t make it any less real, only unnecessary.

I don’t mean to drive this topic into the ground, but it is very important that the naloxone is not misunderstood. Actually, if someone didn’t know anything about naloxone that would not likely hinder their treatment, but in light of the recent incorrect posts, wrong concepts of the function of naloxone could hinder someone’s treatment.

Nancy quoted it well in another post as well reprinted below.
Quote:
quote:Originally posted by NancyB

More about naloxone.
From: http://buprenorphine.samhsa.gov/about.html

Because of its opioid agonist effects, buprenorphine is abusable, particularly by individuals who are not physically addicted to opioids. Naloxone is added to buprenorphine to decrease the likelihood of diversion and abuse of the combination product. Sublingual buprenorphine has moderate bioavailability, while sublingual naloxone has poor bioavailability. Thus, when the buprenorphine/naloxone tablet is taken in sublingual form, the buprenorphine opioid agonist effect predominates, and the naloxone does not precipitate opioid withdrawal in the opioid-addicted user.

From the SAMHSA TIP 40, Pages 8-9
The buprenorphine/naloxone combination tablet appears to have reduced abuse potential
compared with buprenorphine alone when studied in opioid-dependent populations. It
works on the principle that naloxone is approximately 10–20 times more potent by
injection than by the sublingual route. Therefore, if the combination is taken sublingually,
as directed, the small amount of naloxone available should not interfere with the desired effects of buprenorphine. If the combination form is dissolved and injected by an individual physically dependent on opioids, however, the increased bioavailability of naloxone via the parenteral route should precipitate an opioid withdrawal syndrome.

Nancy
Caroline explained another point so concise and eloquently I must include it here as well.

Quote:
quote:Originally posted by Caroline

JAT, I think what you have misunderstood regarding naloxone and what you've seemed to say in some of your posts, is that naloxone inhibits the production of endorphins (which it doesn't). I am familiar with the acupuncture studies, mostly attributed to Dr. Bruce Pomeranz, where the effects of acupuncture can be blunted by naloxone, and where acupuncture seems to facilitate the release of endorphins. Well, naloxone does NOT stop the production of endorphins, it only blocks endorphins from activating the opioid receptor sites. There is no damage (as you have implied) to the endorphin producing ability of the body. Also, the effect of naloxone is very short-lived, and whatever opioids there are in your body, either endogenous (natural) or exogenous (from outside sources), will still be there to again activate the receptors. In a serious heroin overdose, you cannot give just one dose of naloxone...it doesn't last long enough. And well, Subzero is right...the naloxone in Suboxone is VERY poorly absorbed and basically has NO effect. I've posted the references to this in the past. Keep in mind that any miniscule amount that may possibly be absorbed would be VERY short-acting. You really need to go back to your studies and re-read them thoroughly, and if you have any difficulty with interpreting them, we can help you.
Caroline
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Unread 09-30-2006, 12:09 AM   #2
OhioMike
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Suture,

As always, THANK YOU!

Mike
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Unread 09-30-2006, 12:59 AM   #3
Suture
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Thanks Mike, I feel we have reputation to uphold here


Splitting tablets.

For an FDA approved prescription pharmaceutical to have a scoreline on it, it must show the FDA that when the pill is split in two that the medication within the tablet is divided evenly. The FDA has strict tests that assure equal distribution of active ingredients throughout a tablet that is to have a scoreline on it. Often, it is only a matter of showing consistency in the manufacturing processes and no special modifications need to be made.

Pharmaceutical manufacturers often adopt manufacturing protocols that always ensure equal distribution of the medication whether they are seeking scoreline status or not. Consistency in the manufacturing process translates into more efficacy and thus lower costs.

Suboxone/Subutex does not have a scoreline, it does have a sword logo which could look like a line at first glance. The manufacturers of sub did not seek scoreline status, so the FDA never did the test to check for consistent distribution of the active ingredients throughout the pill. In conversations with the manufacturer I asked if there were any unusual characteristics that would make it more likely that sub would be unevenly dispersed. The answer was "No.”

So although the manufacturer cannot guarantee you will have equal medication in each part of a single split pill, and they cannot instruct people to split their pills, there is also no evidence that would suggest that it would be unusually uneven either.

This is true for both Suboxone and Subutex, there is no advantage in one over the other in regard to even distribution of medication within a tablet.

I understand all this to mean that if I want to split my medication I can without any concern, even though the manufacturer cannot condone it.

S-
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Unread 09-30-2006, 12:04 PM   #4
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That brings up another question, If they cant tell you to split the pills, then why is 2mg the smallest dose size?
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Unread 10-01-2006, 08:31 PM   #5
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Suture, I am a believer in the naloxone thing. I read all this stuff over and over and never ever suspected that naloxone was causing me so much grief.

I spent those first weeks not whining to anyone about how bad I felt. I was ready to quit treatment after only 5 weeks on suboxone.

The postings on naloxone safety were the reason I never suspected it.

At week 6. My doctor and I dicussed all these odd symptoms and he examined the ones that were physical. I asked him if the lunesta did those things. No he said. We talked some more. He told me that he was switching me to subutex. I about fell on the floor. Huh? I had heard it tasted bad. Plus Suri switched and she didn't feel better so I held out little hope. I even had the nerve to disagree with him (dumb) stating boldly that naloxone was not the problem, I was. He was firm. So I agreed.

I noticed the difference almost immediately. The 1st day on subutex I actually had some energy. I still wasn't convinced. By day 5, the physical symptoms were really easing up. I was starting to really notice the difference. By day 10 all my physical symptoms had almost ceased. By day 15 I felt better than I had in years and that made me a firm believer.

I have progressed rapidly. To think that I was ready to quit.

I am very convinced now that I should have reported all that stuff earlier on and I wouldn't have had to suffer so much. I am also convinced I would have been further along with my treatment and taper if not for the naloxone reaction.

With sub being in its baby years and naloxone being there just for the inj. reasons. I wonder why anyone would want to put addicts through this terrible misery. It may even account for some quitting the program early on. This misunderstanding almost led to my relapse.

Other countries take subutex. I know people abuse stuff everywhere. But that doesn't mean that I have to suffer because of it.

Not all doctors are going to catch this early on like my doctor did. He was genius in my book. Angel
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Unread 10-01-2006, 08:47 PM   #6
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Hi Angel, Since I have switched to subutex (about 7 weeks now) I am much better. I felt a difference right away physically, but it took a while for me mentally. I am down to 1mg. a day and doing fine. My back pain had subsided but since I have been moving, my back has been bad the last few days. I'm so happy you are feeling better on subutex.

Suri
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Unread 10-01-2006, 08:48 PM   #7
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Quote:
quote:Other countries take subutex. I know people abuse stuff everywhere. But that doesn't mean that I have to suffer because of it.
Yes, but some countries actually BAN subutex because of the abuse potential...

http://news.bbc.co.uk/2/hi/uk_news/scotland/2980205.stm

And you are right, just because some people abuse it doesn't mean the majority of people who don't abuse it should suffer. That's what I don't get about this idea that NO ONE should be able to use it because of a few people...what screwed-up thinking these people in government have...

MarLou
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Unread 10-01-2006, 08:49 PM   #8
Suture
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Angel,
Maybe you are one of those people who are hypersensitive to naloxone. Maybe it was the placebo effect. Maybe the symptoms you had would have disappeared anyways, they are common in the beginning of treatment with many people. Maybe it’s a combination of these things, or 1000 other things. The point is there is no way to tell, with the given info, what caused your symptoms. You found something that works for you, that’s good. There are always exceptions, you don’t have to dispute the science to validate your experience, it's accounted for in the science.
S-
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Unread 10-01-2006, 09:11 PM   #9
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Quote:
quote:Originally posted by Suri

Hi Angel, Since I have switched to subutex (about 7 weeks now) I am much better. I felt a difference right away physically, but it took a while for me mentally. I am down to 1mg. a day and doing fine. My back pain had subsided but since I have been moving, my back has been bad the last few days. I'm so happy you are feeling better on subutex.

Suri

Thanks Suri. Good to hear that. I wondered about that switch and if you got better. Who wouldofthunk that is was the naloxone?

God, it feels great to feel good. Angel
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Unread 10-01-2006, 10:08 PM   #10
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Hi angel, I posted this to you yesterday in the energy loss around 3 topic, I'm not sure if you did see it. I just wanted to let you know.


Hi angel, I wish you had mentioned those problems before because others have had swelling, we suggested they try to switch to see if they were hypersensitive to the naloxone. And when they did, the swelling did go. Just wanted you to know you're not alone in that. Glimmertwin, Stacey, Spanky, are a few that come to mind right off the bat.

In any event, I'm glad things are going well for you!!!!

Nancy
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Unread 10-01-2006, 10:41 PM   #11
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Quote:
quote:Originally posted by NancyB

Hi angel, I posted this to you yesterday in the energy loss around 3 topic, I'm not sure if you did see it. I just wanted to let you know.


Hi angel, I wish you had mentioned those problems before because others have had swelling, we suggested they try to switch to see if they were hypersensitive to the naloxone. And when they did, the swelling did go. Just wanted you to know you're not alone in that. Glimmertwin, Stacey, Spanky, are a few that come to mind right off the bat.

In any event, I'm glad things are going well for you!!!!

Nancy
Nance, I found it difficult to say anything in chat because I didn't want to take someone elses spot for one. For two I have been away from here a lot because I feel so darn good.

The biggest reason I said nothing about my symptoms here is because I didn't think it had anything to do with anything other than me. Especially didn't consider Naloxone based on strong posts such as this. I didn't feel there was any possibility that I was in that 1%.

I mentioned nothing because I assumed that it would make no difference. Crying about my problems wasn't going to help them. So I didn't.

I just knew that this 'magic' pill wasn't on my side and I was ready to quit.

The fact I get better almost immediately is all I need to know. It really rains on my parade when I read that I would have gotten better anyway if I had just suffered longer. Huh? That doesn't even make sense. That is the most confusing.

I can see already that the mention of it causes controversy. I saw it happen before. I layed low because I already knew and predicted what would be said.

I see now that it was pointless to say anything. Even now I get the same information I got before. I spent weeks blaming myself and went into a terrible depression. I don't think that should have even happened. Angel
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Unread 10-01-2006, 10:45 PM   #12
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Angel,

In your case and several others staying on suboxone any longer than you did wouldnt have helped you at all, switching to subutex when you did probably saved your life from addiction, Some people are just sensitive to the nalexone and im glad they can get subutex.

Brett
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Unread 10-01-2006, 11:44 PM   #13
Suture
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Angel,
If you read back through some earlier posts from the last 10 months or so, you will see there were many people that took a few weeks to feel right. Especially the ones that transitioned from methadone or OxyContins. They were helped along and coached through their symptoms, some were told to ask their doctor about subutex, but with most the symptoms cleared up. So you see your fear was unfounded, you could have been honest about your symptoms and you would have been helped.

Quote:
quote:Angel said, "The fact I get better almost immediately is all I need to know. It really rains on my parade when I read that I would have gotten better anyway if I had just suffered longer. Huh? That doesn't even make sense….”
Nobody is saying you would have, don’t you understand? We are saying that the switch to Subutex does not prove anything, there are way too many variables to be that conclusive. I’m glad it appeared to work for you. I don’t understand why you are so obsessed with this issue. No treatment works the same for everyone, that doesn’t mean all of the science is wrong.

S-
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Unread 10-02-2006, 02:40 AM   #14
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Angel,
Do you disagree with either of these points Suture made?

First, it is very important to understand that the naloxone present in Suboxone(but not Subutex) is only there to prevent misuse by injection. It serves no other purpose.


Secondly, only a miniscule amount gets into the blood when taken sublingually. With the exception of a very small percentage of individuals who are hypersensitive to it (some on this site), that amount of naloxone has no perceivable effect and is considered clinically insignificant.


It seems that you do not understand that the naloxone is not absorbed by the body in significant amounts when taken sublingually. You talk about the effects of naloxone in the brain, what you don't seem to understand is the naloxone will not get to the brain, in significant amounts, unless you shoot it. So all this speculation about what happens in the brain with naloxone is irrelivent unless you plan on shooting you medicine, do you?
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Unread 10-02-2006, 06:51 AM   #15
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Suture, Caroline and Sub,

Thank you for covering this issue as thoroughly as you have. I hope the information shared, along with the insight and understanding can help put this issue to rest.

I see nothing constructive in pitting one Sub against the other. The simple fact is this, if by chance and person is overly sensitive to the small amount of naloxone which enters the body, then they have a choice. We should be thankful.

There is no conspiracy here by the manufacturer to dupe anyone about the purpose of using naloxone. In fact it had to be used to get government approval so that Sub could not be abused by IV drug users, as so many other things in the past have been.

Also no medication is going to work for everyone. That is an impossible reality. And just because it might not work for some does not make it a bad medication.

In regard to the receptors and our ability to produce naturally it is a pretty simple deduction. If our body was not producing naturally we would not be able to continually lower our dose. Does this mean that everyone will heal completely 100% of course not. However, the cause of that is for past abuse, not Sub.

Mike
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Unread 10-03-2006, 08:48 PM   #16
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I agree Mike, well said.
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Unread 10-03-2006, 08:48 PM   #17
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I agree Mike, well said.
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Unread 10-03-2006, 09:06 PM   #18
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Mike, my reason for being mad right now is because Suture is discrediting my experience. I never thought he would do something like that. I respected what he said before about Naloxone and waiting and the affinity. I bought into that and I got sick. Extremely sick. I could NOT hardly get out of bed. I started subutex and quite rapidly symptoms started to dissipate. It wasn't over night. The swelling went last. I finally have a chance and now I am being told to shut up?

You told me Suture that if I had just suffered a little longer, maybe the symptoms would ease up anyway? Right? You are leading others to believe that it cannot happen to them. That is why I never thought it was the naloxone. I had read all of yours and others remarks about the absorption rate, etc. You had convinced me that it is a ME problem and I blamed MYSELF. I cried for weeks over it and couldn't understand why I was getting worse, not better. All because I was convinced that there was no possible way that naloxone could be the cause. By posts like this.

This topic was put here as a buffer due to another post I made.

Suture-----you have been on 16mg of sub for years. I don't discredit or challenge YOUR reasons for being on sub for so long. I respect YOUR experience. I DON'T CARE what it takes for you.

I know exactly why doctors and sub manuf don't want someone to advocate for subutex. I am not stupid. But that doesn't mean my experience should be taken so lightly. I resent that.

To see that there is advocation, here, in this forum, for people to share their sub with others. Well....that is just shocking.

If almost 6 weeks wasn't long enough to wait to feel good, then what do you propose to wait for, months? In the mean time, people cannot progress. I thought sub was about progress. How was I supposed to go to NA or do ANYTHING like that? How?

When do you know? How do you know? My doctor saw immediately what was going on and my only regret is not telling him of it sooner. Angel
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Unread 10-03-2006, 09:06 PM   #19
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Mike, my reason for being mad right now is because Suture is discrediting my experience. I never thought he would do something like that. I respected what he said before about Naloxone and waiting and the affinity. I bought into that and I got sick. Extremely sick. I could NOT hardly get out of bed. I started subutex and quite rapidly symptoms started to dissipate. It wasn't over night. The swelling went last. I finally have a chance and now I am being told to shut up?

You told me Suture that if I had just suffered a little longer, maybe the symptoms would ease up anyway? Right? You are leading others to believe that it cannot happen to them. That is why I never thought it was the naloxone. I had read all of yours and others remarks about the absorption rate, etc. You had convinced me that it is a ME problem and I blamed MYSELF. I cried for weeks over it and couldn't understand why I was getting worse, not better. All because I was convinced that there was no possible way that naloxone could be the cause. By posts like this.

This topic was put here as a buffer due to another post I made.

Suture-----you have been on 16mg of sub for years. I don't discredit or challenge YOUR reasons for being on sub for so long. I respect YOUR experience. I DON'T CARE what it takes for you.

I know exactly why doctors and sub manuf don't want someone to advocate for subutex. I am not stupid. But that doesn't mean my experience should be taken so lightly. I resent that.

To see that there is advocation, here, in this forum, for people to share their sub with others. Well....that is just shocking.

If almost 6 weeks wasn't long enough to wait to feel good, then what do you propose to wait for, months? In the mean time, people cannot progress. I thought sub was about progress. How was I supposed to go to NA or do ANYTHING like that? How?

When do you know? How do you know? My doctor saw immediately what was going on and my only regret is not telling him of it sooner. Angel
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Unread 10-03-2006, 09:23 PM   #20
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If nalexone doesnt bother some people why do we recomend spitting instead of swallowing? I think it is very possible some people cant tolerate the nalexone and those people should be given subutex instead. We have several here that might not be in recovery if it were not for subutex. I personallyy dont have any side effects from suboxone that I know of.

Brett

Ps.
Who locked my endorphine producin topic????????????????????????
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Unread 10-03-2006, 09:23 PM   #21
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If nalexone doesnt bother some people why do we recomend spitting instead of swallowing? I think it is very possible some people cant tolerate the nalexone and those people should be given subutex instead. We have several here that might not be in recovery if it were not for subutex. I personallyy dont have any side effects from suboxone that I know of.

Brett

Ps.
Who locked my endorphine producin topic????????????????????????
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Unread 10-03-2006, 09:39 PM   #22
Suture
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Angel,
Read what I wrote again, and as many times as it takes until you understand what I wrote because you clearly don’t. This is the last time I will respond to you.
S-
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Unread 10-03-2006, 09:48 PM   #23
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Suture-------likewise. Angel
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Unread 10-04-2006, 03:25 PM   #24
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Brett:

I'm guessing that your thread got locked because of the unpleasantness that went on between a couple of other members. If you ask Administration, maybe they will re-open it for you.

By the way, you didn't mention if my advice was of any help to you. Were you able to check out the info I provided?


[u]FACTS REGARDING SUBUTEX, SUBOXONE, & NALOXONE</u>

The following information was partially in response to a question Brett asked regarding endorphins but since I think that much of the info is pertinent to this topic, I'll repost some of the information here because the initial post of this thread seems to quote some FDA info yet ignore other FDA info and downgrades the effect of Naloxone on our bodies, and ultimately, our progress to be free of these meds.

As I quote below, I use the FDA info along with multiple conversations with the manufacturer and other sources to make the important point that some members here, along with even doctors in States where Sub. is available, are not following FDA instructions with both Subutex and Suboxone. And some members are discounting the effect of Naloxone and its' power to block endorphin absorption by the body. This is all in contrast to the instructions of both the manufacturer and the FDA.

Now, as we all know, Suboxone has two components: Bup. and Naloxone. As a partial opiate, yes, the Bup. will block some of your endorphins because it occupies a portion of the very receptor in which your endorphins are seeking to place themselves. That's the great thing about Bup. is that since it is only a partial opiate, it only partially blocks the endorphin absorption. That's why Bup. is such a great drug to help people taper off of as opposed to full opiates.

Next, you have Naloxone. Naloxone was placed together with Bup. as a method to discourage people from shooting up the Suboxone into your body. Good idea but there are drawbacks. First, anyone that is determined enough can figure out from sources on the internet how to get around the Naloxone "road block". Due to the rules of this forum (and common decency), I am prohibited from explaining how to do that.

Second, Naloxone is an endorphin blocker. For more info on Naloxone as an endorphin blocker, check out:

http://en.wikipedia.org/wiki/Endorphin

http://en.wikipedia.org/wiki/Naloxone

http://www.hallym.ac.kr/~neuro/kns/t...ical/endo.html. The info regarding Naloxone's blocking effects is near the bottom of the article.

http://www.ucihealth.com/News/UCI%20...odPressure.htm. This article talks a little about Naloxone's ability to disrupt the body's endorphin system when the patient is using acupuncture. By the way, regular acupuncture treatments are an excellent way to help your body's endorphin system. I have used it previously and I can personally attest to it.

Now, keep in mind that while it's true that Naloxone blocks endorphins, the question is, is there enough Naloxone in Suboxone to block your endorphins from reaching your receptors? The answer can be found in a 4 week study by Body System and Treatment Group where the Naloxone in Suboxone was found to have caused various side effects, and while endorphins were obviously not addressed, the fact that more people experienced more pain while taking Suboxone clearly indicates that the pain-blocking effects of endorphins were they themselves blocked. The study can be found at: http://www.rxlist.com/cgi/generic3/suboxone_ad.htm. I know there are people that like to create their own world of what they think is the way things should be but I can only go with what medical science has proved. If someone has a problem with that info, please address it to the source and not me. So, clearly, contrary to the dismissing of Naloxone's bioavailability, it does have the ability, and there is enough of it in Suboxone, to block essential endorphins which could very possibly speed your recovery and end your need to remain in this program.

When the FDA approved Subutex/Suboxone, they issued instructions that patients should go into the Induction Phase using Subutex. The manufacturer has verbally stated the same to me personally (the name of the person I spoke to is available by email to me only). Now, the question is why would the FDA want the Induction Phase performed with Subutex? Simply because they are aware that Suboxone has more side effects and that they want to see how you do on the Bup. first before moving you to Suboxone. In this manner, if you start having some weird side effects, then the doctor could easily identify the problem and move you back to Subutex. The FDA info about this can be found at: http://www.fda.gov/cder/foi/label/20...20induction%22 . Additional info can be found at: http://www.rxlist.com/cgi/generic3/suboxone_ids.htm.

The odd thing here is that, to my knowledge, the members "banging the drum" for Suboxone, have they themselves never been on Subutex and therefore do not know if Subutex could indeed make them feel better and help them progress off this medication even faster!! My doctor has stated that none of his other patients have progressed as rapidly as I have. While there could be any number of reasons why I have done better than his other patients, one thing is certain, of all his other patients, I'm the only one on Subutex!! All his other patients are taking Suboxone.

So, to summarize, yes, your endorphin level will rise as you decrease your dose level and you can do things like exercise and eat brain-repairing foods that will aid in that recovery. I recommend a book titled, "End Your Addiciton Now" by Dr. Charles Gant. It has great info regarding what things you should do to help your body, especially your brain, to recover. And, if you find that you are experiencing more pain and other side effects with Suboxone, then what I would do is simply ask my doctor to try putting me on Subutex or putting you back on Subutex, assuming your doctor followed FDA instruction and had you on Subutex during the Induction Phase.

As we've all discussed, everybody is different. Endorphin production will operate differently in everyone. Some of the factors involved in endorphin production is what was your DOC, how long were you on it, how healthy you are, what you eat, stress levels, nutrition, etc. Some people here use Suboxone and say they do wonderfully. I used Suboxone and it made me sick so my doctor put me on Subutex and I'm doing fine. The other advantage for me using Subutex is that I can purchase the 8mg. pills and cut them to the dose I need. The manufacturer recommends against doing that with Suboxone or Subutex but they don't mind patients doing that with Subutex because the only active ingredient in Subutex is Buprenorphrine. However, they don't recommend and they are firm on this, that you don't cut the Suboxone tablets because there is no guarantee that you will get the correct balanced amount of Bup. and Naloxone in your dose.

I take to heart everyone's concern about endorphins because they truly are the body's natural pain-killing and even "euphoric-casuing" drug. I used to go to the gym and do heavy weightlifting. After my workout, I always felt so good it felt better than anything else I could do for my body.

I'm hoping that within a few days I will have the opportunity to post a "Facts about Subutex" topic that will specifically address issues surrounding Subutex and why it is truly the best choice for most people in this program.

In the meantime, any questions that I can answer regarding Subutex, please let me know. Thank you.


God Bless,
JAT

P.S. Angel and Suri, I'm glad you were able to use Subutex to free yourselves from those side effects caused by Naloxone.
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Unread 10-04-2006, 03:25 PM   #25
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Brett:

I'm guessing that your thread got locked because of the unpleasantness that went on between a couple of other members. If you ask Administration, maybe they will re-open it for you.

By the way, you didn't mention if my advice was of any help to you. Were you able to check out the info I provided?


[u]FACTS REGARDING SUBUTEX, SUBOXONE, & NALOXONE</u>

The following information was partially in response to a question Brett asked regarding endorphins but since I think that much of the info is pertinent to this topic, I'll repost some of the information here because the initial post of this thread seems to quote some FDA info yet ignore other FDA info and downgrades the effect of Naloxone on our bodies, and ultimately, our progress to be free of these meds.

As I quote below, I use the FDA info along with multiple conversations with the manufacturer and other sources to make the important point that some members here, along with even doctors in States where Sub. is available, are not following FDA instructions with both Subutex and Suboxone. And some members are discounting the effect of Naloxone and its' power to block endorphin absorption by the body. This is all in contrast to the instructions of both the manufacturer and the FDA.

Now, as we all know, Suboxone has two components: Bup. and Naloxone. As a partial opiate, yes, the Bup. will block some of your endorphins because it occupies a portion of the very receptor in which your endorphins are seeking to place themselves. That's the great thing about Bup. is that since it is only a partial opiate, it only partially blocks the endorphin absorption. That's why Bup. is such a great drug to help people taper off of as opposed to full opiates.

Next, you have Naloxone. Naloxone was placed together with Bup. as a method to discourage people from shooting up the Suboxone into your body. Good idea but there are drawbacks. First, anyone that is determined enough can figure out from sources on the internet how to get around the Naloxone "road block". Due to the rules of this forum (and common decency), I am prohibited from explaining how to do that.

Second, Naloxone is an endorphin blocker. For more info on Naloxone as an endorphin blocker, check out:

http://en.wikipedia.org/wiki/Endorphin

http://en.wikipedia.org/wiki/Naloxone

http://www.hallym.ac.kr/~neuro/kns/t...ical/endo.html. The info regarding Naloxone's blocking effects is near the bottom of the article.

http://www.ucihealth.com/News/UCI%20...odPressure.htm. This article talks a little about Naloxone's ability to disrupt the body's endorphin system when the patient is using acupuncture. By the way, regular acupuncture treatments are an excellent way to help your body's endorphin system. I have used it previously and I can personally attest to it.

Now, keep in mind that while it's true that Naloxone blocks endorphins, the question is, is there enough Naloxone in Suboxone to block your endorphins from reaching your receptors? The answer can be found in a 4 week study by Body System and Treatment Group where the Naloxone in Suboxone was found to have caused various side effects, and while endorphins were obviously not addressed, the fact that more people experienced more pain while taking Suboxone clearly indicates that the pain-blocking effects of endorphins were they themselves blocked. The study can be found at: http://www.rxlist.com/cgi/generic3/suboxone_ad.htm. I know there are people that like to create their own world of what they think is the way things should be but I can only go with what medical science has proved. If someone has a problem with that info, please address it to the source and not me. So, clearly, contrary to the dismissing of Naloxone's bioavailability, it does have the ability, and there is enough of it in Suboxone, to block essential endorphins which could very possibly speed your recovery and end your need to remain in this program.

When the FDA approved Subutex/Suboxone, they issued instructions that patients should go into the Induction Phase using Subutex. The manufacturer has verbally stated the same to me personally (the name of the person I spoke to is available by email to me only). Now, the question is why would the FDA want the Induction Phase performed with Subutex? Simply because they are aware that Suboxone has more side effects and that they want to see how you do on the Bup. first before moving you to Suboxone. In this manner, if you start having some weird side effects, then the doctor could easily identify the problem and move you back to Subutex. The FDA info about this can be found at: http://www.fda.gov/cder/foi/label/20...20induction%22 . Additional info can be found at: http://www.rxlist.com/cgi/generic3/suboxone_ids.htm.

The odd thing here is that, to my knowledge, the members "banging the drum" for Suboxone, have they themselves never been on Subutex and therefore do not know if Subutex could indeed make them feel better and help them progress off this medication even faster!! My doctor has stated that none of his other patients have progressed as rapidly as I have. While there could be any number of reasons why I have done better than his other patients, one thing is certain, of all his other patients, I'm the only one on Subutex!! All his other patients are taking Suboxone.

So, to summarize, yes, your endorphin level will rise as you decrease your dose level and you can do things like exercise and eat brain-repairing foods that will aid in that recovery. I recommend a book titled, "End Your Addiciton Now" by Dr. Charles Gant. It has great info regarding what things you should do to help your body, especially your brain, to recover. And, if you find that you are experiencing more pain and other side effects with Suboxone, then what I would do is simply ask my doctor to try putting me on Subutex or putting you back on Subutex, assuming your doctor followed FDA instruction and had you on Subutex during the Induction Phase.

As we've all discussed, everybody is different. Endorphin production will operate differently in everyone. Some of the factors involved in endorphin production is what was your DOC, how long were you on it, how healthy you are, what you eat, stress levels, nutrition, etc. Some people here use Suboxone and say they do wonderfully. I used Suboxone and it made me sick so my doctor put me on Subutex and I'm doing fine. The other advantage for me using Subutex is that I can purchase the 8mg. pills and cut them to the dose I need. The manufacturer recommends against doing that with Suboxone or Subutex but they don't mind patients doing that with Subutex because the only active ingredient in Subutex is Buprenorphrine. However, they don't recommend and they are firm on this, that you don't cut the Suboxone tablets because there is no guarantee that you will get the correct balanced amount of Bup. and Naloxone in your dose.

I take to heart everyone's concern about endorphins because they truly are the body's natural pain-killing and even "euphoric-casuing" drug. I used to go to the gym and do heavy weightlifting. After my workout, I always felt so good it felt better than anything else I could do for my body.

I'm hoping that within a few days I will have the opportunity to post a "Facts about Subutex" topic that will specifically address issues surrounding Subutex and why it is truly the best choice for most people in this program.

In the meantime, any questions that I can answer regarding Subutex, please let me know. Thank you.


God Bless,
JAT

P.S. Angel and Suri, I'm glad you were able to use Subutex to free yourselves from those side effects caused by Naloxone.
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Unread 10-04-2006, 04:49 PM   #26
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Jat, Suboxone, given enough, can occupy 100% of the opioid receptor sites and be able to block all of them from other opioids. (Except of course that receptors have a life span with a constant turnover.) Bupe being a 'partial' opioid means the sub will only patially activate the receptors and is weak in this regard, compared to a full opioid agonist. I don't know if I'm making myself clear, but again, because bupe is a partial agonist means that it only partially activates the receptor and has nothing to do with it's ability to block or its very strong affinity for the receptors. It is only when you decrease your sub intake to a level where not all the receptors are blocked (ie, the bupe is attached rather than other opioids trying to get on), can other opioids begin to attach and activate the receptors. Another thing is that naloxone is an opioid antagonist and will attach to the opioid receptors thereby blocking other opioids from activating the receptors and what I think you are saying is that endorphin production is stopped by the naloxone....well, there is no such evidence that this is the case. Naloxone is short-acting (about an hour or so) and when the naloxone starts to leave the receptors, whatever opioids are around in your system will again attach to the receptors to activate them...it doesn't do anything to destroy other opioids, either endogenous or exogenous. That is why more than one dose of naloxone is usually required in a heroin overdose, because in an hour or so, the patient could go back into respiratory depression and stop breathing. Naloxone acts very quickly so if given by injection, anyone on heroin would go into immediate withdrawal. Because it is short-acting, any minute amount that might happen to be absorbed through the GI system, if it did have an effect, would not last very long. Any minute amount of absorbed naloxone in the suboxone is not pharmacologically active. Any reaction to naloxone in the suboxone is more likely an idiosyncratic allergic-type response, that only happens rarely. The one patient I had with swelling of his hands was because of his injecting his veins so much that he developed edema from the scarring. When on Suboxone, the swelling did seem to increase, so I put him on Subutex so as to not possibly aggravate his symptoms. However, the swelling only dimished slowly over time when his injecting ceased and his body was able to start recovering from the 10 years of the abuse.
Caroline


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Unread 10-04-2006, 05:13 PM   #27
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Hey JAT, now that you're obviously feeling better, have you got a job yet? Maybe you should redirect your energies in that gig, stop worrying about the clinically insignificant amount of naloxone in suboxone, be thankful that the switch works for you and get on with your LIFE! That's what it's all about man! Living! Not obsessing. Or maybe go to medical school and get a better grasp on it and then you can talk to Caroline on a peer-to-peer basis.


http://www.naabt.org/forum/topic.asp?TOPIC_ID=1596

With all due respect and big beams to you! -Mary

And all of you on suboxone, the sky is not falling!
If it ain't broke, why fix it?
To each their own.
I'm allergic to peanuts, should the whole world be warned not to eat a Snickers?
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Unread 10-04-2006, 06:03 PM   #28
OhioMike
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Caroline thank you for another good description. Mary can I have your snickers?

Mike
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Unread 10-04-2006, 06:20 PM   #29
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No, Mike, as much as I'd love for you to have it, I'm afraid it might interfere with your endorphin production, respiratory depression, or even cause you to go into Anaphylactic Shock.

I'm out to save everyone from themselves. One Snickers at a time.

With joy and exhuberance on my new found calling! -Mary

But I will share my Dove Dark Chocolate if you'd like.... LOL!!!
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Unread 10-04-2006, 11:28 PM   #30
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I see how it is. If you have a bad reaction to something, no need to say anything about it. Nobody said the sky was falling. Angel
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Unread 10-04-2006, 11:43 PM   #31
CK1976
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Angel,
WHAT ARE YOU TALKING ABOUT????????????
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Unread 10-05-2006, 12:15 AM   #32
Leviticus 13 4
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Quote:
quote:Originally posted by angel

I see how it is. If you have a bad reaction to something, no need to say anything about it. Nobody said the sky was falling. Angel
What the sky is falling?!? What will happen to my endorphins?? How can the sky fall? Are you sure the groud is not rapidly rising? I'm tall does that mean the sky will fall on me first??
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Unread 10-05-2006, 12:45 AM   #33
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Angel, Maybe you didn't read my post above that one, it was directed to JAT not you. God you just think you know everything. And, unfortunately for you, you have ZERO sense of humor.

You just don't get it. If you have a bad reaction, you SAY something. You don't go on and on about how you have 'no problems' and everything's great, and then BAM! you're a subutex expert because you had all these problems. I used to believe you. Now how do I even know that you had problems when all you did was lie and say you felt good? All of a sudden you're following JAT around like disciple. Go somewhere else and spread the word. christ.

For the record, any other time people have had problems, with swelling, with itching, with constant headaches, we ALWAYS say see if you can try subutex. You might be allergic to the naloxone. You think you're that special that we'd say oh angel, just suffer? Get over yourself.

For all the reading you supposedly do, didn't you ever read this?
http://www.nlm.nih.gov/medlineplus/d...r/a605002.html
Buprenorphine or buprenorphine and naloxone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
• headache
• stomach pain
• constipation
• vomiting
• difficulty falling asleep or staying asleep
• sweating

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:
• hives
• skin rash
• itching
• difficulty breathing or swallowing
• slowed breathing
• upset stomach
• extreme tiredness
• unusual bleeding or bruising
• lack of energy
• loss of appetite
• pain in the upper right part of the stomach
• yellowing of the skin or eyes
• flu-like symptoms

Buprenorphine or buprenorphine and naloxone may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

I just don't understand why it's so hard get the part that it has NOTHING TO DO WITH YOUR FREAKIN' ENDORPHINS! Have you no clue what an allergic reaction is.

Good luck with your recovery. Wear a hat and earplugs, that'll help keep the endorphins in too.
-Mary

My apologies to everyone else. But, I'm sick of this spreading fear for no reason. Especially to those who just started or who are going to start soon.
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Unread 10-05-2006, 01:44 AM   #34
OhioMike
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Mary .......... ur my HERO!
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Unread 10-05-2006, 06:13 AM   #35
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SUTURE IS ALWAYS RIGHT! if you don't believe hime hust read the educational portions of naabt
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Unread 10-05-2006, 06:29 AM   #36
OhioMike
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Ryan your sarcasm is childish. Suture shares in an adult fashion and tries to pass along solid information which can be helpful to those in need. Suture does not strive to create fear or deception like you do!

WARNING TO ALL READERS: THIS MANS [Ryannnn65] ADVICE CAN BE HARMFUL TO YOUR RECOVERY. PROTECT YOURSELF AND PASS OVER HIS POSTS.

Mike
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Unread 10-05-2006, 10:19 AM   #37
Jaywalker
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THANK YOU MARY!!!

I've been silent out of some strange sense of decorum....

Maybe this useless dialogue can finally be put to rest!!

Jay
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Unread 10-05-2006, 11:45 AM   #38
OhioMike
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Sadly there seems to be multiple threads of the same issue.

Mike
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Unread 10-05-2006, 04:48 PM   #39
JAT
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Mary, I posted this before our chat. I didn't erase it because I figured you already read it. Nevertheless, lots of peace & love to you!! If you are offended by anything I said here, just say the word and I'll delete the post. Thanks for the great chat!!

Regards,
JAT



Mary, thanks for the advice and concern about how I use my time, but I thought the idea was to share information about Subutex/Suboxone, discuss topics associated with this program, share personal experiences, and support one another. You seem to be getting all worked up over my input and then accuse others who have experienced side effects with Suboxone as "following me around". Have you actually read Angel's personal experience? She was like you, a Suboxone lover and even though she wasn't doing well on it, her doctor convinced her to switch to Subutex, which improved her situation considerably. And now because she supports Subutex, you attack her? Wow. Simply because she supports Subutex and how to possibly eliminate the side effects other people are feeling? Come on, that's not right. I see nothing wrong with posting medically supported info and then discussing it. This is a forum for discussion, not a webpage for dictation of one perspective.

As to your unkind comment that because I'm not in the healthcare field, as is Caroline (I looked at her profile so I'm sorry I don't know what she does in the healthcare field), I don't have the right to comment on these subjects, that saddens me to read that you feel you have to make such a mean-spirited remark. No, I'm not in the healthcare field but I do know ALOT about the subject because I've spent years studying, and LIVING it. But I don't think I need a medical degree to post links to the FDA and other medical information that support my points.

Quote:
quote:I'm allergic to peanuts, should the whole world be warned not to eat a Snickers?
Bad analogy. Aside from the fact that Snickers is not required to warn of potential side effects, your analogy is not not even remotely close to something like Naloxone being given to people who don't need it. If you're allergic to peanuts in Snickers, then don't eat it. Why? Because no matter what, the peanuts in Snickers will make you sick. Those people who are allergic to peanuts should be warned to stay away from Snickers. But if they put Naloxone in it, will you still eat it?

I realize that there is a large block of people who have never been on Subutex. I realize that these people don't want to hear anyone saying anything that doesn't fit their thinking of the program. They call such information "useless dialogue" even though obviously it's not. But, all I'm doing is pointing out FDA, manufacturer comments, and other medical sources that demonstrate a partial and in some case, a complete misunderstanding of how this program works or should work. We all know that doctors take liberties with some of their treatments, why would you think the same is not true with the Sub. program? For example, I had a discussion with a Addictionologist doctor that insisted that anti-depressants were part of EVERY patients Sub. treatment!! You and I know that's crazy, but this doctor thought nothing of putting people on AD's without verifying the need. This is part of what I'm talking about and I think it needs addressing, even OhioMike who claims you as his "hero", agrees with the idea that we have to stay on top of our doctors lest they get us involved with meds that will take us in the wrong direction. He's right, and I'm pointing out situations where that is happening within the Sub. program.

My purpose is to specifically address things that help people better understand various aspects of the program and its' components. I'm merely answering questions and clearing up confusion using the very tools available to us all, links to medical sources.

Others here spend far more time posting info in this forum and you yell at me to go get a job?!! Since you're interested in my work life even though it's not any of your business how I use my time, yes, I am working but I also put time aside to share information with other people who are struggling. The info I posted is well documented and links are given. Again, if you have a problem with the info, go yell at the source not me. And, my personal experiences are my own and I was under the impression that discussing our personal experiences was important here. You guys were here to help me when I was suffering at my worst and I'm only giving back help as I received it. I always thought that was the right thing to do. Am I wrong?

Contrary to what you said, I'm not trying to scare anyone but instead share information by doctors and medical studies to help people along into a speedy recovery. And for that, you jump down my throat?

Caroline is correct in what she said in her post just above, but that doesn't contrast with the info I posted. Also, my description of how Bup. occupies a partial aspect of the opiod receptor is correct. Caroline phrased it differently, but it is accurate. The problem with Caroline's comments (and I absolutely appreciate her input and encouragement) is that I don't think she's taking the time to really read what I've posted. Or, look at the links I've given. For example, Caroline was mistaken when she said:

Quote:
quote: I think you are saying is that endorphin production is stopped by the naloxone....
No, that's not what I said. If she goes back and reads what I wrote and the resources that I gave a link to, she will see I'm taking about how Naloxone interupts the endorphin process, not stops it. And, I gave links to resources where she can verify that info.

Finally, since it sounds like you prefer that I focus on my work rather than post medically relevant info, I'll limit my time here to posting personal experience and personal support. I was just trying to bring a different perspective and make corrections to misunderstandings not get every "Naloxone fan" ranting and raving.

By the way, you have my email address and instead of posting here, you could have simply made your feelings known to me in private and I would respected your wishes.
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Unread 10-06-2006, 01:10 AM   #40
Mary
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Hey JAT, peace and love back at 'cha! Great to chat tonight too! Keep me posted on how you do with the .5 drop. I'll help you all I can. I'll see if anyone I know knows anything more about any alternatives for your sleep gig. Glad we got to know each other better. Big tapering beams to you!! -Mary
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Unread 10-07-2006, 03:03 PM   #41
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Mary, I can't believe I missed your post here until just now.

Thank you for your help. I really appreciate your efforts. Lots of love, hugs, and kisses!!

Regards,
JAT
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